|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$173.76
|
|
|
Service Code
|
NDC 13668059181
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$147.70
|
| Rate for Payer: BCBS Trust/PPO |
$141.84
|
| Rate for Payer: BCN Commercial |
$134.28
|
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.01
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.70
|
| Rate for Payer: Nomi Health Commercial |
$142.48
|
| Rate for Payer: PHP Commercial |
$147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.94
|
| Rate for Payer: Priority Health HMO/PPO |
$151.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.91
|
| Rate for Payer: UHC Core |
$145.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.32
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$173.76
|
|
|
Service Code
|
NDC 13668059180
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$147.70
|
| Rate for Payer: Aetna Medicare |
$45.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.30
|
| Rate for Payer: BCBS Complete |
$69.50
|
| Rate for Payer: BCBS MAPPO |
$43.44
|
| Rate for Payer: BCBS Trust/PPO |
$142.85
|
| Rate for Payer: BCN Commercial |
$135.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.44
|
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.44
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.70
|
| Rate for Payer: Nomi Health Commercial |
$142.48
|
| Rate for Payer: PACE Senior Care Partners |
$41.27
|
| Rate for Payer: PACE SWMI |
$43.44
|
| Rate for Payer: PHP Commercial |
$147.70
|
| Rate for Payer: PHP Medicare Advantage |
$43.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.94
|
| Rate for Payer: Priority Health HMO/PPO |
$151.17
|
| Rate for Payer: Priority Health Medicare |
$43.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.42
|
| Rate for Payer: Railroad Medicare Medicare |
$43.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.91
|
| Rate for Payer: UHC Core |
$145.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.44
|
| Rate for Payer: UHC Exchange |
$43.44
|
| Rate for Payer: UHC Medicare Advantage |
$43.44
|
| Rate for Payer: VA VA |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.32
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$923.49
|
|
|
Service Code
|
NDC 13668059182
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.33 |
| Max. Negotiated Rate |
$831.14 |
| Rate for Payer: Aetna Commercial |
$784.97
|
| Rate for Payer: Aetna Medicare |
$240.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.59
|
| Rate for Payer: BCBS Complete |
$369.40
|
| Rate for Payer: BCBS MAPPO |
$230.87
|
| Rate for Payer: BCBS Trust/PPO |
$759.20
|
| Rate for Payer: BCN Commercial |
$718.01
|
| Rate for Payer: BCN Medicare Advantage |
$230.87
|
| Rate for Payer: Cash Price |
$738.79
|
| Rate for Payer: Cofinity Commercial |
$794.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.87
|
| Rate for Payer: Healthscope Commercial |
$831.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$784.97
|
| Rate for Payer: Nomi Health Commercial |
$757.26
|
| Rate for Payer: PACE Senior Care Partners |
$219.33
|
| Rate for Payer: PACE SWMI |
$230.87
|
| Rate for Payer: PHP Commercial |
$784.97
|
| Rate for Payer: PHP Medicare Advantage |
$230.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.27
|
| Rate for Payer: Priority Health HMO/PPO |
$803.44
|
| Rate for Payer: Priority Health Medicare |
$233.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.74
|
| Rate for Payer: Railroad Medicare Medicare |
$230.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.67
|
| Rate for Payer: UHC Core |
$771.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.87
|
| Rate for Payer: UHC Exchange |
$230.87
|
| Rate for Payer: UHC Medicare Advantage |
$230.87
|
| Rate for Payer: VA VA |
$230.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.62
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$173.76
|
|
|
Service Code
|
NDC 13668059180
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$147.70
|
| Rate for Payer: BCBS Trust/PPO |
$141.84
|
| Rate for Payer: BCN Commercial |
$134.28
|
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.01
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.70
|
| Rate for Payer: Nomi Health Commercial |
$142.48
|
| Rate for Payer: PHP Commercial |
$147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.94
|
| Rate for Payer: Priority Health HMO/PPO |
$151.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.91
|
| Rate for Payer: UHC Core |
$145.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.32
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$173.76
|
|
|
Service Code
|
NDC 13668059181
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Aetna Commercial |
$147.70
|
| Rate for Payer: Aetna Medicare |
