Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GUANFACINE 1 MG TABLET

Facility

$6.37

Service Code	NDC 68084074895
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.14
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$4.46
Rate for Payer: Cofinity Commercial	$5.48
Rate for Payer: Cofinity Medicare Advantage	$4.46
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.14
Rate for Payer: Priority Health SBD	$4.01

GUANFACINE 1 MG TABLET

Facility

$261.08

Service Code	NDC 60687071021
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$104.43
Max. Negotiated Rate	$234.97
Rate for Payer: Aetna Commercial	$221.92
Rate for Payer: Aetna Medicare	$130.54
Rate for Payer: Aetna New Business (MI Preferred)	$169.70
Rate for Payer: BCBS Complete	$104.43
Rate for Payer: Cash Price	$208.86
Rate for Payer: Cofinity Commercial	$182.76
Rate for Payer: Cofinity Commercial	$224.53
Rate for Payer: Cofinity Medicare Advantage	$182.76
Rate for Payer: Encore Health Key Benefits Commercial	$208.86
Rate for Payer: Healthscope Commercial	$234.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.92
Rate for Payer: PHP Commercial	$221.92
Rate for Payer: Priority Health Cigna Priority Health	$169.70
Rate for Payer: Priority Health SBD	$164.48

GUANFACINE 1 MG TABLET

Facility

$6.33

Service Code	NDC 68094001959
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna New Business (MI Preferred)	$4.11
Rate for Payer: Cash Price	$5.06
Rate for Payer: Cofinity Commercial	$4.43
Rate for Payer: Cofinity Commercial	$5.44
Rate for Payer: Cofinity Medicare Advantage	$4.43
Rate for Payer: Encore Health Key Benefits Commercial	$5.06
Rate for Payer: Healthscope Commercial	$5.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.38
Rate for Payer: PHP Commercial	$5.38
Rate for Payer: Priority Health Cigna Priority Health	$4.11
Rate for Payer: Priority Health SBD	$3.99

GUAR GUM ORAL POWDER PACKET

Facility

$3.32

Service Code	NDC 43900097647
Hospital Charge Code	30538
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

GUAR GUM ORAL POWDER PACKET

Facility

$3.32

Service Code	NDC 43900097647
Hospital Charge Code	30538
Hospital Revenue Code	637
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: BCBS Complete	$1.33
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN

Facility

$51.03

Service Code	HCPCS 90648
Hospital Charge Code	11931
Hospital Revenue Code	636
Min. Negotiated Rate	$20.41
Max. Negotiated Rate	$45.93
Rate for Payer: Aetna Commercial	$43.38
Rate for Payer: Aetna Medicare	$25.52
Rate for Payer: Aetna New Business (MI Preferred)	$33.17
Rate for Payer: BCBS Complete	$20.41
Rate for Payer: BCBS Trust/PPO	$36.24
Rate for Payer: BCN Commercial	$36.24
Rate for Payer: Cash Price	$40.82
Rate for Payer: Cash Price	$40.82
Rate for Payer: Cofinity Commercial	$35.72
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Medicare Advantage	$35.72
Rate for Payer: Encore Health Key Benefits Commercial	$40.82
Rate for Payer: Healthscope Commercial	$45.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.38
Rate for Payer: PHP Commercial	$43.38
Rate for Payer: Priority Health Cigna Priority Health	$33.17
Rate for Payer: Priority Health SBD	$32.15

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN

Facility

$51.03

Service Code	HCPCS 90648
Hospital Charge Code	11931
Hospital Revenue Code	636
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$45.93
Rate for Payer: Aetna Commercial	$43.38
Rate for Payer: Aetna New Business (MI Preferred)	$33.17
Rate for Payer: Cash Price	$40.82
Rate for Payer: Cofinity Commercial	$35.72
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Medicare Advantage	$35.72
Rate for Payer: Encore Health Key Benefits Commercial	$40.82
Rate for Payer: Healthscope Commercial	$45.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.38
Rate for Payer: PHP Commercial	$43.38
Rate for Payer: Priority Health Cigna Priority Health	$33.17
Rate for Payer: Priority Health SBD	$32.15

HAIR REMOVAL

Professional

Both

$82.00

Service Code	HCPCS 00170
Hospital Revenue Code	960
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$53.30

