|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$85.06
|
|
|
Service Code
|
NDC 50268008712
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$76.55 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: Aetna Medicare |
$22.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.58
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS MAPPO |
$21.27
|
| Rate for Payer: BCBS Trust/PPO |
$69.93
|
| Rate for Payer: BCN Commercial |
$69.93
|
| Rate for Payer: BCN Medicare Advantage |
$21.27
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cofinity Commercial |
$73.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.27
|
| Rate for Payer: Healthscope Commercial |
$76.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.80
|
| Rate for Payer: Mclaren Medicaid |
$15.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.33
|
| Rate for Payer: Meridian Medicaid |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.30
|
| Rate for Payer: Nomi Health Commercial |
$69.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.80
|
| Rate for Payer: PACE Senior Care Partners |
$20.20
|
| Rate for Payer: PACE SWMI |
$21.27
|
| Rate for Payer: PHP Commercial |
$72.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.00
|
| Rate for Payer: Priority Health Medicare |
$21.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.85
|
| Rate for Payer: UHC Core |
$71.03
|
| Rate for Payer: UHC Exchange |
$21.27
|
| Rate for Payer: UHC Medicaid |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$21.27
|
| Rate for Payer: UHCCP Medicaid |
$15.00
|
| Rate for Payer: VA VA |
$21.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.80
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.42 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: BCBS Trust/PPO |
$165.44
|
| Rate for Payer: BCN Commercial |
$165.44
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: Nomi Health Commercial |
$164.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.23
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.27
|
| Rate for Payer: UHC Core |
$167.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.31 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: Aetna Medicare |
$52.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.60
|
| Rate for Payer: BCBS Complete |
$37.08
|
| Rate for Payer: BCBS MAPPO |
$50.08
|
| Rate for Payer: BCBS Trust/PPO |
$164.67
|
| Rate for Payer: BCN Commercial |
$164.67
|
| Rate for Payer: BCN Medicare Advantage |
$50.08
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.08
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: Mclaren Medicaid |
$35.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.58
|
| Rate for Payer: Meridian Medicaid |
$37.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: Nomi Health Commercial |
$164.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.23
|
| Rate for Payer: PACE Senior Care Partners |
$47.57
|
| Rate for Payer: PACE SWMI |
$50.08
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: PHP Medicare Advantage |
$50.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.27
|
| Rate for Payer: Priority Health Medicare |
$50.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.42
|
| Rate for Payer: Railroad Medicare Medicare |
$50.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.27
|
| Rate for Payer: UHC Core |
$167.26
|
| Rate for Payer: UHC Exchange |
$50.08
|
| Rate for Payer: UHC Medicaid |
$35.31
|
| Rate for Payer: UHC Medicare Advantage |
$50.08
|
| Rate for Payer: UHCCP Medicaid |
$35.31
|
| Rate for Payer: VA VA |
$50.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50268008711
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: Meridian Medicaid |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.17 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: Aetna Medicare |
$522.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$627.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.77
|
| Rate for Payer: BCBS Complete |
$371.84
|
| Rate for Payer: BCBS MAPPO |
$502.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.50
|
| Rate for Payer: BCN Commercial |
$1,651.50
|
| Rate for Payer: BCN Medicare Advantage |
$502.22
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Commercial |
$1,727.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.22
|
| Rate for Payer: Healthscope Commercial |
$1,807.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Mclaren Medicaid |
$354.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.33
|
| Rate for Payer: Meridian Medicaid |
$371.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$552.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.55
|
| Rate for Payer: Nomi Health Commercial |
$1,647.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.66
|
| Rate for Payer: PACE Senior Care Partners |
$477.11
|
| Rate for Payer: PACE SWMI |
$502.22
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: PHP Medicare Advantage |
$502.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,747.73
|
| Rate for Payer: Priority Health Medicare |