$45.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.30
|
| Rate for Payer: BCBS Complete |
$69.50
|
| Rate for Payer: BCBS MAPPO |
$43.44
|
| Rate for Payer: BCBS Trust/PPO |
$142.85
|
| Rate for Payer: BCN Commercial |
$135.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.44
|
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.44
|
| Rate for Payer: Healthscope Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.70
|
| Rate for Payer: Nomi Health Commercial |
$142.48
|
| Rate for Payer: PACE Senior Care Partners |
$41.27
|
| Rate for Payer: PACE SWMI |
$43.44
|
| Rate for Payer: PHP Commercial |
$147.70
|
| Rate for Payer: PHP Medicare Advantage |
$43.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.94
|
| Rate for Payer: Priority Health HMO/PPO |
$151.17
|
| Rate for Payer: Priority Health Medicare |
$43.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.42
|
| Rate for Payer: Railroad Medicare Medicare |
$43.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.91
|
| Rate for Payer: UHC Core |
$145.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.44
|
| Rate for Payer: UHC Exchange |
$43.44
|
| Rate for Payer: UHC Medicare Advantage |
$43.44
|
| Rate for Payer: VA VA |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.32
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$1,276.73
|
|
|
Service Code
|
NDC 00781232151
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$829.87 |
| Max. Negotiated Rate |
$1,149.06 |
| Rate for Payer: Aetna Commercial |
$1,085.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.19
|
| Rate for Payer: BCN Commercial |
$986.66
|
| Rate for Payer: Cash Price |
$1,021.38
|
| Rate for Payer: Cofinity Commercial |
$1,097.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.38
|
| Rate for Payer: Healthscope Commercial |
$1,149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.22
|
| Rate for Payer: Nomi Health Commercial |
$1,046.92
|
| Rate for Payer: PHP Commercial |
$1,085.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.52
|
| Rate for Payer: UHC Core |
$1,066.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.55
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$923.49
|
|
|
Service Code
|
NDC 13668059182
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$600.27 |
| Max. Negotiated Rate |
$831.14 |
| Rate for Payer: Aetna Commercial |
$784.97
|
| Rate for Payer: BCBS Trust/PPO |
$753.84
|
| Rate for Payer: BCN Commercial |
$713.67
|
| Rate for Payer: Cash Price |
$738.79
|
| Rate for Payer: Cofinity Commercial |
$794.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.79
|
| Rate for Payer: Healthscope Commercial |
$831.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$784.97
|
| Rate for Payer: Nomi Health Commercial |
$757.26
|
| Rate for Payer: PHP Commercial |
$784.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.27
|
| Rate for Payer: Priority Health HMO/PPO |
$803.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.67
|
| Rate for Payer: UHC Core |
$771.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.62
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$255.38
|
|
|
Service Code
|
NDC 00781232106
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$217.07
|
| Rate for Payer: Aetna Medicare |
$66.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.81
|
| Rate for Payer: BCBS Complete |
$102.15
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$209.95
|
| Rate for Payer: BCN Commercial |
$198.56
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.07
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: PACE Senior Care Partners |
$60.65
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Commercial |
$217.07
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.00
|
| Rate for Payer: Priority Health HMO/PPO |
$222.18
|
| Rate for Payer: Priority Health Medicare |
$64.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.10
|
| Rate for Payer: Railroad Medicare Medicare |
$63.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.84
|
| Rate for Payer: UHC Exchange |
$63.84
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: VA VA |
$63.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.54
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
OP
|
$1,276.73
|
|
|
Service Code
|
NDC 00781232151
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.22 |
| Max. Negotiated Rate |
$1,149.06 |
| Rate for Payer: Aetna Commercial |
$1,085.22
|
| Rate for Payer: Aetna Medicare |
$331.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$398.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$398.98
|
| Rate for Payer: BCBS Complete |
$510.69
|
| Rate for Payer: BCBS MAPPO |
$319.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.60
|
| Rate for Payer: BCN Commercial |
$992.66
|
