|
ARIPIPRAZOLE 10 MG TAB
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41642991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
ARIPIPRAZOLE 15 MG TAB
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41653140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
ARIPIPRAZOLE 15 MG TAB
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41643140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
ARIPIPRAZOLE 2 MG TAB
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41654972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
ARIPIPRAZOLE 2 MG TAB
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41644972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
ARIPIPRAZOLE 400MG INJ
|
Facility
IP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
|
|
ARIPIPRAZOLE 400MG INJ
|
Facility
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE 400MG INJ
|
Facility
IP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
|
|
ARIPIPRAZOLE 400MG INJ
|
Facility
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE 400MG INJ (IP)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
ARIPIPRAZOLE 400MG INJ (IP)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE 400MG INJ (IP)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
ARIPIPRAZOLE 400MG INJ (IP)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE 5 MG TAB
|
Facility
OP
|
$36.09
|
|
| Hospital Charge Code |
41653139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.04
|
| Rate for Payer: Aetna Government |
$18.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.54
|
| Rate for Payer: Group Health Inc Commercial |
$18.04
|
| Rate for Payer: Group Health Inc Medicare |
$12.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.46
|
|
|
ARIPIPRAZOLE 5 MG TAB
|
Facility
OP
|
$36.09
|
|
| Hospital Charge Code |
41643139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.04
|
| Rate for Payer: Aetna Government |
$18.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.54
|
| Rate for Payer: Group Health Inc Commercial |
$18.04
|
| Rate for Payer: Group Health Inc Medicare |
$12.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.46
|
|
|
ARIPIPRAZOLE 9.75 MG INJ
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
41655138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
|
|
ARIPIPRAZOLE 9.75 MG INJ
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
41655138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
ARIPIPRAZOLE 9.75 MG INJ
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
41645138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
|
|
ARIPIPRAZOLE 9.75 MG INJ
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
HCPCS J0400
|
| Hospital Charge Code |
41645138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
ARIPIPRAZOLE LA 300MG INJ (IP)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE LA 300MG INJ (IP)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE LA 300MG INJ (IP)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
ARIPIPRAZOLE LA 300MG INJ (IP)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
ARIPIPRAZOLE LO 300MG INJ
|
Facility
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.81
|
| Rate for Payer: Aetna Government |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.15
|
| Rate for Payer: Group Health Inc Commercial |
$6.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.22
|
| Rate for Payer: SOMOS Essential |
$7.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE LO 300MG INJ
|
Facility
IP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.80
|
|
