|
ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,123.08
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
28947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$494.16 |
| Max. Negotiated Rate |
$1,010.77 |
| Rate for Payer: Aetna American Axle |
$730.00
|
| Rate for Payer: Aetna American Axle |
$118.03
|
| Rate for Payer: Aetna American Axle |
$443.16
|
| Rate for Payer: Aetna American Axle |
$442.05
|
| Rate for Payer: Aetna Commercial |
$154.35
|
| Rate for Payer: Aetna Commercial |
$954.62
|
| Rate for Payer: Aetna Commercial |
$578.07
|
| Rate for Payer: Aetna Commercial |
$579.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.16
|
| Rate for Payer: Cash Price |
$898.46
|
| Rate for Payer: Cash Price |
$545.42
|
| Rate for Payer: Cash Price |
$145.27
|
| Rate for Payer: Cash Price |
$544.06
|
| Rate for Payer: Cofinity Commercial |
$965.85
|
| Rate for Payer: Cofinity Commercial |
$786.16
|
| Rate for Payer: Cofinity Commercial |
$476.06
|
| Rate for Payer: Cofinity Commercial |
$127.11
|
| Rate for Payer: Cofinity Commercial |
$156.17
|
| Rate for Payer: Cofinity Commercial |
$586.33
|
| Rate for Payer: Cofinity Commercial |
$477.25
|
| Rate for Payer: Cofinity Commercial |
$584.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.46
|
| Rate for Payer: Healthscope Commercial |
$163.43
|
| Rate for Payer: Healthscope Commercial |
$613.60
|
| Rate for Payer: Healthscope Commercial |
$612.07
|
| Rate for Payer: Healthscope Commercial |
$1,010.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$477.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$579.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$954.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$578.07
|
| Rate for Payer: PHP Commercial |
$954.62
|
| Rate for Payer: PHP Commercial |
$154.35
|
| Rate for Payer: PHP Commercial |
$578.07
|
| Rate for Payer: PHP Commercial |
$579.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.06
|
| Rate for Payer: Priority Health SBD |
$429.52
|
| Rate for Payer: Priority Health SBD |
$428.45
|
| Rate for Payer: Priority Health SBD |
$707.54
|
| Rate for Payer: Priority Health SBD |
$114.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$299.24
|
| Rate for Payer: UMR Bronson Commercial |
$494.16
|
| Rate for Payer: UMR Bronson Commercial |
$299.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.34
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$442.43
|
|
|
Service Code
|
HCPCS J0891
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$398.19 |
| Rate for Payer: Aetna American Axle |
$287.58
|
| Rate for Payer: Aetna Commercial |
$376.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.58
|
| Rate for Payer: Cash Price |
$353.94
|
| Rate for Payer: Cofinity Commercial |
$309.70
|
| Rate for Payer: Cofinity Commercial |
$380.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.94
|
| Rate for Payer: Healthscope Commercial |
$398.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.07
|
| Rate for Payer: PHP Commercial |
$376.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.70
|
| Rate for Payer: Priority Health SBD |
$278.73
|
| Rate for Payer: UMR Bronson Commercial |
$194.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.82
|
|
|
ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$334.78
|
|
|
Service Code
|
HCPCS J0898
|
| Hospital Charge Code |
152708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.30 |
| Max. Negotiated Rate |
$301.30 |
| Rate for Payer: Aetna American Axle |
$217.61
|
| Rate for Payer: Aetna Commercial |
$284.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.61
|
| Rate for Payer: Cash Price |
$267.82
|
| Rate for Payer: Cofinity Commercial |
$234.35
|
| Rate for Payer: Cofinity Commercial |
$287.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.82
|
| Rate for Payer: Healthscope Commercial |
$301.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.56
|
| Rate for Payer: PHP Commercial |
$284.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.35
|
| Rate for Payer: Priority Health SBD |
$210.91
|
| Rate for Payer: UMR Bronson Commercial |
$147.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.08
|
|
|
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 |
$146.48 |
| Max. Negotiated Rate |
$299.63 |
| Rate for Payer: Aetna American Axle |
$216.40
|
| Rate for Payer: Aetna American Axle |
$268.27
|
| Rate for Payer: Aetna American Axle |
$278.82
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna Commercial |
$282.98
|
| Rate for Payer: Aetna Commercial |
$350.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.27
|
| Rate for Payer: Cash Price |
$343.17
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$330.18
|
| Rate for Payer: Cofinity Commercial |
$288.91
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$354.95
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Cofinity Commercial |
$300.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$386.06
|
| Rate for Payer: Healthscope Commercial |
$299.63
|
| Rate for Payer: Healthscope Commercial |
$371.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.98
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$350.82
|
| Rate for Payer: PHP Commercial |
$282.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.27
|
| Rate for Payer: Priority Health SBD |
$260.02
|
| Rate for Payer: Priority Health SBD |
$270.24
|
| Rate for Payer: Priority Health SBD |
$209.74
|
| Rate for Payer: UMR Bronson Commercial |
$181.60
|
| Rate for Payer: UMR Bronson Commercial |
$146.48
|
| Rate for Payer: UMR Bronson Commercial |
$188.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.69
|
|
|
ARGATROBAN 50 MG/50 ML (1 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$473.78
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
155428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.46 |
| Max. Negotiated Rate |
$426.40 |
| Rate for Payer: Aetna American Axle |
$307.96
|
| Rate for Payer: Aetna American Axle |
$525.54
|
| Rate for Payer: Aetna Commercial |
$687.24
|
| Rate for Payer: Aetna Commercial |
$402.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.54
|
| Rate for Payer: Cash Price |
$379.02
|
| Rate for Payer: Cash Price |
$646.82
|
| Rate for Payer: Cofinity Commercial |
$331.65
|
| Rate for Payer: Cofinity Commercial |
$407.45
|
| Rate for Payer: Cofinity Commercial |
$565.96
|
| Rate for Payer: Cofinity Commercial |
$695.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.82
|
| Rate for Payer: Healthscope Commercial |
$727.67
|
| Rate for Payer: Healthscope Commercial |
$426.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.24
|
| Rate for Payer: PHP Commercial |
$402.71
|
| Rate for Payer: PHP Commercial |
$687.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.96
|
| Rate for Payer: Priority Health SBD |
$298.48
|
| Rate for Payer: Priority Health SBD |
$509.37
|
| Rate for Payer: UMR Bronson Commercial |