| Rate for Payer: BCN Medicare Advantage |
$319.18
|
| Rate for Payer: Cash Price |
$1,021.38
|
| Rate for Payer: Cofinity Commercial |
$1,097.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.18
|
| Rate for Payer: Healthscope Commercial |
$1,149.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.22
|
| Rate for Payer: Nomi Health Commercial |
$1,046.92
|
| Rate for Payer: PACE Senior Care Partners |
$303.22
|
| Rate for Payer: PACE SWMI |
$319.18
|
| Rate for Payer: PHP Commercial |
$1,085.22
|
| Rate for Payer: PHP Medicare Advantage |
$319.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.76
|
| Rate for Payer: Priority Health Medicare |
$322.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.41
|
| Rate for Payer: Railroad Medicare Medicare |
$319.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.52
|
| Rate for Payer: UHC Core |
$1,066.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.18
|
| Rate for Payer: UHC Exchange |
$319.18
|
| Rate for Payer: UHC Medicare Advantage |
$319.18
|
| Rate for Payer: VA VA |
$319.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.55
|
|
|
APREPITANT 40 MG CAPSULE
|
Facility
|
IP
|
$255.38
|
|
|
Service Code
|
NDC 00781232106
|
| Hospital Charge Code |
76843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Commercial |
$217.07
|
| Rate for Payer: BCBS Trust/PPO |
$208.47
|
| Rate for Payer: BCN Commercial |
$197.36
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$229.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.07
|
| Rate for Payer: Nomi Health Commercial |
$209.41
|
| Rate for Payer: PHP Commercial |
$217.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.00
|
| Rate for Payer: Priority Health HMO/PPO |
$222.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.54
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$332.92
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.40 |
| Max. Negotiated Rate |
$299.63 |
| Rate for Payer: Aetna Commercial |
$282.98
|
| Rate for Payer: BCBS Trust/PPO |
$271.76
|
| Rate for Payer: BCN Commercial |
$257.28
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$299.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.98
|
| Rate for Payer: Nomi Health Commercial |
$272.99
|
| Rate for Payer: PHP Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO |
$289.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.97
|
| Rate for Payer: UHC Core |
$277.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.69
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$332.92
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$299.63 |
| Rate for Payer: Aetna Commercial |
$282.98
|
| Rate for Payer: Aetna Medicare |
$86.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.04
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$273.69
|
| Rate for Payer: BCN Commercial |
$258.85
|
| Rate for Payer: BCN Medicare Advantage |
$83.23
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$299.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.69
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.39
|
| Rate for Payer: Meridian Medicaid |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.98
|
| Rate for Payer: Nomi Health Commercial |
$272.99
|
| Rate for Payer: PACE Senior Care Partners |
$79.07
|
| Rate for Payer: PACE SWMI |
$83.23
|
| Rate for Payer: PHP Commercial |
$282.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO |
$289.64
|
| Rate for Payer: Priority Health Medicare |
$84.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.06
|
| Rate for Payer: Railroad Medicare Medicare |
$83.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.97
|
| Rate for Payer: UHC Core |
$277.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.23
|
| Rate for Payer: UHC Exchange |
$83.23
|
| Rate for Payer: UHC Medicare Advantage |
$83.23
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$83.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.69
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$477.11 |
| 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 |
$627.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.78
|
| Rate for Payer: BCBS Complete |
$803.55
|
| Rate for Payer: BCBS MAPPO |
$502.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.50
|
| Rate for Payer: BCN Commercial |
$1,561.90
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.55
|
| Rate for Payer: Nomi Health Commercial |
$1,647.28
|
| 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 Cigna Priority Health |
$1,305.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.73
|
| Rate for Payer: Priority Health Medicare |
$507.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.95
|
| 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 Dual Complete DSNP |
$502.22
|
| Rate for Payer: UHC Exchange |
$502.22