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT

Facility

$9,991.56

Service Code	CPT 28289
Hospital Revenue Code	360
Min. Negotiated Rate	$488.39
Max. Negotiated Rate	$9,991.56
Rate for Payer: Aetna Medicare	$3,306.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,973.75
Rate for Payer: Amish Plain Church Group Commercial	$3,973.75
Rate for Payer: BCBS Complete	$1,789.14
Rate for Payer: BCBS MAPPO	$3,179.00
Rate for Payer: BCBS Trust/PPO	$1,271.09
Rate for Payer: BCN Commercial	$1,271.09
Rate for Payer: BCN Medicare Advantage	$3,179.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,179.00
Rate for Payer: Mclaren Medicaid	$1,703.94
Rate for Payer: Mclaren Medicare	$3,179.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,337.95
Rate for Payer: Meridian Medicaid	$1,789.14
Rate for Payer: MI Amish Medical Board Commercial	$3,655.85
Rate for Payer: Nomi Health Commercial	$6,675.90
Rate for Payer: PACE Medicare	$3,020.05
Rate for Payer: PACE SWMI	$3,179.00
Rate for Payer: PHP Medicare Advantage	$3,179.00
Rate for Payer: Priority Health Choice Medicaid	$1,703.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,991.56
Rate for Payer: Priority Health Medicare	$3,179.00
Rate for Payer: Priority Health Narrow Network	$7,993.25
Rate for Payer: Railroad Medicare Medicare	$3,179.00
Rate for Payer: UHC All Payor (Choice/PPO)	$488.39
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,179.00
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$3,179.00
Rate for Payer: UHCCP Medicaid	$1,789.78
Rate for Payer: VA VA	$3,179.00

HALOPERIDOL 0.5 MG TABLET

Facility

$289.75

Service Code	NDC 51079073320
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$182.54
Max. Negotiated Rate	$260.78
Rate for Payer: Aetna Commercial	$246.29
Rate for Payer: Aetna New Business (MI Preferred)	$188.34
Rate for Payer: Cash Price	$231.80
Rate for Payer: Cofinity Commercial	$202.82
Rate for Payer: Cofinity Commercial	$249.18
Rate for Payer: Cofinity Medicare Advantage	$202.82
Rate for Payer: Encore Health Key Benefits Commercial	$231.80
Rate for Payer: Healthscope Commercial	$260.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.29
Rate for Payer: PHP Commercial	$246.29
Rate for Payer: Priority Health Cigna Priority Health	$188.34
Rate for Payer: Priority Health SBD	$182.54

HALOPERIDOL 0.5 MG TABLET

Facility

$2,299.00

Service Code	NDC 00378035110
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$919.60
Max. Negotiated Rate	$2,069.10
Rate for Payer: Aetna Commercial	$1,954.15
Rate for Payer: Aetna Medicare	$1,149.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,494.35
Rate for Payer: BCBS Complete	$919.60
Rate for Payer: Cash Price	$1,839.20
Rate for Payer: Cofinity Commercial	$1,609.30
Rate for Payer: Cofinity Commercial	$1,977.14
Rate for Payer: Cofinity Medicare Advantage	$1,609.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,839.20
Rate for Payer: Healthscope Commercial	$2,069.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,954.15
Rate for Payer: PHP Commercial	$1,954.15
Rate for Payer: Priority Health Cigna Priority Health	$1,494.35
Rate for Payer: Priority Health SBD	$1,448.37

HALOPERIDOL 0.5 MG TABLET

Facility

$2.90

Service Code	NDC 51079073301
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$2.61
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna Medicare	$1.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.88
Rate for Payer: BCBS Complete	$1.16
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Cofinity Medicare Advantage	$2.03
Rate for Payer: Encore Health Key Benefits Commercial	$2.32
Rate for Payer: Healthscope Commercial	$2.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.46
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health Cigna Priority Health	$1.88
Rate for Payer: Priority Health SBD	$1.83

HALOPERIDOL 0.5 MG TABLET

Facility

$2.90

Service Code	NDC 51079073301
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.61
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.88
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cofinity Commercial	$2.03
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Cofinity Medicare Advantage	$2.03
Rate for Payer: Encore Health Key Benefits Commercial	$2.32
Rate for Payer: Healthscope Commercial	$2.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.46
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health Cigna Priority Health	$1.88
Rate for Payer: Priority Health SBD	$1.83

