St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 5 MG PO TABS

Facility

$10.04

Service Code	NDC 0904736706
Hospital Charge Code	0904736706
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02

ARIPIPRAZOLE 5 MG PO TABS

Facility

$32.11

Service Code	NDC 4359896630
Hospital Charge Code	4359896630
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.05

ARIPIPRAZOLE 5 MG PO TABS

Facility

$32.01

Service Code	NDC 6787743103
Hospital Charge Code	6787743103
Hospital Revenue Code	250
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

ARIPIPRAZOLE 5 MG PO TABS

Facility

$32.07

Service Code	NDC 1672927901
Hospital Charge Code	1672927901
Hospital Revenue Code	250
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.04

ARIPIPRAZOLE ER 300 MG IM PRSY

Facility

$2.00

Service Code	HCPCS J0401
Hospital Charge Code	5914804580
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

ARIPIPRAZOLE ER 300 MG IM PRSY

Facility

$2.00

Service Code	HCPCS J0401
Hospital Charge Code	5914804580
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 300 MG IM SRER

Facility

$2.00

Service Code	HCPCS J0401
Hospital Charge Code	5914801871
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 300 MG IM SRER

Facility

$0.01

Service Code	HCPCS J0401
Hospital Charge Code	5914823212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ARIPIPRAZOLE ER 300 MG IM SRER

Facility

$2.00

Service Code	HCPCS J0401
Hospital Charge Code	5914801871
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

ARIPIPRAZOLE ER 300 MG IM SRER

Facility

$0.01

Service Code	HCPCS J0401
Hospital Charge Code	5914823212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
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	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 400 MG IM PRSY

Facility

$3.00

Service Code	HCPCS J0401
Hospital Charge Code	5914807280
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 400 MG IM PRSY

Facility

$3.00

Service Code	HCPCS J0401
Hospital Charge Code	5914807280
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

ARIPIPRAZOLE ER 400 MG IM SRER

Facility

$3.00

Service Code	HCPCS J0401
Hospital Charge Code	5914801971
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Elderplan Medicare Advantage	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 400 MG IM SRER

Facility

$3.00

Service Code	HCPCS J0401
Hospital Charge Code	5914801971
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

ARIPIPRAZOLE ER 400 MG IM SRER

Facility

$0.01

Service Code	HCPCS J0401
Hospital Charge Code	5914824512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.28
Rate for Payer: Aetna Government	$7.28
Rate for Payer: Affinity Essential Plan 1&2	$5.10
Rate for Payer: Affinity Essential Plan 3&4	$5.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.10
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.28
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	$7.28
Rate for Payer: EmblemHealth Commercial	$7.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.55
Rate for Payer: Fidelis Essential Plan Aliesa	$6.19
Rate for Payer: Fidelis Essential Plan QHP	$6.48
Rate for Payer: Fidelis Medicare Advantage	$7.28
Rate for Payer: Fidelis Qualified Health Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$7.28
Rate for Payer: Group Health Inc Medicare	$7.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.28
Rate for Payer: Hamaspik Choice Inc Medicare	$7.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.28
Rate for Payer: Healthfirst Medicare Advantage	$6.19
Rate for Payer: Healthfirst QHP	$7.28
Rate for Payer: Humana Medicare	$7.43
Rate for Payer: Senior Whole Health Medicare Advantage	$7.28
Rate for Payer: United Healthcare Medicare Advantage	$7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$6.92

ARIPIPRAZOLE ER 400 MG IM SRER

Facility

$0.01

Service Code	HCPCS J0401
Hospital Charge Code	5914824512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

ARIPIPRAZOLE ER 720 MG/2.4ML IM PRSY

Facility

$2.00

Service Code	NDC 5914810280
Hospital Charge Code	5914810280
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: EmblemHealth Commercial	$1.00
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

ARIPIPRAZOLE ER 720 MG/2.4ML IM PRSY

Facility

$2.00

Service Code	NDC 5914810280
Hospital Charge Code	5914810280
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

ARIPIPRAZOLE LAUROXIL ER 441 MG/1.6ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ARIPIPRAZOLE LAUROXIL ER 441 MG/1.6ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Affinity Essential Plan 1&2	$2.35
Rate for Payer: Affinity Essential Plan 3&4	$2.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.35
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$3.35
Rate for Payer: EmblemHealth Commercial	$3.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.02
Rate for Payer: Fidelis Essential Plan Aliesa	$2.85
Rate for Payer: Fidelis Essential Plan QHP	$2.98
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Fidelis Qualified Health Plan	$2.98
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.35
Rate for Payer: Healthfirst Medicare Advantage	$2.85
Rate for Payer: Healthfirst QHP	$3.35
Rate for Payer: Humana Medicare	$3.42
Rate for Payer: Senior Whole Health Medicare Advantage	$3.35
Rate for Payer: United Healthcare Medicare Advantage	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.18
Rate for Payer: Wellcare Medicare	$3.18

ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Affinity Essential Plan 1&2	$2.35
Rate for Payer: Affinity Essential Plan 3&4	$2.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.35
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$3.35
Rate for Payer: EmblemHealth Commercial	$3.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.02
Rate for Payer: Fidelis Essential Plan Aliesa	$2.85
Rate for Payer: Fidelis Essential Plan QHP	$2.98
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Fidelis Qualified Health Plan	$2.98
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.35
Rate for Payer: Healthfirst Medicare Advantage	$2.85
Rate for Payer: Healthfirst QHP	$3.35
Rate for Payer: Humana Medicare	$3.42
Rate for Payer: Senior Whole Health Medicare Advantage	$3.35
Rate for Payer: United Healthcare Medicare Advantage	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.18
Rate for Payer: Wellcare Medicare	$3.18

ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Affinity Essential Plan 1&2	$2.35
Rate for Payer: Affinity Essential Plan 3&4	$2.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.35
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$3.35
Rate for Payer: EmblemHealth Commercial	$3.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.02
Rate for Payer: Fidelis Essential Plan Aliesa	$2.85
Rate for Payer: Fidelis Essential Plan QHP	$2.98
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Fidelis Qualified Health Plan	$2.98
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.35
Rate for Payer: Healthfirst Medicare Advantage	$2.85
Rate for Payer: Healthfirst QHP	$3.35
Rate for Payer: Humana Medicare	$3.42
Rate for Payer: Senior Whole Health Medicare Advantage	$3.35
Rate for Payer: United Healthcare Medicare Advantage	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.18
Rate for Payer: Wellcare Medicare	$3.18

ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY

Facility

$1.00

Service Code	HCPCS J1944
Hospital Charge Code	6575740301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS

Facility

$6.74

Service Code	NDC 0078056845
Hospital Charge Code	0078056845
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.37

Know your out-of-pocket cost for care.

All Charges