Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$1.14
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare	$1.43
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

$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 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)	$2,908.43
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	$2,908.43
Rate for Payer: Priority Health SBD	$2,818.93

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)	$290.23
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	$290.23
Rate for Payer: Priority Health SBD	$281.30

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

$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)	$290.23
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	$290.23
Rate for Payer: Priority Health SBD	$281.30

HALOPERIDOL 5 MG TABLET

Facility

$2.74

Service Code	NDC 51079073601
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare	$1.37
Rate for Payer: Aetna New Business (MI Preferred)	$1.78
Rate for Payer: BCBS Complete	$1.10
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

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

HALOPERIDOL 5 MG TABLET

Facility

$415.15

Service Code	NDC 00904678261
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$166.06
Max. Negotiated Rate	$373.63
Rate for Payer: Aetna Commercial	$352.88
Rate for Payer: Aetna Medicare	$207.57
Rate for Payer: Aetna New Business (MI Preferred)	$269.85
Rate for Payer: BCBS Complete	$166.06
Rate for Payer: Cash Price	$332.12
Rate for Payer: Cofinity Commercial	$290.61
Rate for Payer: Cofinity Commercial	$357.03
Rate for Payer: Cofinity Medicare Advantage	$290.61
Rate for Payer: Encore Health Key Benefits Commercial	$332.12
Rate for Payer: Healthscope Commercial	$373.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$352.88
Rate for Payer: PHP Commercial	$352.88
Rate for Payer: Priority Health Cigna Priority Health	$269.85
Rate for Payer: Priority Health SBD	$261.54

HALOPERIDOL 5 MG TABLET

Facility

$425.60

Service Code	NDC 68382007901
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$268.13
Max. Negotiated Rate	$383.04
Rate for Payer: Aetna Commercial	$361.76
Rate for Payer: Aetna New Business (MI Preferred)	$276.64
Rate for Payer: Cash Price	$340.48
Rate for Payer: Cofinity Commercial	$297.92
Rate for Payer: Cofinity Commercial	$366.02
Rate for Payer: Cofinity Medicare Advantage	$297.92
Rate for Payer: Encore Health Key Benefits Commercial	$340.48
Rate for Payer: Healthscope Commercial	$383.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.76
Rate for Payer: PHP Commercial	$361.76
Rate for Payer: Priority Health Cigna Priority Health	$276.64
Rate for Payer: Priority Health SBD	$268.13

HALOPERIDOL 5 MG TABLET

Facility

$273.60

Service Code	NDC 51079073620
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$109.44
Max. Negotiated Rate	$246.24
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare	$136.80
Rate for Payer: Aetna New Business (MI Preferred)	$177.84
Rate for Payer: BCBS Complete	$109.44
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

$415.15

Service Code	NDC 00904678261
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$261.54
Max. Negotiated Rate	$373.63
Rate for Payer: Aetna Commercial	$352.88
Rate for Payer: Aetna New Business (MI Preferred)	$269.85
Rate for Payer: Cash Price	$332.12
Rate for Payer: Cofinity Commercial	$290.61
Rate for Payer: Cofinity Commercial	$357.03
Rate for Payer: Cofinity Medicare Advantage	$290.61
Rate for Payer: Encore Health Key Benefits Commercial	$332.12
Rate for Payer: Healthscope Commercial	$373.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$352.88
Rate for Payer: PHP Commercial	$352.88
Rate for Payer: Priority Health Cigna Priority Health	$269.85
Rate for Payer: Priority Health SBD	$261.54