HALOPERIDOL 0.5 MG TABLET

Facility

$2,299.00

Service Code	NDC 00378035110
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$1,448.37
Max. Negotiated Rate	$2,069.10
Rate for Payer: Aetna Commercial	$1,954.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,494.35
Rate for Payer: Cash Price	$1,839.20
Rate for Payer: Cofinity Commercial	$1,609.30
Rate for Payer: Cofinity Commercial	$1,977.14
Rate for Payer: Cofinity Medicare Advantage	$1,609.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,839.20
Rate for Payer: Healthscope Commercial	$2,069.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,954.15
Rate for Payer: PHP Commercial	$1,954.15
Rate for Payer: Priority Health Cigna Priority Health	$1,494.35
Rate for Payer: Priority Health SBD	$1,448.37

HALOPERIDOL 0.5 MG TABLET

Facility

$289.75

Service Code	NDC 51079073320
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$115.90
Max. Negotiated Rate	$260.78
Rate for Payer: Aetna Commercial	$246.29
Rate for Payer: Aetna Medicare	$144.88
Rate for Payer: Aetna New Business (MI Preferred)	$188.34
Rate for Payer: BCBS Complete	$115.90
Rate for Payer: Cash Price	$231.80
Rate for Payer: Cofinity Commercial	$202.82
Rate for Payer: Cofinity Commercial	$249.18
Rate for Payer: Cofinity Medicare Advantage	$202.82
Rate for Payer: Encore Health Key Benefits Commercial	$231.80
Rate for Payer: Healthscope Commercial	$260.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.29
Rate for Payer: PHP Commercial	$246.29
Rate for Payer: Priority Health Cigna Priority Health	$188.34
Rate for Payer: Priority Health SBD	$182.54

HALOPERIDOL 2 MG TABLET

Facility

$4,474.50

Service Code	NDC 00378021410
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$1,789.80
Max. Negotiated Rate	$4,027.05
Rate for Payer: Aetna Commercial	$3,803.32
Rate for Payer: Aetna Medicare	$2,237.25
Rate for Payer: Aetna New Business (MI Preferred)	$2,908.42
Rate for Payer: BCBS Complete	$1,789.80
Rate for Payer: Cash Price	$3,579.60
Rate for Payer: Cofinity Commercial	$3,132.15
Rate for Payer: Cofinity Commercial	$3,848.07
Rate for Payer: Cofinity Medicare Advantage	$3,132.15
Rate for Payer: Encore Health Key Benefits Commercial	$3,579.60
Rate for Payer: Healthscope Commercial	$4,027.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,803.32
Rate for Payer: PHP Commercial	$3,803.32
Rate for Payer: Priority Health Cigna Priority Health	$2,908.42
Rate for Payer: Priority Health SBD	$2,818.94

HALOPERIDOL 2 MG TABLET

Facility

$446.50

Service Code	NDC 00378021401
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$178.60
Max. Negotiated Rate	$401.85
Rate for Payer: Aetna Commercial	$379.52
Rate for Payer: Aetna Medicare	$223.25
Rate for Payer: Aetna New Business (MI Preferred)	$290.22
Rate for Payer: BCBS Complete	$178.60
Rate for Payer: Cash Price	$357.20
Rate for Payer: Cofinity Commercial	$312.55
Rate for Payer: Cofinity Commercial	$383.99
Rate for Payer: Cofinity Medicare Advantage	$312.55
Rate for Payer: Encore Health Key Benefits Commercial	$357.20
Rate for Payer: Healthscope Commercial	$401.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$379.52
Rate for Payer: PHP Commercial	$379.52
Rate for Payer: Priority Health Cigna Priority Health	$290.22
Rate for Payer: Priority Health SBD	$281.30

HALOPERIDOL 2 MG TABLET

Facility

$446.50

Service Code	NDC 00378021401
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$401.85
Rate for Payer: Aetna Commercial	$379.52
Rate for Payer: Aetna New Business (MI Preferred)	$290.22
Rate for Payer: Cash Price	$357.20
Rate for Payer: Cofinity Commercial	$312.55
Rate for Payer: Cofinity Commercial	$383.99
Rate for Payer: Cofinity Medicare Advantage	$312.55
Rate for Payer: Encore Health Key Benefits Commercial	$357.20
Rate for Payer: Healthscope Commercial	$401.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$379.52
Rate for Payer: PHP Commercial	$379.52
Rate for Payer: Priority Health Cigna Priority Health	$290.22
Rate for Payer: Priority Health SBD	$281.30

