|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$204.25
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna Medicare |
$53.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.83
|
| Rate for Payer: BCBS Complete |
$37.81
|
| Rate for Payer: BCBS MAPPO |
$51.06
|
| Rate for Payer: BCBS Trust/PPO |
$167.91
|
| Rate for Payer: BCN Commercial |
$167.91
|
| Rate for Payer: BCN Medicare Advantage |
$51.06
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.06
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Mclaren Medicaid |
$36.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$37.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Nomi Health Commercial |
$167.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PACE Senior Care Partners |
$48.51
|
| Rate for Payer: PACE SWMI |
$51.06
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: PHP Medicare Advantage |
$51.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.70
|
| Rate for Payer: Priority Health Medicare |
$51.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.16
|
| Rate for Payer: Railroad Medicare Medicare |
$51.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.74
|
| Rate for Payer: UHC Core |
$170.55
|
| Rate for Payer: UHC Exchange |
$51.06
|
| Rate for Payer: UHC Medicaid |
$36.01
|
| Rate for Payer: UHC Medicare Advantage |
$51.06
|
| Rate for Payer: UHCCP Medicaid |
$36.01
|
| Rate for Payer: VA VA |
$51.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.16 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$168.69
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Nomi Health Commercial |
$167.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.74
|
| Rate for Payer: UHC Core |
$170.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
QUETIAPINE 12.5 MG CUSTOM TAB
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
NDC 09900000311
|
| Hospital Charge Code |
155122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.76
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.61
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.61
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.83
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.83
|
| Rate for Payer: PACE Senior Care Partners |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.61
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.12
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicaid |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
| Rate for Payer: VA VA |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.83
|
|
|
QUETIAPINE 12.5 MG CUSTOM TAB
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
NDC 09900000311
|
| Hospital Charge Code |
155122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.95
|
| Rate for Payer: Healthscope Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.83
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.83
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$105.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.31
|
| Rate for Payer: BCBS Complete |
$74.82
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCN Commercial |
$332.29
|
| Rate for Payer: BCN Medicare Advantage |
$101.05
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.05
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Mclaren Medicaid |
$71.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PACE Senior Care Partners |
$96.00
|
| Rate for Payer: PACE SWMI |
$101.05
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: Railroad Medicare Medicare |
$101.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Exchange |
$101.05
|
| Rate for Payer: UHC Medicaid |
$71.26
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: UHCCP Medicaid |
$71.26
|
| Rate for Payer: VA VA |
$101.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 67877024201
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$64.05
|
| Rate for Payer: BCN Commercial |
$64.05
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 67877024201
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.23
|
| Rate for Payer: BCBS Complete |
$14.35
|
| Rate for Payer: BCBS MAPPO |
$19.39
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$63.75
|
| Rate for Payer: BCN Medicare Advantage |
$19.39
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.39
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Mclaren Medicaid |
$13.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.36
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Nomi Health Commercial |
$63.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PACE Senior Care Partners |
$18.42
|
| Rate for Payer: PACE SWMI |
$19.39
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: PHP Medicare Advantage |
$19.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.47
|
| Rate for Payer: Priority Health Medicare |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$19.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UHC Medicaid |
$13.67
|
| Rate for Payer: UHC Medicare Advantage |
$19.39
|
| Rate for Payer: UHCCP Medicaid |
$13.67
|
| Rate for Payer: VA VA |
$19.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: BCBS Trust/PPO |
$333.83
|
| Rate for Payer: BCN Commercial |
$333.83
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$328.70
|
|
|
Service Code
|
NDC 60687033801
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.95 |
| Max. Negotiated Rate |
$295.83 |
| Rate for Payer: Aetna Commercial |
$279.39
|
| Rate for Payer: Aetna Medicare |
