|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 3172282730
|
| Hospital Charge Code |
3172282730
|
|
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: EmblemHealth Commercial |
$16.05
|
| 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
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 4354730403
|
| Hospital Charge Code |
4354730403
|
|
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: EmblemHealth Commercial |
$16.04
|
| 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
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 6586266330
|
| Hospital Charge Code |
6586266330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.06
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
NDC 4354730403
|
| Hospital Charge Code |
4354730403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 1672928010
|
| Hospital Charge Code |
1672928010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.06
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 6586266330
|
| Hospital Charge Code |
6586266330
|
|
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: EmblemHealth Commercial |
$16.06
|
| 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
|
Facility
|
IP
|
$32.07
|
|
|
Service Code
|
NDC 1672928001
|
| Hospital Charge Code |
1672928001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.07
|
|
|
Service Code
|
NDC 1672928001
|
| Hospital Charge Code |
1672928001
|
|
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: EmblemHealth Commercial |
$16.04
|
| 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
|
Facility
|
IP
|
$29.93
|
|
|
Service Code
|
NDC 5026808911
|
| Hospital Charge Code |
5026808911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.96
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
NDC 6516289803
|
| Hospital Charge Code |
6516289803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 6516289803
|
| Hospital Charge Code |
6516289803
|
|
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: EmblemHealth Commercial |
$16.04
|
| 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
|
Facility
|
IP
|
$10.04
|
|
|
Service Code
|
NDC 0904736806
|
| Hospital Charge Code |
0904736806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
IP
|
$32.01
|
|
|
Service Code
|
NDC 6787743203
|
| Hospital Charge Code |
6787743203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 3172282730
|
| Hospital Charge Code |
3172282730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.05
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.01
|
|
|
Service Code
|
NDC 6787743203
|
| Hospital Charge Code |
6787743203
|
|
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: EmblemHealth Commercial |
$16.00
|
| 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
|
Facility
|
OP
|
$29.93
|
|
|
Service Code
|
NDC 5026808911
|
| Hospital Charge Code |
5026808911
|
|
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: EmblemHealth Commercial |
$14.96
|
| 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
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 0904736806
|
| Hospital Charge Code |
0904736806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ARIPIPRAZOLE 10 MG PO TABS
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 1672928010
|
| Hospital Charge Code |
1672928010
|
|
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: EmblemHealth Commercial |
$16.06
|
| 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 15 MG PO TABS
|
Facility
|
OP
|
$30.61
|
|
|
Service Code
|
NDC 5026809012
|
| Hospital Charge Code |
5026809012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$24.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.31
|
| Rate for Payer: Aetna Government |
$15.31
|
| Rate for Payer: Brighton Health Commercial |
$22.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.82
|
| Rate for Payer: EmblemHealth Commercial |
$15.31
|
| Rate for Payer: Group Health Inc Commercial |
$15.31
|
| Rate for Payer: Group Health Inc Medicare |
$10.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.90
|
|
|
ARIPIPRAZOLE 15 MG PO TABS
|
Facility
|
OP
|
$32.08
|
|
|
Service Code
|
NDC 4354730503
|
| Hospital Charge Code |
4354730503
|
|
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: EmblemHealth Commercial |
$16.04
|
| 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
|
Facility
|
OP
|
$23.35
|
|
|
Service Code
|
NDC 5914800913
|
| Hospital Charge Code |
5914800913
|
|
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: EmblemHealth Commercial |
$11.68
|
| 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
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 1672928110
|
| Hospital Charge Code |
1672928110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.06
|
|
|
ARIPIPRAZOLE 15 MG PO TABS
|
Facility
|
IP
|
$23.35
|
|
|
Service Code
|
NDC 5914800913
|
| Hospital Charge Code |
5914800913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$11.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.68
|
|
|
ARIPIPRAZOLE 15 MG PO TABS
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 1672928110
|
| Hospital Charge Code |
1672928110
|
|
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: EmblemHealth Commercial |
$16.06
|
| 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 15 MG PO TABS
|
Facility
|
IP
|
$32.08
|
|
|
Service Code
|
NDC 6516289903
|
| Hospital Charge Code |
6516289903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
|