$507.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,398.18
|
| Rate for Payer: Railroad Medicare Medicare |
$502.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.81
|
| Rate for Payer: UHC Core |
$1,677.41
|
| Rate for Payer: UHC Exchange |
$502.22
|
| Rate for Payer: UHC Medicaid |
$354.17
|
| Rate for Payer: UHC Medicare Advantage |
$502.22
|
| Rate for Payer: UHCCP Medicaid |
$354.17
|
| Rate for Payer: VA VA |
$502.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$637.59
|
|
|
Service Code
|
NDC 00904650904
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.41 |
| Max. Negotiated Rate |
$573.83 |
| Rate for Payer: Aetna Commercial |
$541.95
|
| Rate for Payer: Aetna Medicare |
$165.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.25
|
| Rate for Payer: BCBS Complete |
$118.02
|
| Rate for Payer: BCBS MAPPO |
$159.40
|
| Rate for Payer: BCBS Trust/PPO |
$524.16
|
| Rate for Payer: BCN Commercial |
$524.16
|
| Rate for Payer: BCN Medicare Advantage |
$159.40
|
| Rate for Payer: Cash Price |
$510.07
|
| Rate for Payer: Cofinity Commercial |
$548.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.40
|
| Rate for Payer: Healthscope Commercial |
$573.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.19
|
| Rate for Payer: Mclaren Medicaid |
$112.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.37
|
| Rate for Payer: Meridian Medicaid |
$118.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.95
|
| Rate for Payer: Nomi Health Commercial |
$522.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$478.19
|
| Rate for Payer: PACE Senior Care Partners |
$151.43
|
| Rate for Payer: PACE SWMI |
$159.40
|
| Rate for Payer: PHP Commercial |
$541.95
|
| Rate for Payer: PHP Medicare Advantage |
$159.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$554.70
|
| Rate for Payer: Priority Health Medicare |
$160.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.76
|
| Rate for Payer: Railroad Medicare Medicare |
$159.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.08
|
| Rate for Payer: UHC Core |
$532.39
|
| Rate for Payer: UHC Exchange |
$159.40
|
| Rate for Payer: UHC Medicaid |
$112.41
|
| Rate for Payer: UHC Medicare Advantage |
$159.40
|
| Rate for Payer: UHCCP Medicaid |
$112.41
|
| Rate for Payer: VA VA |
$159.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.19
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50268008711
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,398.18 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,659.13
|
| Rate for Payer: BCN Commercial |
$1,659.13
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Commercial |
$1,727.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.55
|
| Rate for Payer: Nomi Health Commercial |
$1,647.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.66
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,747.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,398.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.81
|
| Rate for Payer: UHC Core |
$1,677.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$85.06
|
|
|
Service Code
|
NDC 50268008712
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$76.55 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: BCBS Trust/PPO |
$70.25
|
| Rate for Payer: BCN Commercial |
$70.25
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cofinity Commercial |
$73.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.05
|
| Rate for Payer: Healthscope Commercial |
$76.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.30
|
| Rate for Payer: Nomi Health Commercial |
$69.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.80
|
| Rate for Payer: PHP Commercial |
$72.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.85
|
| Rate for Payer: UHC Core |
$71.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.80
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$10.66
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$47.33
|
| Rate for Payer: BCN Commercial |
$47.33
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Mclaren Medicaid |
$10.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$10.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PACE Senior Care Partners |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.09
|
| Rate for Payer: Priority Health Medicare |
$14.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.07
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.66
|
| Rate for Payer: UHC Core |
$48.07
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicaid |
$10.15
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$10.15
|
| Rate for Payer: VA VA |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: BCBS Trust/PPO |
$47.55
|
| Rate for Payer: BCN Commercial |
$47.55
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Nomi Health Commercial |
$47.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.66
|
| Rate for Payer: UHC Core |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$637.59
|
|
|
Service Code
|
NDC 00904650904
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$443.76 |