$355.75
|
| Rate for Payer: UMR Bronson Commercial |
$208.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.39
|
|
|
ARGININE HCL (L-ARGININE) 10 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$180.96
|
|
|
Service Code
|
NDC 0009-0436-01
|
| Hospital Charge Code |
9123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna American Axle |
$117.62
|
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.77
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.82
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UMR Bronson Commercial |
$79.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.72
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$70.97
|
|
|
Service Code
|
NDC 65162-899-03
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$63.87 |
| Rate for Payer: Aetna American Axle |
$46.13
|
| Rate for Payer: Aetna Commercial |
$60.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.13
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cofinity Commercial |
$49.68
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Healthscope Commercial |
$63.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.32
|
| Rate for Payer: PHP Commercial |
$60.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.68
|
| Rate for Payer: Priority Health SBD |
$44.71
|
| Rate for Payer: UMR Bronson Commercial |
$31.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.23
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 43598-968-30
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.62
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 27241-054-03
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.62
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505-2675-3
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.41
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$87.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148-009-13
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$883.91 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna American Axle |
$1,305.77
|
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Commercial |
$1,406.22
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,406.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,406.22
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UMR Bronson Commercial |
$883.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
NDC 67877-433-03
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.72
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.88
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$578.16
|
|
|
Service Code
|
NDC 66689-735-05
|
| Hospital Charge Code |
40446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.39 |
| Max. Negotiated Rate |
$520.34 |
| Rate for Payer: Aetna American Axle |
$375.80
|
| Rate for Payer: Aetna Commercial |
$491.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.80
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$404.71
|
| Rate for Payer: Cofinity Commercial |
$497.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$520.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: PHP Commercial |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health SBD |
$364.24
|
| Rate for Payer: UMR Bronson Commercial |
$254.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.62
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148-006-13
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$883.91 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna American Axle |
$1,305.77
|
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Commercial |
$1,406.22
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,406.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,406.22
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UMR Bronson Commercial |
$883.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505-3075-3
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.41
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$87.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$103.64
|
|
|
Service Code
|
NDC 65162-896-03
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$93.28 |
| Rate for Payer: Aetna American Axle |
$67.37
|
| Rate for Payer: Aetna Commercial |
$88.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.37
|
| Rate for Payer: Cash Price |
$82.91
|
| Rate for Payer: Cofinity Commercial |
$72.55
|
| Rate for Payer: Cofinity Commercial |
$89.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.91
|
| Rate for Payer: Healthscope Commercial |
$93.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.09
|
| Rate for Payer: PHP Commercial |
$88.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.55
|
| Rate for Payer: Priority Health SBD |
$65.29
|
| Rate for Payer: UMR Bronson Commercial |
$45.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.73
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505-2673-3
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.41
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$87.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$81.23
|
|
|
Service Code
|
NDC 65162-897-03
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna American Axle |
$52.80
|
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.86
|
| Rate for Payer: Priority Health SBD |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$35.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$1,773.41
|
|
|
Service Code
|
NDC 0904-6510-61
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$1,596.07 |
| Rate for Payer: Aetna American Axle |
$1,152.72
|
| Rate for Payer: Aetna Commercial |
$1,507.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.72
|
| Rate for Payer: Cash Price |
$1,418.73
|
| Rate for Payer: Cofinity Commercial |
$1,241.39
|
| Rate for Payer: Cofinity Commercial |
$1,525.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.73
|
| Rate for Payer: Healthscope Commercial |
$1,596.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,241.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,330.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,507.40
|
| Rate for Payer: PHP Commercial |
$1,507.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,241.39
|
| Rate for Payer: Priority Health SBD |
$1,117.25
|
| Rate for Payer: UMR Bronson Commercial |
$780.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,330.06
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,462.40
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,403.46 |
| Max. Negotiated Rate |
$4,916.16 |
| Rate for Payer: Aetna American Axle |
$3,550.56
|
| Rate for Payer: Aetna Commercial |
$4,643.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,550.56
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| Rate for Payer: Cofinity Commercial |
$4,697.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,369.92
|
| Rate for Payer: Healthscope Commercial |
