Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$6.00

Service Code	NDC 70710-1643-1
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$5.99

Service Code	NDC 72485-108-05
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$4.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.59
Rate for Payer: Aetna of CA Government/Medicare	$3.59
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.59
Rate for Payer: LLUH Dept of Risk Management WC	$3.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.49

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$6.00

Service Code	NDC 70710-1643-5
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$5.99

Service Code	NDC 72485-108-01
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.79
Rate for Payer: Health Smart Auto/Commercial	$3.59
Rate for Payer: LLUH Dept of Risk Management WC	$3.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.49

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$6.00

Service Code	NDC 70069-271-25
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$19.29

Service Code	NDC 51754-0203-2
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$14.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.57
Rate for Payer: Aetna of CA Government/Medicare	$11.57
Rate for Payer: Cash Price	$8.68
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.47

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$19.29

Service Code	NDC 51754-0203-2
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$15.43
Rate for Payer: Cash Price	$8.68
Rate for Payer: Cigna of CA HMO/PPO	$15.43
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.47

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$6.00

Service Code	NDC 70710-1643-5
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$6.00

Service Code	NDC 70069-271-05
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 40 MG TABLET [8529]

Facility

$0.19

Service Code	NDC 0591-0404-01
Hospital Charge Code	1711492
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of CA HMO/PPO	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

VERAPAMIL 40 MG TABLET [8529]

Facility

$0.19

Service Code	NDC 0591-0404-01
Hospital Charge Code	1711492
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.11
Rate for Payer: Aetna of CA Government/Medicare	$0.11
Rate for Payer: Cash Price	$0.09
Rate for Payer: Health Smart Auto/Commercial	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.14

VERAPAMIL 80 MG TABLET [8530]

Facility

$0.14

Service Code	NDC 23155-026-01
Hospital Charge Code	1710483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.08
Rate for Payer: Aetna of CA Government/Medicare	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

VERAPAMIL 80 MG TABLET [8530]

Facility

$0.14

Service Code	NDC 23155-026-01
Hospital Charge Code	1710483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.11
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.11

VERAPAMIL 80 MG TABLET [8530]

Facility

$0.06

Service Code	NDC 0591-0343-01
Hospital Charge Code	1710483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

VERAPAMIL 80 MG TABLET [8530]

Facility

$0.06

Service Code	NDC 0591-0343-01
Hospital Charge Code	1710483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.04
Rate for Payer: Aetna of CA Government/Medicare	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.05

VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE [23150]

Facility

$1.83

Service Code	NDC 0591-2882-01
Hospital Charge Code	ERX23150
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE [23150]

Facility

$1.83

Service Code	NDC 0378-6380-01
Hospital Charge Code	ERX23150
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.10
Rate for Payer: Aetna of CA Government/Medicare	$1.10
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE [23150]

Facility

$1.83

Service Code	NDC 0378-6380-01
Hospital Charge Code	ERX23150
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.82
Rate for Payer: Cigna of CA HMO/PPO	$1.46
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE [23150]

Facility

$1.83

Service Code	NDC 0591-2882-01
Hospital Charge Code	ERX23150
Hospital Revenue Code	259
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.10
Rate for Payer: Aetna of CA Government/Medicare	$1.10
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Smart Auto/Commercial	$1.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.10
Rate for Payer: LLUH Dept of Risk Management WC	$1.01
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.37

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [11639]

Facility

$0.72

Service Code	NDC 68462-292-01
Hospital Charge Code	1711621
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [11639]

Facility

$0.72

Service Code	NDC 68462-292-01
Hospital Charge Code	1711621
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.58
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [11640]

Facility

$0.39

Service Code	NDC 68462-293-01
Hospital Charge Code	1711477
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [11640]

Facility

$0.39

Service Code	NDC 68462-293-01
Hospital Charge Code	1711477
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [8531]

Facility

$0.28

Service Code	NDC 75834-159-01
Hospital Charge Code	1712020
Hospital Revenue Code	259
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.17
Rate for Payer: Aetna of CA Government/Medicare	$0.17
Rate for Payer: Cash Price	$0.13
Rate for Payer: Health Smart Auto/Commercial	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.17
Rate for Payer: LLUH Dept of Risk Management WC	$0.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.21

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [8531]

Facility

$0.37

Service Code	NDC 68462-260-01
Hospital Charge Code	1712020
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

Know your out-of-pocket cost for care.

All Charges