| Max. Negotiated Rate |
$573.83 |
| Rate for Payer: Aetna Commercial |
$541.95
|
| Rate for Payer: BCBS Trust/PPO |
$526.59
|
| Rate for Payer: BCN Commercial |
$526.59
|
| Rate for Payer: Cash Price |
$510.07
|
| Rate for Payer: Cofinity Commercial |
$548.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.07
|
| Rate for Payer: Healthscope Commercial |
$573.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.95
|
| Rate for Payer: Nomi Health Commercial |
$522.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$478.19
|
| Rate for Payer: PHP Commercial |
$541.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$554.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.08
|
| Rate for Payer: UHC Core |
$532.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.19
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$943.87
|
|
|
Service Code
|
NDC 00904736761
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$849.48 |
| Rate for Payer: Aetna Commercial |
$802.29
|
| Rate for Payer: Aetna Medicare |
$245.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.96
|
| Rate for Payer: BCBS Complete |
$174.71
|
| Rate for Payer: BCBS MAPPO |
$235.97
|
| Rate for Payer: BCBS Trust/PPO |
$775.96
|
| Rate for Payer: BCN Commercial |
$775.96
|
| Rate for Payer: BCN Medicare Advantage |
$235.97
|
| Rate for Payer: Cash Price |
$755.10
|
| Rate for Payer: Cofinity Commercial |
$811.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.97
|
| Rate for Payer: Healthscope Commercial |
$849.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$707.90
|
| Rate for Payer: Mclaren Medicaid |
$166.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.77
|
| Rate for Payer: Meridian Medicaid |
$174.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.29
|
| Rate for Payer: Nomi Health Commercial |
$773.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.90
|
| Rate for Payer: PACE Senior Care Partners |
$224.17
|
| Rate for Payer: PACE SWMI |
$235.97
|
| Rate for Payer: PHP Commercial |
$802.29
|
| Rate for Payer: PHP Medicare Advantage |
$235.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$821.17
|
| Rate for Payer: Priority Health Medicare |
$238.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$656.93
|
| Rate for Payer: Railroad Medicare Medicare |
$235.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.61
|
| Rate for Payer: UHC Core |
$788.13
|
| Rate for Payer: UHC Exchange |
$235.97
|
| Rate for Payer: UHC Medicaid |
$166.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.97
|
| Rate for Payer: UHCCP Medicaid |
$166.40
|
| Rate for Payer: VA VA |
$235.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$707.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$943.87
|
|
|
Service Code
|
NDC 00904736761
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$849.48 |
| Rate for Payer: Aetna Commercial |
$802.29
|
| Rate for Payer: BCBS Trust/PPO |
$779.54
|
| Rate for Payer: BCN Commercial |
$779.54
|
| Rate for Payer: Cash Price |
$755.10
|
| Rate for Payer: Cofinity Commercial |
$811.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.10
|
| Rate for Payer: Healthscope Commercial |
$849.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$707.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.29
|
| Rate for Payer: Nomi Health Commercial |
$773.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.90
|
| Rate for Payer: PHP Commercial |
$802.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$821.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$656.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.61
|
| Rate for Payer: UHC Core |
$788.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$707.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.62 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: BCBS Trust/PPO |
$164.49
|
| Rate for Payer: BCN Commercial |
$164.49
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.29
|
| Rate for Payer: Nomi Health Commercial |
$163.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.37
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.26
|
| Rate for Payer: UHC Core |
$166.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,274.98 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.94
|
| Rate for Payer: BCN Commercial |
$1,512.94
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,557.09
|
| Rate for Payer: Nomi Health Commercial |
$1,502.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.90
|
| Rate for Payer: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,593.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,274.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,612.05
|
| Rate for Payer: UHC Core |
$1,529.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$243.68
|
|
|
Service Code
|
NDC 65162089709
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$219.31 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.15
|
| Rate for Payer: BCBS Complete |
$45.11
|
| Rate for Payer: BCBS MAPPO |
$60.92
|
| Rate for Payer: BCBS Trust/PPO |
$200.33
|
| Rate for Payer: BCN Commercial |