HALOPERIDOL 5 MG TABLET

Facility

$425.60

Service Code	NDC 68382007901
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$170.24
Max. Negotiated Rate	$383.04
Rate for Payer: Aetna Commercial	$361.76
Rate for Payer: Aetna Medicare	$212.80
Rate for Payer: Aetna New Business (MI Preferred)	$276.64
Rate for Payer: BCBS Complete	$170.24
Rate for Payer: Cash Price	$340.48
Rate for Payer: Cofinity Commercial	$297.92
Rate for Payer: Cofinity Commercial	$366.02
Rate for Payer: Cofinity Medicare Advantage	$297.92
Rate for Payer: Encore Health Key Benefits Commercial	$340.48
Rate for Payer: Healthscope Commercial	$383.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.76
Rate for Payer: PHP Commercial	$361.76
Rate for Payer: Priority Health Cigna Priority Health	$276.64
Rate for Payer: Priority Health SBD	$268.13

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 LACTATE 2 MG/ML ORAL CONCENTRATE

Facility

$431.46

Service Code	NDC 54838050140
Hospital Charge Code	3585
Hospital Revenue Code	637
Min. Negotiated Rate	$172.58
Max. Negotiated Rate	$388.31
Rate for Payer: Aetna Commercial	$366.74
Rate for Payer: Aetna Medicare	$215.73
Rate for Payer: Aetna New Business (MI Preferred)	$280.45
Rate for Payer: BCBS Complete	$172.58
Rate for Payer: Cash Price	$345.17
Rate for Payer: Cofinity Commercial	$302.02
Rate for Payer: Cofinity Commercial	$371.06
Rate for Payer: Cofinity Medicare Advantage	$302.02
Rate for Payer: Encore Health Key Benefits Commercial	$345.17
Rate for Payer: Healthscope Commercial	$388.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.74
Rate for Payer: PHP Commercial	$366.74
Rate for Payer: Priority Health Cigna Priority Health	$280.45
Rate for Payer: Priority Health SBD	$271.82

HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE

Facility

$431.46

Service Code	NDC 54838050140
Hospital Charge Code	3585
Hospital Revenue Code	637
Min. Negotiated Rate	$271.82
Max. Negotiated Rate	$388.31
Rate for Payer: Aetna Commercial	$366.74
Rate for Payer: Aetna New Business (MI Preferred)	$280.45
Rate for Payer: Cash Price	$345.17
Rate for Payer: Cofinity Commercial	$302.02
Rate for Payer: Cofinity Commercial	$371.06
Rate for Payer: Cofinity Medicare Advantage	$302.02
Rate for Payer: Encore Health Key Benefits Commercial	$345.17
Rate for Payer: Healthscope Commercial	$388.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.74
Rate for Payer: PHP Commercial	$366.74
Rate for Payer: Priority Health Cigna Priority Health	$280.45
Rate for Payer: Priority Health SBD	$271.82

HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE

Facility

$243.96

Service Code	NDC 00121058104
Hospital Charge Code	3585
Hospital Revenue Code	637
Min. Negotiated Rate	$153.69
Max. Negotiated Rate	$219.56
Rate for Payer: Aetna Commercial	$207.37
Rate for Payer: Aetna New Business (MI Preferred)	$158.57
Rate for Payer: Cash Price	$195.17
Rate for Payer: Cofinity Commercial	$170.77
Rate for Payer: Cofinity Commercial	$209.81
Rate for Payer: Cofinity Medicare Advantage	$170.77
Rate for Payer: Encore Health Key Benefits Commercial	$195.17
Rate for Payer: Healthscope Commercial	$219.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.37
Rate for Payer: PHP Commercial	$207.37
Rate for Payer: Priority Health Cigna Priority Health	$158.57
Rate for Payer: Priority Health SBD	$153.69

HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE

Facility

$243.96

Service Code	NDC 00121058104
Hospital Charge Code	3585
Hospital Revenue Code	637
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$219.56
Rate for Payer: Aetna Commercial	$207.37
Rate for Payer: Aetna Medicare	$121.98
Rate for Payer: Aetna New Business (MI Preferred)	$158.57
Rate for Payer: BCBS Complete	$97.58
Rate for Payer: Cash Price	$195.17
Rate for Payer: Cofinity Commercial	$170.77
Rate for Payer: Cofinity Commercial	$209.81
Rate for Payer: Cofinity Medicare Advantage	$170.77
Rate for Payer: Encore Health Key Benefits Commercial	$195.17
Rate for Payer: Healthscope Commercial	$219.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.37
Rate for Payer: PHP Commercial	$207.37
Rate for Payer: Priority Health Cigna Priority Health	$158.57
Rate for Payer: Priority Health SBD	$153.69

HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION

Facility

$12.88

Service Code	HCPCS J1630
Hospital Charge Code	3584
Hospital Revenue Code	636
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna Commercial	$8.95
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: Aetna New Business (MI Preferred)	$6.84
Rate for Payer: Aetna New Business (MI Preferred)	$15.13
Rate for Payer: Cash Price	$8.42
Rate for Payer: Cash Price	$18.62
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$7.37
Rate for Payer: Cofinity Commercial	$9.06
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Commercial	$16.29
Rate for Payer: Cofinity Commercial	$20.01
Rate for Payer: Cofinity Medicare Advantage	$7.37
Rate for Payer: Cofinity Medicare Advantage	$16.29
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$8.42
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Encore Health Key Benefits Commercial	$18.62
Rate for Payer: Healthscope Commercial	$9.48
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Healthscope Commercial	$20.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.78
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: PHP Commercial	$19.78
Rate for Payer: PHP Commercial	$8.95
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health Cigna Priority Health	$6.84
Rate for Payer: Priority Health SBD	$14.66
Rate for Payer: Priority Health SBD	$8.11
Rate for Payer: Priority Health SBD	$6.63

HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION

Facility

$10.53

Service Code	HCPCS J1630
Hospital Charge Code	3584
Hospital Revenue Code	636
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$8.95
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna Medicare	$11.63
Rate for Payer: Aetna Medicare	$5.26
Rate for Payer: Aetna Medicare	$6.44
Rate for Payer: Aetna New Business (MI Preferred)	$15.13
Rate for Payer: Aetna New Business (MI Preferred)	$6.84
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: BCBS Complete	$5.15
Rate for Payer: BCBS Complete	$4.21
Rate for Payer: BCBS Complete	$9.31
Rate for Payer: Cash Price	$18.62
Rate for Payer: Cash Price	$8.42
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$20.01
Rate for Payer: Cofinity Commercial	$9.06
Rate for Payer: Cofinity Commercial	$7.37
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$16.29
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Cofinity Medicare Advantage	$7.37
Rate for Payer: Cofinity Medicare Advantage	$16.29
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Encore Health Key Benefits Commercial	$18.62
Rate for Payer: Encore Health Key Benefits Commercial	$8.42
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Healthscope Commercial	$9.48
Rate for Payer: Healthscope Commercial	$20.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: PHP Commercial	$8.95
Rate for Payer: PHP Commercial	$19.78
Rate for Payer: Priority Health Cigna Priority Health	$6.84
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health SBD	$14.66
Rate for Payer: Priority Health SBD	$8.11
Rate for Payer: Priority Health SBD	$6.63

