|
ARIPIPRAZOLE 15 MG PO TABS [34370]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 43598096830
|
| Hospital Charge Code |
43598096830
|
|
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 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: 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 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: 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 2 MG PO TABS [70306]
|
Facility
|
OP
|
$32.01
|
|
|
Service Code
|
NDC 67877043003
|
| Hospital Charge Code |
67877043003
|
|
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 2 MG PO TABS [70306]
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 43547030203
|
| Hospital Charge Code |
43547030203
|
|
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 2 MG PO TABS [70306]
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
65162089603
|
|
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 2 MG PO TABS [70306]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 16729027810
|
| Hospital Charge Code |
16729027810
|
|
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 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: 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 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: 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 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
|
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 |
41657864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| 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: Affinity Essential Plan 1&2 |
$4.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.77
|
| Rate for Payer: Brighton Health Commercial |
$8.16
|
| 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 Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Humana Medicare |
$6.95
|
| 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: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| 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
|
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.77 |
| 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: Affinity Essential Plan 1&2 |
$4.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.77
|
| Rate for Payer: Brighton Health Commercial |
$8.16
|
| 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 Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Humana Medicare |
$6.95
|
| 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: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| 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: Affinity Essential Plan 1&2 |
$4.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.77
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| 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 Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Humana Medicare |
$6.95
|
| 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: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| 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: Affinity Essential Plan 1&2 |
$4.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.77
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| 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 Medicare Advantage |
$5.79
|
| Rate for Payer: Healthfirst QHP |
$6.81
|
| Rate for Payer: Humana Medicare |
$6.95
|
| 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: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| 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 PO TABS [36438]
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
65162089703
|
|
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 5 MG PO TABS [36438]
|
Facility
|
OP
|
$23.16
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
00904651061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.58
|
| Rate for Payer: Aetna Government |
$11.58
|
| Rate for Payer: Brighton Health Commercial |
$17.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.75
|
| Rate for Payer: Group Health Inc Commercial |
$11.58
|
| Rate for Payer: Group Health Inc Medicare |
$8.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.05
|
|
|
ARIPIPRAZOLE 5 MG PO TABS [36438]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 43598096630
|
| Hospital Charge Code |
43598096630
|
|
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 5 MG PO TABS [36438]
|
Facility
|
OP
|
$32.07
|
|
|
Service Code
|
NDC 16729027901
|
| Hospital Charge Code |
16729027901
|
|
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 5 MG PO TABS [36438]
|
Facility
|
OP
|
$32.01
|
|
|
Service Code
|
NDC 67877043103
|
| Hospital Charge Code |
67877043103
|
|
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 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: Brighton Health Commercial |
$27.07
|
| 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: Brighton Health Commercial |
$27.07
|
| 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
|
|