$200.33
|
| Rate for Payer: BCN Medicare Advantage |
$60.92
|
| Rate for Payer: Cash Price |
$194.94
|
| Rate for Payer: Cofinity Commercial |
$209.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.92
|
| Rate for Payer: Healthscope Commercial |
$219.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.76
|
| Rate for Payer: Mclaren Medicaid |
$42.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.97
|
| Rate for Payer: Meridian Medicaid |
$45.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.13
|
| Rate for Payer: Nomi Health Commercial |
$199.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.76
|
| Rate for Payer: PACE Senior Care Partners |
$57.87
|
| Rate for Payer: PACE SWMI |
$60.92
|
| Rate for Payer: PHP Commercial |
$207.13
|
| Rate for Payer: PHP Medicare Advantage |
$60.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.00
|
| Rate for Payer: Priority Health Medicare |
$61.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.60
|
| Rate for Payer: Railroad Medicare Medicare |
$60.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.44
|
| Rate for Payer: UHC Core |
$203.47
|
| Rate for Payer: UHC Exchange |
$60.92
|
| Rate for Payer: UHC Medicaid |
$42.96
|
| Rate for Payer: UHC Medicare Advantage |
$60.92
|
| Rate for Payer: UHCCP Medicaid |
$42.96
|
| Rate for Payer: VA VA |
$60.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.76
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 27241005203
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: BCBS Trust/PPO |
$77.43
|
| Rate for Payer: BCN Commercial |
$77.43
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Nomi Health Commercial |
$76.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.31
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.50
|
| Rate for Payer: UHC Core |
$78.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.24
|
| Rate for Payer: BCBS Complete |
$36.86
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$163.73
|
| Rate for Payer: BCN Commercial |
$163.73
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Mclaren Medicaid |
$35.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: Meridian Medicaid |
$36.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.29
|
| Rate for Payer: Nomi Health Commercial |
$163.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.37
|
| Rate for Payer: PACE Senior Care Partners |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.27
|
| Rate for Payer: Priority Health Medicare |
$50.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.62
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.26
|
| Rate for Payer: UHC Core |
$166.30
|
| Rate for Payer: UHC Exchange |
$49.79
|
| Rate for Payer: UHC Medicaid |
$35.11
|
| Rate for Payer: UHC Medicare Advantage |
$49.79
|
| Rate for Payer: UHCCP Medicaid |
$35.11
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: BCBS Trust/PPO |
$62.85
|
| Rate for Payer: BCN Commercial |
$62.85
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Nomi Health Commercial |
$62.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.08
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.97
|
| Rate for Payer: UHC Core |
$63.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.08
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna Medicare |
$476.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$572.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$572.46
|
| Rate for Payer: BCBS Complete |
$339.08
|
| Rate for Payer: BCBS MAPPO |
$457.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.98
|
| Rate for Payer: BCN Commercial |
$1,505.98
|
| Rate for Payer: BCN Medicare Advantage |
$457.97
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.97
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.90
|
| Rate for Payer: Mclaren Medicaid |
$322.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$480.87
|
| Rate for Payer: Meridian Medicaid |
$339.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$526.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$503.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,557.09
|
| Rate for Payer: Nomi Health Commercial |
$1,502.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.90
|
| Rate for Payer: PACE Senior Care Partners |
$435.07
|
| Rate for Payer: PACE SWMI |
$457.97
|
| Rate for Payer: PHP Commercial |
$1,557.09
|
| Rate for Payer: PHP Medicare Advantage |
$457.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,593.73
|
| Rate for Payer: Priority Health Medicare |
$462.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,274.98
|
| Rate for Payer: Railroad Medicare Medicare |
$457.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,612.05
|
| Rate for Payer: UHC Core |
$1,529.61
|
| Rate for Payer: UHC Exchange |
$457.97
|
| Rate for Payer: UHC Medicaid |
$322.96
|
| Rate for Payer: UHC Medicare Advantage |
$457.97
|
| Rate for Payer: UHCCP Medicaid |
$322.96
|
| Rate for Payer: VA VA |
$457.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$939.99
|
|
|
Service Code
|
NDC 00904651006