HC 11 DEOXYCORTISOL

Facility

$65.55

Service Code	CPT 82634
Hospital Charge Code	30100189
Hospital Revenue Code	301
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$82.42
Rate for Payer: Aetna Commercial	$55.72
Rate for Payer: Aetna Medicare	$30.45
Rate for Payer: Aetna New Business (MI Preferred)	$42.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$36.60
Rate for Payer: Amish Plain Church Group Commercial	$36.60
Rate for Payer: BCBS Complete	$16.48
Rate for Payer: BCBS MAPPO	$29.28
Rate for Payer: BCN Medicare Advantage	$29.28
Rate for Payer: Cash Price	$52.44
Rate for Payer: Cash Price	$52.44
Rate for Payer: Cofinity Commercial	$56.37
Rate for Payer: Cofinity Commercial	$45.88
Rate for Payer: Cofinity Medicare Advantage	$45.88
Rate for Payer: Encore Health Key Benefits Commercial	$52.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$29.28
Rate for Payer: Healthscope Commercial	$58.99
Rate for Payer: Mclaren Medicaid	$15.69
Rate for Payer: Mclaren Medicare	$29.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.74
Rate for Payer: Meridian Medicaid	$16.48
Rate for Payer: MI Amish Medical Board Commercial	$33.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.72
Rate for Payer: PACE Medicare	$27.82
Rate for Payer: PACE SWMI	$29.28
Rate for Payer: PHP Commercial	$55.72
Rate for Payer: PHP Medicare Advantage	$29.28
Rate for Payer: Priority Health Choice Medicaid	$15.69
Rate for Payer: Priority Health Cigna Priority Health	$42.61
Rate for Payer: Priority Health Medicare	$29.28
Rate for Payer: Priority Health SBD	$41.30
Rate for Payer: Railroad Medicare Medicare	$29.28
Rate for Payer: UHC All Payor (Choice/PPO)	$82.42
Rate for Payer: UHC Dual Complete DSNP	$29.28
Rate for Payer: UHC Medicare Advantage	$29.28
Rate for Payer: UHCCP Medicaid	$16.48
Rate for Payer: VA VA	$29.28

HC 11 DEOXYCORTISOL

Facility

$65.55

Service Code	CPT 82634
Hospital Charge Code	30100189
Hospital Revenue Code	301
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$58.99
Rate for Payer: Aetna Commercial	$55.72
Rate for Payer: Aetna New Business (MI Preferred)	$42.61
Rate for Payer: Cash Price	$52.44
Rate for Payer: Cofinity Commercial	$45.88
Rate for Payer: Cofinity Commercial	$56.37
Rate for Payer: Cofinity Medicare Advantage	$45.88
Rate for Payer: Encore Health Key Benefits Commercial	$52.44
Rate for Payer: Healthscope Commercial	$58.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.72
Rate for Payer: PHP Commercial	$55.72
Rate for Payer: Priority Health Cigna Priority Health	$42.61
Rate for Payer: Priority Health SBD	$41.30

HC 1/2 X 1/2 STERILE W/LL

Facility

$6.89

Hospital Charge Code	27000680
Hospital Revenue Code	270
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna Commercial	$5.86
Rate for Payer: Aetna Medicare	$3.44
Rate for Payer: Aetna New Business (MI Preferred)	$4.48
Rate for Payer: BCBS Complete	$2.76
Rate for Payer: Cash Price	$5.51
Rate for Payer: Cofinity Commercial	$4.82
Rate for Payer: Cofinity Commercial	$5.93
Rate for Payer: Cofinity Medicare Advantage	$4.82
Rate for Payer: Encore Health Key Benefits Commercial	$5.51
Rate for Payer: Healthscope Commercial	$6.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.86
Rate for Payer: PHP Commercial	$5.86
Rate for Payer: Priority Health Cigna Priority Health	$4.48
Rate for Payer: Priority Health SBD	$4.34

HC 1/2 X 1/2 STERILE W/LL

Facility

$6.89

Hospital Charge Code	27000680
Hospital Revenue Code	270
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna Commercial	$5.86
Rate for Payer: Aetna New Business (MI Preferred)	$4.48
Rate for Payer: Cash Price	$5.51
Rate for Payer: Cofinity Commercial	$4.82
Rate for Payer: Cofinity Commercial	$5.93
Rate for Payer: Cofinity Medicare Advantage	$4.82
Rate for Payer: Encore Health Key Benefits Commercial	$5.51
Rate for Payer: Healthscope Commercial	$6.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.86
Rate for Payer: PHP Commercial	$5.86
Rate for Payer: Priority Health Cigna Priority Health	$4.48
Rate for Payer: Priority Health SBD	$4.34

Know your out-of-pocket cost for care.

All Charges