|
| Rate for Payer: UHC Medicare Advantage |
$502.22
|
| 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 |
$151.43 |
| 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 |
$255.04
|
| Rate for Payer: BCBS MAPPO |
$159.40
|
| Rate for Payer: BCBS Trust/PPO |
$524.16
|
| Rate for Payer: BCN Commercial |
$495.73
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.95
|
| Rate for Payer: Nomi Health Commercial |
$522.82
|
| 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 Cigna Priority Health |
$414.43
|
| Rate for Payer: Priority Health HMO/PPO |
$554.70
|
| Rate for Payer: Priority Health Medicare |
$160.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.19
|
| 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 Dual Complete DSNP |
$159.40
|
| Rate for Payer: UHC Exchange |
$159.40
|
| Rate for Payer: UHC Medicare Advantage |
$159.40
|
| Rate for Payer: VA VA |
$159.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.19
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,305.77 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.85
|
| Rate for Payer: BCN Commercial |
$1,552.46
|
| 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: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.95
|
| 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
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: BCBS Trust/PPO |
$163.51
|
| Rate for Payer: BCN Commercial |
$154.80
|
| 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: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health HMO/PPO |
$174.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.21
|
| 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
|
$62.70
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.59
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: BCBS MAPPO |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$48.75
|
| Rate for Payer: BCN Medicare Advantage |
$15.68
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$51.41
|
| Rate for Payer: PACE Senior Care Partners |
$14.89
|
| Rate for Payer: PACE SWMI |
$15.68
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health HMO/PPO |
$54.55
|
| Rate for Payer: Priority Health Medicare |
$15.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.01
|
| Rate for Payer: Railroad Medicare Medicare |
$15.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC Core |
$52.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.68
|
| Rate for Payer: UHC Exchange |
$15.68
|
| Rate for Payer: UHC Medicare Advantage |
$15.68
|
| Rate for Payer: VA VA |
$15.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.02
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.57 |
| 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 |
$80.12
|
| Rate for Payer: BCBS MAPPO |
$50.08
|
| Rate for Payer: BCBS Trust/PPO |
$164.67
|
| Rate for Payer: BCN Commercial |
$155.74
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: Nomi Health Commercial |
$164.25
|
| 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 Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health HMO/PPO |
$174.27
|
| Rate for Payer: Priority Health Medicare |
$50.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.21
|
| 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 Dual Complete DSNP |
$50.08
|
| Rate for Payer: UHC Exchange |
$50.08
|
| Rate for Payer: UHC Medicare Advantage |
$50.08
|
| Rate for Payer: VA VA |
$50.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$62.70
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.18
|
| Rate for Payer: BCN Commercial |
$48.45
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$51.41
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health HMO/PPO |
$54.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.18
|
| Rate for Payer: UHC Core |
$52.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.02
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$637.59
|
|
|
Service Code
|
NDC 00904650904
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$414.43 |
| Max. Negotiated Rate |
$573.83 |
| Rate for Payer: Aetna Commercial |
$541.95
|
| Rate for Payer: BCBS Trust/PPO |
$520.46
|
| Rate for Payer: BCN Commercial |
$492.73
|
| 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: PHP Commercial |
$541.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.43
|
| Rate for Payer: Priority Health HMO/PPO |
$554.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.19
|
| 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
|
IP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,190.72 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.36
|
| Rate for Payer: BCN Commercial |
$1,415.67
|
| 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: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,593.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,227.35
