St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VENTRALIGHT MESH 4 X 6

Facility

$2,650.00

Service Code	HCPCS C1781
Hospital Charge Code	64905939
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$2,782.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,457.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,590.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,523.75
Rate for Payer: EmblemHealth Commercial	$1,325.00
Rate for Payer: Fidelis Medicare Advantage	$2,782.50
Rate for Payer: Group Health Inc Commercial	$1,325.00
Rate for Payer: Group Health Inc Medicare	$927.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,722.50

VENTRALIGHT MESH 4 X 6

Facility

$2,650.00

Service Code	HCPCS C1781
Hospital Charge Code	64905939
Hospital Revenue Code	278
Min. Negotiated Rate	$1,325.00
Max. Negotiated Rate	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,325.00

VENTRALIGHT ST MESH 7' X 9

Facility

$4,212.50

Service Code	HCPCS C1781
Hospital Charge Code	64905941
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,423.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,316.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,527.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,106.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,422.19
Rate for Payer: EmblemHealth Commercial	$2,106.25
Rate for Payer: Fidelis Medicare Advantage	$4,423.12
Rate for Payer: Group Health Inc Commercial	$2,106.25
Rate for Payer: Group Health Inc Medicare	$1,474.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,106.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,106.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,738.12

VENTRALIGHT ST MESH 7' X 9

Facility

$4,212.50

Service Code	HCPCS C1781
Hospital Charge Code	64905941
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.25
Max. Negotiated Rate	$2,106.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,106.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,106.25

VENTRICULAR DRAINAGE

Facility

$2,459.50

Service Code	HCPCS 61020
Hospital Charge Code	40000550
Hospital Revenue Code	360
Min. Negotiated Rate	$843.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Brighton Health Commercial	$1,844.62
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,054.06
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$1,054.06
Rate for Payer: Group Health Inc Medicare	$1,054.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

VENTRICULAR DRAINAGE

Facility

$2,459.50

Service Code	HCPCS 61020
Hospital Charge Code	40000550
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,054.06

VENTRICULAR LEAD 4092-58CM

Facility

$1,300.00

Hospital Charge Code	40200397
Hospital Revenue Code	270
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$650.00
Rate for Payer: Aetna Government	$650.00
Rate for Payer: Brighton Health Commercial	$975.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$884.00
Rate for Payer: Group Health Inc Commercial	$650.00
Rate for Payer: Group Health Inc Medicare	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00

VENTRICULAR LEAD CAPSURE SENSE

Facility

$1,900.00

Hospital Charge Code	40200396
Hospital Revenue Code	270
Min. Negotiated Rate	$665.00
Max. Negotiated Rate	$1,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,045.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$950.00
Rate for Payer: Aetna Government	$950.00
Rate for Payer: Brighton Health Commercial	$1,425.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,292.00
Rate for Payer: Group Health Inc Commercial	$950.00
Rate for Payer: Group Health Inc Medicare	$665.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$37,939.33

Service Code	MSDRG 032
Min. Negotiated Rate	$17,295.87
Max. Negotiated Rate	$37,939.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31,757.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37,195.42
Rate for Payer: Aetna Government	$37,195.42
Rate for Payer: Brighton Health Commercial	$31,230.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37,939.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37,193.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,694.06
Rate for Payer: Elderplan Medicare Advantage	$35,335.65
Rate for Payer: EmblemHealth Commercial	$18,468.80
Rate for Payer: Fidelis Medicare Advantage	$37,195.42
Rate for Payer: Group Health Inc Commercial	$37,195.42
Rate for Payer: Group Health Inc Medicare	$37,195.42
Rate for Payer: Hamaspik Choice Inc Medicare	$37,195.42
Rate for Payer: Healthfirst Medicare Advantage	$17,295.87
Rate for Payer: Senior Whole Health Medicare Advantage	$37,195.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37,195.42
Rate for Payer: Wellcare Medicare	$35,335.65

