|
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 |
$5.25 |
| 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: Brighton Health Commercial |
$0.52
|
| 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: United Healthcare Commercial |
$5.25
|
| 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 |
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 |
$5.25 |
| 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: Brighton Health Commercial |
$0.52
|
| 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: United Healthcare Commercial |
$5.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
ARIPIPRAZOLE ER 300 MG IM PRSY [146003]
|
Facility
|
OP
|
$2,537.86
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
59148004580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$2,030.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,395.82
|
| 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 |
$1,903.40
|
| 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 |
$2,030.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.06
|
| 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 |
$1,268.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.81
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,649.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE ER 300 MG IM SRER [146005]
|
Facility
|
OP
|
$2,537.86
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
59148001871
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$2,030.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,395.82
|
| 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 |
$1,903.40
|
| 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 |
$2,030.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.06
|
| 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 |
$1,268.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.81
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,649.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE ER 400 MG IM PRSY [146004]
|
Facility
|
OP
|
$3,383.81
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
59148007280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$2,707.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,861.10
|
| 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 |
$2,537.86
|
| 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 |
$2,707.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,300.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.06
|
| 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 |
$1,691.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.81
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,199.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
|
|
ARIPIPRAZOLE ER 400 MG IM SRER [146006]
|
Facility
|
OP
|
$3,383.81
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
59148001971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$2,707.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,861.10
|
| 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 |
$2,537.86
|
| 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 |
$2,707.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,300.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.81
|
| Rate for Payer: EmblemHealth Commercial |
$6.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.06
|
| 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 |
$1,691.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.81
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,199.48
|
| 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 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: 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 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: 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 LAUROXIL ER 441 MG/1.6ML IM PRSY [130363]
|
Facility
|
OP
|
$1,158.49
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
65757040103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$926.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$637.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.77
|
| Rate for Payer: Aetna Government |
$3.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$868.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$926.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$787.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$3.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.77
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$579.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.20
|
| Rate for Payer: Healthfirst QHP |
$3.77
|
| Rate for Payer: Humana Medicare |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$753.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
|
|
ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY [130364]
|
Facility
|
OP
|
$1,159.38
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
65757040203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$927.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$637.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.77
|
| Rate for Payer: Aetna Government |
$3.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$869.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$927.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$788.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$3.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.77
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$579.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.20
|
| Rate for Payer: Healthfirst QHP |
$3.77
|
| Rate for Payer: Humana Medicare |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$753.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
|
|
ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY [130365]
|
Facility
|
OP
|
$1,158.49
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
65757040301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$926.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$637.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.77
|
| Rate for Payer: Aetna Government |
$3.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$868.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$926.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$787.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$3.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.77
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$579.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.20
|
| Rate for Payer: Healthfirst QHP |
$3.77
|
| Rate for Payer: Humana Medicare |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$753.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
|
|
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
|
|
|
ARIPIPRAZOLE LO 300MG INJ
|
Facility
|
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41657861
|
|
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
|
|
|
ARIPIPRAZONE LA 300MG INJ
|
Facility
|
IP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647861
|
|
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
|
|
|
ARIPIPRAZONE LA 300MG INJ
|
Facility
|
OP
|
$13.60
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
41647861
|
|
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
|
|
|
ARM15T ROD 200MM
|
Facility
|
OP
|
$1,077.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,131.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$592.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$646.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$538.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$619.56
|
| Rate for Payer: EmblemHealth Commercial |
$538.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,131.38
|
| Rate for Payer: Group Health Inc Commercial |
$538.75
|
| Rate for Payer: Group Health Inc Medicare |
$377.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.38
|
|
|
ARM15T ROD 200MM
|
Facility
|
IP
|
$1,077.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.75 |
| Max. Negotiated Rate |
$538.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.75
|
|
|
ARM15T ROD 300MM
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$773.75 |
| Max. Negotiated Rate |
$773.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.75
|
|
|
ARM15T ROD 300MM
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,624.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$851.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$928.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$773.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$889.81
|
| Rate for Payer: EmblemHealth Commercial |
$773.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,624.88
|
| Rate for Payer: Group Health Inc Commercial |
$773.75
|
| Rate for Payer: Group Health Inc Medicare |
$541.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,005.88
|
|
|
ARM15T ROD, 35MM
|
Facility
|
OP
|
$912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$958.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$501.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$547.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$456.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$524.69
|
| Rate for Payer: EmblemHealth Commercial |
$456.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$958.12
|
| Rate for Payer: Group Health Inc Commercial |
$456.25
|
| Rate for Payer: Group Health Inc Medicare |
$319.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$593.12
|
|
|
ARM15T ROD, 35MM
|
Facility
|
IP
|
$912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.25 |
| Max. Negotiated Rate |
$456.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.25
|
|
|
ARM15T ROD 40MM
|
Facility
|
IP
|
$912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.25 |
| Max. Negotiated Rate |
$456.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.25
|
|
