St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HALOPERIDOL DECANOATE 100MG/1ML

Facility

$52.27

Service Code	HCPCS J1631
Hospital Charge Code	41656018
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$33.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$31.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.06
Rate for Payer: Group Health Inc Commercial	$26.14
Rate for Payer: Group Health Inc Medicare	$18.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.14
Rate for Payer: Hamaspik Choice Inc Medicare	$26.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.98

HALOPERIDOL DECANOATE 100MG/1ML

Facility

$52.27

Service Code	HCPCS J1631
Hospital Charge Code	41656018
Hospital Revenue Code	636
Min. Negotiated Rate	$26.14
Max. Negotiated Rate	$26.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.14
Rate for Payer: Hamaspik Choice Inc Medicare	$26.14

HALOPERIDOL DECANOATE 100MG/1ML

Facility

$52.27

Service Code	HCPCS J1631
Hospital Charge Code	41646018
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$33.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$31.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.06
Rate for Payer: Group Health Inc Commercial	$26.14
Rate for Payer: Group Health Inc Medicare	$18.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.14
Rate for Payer: Hamaspik Choice Inc Medicare	$26.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.98

HALOPERIDOL DECANOATE 100MG/1ML

Facility

$52.27

Service Code	HCPCS J1631
Hospital Charge Code	41646018
Hospital Revenue Code	636
Min. Negotiated Rate	$26.14
Max. Negotiated Rate	$26.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.14
Rate for Payer: Hamaspik Choice Inc Medicare	$26.14

HALOPERIDOL DECANOATE 100 MG INJ

Facility

$1.53

Service Code	HCPCS J1631
Hospital Charge Code	41642271
Hospital Revenue Code	636
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

HALOPERIDOL DECANOATE 100 MG INJ

Facility

$1.53

Service Code	HCPCS J1631
Hospital Charge Code	41642271
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77

HALOPERIDOL DECANOATE 100 MG INJ

Facility

$1.53

Service Code	HCPCS J1631
Hospital Charge Code	41652271
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77

HALOPERIDOL DECANOATE 100 MG INJ

Facility

$1.53

Service Code	HCPCS J1631
Hospital Charge Code	41652271
Hospital Revenue Code	636
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$61.78

Service Code	HCPCS J1631
Hospital Charge Code	63323047101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$49.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$46.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.01
Rate for Payer: Group Health Inc Commercial	$30.89
Rate for Payer: Group Health Inc Medicare	$21.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.89
Rate for Payer: Hamaspik Choice Inc Medicare	$30.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.16

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$52.80

Service Code	HCPCS J1631
Hospital Charge Code	70710146301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$42.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$39.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.90
Rate for Payer: Group Health Inc Commercial	$26.40
Rate for Payer: Group Health Inc Medicare	$18.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.40
Rate for Payer: Hamaspik Choice Inc Medicare	$26.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.32

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$48.50

Service Code	HCPCS J1631
Hospital Charge Code	70069038301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$38.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$36.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.98
Rate for Payer: Group Health Inc Commercial	$24.25
Rate for Payer: Group Health Inc Medicare	$16.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.25
Rate for Payer: Hamaspik Choice Inc Medicare	$24.25
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.52

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$52.44

Service Code	HCPCS J1631
Hospital Charge Code	00703713103
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$41.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$39.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.66
Rate for Payer: Group Health Inc Commercial	$26.22
Rate for Payer: Group Health Inc Medicare	$18.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.22
Rate for Payer: Hamaspik Choice Inc Medicare	$26.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.09

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$52.32

Service Code	HCPCS J1631
Hospital Charge Code	25021083405
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$41.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$39.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.58
Rate for Payer: Group Health Inc Commercial	$26.16
Rate for Payer: Group Health Inc Medicare	$18.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.16
Rate for Payer: Hamaspik Choice Inc Medicare	$26.16
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.01

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$36.00

Service Code	HCPCS J1631
Hospital Charge Code	71288050301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$28.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.48
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$48.00

Service Code	HCPCS J1631
Hospital Charge Code	25021083301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$44.23

Service Code	HCPCS J1631
Hospital Charge Code	00143929601
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$35.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$33.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.08
Rate for Payer: Group Health Inc Commercial	$22.12
Rate for Payer: Group Health Inc Medicare	$15.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.12
Rate for Payer: Hamaspik Choice Inc Medicare	$22.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.75

HALOPERIDOL DECANOATE 100 MG/ML IM SOLN [10162]

