|
QUINAGLUTE/324MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
QUINAGLUTE/324MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
QUINAMM/260MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
QUINAMM/260MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
QUINAPRIL 10MCG/5ML
|
Facility
|
IP
|
$21.15
|
|
| Hospital Charge Code |
6017065
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.17
|
|
|
QUINAPRIL 10MCG/5ML
|
Facility
|
OP
|
$21.15
|
|
| Hospital Charge Code |
6017065
|
|
Hospital Revenue Code
|
252
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Aetna Commercial |
$8.04
|
| Rate for Payer: Aetna Medicare Advantage |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.39
|
| Rate for Payer: Cigna Commercial |
$10.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.34
|
| Rate for Payer: Oxford Commercial |
$4.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.56
|
|
|
QUINAPRIL 10 MG TAB
|
Facility
|
IP
|
$2.20
|
|
| Hospital Charge Code |
60627605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
|
|
QUINAPRIL 10 MG TAB
|
Facility
|
OP
|
$2.20
|
|
| Hospital Charge Code |
60627605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.56
|
| Rate for Payer: Cigna Commercial |
$1.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$0.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
QUINAPRIL 20 MG TAB
|
Facility
|
OP
|
$2.20
|
|
| Hospital Charge Code |
60628798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.56
|
| Rate for Payer: Cigna Commercial |
$1.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$0.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
QUINAPRIL 20 MG TAB
|
Facility
|
IP
|
$2.20
|
|
| Hospital Charge Code |
60628798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
|
|
QUINAPRIL 40 MG TAB
|
Facility
|
IP
|
$2.20
|
|
| Hospital Charge Code |
60627606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
|
|
QUINAPRIL 40 MG TAB
|
Facility
|
OP
|
$2.20
|
|
| Hospital Charge Code |
60627606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.56
|
| Rate for Payer: Cigna Commercial |
$1.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$0.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
QUINAPRIL 5 MG TAB
|
Facility
|
IP
|
$2.20
|
|
| Hospital Charge Code |
60628799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
|
|
QUINAPRIL 5 MG TAB
|
Facility
|
OP
|
$2.20
|
|
| Hospital Charge Code |
60628799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare Advantage |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.56
|
| Rate for Payer: Cigna Commercial |
$1.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$0.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
QUINAPRIL TAB 40MG
|
Facility
|
IP
|
$7.70
|
|
| Hospital Charge Code |
60628694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
|
|
QUINAPRIL TAB 40MG
|
Facility
|
OP
|
$7.70
|
|
| Hospital Charge Code |
60628694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$2.93
|
| Rate for Payer: Aetna Medicare Advantage |
$2.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.96
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.31
|
| Rate for Payer: Oxford Commercial |
$1.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
QUINDINE 300/BULK
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
QUINDINE 300/BULK
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
QUINDINE/300MG/UD
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
60634684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
QUINDINE/300MG/UD
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
60634684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
QUINIDEX/300MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
QUINIDEX/300MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
QUINIDEX/300MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
QUINIDEX/300MG/TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
QUINIDINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 80194
|
| Hospital Charge Code |
3002300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|