|
HALOPERIDOL 0.5 MG PO TABS
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 0378035101
|
| Hospital Charge Code |
0378035101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
HALOPERIDOL 0.5 MG PO TABS
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 5107973320
|
| Hospital Charge Code |
5107973320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 5107973420
|
| Hospital Charge Code |
5107973420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0904739061
|
| Hospital Charge Code |
0904739061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0904739061
|
| Hospital Charge Code |
0904739061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 0904724161
|
| Hospital Charge Code |
0904724161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: EmblemHealth Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 0904724161
|
| Hospital Charge Code |
0904724161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
|
|
HALOPERIDOL 1 MG PO TABS
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 5107973420
|
| Hospital Charge Code |
5107973420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
|
|
HALOPERIDOL 2 MG PO TABS
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 5107973520
|
| Hospital Charge Code |
5107973520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
HALOPERIDOL 2 MG PO TABS
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 5107973501
|
| Hospital Charge Code |
5107973501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
HALOPERIDOL 2 MG PO TABS
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 5107973520
|
| Hospital Charge Code |
5107973520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
HALOPERIDOL 2 MG PO TABS
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 5107973501
|
| Hospital Charge Code |
5107973501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
NDC 0832154089
|
| Hospital Charge Code |
0832154089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 6068716101
|
| Hospital Charge Code |
6068716101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 6838207901
|
| Hospital Charge Code |
6838207901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.51
|
| Rate for Payer: Aetna Government |
$0.51
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: EmblemHealth Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 0904678261
|
| Hospital Charge Code |
0904678261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 0378032710
|
| Hospital Charge Code |
0378032710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.51
|
| Rate for Payer: Aetna Government |
$0.51
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: EmblemHealth Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 5107973620
|
| Hospital Charge Code |
5107973620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 0904678261
|
| Hospital Charge Code |
0904678261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 0378032710
|
| Hospital Charge Code |
0378032710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 6838207910
|
| Hospital Charge Code |
6838207910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.51
|
| Rate for Payer: Aetna Government |
$0.51
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: EmblemHealth Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 6838207910
|
| Hospital Charge Code |
6838207910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 6838207901
|
| Hospital Charge Code |
6838207901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
NDC 0832154089
|
| Hospital Charge Code |
0832154089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.75
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.72
|
|
|
HALOPERIDOL 5 MG PO TABS
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 6068716101
|
| Hospital Charge Code |
6068716101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|