|
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
|
$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 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
|
$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 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
|
$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 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 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
|
$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
|
$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
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 |
$4,697.66
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| 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 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 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 |
$4,697.66
|
| Rate for Payer: Cofinity Commercial |
$3,823.68
|
| 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
|
|
|
ARMODAFINIL 150 MG TABLET
|
Facility
IP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459-215-30
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,655.78 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Commercial |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,198.66
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.19
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,655.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
IP
|
$76.67
|
|
|
Service Code
|
NDC 69339-177-03
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.67
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| Rate for Payer: UMR Bronson Commercial |
$33.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
|
Facility
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$662.09 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,319.56
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$662.09
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); TIBIA AND FIBULA, PROXIMAL
|
Facility
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$730.52 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.38
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$730.52
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.10
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$456.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$656.85 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.54
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$656.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
