St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ARGATROBAN 250MG/2.5ML INJ - 5MG

Facility

$22.77

Hospital Charge Code	41648046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Brighton Health Commercial	$17.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROBAN 250 MG/2.5ML IV SOLN [28947]

Facility

$244.80

Service Code	HCPCS J0883
Hospital Charge Code	67457021202
Hospital Revenue Code	278
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$159.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$146.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.76
Rate for Payer: Elderplan Medicare Advantage	$1.22
Rate for Payer: EmblemHealth Commercial	$122.40
Rate for Payer: Fidelis Medicare Advantage	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40
Rate for Payer: Healthfirst Medicare Advantage	$1.04
Rate for Payer: Healthfirst QHP	$1.22
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Senior Whole Health Medicare Advantage	$1.22
Rate for Payer: United Healthcare Medicare Advantage	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.97

ARGATROBAN 250 MG/2.5ML IV SOLN [28947]

Facility

$244.80

Service Code	HCPCS J0883
Hospital Charge Code	42023018201
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40

ARGATROBAN 250 MG/2.5ML IV SOLN [28947]

Facility

$244.80

Service Code	HCPCS J0883
Hospital Charge Code	42023018201
Hospital Revenue Code	278
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$159.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$146.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.76
Rate for Payer: Elderplan Medicare Advantage	$1.22
Rate for Payer: EmblemHealth Commercial	$122.40
Rate for Payer: Fidelis Medicare Advantage	$1.22
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40
Rate for Payer: Healthfirst Medicare Advantage	$1.04
Rate for Payer: Healthfirst QHP	$1.22
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Senior Whole Health Medicare Advantage	$1.22
Rate for Payer: United Healthcare Medicare Advantage	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.97

ARGATROBAN 250 MG/2.5ML IV SOLN [28947]

Facility

$244.80

Service Code	HCPCS J0883
Hospital Charge Code	67457021202
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.40
Rate for Payer: Hamaspik Choice Inc Medicare	$122.40

ARGATROBAN 250MG/D5W250ML INF 5MG

Facility

$22.77

Hospital Charge Code	41658049
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Brighton Health Commercial	$17.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROBAN 250MG/D5W250ML INF 5MG

Facility

$22.77

Hospital Charge Code	41648049
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Brighton Health Commercial	$17.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARGATROGAN 250MG/2.5ML INJ - 5MG

Facility

$22.77

Hospital Charge Code	41658046
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$18.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.38
Rate for Payer: Aetna Government	$11.38
Rate for Payer: Brighton Health Commercial	$17.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.48
Rate for Payer: Group Health Inc Commercial	$11.38
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.38
Rate for Payer: Hamaspik Choice Inc Medicare	$11.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.80

ARHTHROSCOPY KNEE MEDIAL OR LATRL

Facility

$8,291.05

Service Code	HCPCS 29881
Hospital Charge Code	40024228
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

ARHTHROSCOPY KNEE MEDIAL OR LATRL

Facility

$8,291.05

Service Code	HCPCS 29881
Hospital Charge Code	40024228
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.07

Service Code	NDC 16729028001
Hospital Charge Code	16729028001
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$25.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$24.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.81
Rate for Payer: Group Health Inc Commercial	$16.04
Rate for Payer: Group Health Inc Medicare	$11.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04
Rate for Payer: Hamaspik Choice Inc Medicare	$16.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.85

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.11

Service Code	NDC 31722082730
Hospital Charge Code	31722082730
Hospital Revenue Code	250
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$25.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.05
Rate for Payer: Aetna Government	$16.05
Rate for Payer: Brighton Health Commercial	$24.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.83
Rate for Payer: Group Health Inc Commercial	$16.05
Rate for Payer: Group Health Inc Medicare	$11.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.05
Rate for Payer: Hamaspik Choice Inc Medicare	$16.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.87

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.08

Service Code	NDC 43547030403
Hospital Charge Code	43547030403
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$25.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$24.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.81
Rate for Payer: Group Health Inc Commercial	$16.04
Rate for Payer: Group Health Inc Medicare	$11.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04
Rate for Payer: Hamaspik Choice Inc Medicare	$16.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.85