Facility

$52.80

Service Code	HCPCS J1631
Hospital Charge Code	67457040913
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$42.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$39.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.90
Rate for Payer: Group Health Inc Commercial	$26.40
Rate for Payer: Group Health Inc Medicare	$18.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.40
Rate for Payer: Hamaspik Choice Inc Medicare	$26.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.32

HALOPERIDOL DECANOATE 50 MG/ML IM SOLN [10163]

Facility

$31.07

Service Code	HCPCS J1631
Hospital Charge Code	10147092103
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$24.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$23.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.13
Rate for Payer: Group Health Inc Commercial	$15.53
Rate for Payer: Group Health Inc Medicare	$10.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.53
Rate for Payer: Hamaspik Choice Inc Medicare	$15.53
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.19

HALOPERIDOL DECANOATE 50 MG/ML IM SOLN [10163]

Facility

$26.68

Service Code	HCPCS J1631
Hospital Charge Code	70069038110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$21.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$20.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.14
Rate for Payer: Group Health Inc Commercial	$13.34
Rate for Payer: Group Health Inc Medicare	$9.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.34
Rate for Payer: Hamaspik Choice Inc Medicare	$13.34
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.75
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.34

HALOPERIDOL DECANOATE 50 MG/ML INJ

Facility

$42.52

Service Code	HCPCS J1631
Hospital Charge Code	41640687
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$21.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.26
Rate for Payer: Hamaspik Choice Inc Medicare	$21.26

HALOPERIDOL DECANOATE 50 MG/ML INJ

Facility

$42.52

Service Code	HCPCS J1631
Hospital Charge Code	41650687
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$21.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.26
Rate for Payer: Hamaspik Choice Inc Medicare	$21.26

HALOPERIDOL DECANOATE 50 MG/ML INJ

Facility

$42.52

Service Code	HCPCS J1631
Hospital Charge Code	41640687
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$27.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$25.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.45
Rate for Payer: Group Health Inc Commercial	$21.26
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.26
Rate for Payer: Hamaspik Choice Inc Medicare	$21.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.64

HALOPERIDOL DECANOATE 50 MG/ML INJ

Facility

$42.52

Service Code	HCPCS J1631
Hospital Charge Code	41650687
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$27.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.57
Rate for Payer: Aetna Government	$9.57
Rate for Payer: Brighton Health Commercial	$25.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.45
Rate for Payer: Group Health Inc Commercial	$21.26
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.26
Rate for Payer: Hamaspik Choice Inc Medicare	$21.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.15
Rate for Payer: SOMOS Essential	$7.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.64

HALOPERIDOL (HALDOL(R)) SERUM

Facility

$40.04

Service Code	HCPCS 80173
Hospital Charge Code	40609723
Hospital Revenue Code	301
Rate for Payer: Cash Price	$15.78

HALOPERIDOL (HALDOL(R)) SERUM

Facility

$40.04

Service Code	HCPCS 80173
Hospital Charge Code	40609723
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$30.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Affinity Essential Plan 1&2	$11.05
Rate for Payer: Affinity Essential Plan 3&4	$11.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.05
Rate for Payer: Brighton Health Commercial	$30.03
Rate for Payer: Cash Price	$15.78
Rate for Payer: Cash Price	$15.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.58
Rate for Payer: Elderplan Medicare Advantage	$15.78
Rate for Payer: EmblemHealth Commercial	$15.78
Rate for Payer: Fidelis Essential Plan Aliesa	$13.41
Rate for Payer: Fidelis Essential Plan QHP	$14.04
Rate for Payer: Fidelis Medicare Advantage	$15.78
Rate for Payer: Fidelis Qualified Health Plan	$14.04
Rate for Payer: Group Health Inc Commercial	$15.78
Rate for Payer: Group Health Inc Medicare	$15.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.02
Rate for Payer: Hamaspik Choice Inc Medicare	$15.78
Rate for Payer: Healthfirst Medicare Advantage	$15.78
Rate for Payer: Healthfirst QHP	$15.78
Rate for Payer: Humana Medicare	$16.10
Rate for Payer: Senior Whole Health Medicare Advantage	$15.78
Rate for Payer: United Healthcare Commercial	$18.44
Rate for Payer: United Healthcare Medicare Advantage	$15.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.62
Rate for Payer: Wellcare Medicare	$14.20

Know your out-of-pocket cost for care.

All Charges