$4,916.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,823.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,096.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.04
|
| Rate for Payer: PHP Commercial |
$4,643.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.68
|
| Rate for Payer: Priority Health SBD |
$3,441.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,403.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,096.80
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,462.40
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$4,916.16 |
| Rate for Payer: Aetna American Axle |
$3,550.56
|
| Rate for Payer: Aetna Commercial |
$4,643.04
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.51
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.81
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| Rate for Payer: Cofinity Commercial |
$4,697.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,369.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.81
|
| Rate for Payer: Healthscope Commercial |
$4,916.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,823.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,096.80
|
| Rate for Payer: Mclaren Medicaid |
$3.72
|
| Rate for Payer: Mclaren Medicare |
$6.81
|
| Rate for Payer: Meridian Medicaid |
$3.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.04
|
| Rate for Payer: PACE Medicare |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.81
|
| Rate for Payer: PHP Commercial |
$4,643.04
|
| Rate for Payer: PHP Medicare Advantage |
$6.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.02
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Narrow Network |
$16.02
|
| Rate for Payer: Priority Health SBD |
$3,441.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,021.09
|
| Rate for Payer: VA VA |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,096.80
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$5,462.40
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$4,916.16 |
| Rate for Payer: Aetna American Axle |
$3,550.56
|
| Rate for Payer: Aetna Commercial |
$4,643.04
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.51
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.81
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| Rate for Payer: Cofinity Commercial |
$4,697.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,369.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.81
|
| Rate for Payer: Healthscope Commercial |
$4,916.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,823.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,096.80
|
| Rate for Payer: Mclaren Medicaid |
$3.72
|
| Rate for Payer: Mclaren Medicare |
$6.81
|
| Rate for Payer: Meridian Medicaid |
$3.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.04
|
| Rate for Payer: PACE Medicare |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.81
|
| Rate for Payer: PHP Commercial |
$4,643.04
|
| Rate for Payer: PHP Medicare Advantage |
$6.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.02
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Narrow Network |
$16.02
|
| Rate for Payer: Priority Health SBD |
$3,441.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,021.09
|
| Rate for Payer: VA VA |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,096.80
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$5,462.40
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,403.46 |
| Max. Negotiated Rate |
$4,916.16 |
| Rate for Payer: Aetna American Axle |
$3,550.56
|
| Rate for Payer: Aetna Commercial |
$4,643.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,550.56
|
| Rate for Payer: Cash Price |
$4,369.92
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| Rate for Payer: Cofinity Commercial |
$4,697.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,369.92
|
| Rate for Payer: Healthscope Commercial |
$4,916.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,823.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,096.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.04
|
| Rate for Payer: PHP Commercial |
$4,643.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,823.68
|
| Rate for Payer: Priority Health SBD |
$3,441.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,403.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,096.80
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$5,917.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$5,325.84 |
| Rate for Payer: Aetna American Axle |
$3,846.44
|
| Rate for Payer: Aetna Commercial |
$5,029.96
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,846.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.51
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.81
|
| Rate for Payer: Cash Price |
$4,734.08
|
| Rate for Payer: Cash Price |
$4,734.08
|
| Rate for Payer: Cofinity Commercial |
$4,142.32
|
| Rate for Payer: Cofinity Commercial |
$5,089.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,734.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.81
|
| Rate for Payer: Healthscope Commercial |
$5,325.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,142.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,438.20
|
| Rate for Payer: Mclaren Medicaid |
$3.72
|
| Rate for Payer: Mclaren Medicare |
$6.81
|
| Rate for Payer: Meridian Medicaid |
$3.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,029.96
|
| Rate for Payer: PACE Medicare |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.81
|
| Rate for Payer: PHP Commercial |
$5,029.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,142.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.02
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Narrow Network |
$16.02
|
| Rate for Payer: Priority Health SBD |
$3,728.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,189.51
|
| Rate for Payer: VA VA |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,438.20
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$5,917.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,603.74 |
| Max. Negotiated Rate |
$5,325.84 |
| Rate for Payer: Aetna American Axle |
$3,846.44
|
| Rate for Payer: Aetna Commercial |
$5,029.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,846.44
|
| Rate for Payer: Cash Price |
$4,734.08
|
| Rate for Payer: Cofinity Commercial |
$4,142.32
|
| Rate for Payer: Cofinity Commercial |
$5,089.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,734.08
|
| Rate for Payer: Healthscope Commercial |
$5,325.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,142.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,438.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,029.96
|
| Rate for Payer: PHP Commercial |
$5,029.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,142.32
|
| Rate for Payer: Priority Health SBD |
$3,728.09
|
| Rate for Payer: UMR Bronson Commercial |
$2,603.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,438.20
|
|