HALOPERIDOL 2 MG TABLET

Facility

$4,474.50

Service Code	NDC 00378021410
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$2,818.94
Max. Negotiated Rate	$4,027.05
Rate for Payer: Aetna Commercial	$3,803.32
Rate for Payer: Aetna New Business (MI Preferred)	$2,908.42
Rate for Payer: Cash Price	$3,579.60
Rate for Payer: Cofinity Commercial	$3,132.15
Rate for Payer: Cofinity Commercial	$3,848.07
Rate for Payer: Cofinity Medicare Advantage	$3,132.15
Rate for Payer: Encore Health Key Benefits Commercial	$3,579.60
Rate for Payer: Healthscope Commercial	$4,027.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,803.32
Rate for Payer: PHP Commercial	$3,803.32
Rate for Payer: Priority Health Cigna Priority Health	$2,908.42
Rate for Payer: Priority Health SBD	$2,818.94

HALOPERIDOL 2 MG TABLET

Facility

$2.85

Service Code	NDC 51079073501
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare	$1.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: BCBS Complete	$1.14
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Cofinity Medicare Advantage	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.80

HALOPERIDOL 2 MG TABLET

Facility

$284.16

Service Code	NDC 51079073520
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$179.02
Max. Negotiated Rate	$255.74
Rate for Payer: Aetna Commercial	$241.54
Rate for Payer: Aetna New Business (MI Preferred)	$184.70
Rate for Payer: Cash Price	$227.33
Rate for Payer: Cofinity Commercial	$198.91
Rate for Payer: Cofinity Commercial	$244.38
Rate for Payer: Cofinity Medicare Advantage	$198.91
Rate for Payer: Encore Health Key Benefits Commercial	$227.33
Rate for Payer: Healthscope Commercial	$255.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.54
Rate for Payer: PHP Commercial	$241.54
Rate for Payer: Priority Health Cigna Priority Health	$184.70
Rate for Payer: Priority Health SBD	$179.02

HALOPERIDOL 2 MG TABLET

Facility

$284.16

Service Code	NDC 51079073520
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$113.66
Max. Negotiated Rate	$255.74
Rate for Payer: Aetna Commercial	$241.54
Rate for Payer: Aetna Medicare	$142.08
Rate for Payer: Aetna New Business (MI Preferred)	$184.70
Rate for Payer: BCBS Complete	$113.66
Rate for Payer: Cash Price	$227.33
Rate for Payer: Cofinity Commercial	$198.91
Rate for Payer: Cofinity Commercial	$244.38
Rate for Payer: Cofinity Medicare Advantage	$198.91
Rate for Payer: Encore Health Key Benefits Commercial	$227.33
Rate for Payer: Healthscope Commercial	$255.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.54
Rate for Payer: PHP Commercial	$241.54
Rate for Payer: Priority Health Cigna Priority Health	$184.70
Rate for Payer: Priority Health SBD	$179.02

HALOPERIDOL 2 MG TABLET

Facility

$2.85

Service Code	NDC 51079073501
Hospital Charge Code	3581
Hospital Revenue Code	637
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Cofinity Medicare Advantage	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.80

HALOPERIDOL 5 MG TABLET

Facility

$273.60

Service Code	NDC 51079073620
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$172.37
Max. Negotiated Rate	$246.24
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna New Business (MI Preferred)	$177.84
Rate for Payer: Cash Price	$218.88
Rate for Payer: Cofinity Commercial	$191.52
Rate for Payer: Cofinity Commercial	$235.30
Rate for Payer: Cofinity Medicare Advantage	$191.52
Rate for Payer: Encore Health Key Benefits Commercial	$218.88
Rate for Payer: Healthscope Commercial	$246.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$232.56
Rate for Payer: PHP Commercial	$232.56
Rate for Payer: Priority Health Cigna Priority Health	$177.84
Rate for Payer: Priority Health SBD	$172.37

HALOPERIDOL 5 MG TABLET

Facility

$2.74

Service Code	NDC 51079073601
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$1.78
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cofinity Commercial	$1.92
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Medicare Advantage	$1.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.19
Rate for Payer: Healthscope Commercial	$2.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.33
Rate for Payer: PHP Commercial	$2.33
Rate for Payer: Priority Health Cigna Priority Health	$1.78
Rate for Payer: Priority Health SBD	$1.73

Know your out-of-pocket cost for care.

All Charges