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.72 |
| Max. Negotiated Rate |
$845.99 |
| Rate for Payer: Aetna Commercial |
$798.99
|
| Rate for Payer: Aetna Medicare |
$244.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.75
|
| Rate for Payer: BCBS Complete |
$173.99
|
| Rate for Payer: BCBS MAPPO |
$235.00
|
| Rate for Payer: BCBS Trust/PPO |
$772.77
|
| Rate for Payer: BCN Commercial |
$772.77
|
| Rate for Payer: BCN Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$751.99
|
| Rate for Payer: Cofinity Commercial |
$808.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$845.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.99
|
| Rate for Payer: Mclaren Medicaid |
$165.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.75
|
| Rate for Payer: Meridian Medicaid |
$173.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$258.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.99
|
| Rate for Payer: Nomi Health Commercial |
$770.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.99
|
| Rate for Payer: PACE Senior Care Partners |
$223.25
|
| Rate for Payer: PACE SWMI |
$235.00
|
| Rate for Payer: PHP Commercial |
$798.99
|
| Rate for Payer: PHP Medicare Advantage |
$235.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$817.79
|
| Rate for Payer: Priority Health Medicare |
$237.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.23
|
| Rate for Payer: Railroad Medicare Medicare |
$235.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.19
|
| Rate for Payer: UHC Core |
$784.89
|
| Rate for Payer: UHC Exchange |
$235.00
|
| Rate for Payer: UHC Medicaid |
$165.72
|
| Rate for Payer: UHC Medicare Advantage |
$235.00
|
| Rate for Payer: UHCCP Medicaid |
$165.72
|
| Rate for Payer: VA VA |
$235.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.99
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$939.99
|
|
|
Service Code
|
NDC 00904651006
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$654.23 |
| Max. Negotiated Rate |
$845.99 |
| Rate for Payer: Aetna Commercial |
$798.99
|
| Rate for Payer: BCBS Trust/PPO |
$776.34
|
| Rate for Payer: BCN Commercial |
$776.34
|
| Rate for Payer: Cash Price |
$751.99
|
| Rate for Payer: Cofinity Commercial |
$808.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.99
|
| Rate for Payer: Healthscope Commercial |
$845.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.99
|
| Rate for Payer: Nomi Health Commercial |
$770.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.99
|
| Rate for Payer: PHP Commercial |
$798.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$817.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.19
|
| Rate for Payer: UHC Core |
$784.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.99
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: Aetna Medicare |
$19.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.78
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: BCBS MAPPO |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$62.56
|
| Rate for Payer: BCN Commercial |
$62.56
|
| Rate for Payer: BCN Medicare Advantage |
$19.02
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.02
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.08
|
| Rate for Payer: Mclaren Medicaid |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.98
|
| Rate for Payer: Meridian Medicaid |
$14.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Nomi Health Commercial |
$62.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.08
|
| Rate for Payer: PACE Senior Care Partners |
$18.07
|
| Rate for Payer: PACE SWMI |
$19.02
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: PHP Medicare Advantage |
$19.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.21
|
| Rate for Payer: Priority Health Medicare |
$19.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.97
|
| Rate for Payer: Railroad Medicare Medicare |
$19.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.97
|
| Rate for Payer: UHC Core |
$63.54
|
| Rate for Payer: UHC Exchange |
$19.02
|
| Rate for Payer: UHC Medicaid |
$13.42
|
| Rate for Payer: UHC Medicare Advantage |
$19.02
|
| Rate for Payer: UHCCP Medicaid |
$13.42
|
| Rate for Payer: VA VA |
$19.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.08
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$243.68
|
|
|
Service Code
|
NDC 65162089709
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$219.31 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: BCBS Trust/PPO |
$201.26
|
| Rate for Payer: BCN Commercial |
$201.26
|
| Rate for Payer: Cash Price |
$194.94
|
| Rate for Payer: Cofinity Commercial |
$209.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.94
|
| Rate for Payer: Healthscope Commercial |
$219.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.13
|
| Rate for Payer: Nomi Health Commercial |
$199.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.76
|
| Rate for Payer: PHP Commercial |
$207.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.44
|
| Rate for Payer: UHC Core |
$203.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.76
|
|
