|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 51079073620
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Advantage |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
NDC 60687016111
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna American Axle |
$2.46
|
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna Medicare |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.46
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Advantage |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.46
|
| Rate for Payer: UHC Core |
$1.97
|
| Rate for Payer: UHC Exchange |
$1.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$377.28
|
|
|
Service Code
|
NDC 60687016101
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna American Axle |
$245.23
|
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Advantage |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.96
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health SBD |
$237.69
|
| Rate for Payer: UMR Bronson Commercial |
$166.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.96
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna American Axle |
$1.76
|
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.76
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.03
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$270.72
|
|
|
Service Code
|
NDC 51079073620
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Advantage |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.97
|
| Rate for Payer: UHC Core |
$141.05
|
| Rate for Payer: UHC Exchange |
$106.39
|
| Rate for Payer: UMR Bronson Commercial |
$100.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Aetna American Axle |
$1.76
|
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Advantage |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.30
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.03
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$365.76
|
|
|
Service Code
|
NDC 00378032701
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.61
|
| Rate for Payer: Cofinity Advantage |
$256.03
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.61
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.32
|
| Rate for Payer: PHP Commercial |
$310.90
|
| Rate for Payer: Priority Health SBD |
$230.43
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.32
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$341.28
|
|
|
Service Code
|
NDC 58657090301
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$307.15 |
| Rate for Payer: Aetna American Axle |
$221.83
|
| Rate for Payer: Aetna Commercial |
$290.09
|
| Rate for Payer: Aetna Medicare |
$170.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.83
|
| Rate for Payer: BCBS Complete |
$136.51
|
| Rate for Payer: Cash Price |
$273.02
|
| Rate for Payer: Cofinity Advantage |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$293.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.02
|
| Rate for Payer: Healthscope Commercial |
$307.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.96
|
| Rate for Payer: PHP Commercial |
$290.09
|
| Rate for Payer: Priority Health SBD |
$215.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.83
|
| Rate for Payer: UHC Core |
$177.81
|
| Rate for Payer: UHC Exchange |
$134.12
|
| Rate for Payer: UMR Bronson Commercial |
$126.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.96
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$341.28
|
|
|
Service Code
|
NDC 58657090301
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.16 |
| Max. Negotiated Rate |
$307.15 |
| Rate for Payer: Aetna American Axle |
$221.83
|
| Rate for Payer: Aetna Commercial |
$290.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.83
|
| Rate for Payer: Cash Price |
$273.02
|
| Rate for Payer: Cofinity Advantage |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$293.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.02
|
| Rate for Payer: Healthscope Commercial |
$307.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.96
|
| Rate for Payer: PHP Commercial |
$290.09
|
| Rate for Payer: Priority Health SBD |
$215.01
|
| Rate for Payer: UMR Bronson Commercial |
$150.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.96
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 58657090310
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$377.28
|
|
|
Service Code
|
NDC 60687016101
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.59 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna American Axle |
$245.23
|
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna Medicare |
$188.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: BCBS Complete |
$150.91
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Advantage |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.96
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health SBD |
$237.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.23
|
| Rate for Payer: UHC Core |
$196.56
|
| Rate for Payer: UHC Exchange |
$148.27
|
| Rate for Payer: UMR Bronson Commercial |
$139.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.96
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 58657090310
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Advantage |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 60687016111
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna American Axle |
$2.46
|
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.46
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Advantage |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PHP Commercial |
$3.21
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$365.76
|
|
|
Service Code
|
NDC 00378032701
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.33 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.61
|
| Rate for Payer: Cofinity Advantage |
$256.03
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.61
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.32
|
| Rate for Payer: PHP Commercial |
$310.90
|
| Rate for Payer: Priority Health SBD |
$230.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.74
|
| Rate for Payer: UHC Core |
$190.56
|
| Rate for Payer: UHC Exchange |
$143.74
|
| Rate for Payer: UMR Bronson Commercial |
$135.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.32
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 51552051902
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Advantage |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 38779033003
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 38779033003
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.90
|
| Rate for Payer: UHC Core |
$65.65
|
| Rate for Payer: UHC Exchange |
$49.52
|
| Rate for Payer: UMR Bronson Commercial |
$46.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
NDC 51552051902
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Advantage |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.00
|
| Rate for Payer: UHC Core |
$72.94
|
| Rate for Payer: UHC Exchange |
$55.02
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna American Axle |
$36.56
|
| Rate for Payer: Aetna Commercial |
$47.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cofinity Advantage |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.19
|
| Rate for Payer: PHP Commercial |
$47.81
|
| Rate for Payer: Priority Health SBD |
$35.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.19
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna American Axle |
$36.56
|
| Rate for Payer: Aetna Commercial |
$47.81
|
| Rate for Payer: Aetna Medicare |
$28.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: BCBS Complete |
$22.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.76
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cofinity Advantage |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$48.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.19
|
| Rate for Payer: PHP Commercial |
$47.81
|
| Rate for Payer: Priority Health SBD |
$35.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.50
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.19
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$107.15
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna American Axle |
$69.65
|
| Rate for Payer: Aetna Commercial |
$91.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cofinity Advantage |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$92.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.72
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.36
|
| Rate for Payer: PHP Commercial |
$91.08
|
| Rate for Payer: Priority Health SBD |
$67.50
|
| Rate for Payer: UMR Bronson Commercial |
$47.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.36
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$107.15
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna American Axle |
$69.65
|
| Rate for Payer: Aetna Commercial |
$91.08
|
| Rate for Payer: Aetna Medicare |
$53.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: BCBS Complete |
$42.86
|
| Rate for Payer: BCBS Trust/PPO |
$12.76
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cofinity Advantage |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$92.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.72
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.36
|
| Rate for Payer: PHP Commercial |
$91.08
|
| Rate for Payer: Priority Health SBD |
$67.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.50
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.36
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.66
|
|
|
Service Code
|
NDC 54838050140
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$224.69 |
| Rate for Payer: Aetna American Axle |
$162.28
|
| Rate for Payer: Aetna Commercial |
$212.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.28
|
| Rate for Payer: Cash Price |
$199.73
|
| Rate for Payer: Cofinity Advantage |
$174.76
|
| Rate for Payer: Cofinity Commercial |
$214.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.73
|
| Rate for Payer: Healthscope Commercial |
$224.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.25
|
| Rate for Payer: PHP Commercial |
$212.21
|
| Rate for Payer: Priority Health SBD |
$157.29
|
| Rate for Payer: UMR Bronson Commercial |
$109.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.25
|
|
