|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 27241005403
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: BCBS Complete |
$37.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.62
|
| 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 Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$199.16
|
|
|
Service Code
|
NDC 60505267503
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna Medicare |
$99.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: BCBS Complete |
$79.66
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.41
|
| 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 Commercial |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.45
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$73.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$64.13
|
|
|
Service Code
|
NDC 67877043303
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna American Axle |
$41.68
|
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.68
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$55.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$57.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.51
|
| Rate for Payer: PHP Commercial |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health SBD |
$40.40
|
| Rate for Payer: UMR Bronson Commercial |
$28.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.10
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000913
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$743.29 |
| 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 Medicare |
$1,004.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: BCBS Complete |
$803.55
|
| 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: Cofinity Medicare Advantage |
$1,406.22
|
| 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 Commercial |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.77
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UMR Bronson Commercial |
$743.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 27241005403
|
| 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: Cofinity Medicare Advantage |
$65.62
|
| 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 Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| 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
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000913
|
| 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: Cofinity Medicare Advantage |
$1,406.22
|
| 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 Commercial |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.77
|
| 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
|
OP
|
$64.13
|
|
|
Service Code
|
NDC 67877043303
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna American Axle |
$41.68
|
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Aetna Medicare |
$32.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.68
|
| Rate for Payer: BCBS Complete |
$25.65
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$55.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$57.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.51
|
| Rate for Payer: PHP Commercial |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health SBD |
$40.40
|
| Rate for Payer: UMR Bronson Commercial |
$23.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.10
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505267503
|
| 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: Cofinity Medicare Advantage |
$139.41
|
| 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 Commercial |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.45
|
| 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
|
$141.00
|
|
|
Service Code
|
NDC 65162089903
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 43598096830
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: BCBS Complete |
$37.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.62
|
| 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 Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 43598096830
|
| 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: Cofinity Medicare Advantage |
$65.62
|
| 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 Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| 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
|
OP
|
$669.60
|
|
|
Service Code
|
NDC 66689073505
|
| Hospital Charge Code |
40446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.75 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna American Axle |
$435.24
|
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna Medicare |
$334.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: BCBS Complete |
$267.84
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.24
|
| Rate for Payer: Priority Health SBD |
$421.85
|
| Rate for Payer: UMR Bronson Commercial |
$247.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$669.60
|
|
|
Service Code
|
NDC 66689073505
|
| Hospital Charge Code |
40446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.62 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna American Axle |
$435.24
|
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.24
|
| Rate for Payer: Priority Health SBD |
$421.85
|
| Rate for Payer: UMR Bronson Commercial |
$294.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$62.70
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna Medicare |
$31.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: BCBS Complete |
$25.08
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health SBD |
$39.50
|
| Rate for Payer: UMR Bronson Commercial |
$23.20
|
| 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 |
$74.11 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna American Axle |
$130.20
|
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: Aetna Medicare |
$100.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.20
|
| Rate for Payer: BCBS Complete |
$80.12
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Commercial |
$140.22
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health SBD |
$126.20
|
| Rate for Payer: UMR Bronson Commercial |
$74.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| 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: Cofinity Medicare Advantage |
$1,406.22
|
| 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 Commercial |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.77
|
| 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
|
$62.70
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Aetna American Axle |
$40.76
|
| Rate for Payer: Aetna Commercial |
$53.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.76
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$53.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$56.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: PHP Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.76
|
| Rate for Payer: Priority Health SBD |
$39.50
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.02
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$743.29 |
| 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 Medicare |
$1,004.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: BCBS Complete |
$803.55
|
| 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: Cofinity Medicare Advantage |
$1,406.22
|
| 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 Commercial |
$1,707.55
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.77
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UMR Bronson Commercial |
$743.29
|
| 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 |
$88.14 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna American Axle |
$130.20
|
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.20
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Commercial |
$140.22
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health SBD |
$126.20
|
| Rate for Payer: UMR Bronson Commercial |
$88.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$806.02 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna American Axle |
$1,190.72
|
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.72
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Commercial |
$1,282.31
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,282.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.31
|
| 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: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.72
|
| Rate for Payer: Priority Health SBD |
$1,154.08
|
| Rate for Payer: UMR Bronson Commercial |
$806.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| 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: Cofinity Medicare Advantage |
$139.41
|
| 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 Commercial |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.45
|
| 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
|
OP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$677.79 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna American Axle |
$1,190.72
|
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna Medicare |
$915.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.72
|
| Rate for Payer: BCBS Complete |
$732.75
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Commercial |
$1,282.31
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,282.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.31
|
| 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: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.72
|
| Rate for Payer: Priority Health SBD |
$1,154.08
|
| Rate for Payer: UMR Bronson Commercial |
$677.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$81.23
|
|
|
Service Code
|
NDC 65162089703
|
| 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: Cofinity Medicare Advantage |
$56.86
|
| 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 Commercial |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.80
|
| 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
|
OP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna Medicare |
$99.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: BCBS Complete |
$79.66
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.41
|
| 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 Commercial |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.45
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$73.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