|
| 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
|
IP
|
$242.82
|
|
|
Service Code
|
NDC 65162089709
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$218.54 |
| Rate for Payer: Aetna Commercial |
$206.40
|
| Rate for Payer: BCBS Trust/PPO |
$198.21
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: Cash Price |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$208.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.26
|
| Rate for Payer: Healthscope Commercial |
$218.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.40
|
| Rate for Payer: Nomi Health Commercial |
$199.11
|
| Rate for Payer: PHP Commercial |
$206.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.83
|
| Rate for Payer: Priority Health HMO/PPO |
$211.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.68
|
| Rate for Payer: UHC Core |
$202.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.12
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$81.23
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna Medicare |
$21.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.38
|
| Rate for Payer: BCBS Complete |
$32.49
|
| Rate for Payer: BCBS MAPPO |
$20.31
|
| Rate for Payer: BCBS Trust/PPO |
$66.78
|
| Rate for Payer: BCN Commercial |
$63.16
|
| Rate for Payer: BCN Medicare Advantage |
$20.31
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.05
|
| Rate for Payer: Nomi Health Commercial |
$66.61
|
| Rate for Payer: PACE Senior Care Partners |
$19.29
|
| Rate for Payer: PACE SWMI |
$20.31
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: PHP Medicare Advantage |
$20.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.80
|
| Rate for Payer: Priority Health HMO/PPO |
$70.67
|
| Rate for Payer: Priority Health Medicare |
$20.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.42
|
| Rate for Payer: Railroad Medicare Medicare |
$20.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.48
|
| Rate for Payer: UHC Core |
$67.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.31
|
| Rate for Payer: UHC Exchange |
$20.31
|
| Rate for Payer: UHC Medicare Advantage |
$20.31
|
| Rate for Payer: VA VA |
$20.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$242.82
|
|
|
Service Code
|
NDC 65162089709
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$218.54 |
| Rate for Payer: Aetna Commercial |
$206.40
|
| Rate for Payer: Aetna Medicare |
$63.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.88
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$60.70
|
| Rate for Payer: BCBS Trust/PPO |
$199.62
|
| Rate for Payer: BCN Commercial |
$188.79
|
| Rate for Payer: BCN Medicare Advantage |
$60.70
|
| Rate for Payer: Cash Price |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$208.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.70
|
| Rate for Payer: Healthscope Commercial |
$218.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.40
|
| Rate for Payer: Nomi Health Commercial |
$199.11
|
| Rate for Payer: PACE Senior Care Partners |
$57.67
|
| Rate for Payer: PACE SWMI |
$60.70
|
| Rate for Payer: PHP Commercial |
$206.40
|
| Rate for Payer: PHP Medicare Advantage |
$60.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.83
|
| Rate for Payer: Priority Health HMO/PPO |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$61.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.69
|
| Rate for Payer: Railroad Medicare Medicare |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.68
|
| Rate for Payer: UHC Core |
$202.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.70
|
| Rate for Payer: UHC Exchange |
$60.70
|
| Rate for Payer: UHC Medicare Advantage |
$60.70
|
| Rate for Payer: VA VA |
$60.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.12
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$939.99
|
|
|
Service Code
|
NDC 00904651006
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.25 |
| 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 |
$376.00
|
| Rate for Payer: BCBS MAPPO |
$235.00
|
| Rate for Payer: BCBS Trust/PPO |
$772.77
|
| Rate for Payer: BCN Commercial |
$730.84
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.99
|
| Rate for Payer: Nomi Health Commercial |
$770.79
|
| 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 Cigna Priority Health |
$610.99
|
| Rate for Payer: Priority Health HMO/PPO |
$817.79
|
| Rate for Payer: Priority Health Medicare |
$237.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.79
|
| 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 Dual Complete DSNP |
$235.00
|
| Rate for Payer: UHC Exchange |
$235.00
|
| Rate for Payer: UHC Medicare Advantage |
$235.00
|
| Rate for Payer: VA VA |
$235.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.99
|
|