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$71,089.57

Service Code	MSDRG 031
Min. Negotiated Rate	$29,952.65
Max. Negotiated Rate	$71,089.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60,699.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64,414.31
Rate for Payer: Aetna Government	$64,414.31
Rate for Payer: Brighton Health Commercial	$59,690.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$65,702.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71,089.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$58,666.16
Rate for Payer: Elderplan Medicare Advantage	$61,193.59
Rate for Payer: EmblemHealth Commercial	$35,299.80
Rate for Payer: Fidelis Medicare Advantage	$64,414.31
Rate for Payer: Group Health Inc Commercial	$64,414.31
Rate for Payer: Group Health Inc Medicare	$64,414.31
Rate for Payer: Hamaspik Choice Inc Medicare	$64,414.31
Rate for Payer: Healthfirst Medicare Advantage	$29,952.65
Rate for Payer: Senior Whole Health Medicare Advantage	$64,414.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64,414.31
Rate for Payer: Wellcare Medicare	$61,193.59

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$30,429.89

Service Code	MSDRG 033
Min. Negotiated Rate	$13,872.45
Max. Negotiated Rate	$30,429.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23,929.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29,833.23
Rate for Payer: Aetna Government	$29,833.23
Rate for Payer: Brighton Health Commercial	$23,532.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30,429.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28,025.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,128.14
Rate for Payer: Elderplan Medicare Advantage	$28,341.57
Rate for Payer: EmblemHealth Commercial	$13,916.40
Rate for Payer: Fidelis Medicare Advantage	$29,833.23
Rate for Payer: Group Health Inc Commercial	$29,833.23
Rate for Payer: Group Health Inc Medicare	$29,833.23
Rate for Payer: Hamaspik Choice Inc Medicare	$29,833.23
Rate for Payer: Healthfirst Medicare Advantage	$13,872.45
Rate for Payer: Senior Whole Health Medicare Advantage	$29,833.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29,833.23
Rate for Payer: Wellcare Medicare	$28,341.57

VENTRICULOCISTERNOSTOMY 3RD VENTR

Facility

$3,896.38

Service Code	HCPCS 62200
Hospital Charge Code	40004301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,363.73
Max. Negotiated Rate	$2,922.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,143.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,747.13
Rate for Payer: Aetna Government	$1,747.13
Rate for Payer: Brighton Health Commercial	$2,922.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,948.19
Rate for Payer: Group Health Inc Medicare	$1,363.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,948.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,948.19

VENTRICULOCISTERNOSTOMY (TORKILDS

Facility

$4,917.42

Service Code	HCPCS 62180
Hospital Charge Code	40004300
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,688.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,704.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,022.13
Rate for Payer: Aetna Government	$2,022.13
Rate for Payer: Brighton Health Commercial	$3,688.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,458.71
Rate for Payer: Group Health Inc Medicare	$1,721.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,458.71
Rate for Payer: Hamaspik Choice Inc Medicare	$2,458.71

VENTRICULO PERITONEAL SHUNT

Facility

$2,484.35

Service Code	HCPCS 62192
Hospital Charge Code	40004336
Hospital Revenue Code	360
Min. Negotiated Rate	$869.52
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,366.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,227.13
Rate for Payer: Aetna Government	$1,227.13
Rate for Payer: Brighton Health Commercial	$1,863.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,242.18
Rate for Payer: Group Health Inc Medicare	$869.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,242.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,242.18

VENT TUBE WITH TAB 1.14MM

Facility

$112.00

Service Code	HCPCS L8699
Hospital Charge Code	40202359
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

VENT TUBE WITH TAB 1.14MM

Facility

$112.00

Service Code	HCPCS L8699
Hospital Charge Code	40202359
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$117.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.00
Rate for Payer: Aetna Government	$56.00
Rate for Payer: Brighton Health Commercial	$67.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.40
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.80

VERAPAMIL 120 MG TAB

Facility

$0.17

Hospital Charge Code	41653738
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

VERAPAMIL 120 MG TAB

Facility

$0.17

Hospital Charge Code	41643738
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

VERAPAMIL 120 MG TAB SR

Facility

$1.00

Hospital Charge Code	41640604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

VERAPAMIL 120 MG TAB SR

Facility

$1.00

Hospital Charge Code	41650604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

VERAPAMIL 180 MG TAB SR

Facility

$0.49

Hospital Charge Code	41641156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

VERAPAMIL 180 MG TAB SR

Facility

$0.49

Hospital Charge Code	41651156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

VERAPAMIL 240 MG TAB SR

Facility

$1.00

Hospital Charge Code	41640829
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

VERAPAMIL 240 MG TAB SR

Facility

$1.00

Hospital Charge Code	41650829
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

VERAPAMIL 2.5 MG/ML INJ

Facility

$3.00

Hospital Charge Code	41644329
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

Know your out-of-pocket cost for care.

All Charges