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.11

Service Code	NDC 65862066330
Hospital Charge Code	65862066330
Hospital Revenue Code	250
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$25.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.06
Rate for Payer: Aetna Government	$16.06
Rate for Payer: Brighton Health Commercial	$24.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.84
Rate for Payer: Group Health Inc Commercial	$16.06
Rate for Payer: Group Health Inc Medicare	$11.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.06
Rate for Payer: Hamaspik Choice Inc Medicare	$16.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.87

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.11

Service Code	NDC 16729028010
Hospital Charge Code	16729028010
Hospital Revenue Code	250
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$25.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.06
Rate for Payer: Aetna Government	$16.06
Rate for Payer: Brighton Health Commercial	$24.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.84
Rate for Payer: Group Health Inc Commercial	$16.06
Rate for Payer: Group Health Inc Medicare	$11.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.06
Rate for Payer: Hamaspik Choice Inc Medicare	$16.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.87

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$29.93

Service Code	NDC 50268008911
Hospital Charge Code	50268008911
Hospital Revenue Code	250
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$23.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.96
Rate for Payer: Aetna Government	$14.96
Rate for Payer: Brighton Health Commercial	$22.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.35
Rate for Payer: Group Health Inc Commercial	$14.96
Rate for Payer: Group Health Inc Medicare	$10.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.96
Rate for Payer: Hamaspik Choice Inc Medicare	$14.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.45

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.01

Service Code	NDC 67877043203
Hospital Charge Code	67877043203
Hospital Revenue Code	250
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.00
Rate for Payer: Aetna Government	$16.00
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

ARIPIPRAZOLE 10 MG PO TABS [34369]

Facility

$32.08

Service Code	NDC 65162089803
Hospital Charge Code	65162089803
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$25.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$24.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.81
Rate for Payer: Group Health Inc Commercial	$16.04
Rate for Payer: Group Health Inc Medicare	$11.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04
Rate for Payer: Hamaspik Choice Inc Medicare	$16.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.85

ARIPIPRAZOLE 10 MG TAB

Facility

$34.00

Hospital Charge Code	41652991
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: Brighton Health Commercial	$25.50
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 10 MG TAB

Facility

$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: Brighton Health Commercial	$25.50
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 PO TABS [34370]

Facility

$32.08

Service Code	NDC 43547030503
Hospital Charge Code	43547030503
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$25.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$24.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.81
Rate for Payer: Group Health Inc Commercial	$16.04
Rate for Payer: Group Health Inc Medicare	$11.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04
Rate for Payer: Hamaspik Choice Inc Medicare	$16.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.85

ARIPIPRAZOLE 15 MG PO TABS [34370]

Facility

$32.01

Service Code	NDC 67877043303
Hospital Charge Code	67877043303
Hospital Revenue Code	250
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.00
Rate for Payer: Aetna Government	$16.00
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.76
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

ARIPIPRAZOLE 15 MG PO TABS [34370]

Facility

$32.08

Service Code	NDC 65162089903
Hospital Charge Code	65162089903
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$25.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.04
Rate for Payer: Aetna Government	$16.04
Rate for Payer: Brighton Health Commercial	$24.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.81
Rate for Payer: Group Health Inc Commercial	$16.04
Rate for Payer: Group Health Inc Medicare	$11.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04
Rate for Payer: Hamaspik Choice Inc Medicare	$16.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.85

ARIPIPRAZOLE 15 MG PO TABS [34370]

Facility

$23.35

Service Code	NDC 59148000913
Hospital Charge Code	59148000913
Hospital Revenue Code	250
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$18.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.68
Rate for Payer: Aetna Government	$11.68
Rate for Payer: Brighton Health Commercial	$17.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.88
Rate for Payer: Group Health Inc Commercial	$11.68
Rate for Payer: Group Health Inc Medicare	$8.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.68
Rate for Payer: Hamaspik Choice Inc Medicare	$11.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.18

ARIPIPRAZOLE 15 MG PO TABS [34370]

Facility

$32.11

Service Code	NDC 16729028110
Hospital Charge Code	16729028110
Hospital Revenue Code	250
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$25.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.06
Rate for Payer: Aetna Government	$16.06
Rate for Payer: Brighton Health Commercial	$24.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.84
Rate for Payer: Group Health Inc Commercial	$16.06
Rate for Payer: Group Health Inc Medicare	$11.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.06
Rate for Payer: Hamaspik Choice Inc Medicare	$16.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.87

Know your out-of-pocket cost for care.

All Charges