$85.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.72
|
| Rate for Payer: BCBS Complete |
$60.84
|
| Rate for Payer: BCBS MAPPO |
$82.17
|
| Rate for Payer: BCBS Trust/PPO |
$270.22
|
| Rate for Payer: BCN Commercial |
$270.22
|
| Rate for Payer: BCN Medicare Advantage |
$82.17
|
| Rate for Payer: Cash Price |
$262.96
|
| Rate for Payer: Cofinity Commercial |
$282.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.17
|
| Rate for Payer: Healthscope Commercial |
$295.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.53
|
| Rate for Payer: Mclaren Medicaid |
$57.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.28
|
| Rate for Payer: Meridian Medicaid |
$60.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.39
|
| Rate for Payer: Nomi Health Commercial |
$269.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.53
|
| Rate for Payer: PACE Senior Care Partners |
$78.07
|
| Rate for Payer: PACE SWMI |
$82.17
|
| Rate for Payer: PHP Commercial |
$279.39
|
| Rate for Payer: PHP Medicare Advantage |
$82.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.97
|
| Rate for Payer: Priority Health Medicare |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.78
|
| Rate for Payer: Railroad Medicare Medicare |
$82.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.26
|
| Rate for Payer: UHC Core |
$274.46
|
| Rate for Payer: UHC Exchange |
$82.17
|
| Rate for Payer: UHC Medicaid |
$57.95
|
| Rate for Payer: UHC Medicare Advantage |
$82.17
|
| Rate for Payer: UHCCP Medicaid |
$57.95
|
| Rate for Payer: VA VA |
$82.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.53
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$217.38
|
|
|
Service Code
|
NDC 50268063115
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.30 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna Commercial |
$184.77
|
| Rate for Payer: BCBS Trust/PPO |
$179.53
|
| Rate for Payer: BCN Commercial |
$179.53
|
| Rate for Payer: Cash Price |
$173.90
|
| Rate for Payer: Cofinity Commercial |
$186.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.90
|
| Rate for Payer: Healthscope Commercial |
$195.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.77
|
| Rate for Payer: Nomi Health Commercial |
$178.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.03
|
| Rate for Payer: PHP Commercial |
$184.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.29
|
| Rate for Payer: UHC Core |
$181.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.03
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$328.70
|
|
|
Service Code
|
NDC 60687033801
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$295.83 |
| Rate for Payer: Aetna Commercial |
$279.39
|
| Rate for Payer: BCBS Trust/PPO |
$271.47
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$262.96
|
| Rate for Payer: Cofinity Commercial |
$282.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.96
|
| Rate for Payer: Healthscope Commercial |
$295.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.39
|
| Rate for Payer: Nomi Health Commercial |
$269.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.53
|
| Rate for Payer: PHP Commercial |
$279.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.26
|
| Rate for Payer: UHC Core |
$274.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.53
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 60687033811
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.72
|
| Rate for Payer: BCN Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 00904663961
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: BCBS Trust/PPO |
$247.15
|
| Rate for Payer: BCN Commercial |
$247.15
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$260.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.34
|
| Rate for Payer: UHC Core |
$249.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 50268063111
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.36
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicaid |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: UHCCP Medicaid |
$0.77
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 50268063111
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$299.25
|
|
|
Service Code
|
NDC 00904663961
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna Medicare |
$77.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.52
|
| Rate for Payer: BCBS Complete |
$55.39
|
| Rate for Payer: BCBS MAPPO |
$74.81
|
| Rate for Payer: BCBS Trust/PPO |
$246.01
|
| Rate for Payer: BCN Commercial |
$246.01
|
| Rate for Payer: BCN Medicare Advantage |
$74.81
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.81
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Mclaren Medicaid |
$52.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.55
|
| Rate for Payer: Meridian Medicaid |
$55.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.36
|
| Rate for Payer: Nomi Health Commercial |
$245.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.44
|
| Rate for Payer: PACE Senior Care Partners |
$71.07
|
| Rate for Payer: PACE SWMI |
$74.81
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$260.35
|
| Rate for Payer: Priority Health Medicare |
$75.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.28
|
| Rate for Payer: Railroad Medicare Medicare |
$74.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.34
|
| Rate for Payer: UHC Core |
$249.87
|
| Rate for Payer: UHC Exchange |
$74.81
|
| Rate for Payer: UHC Medicaid |
$52.76
|
| Rate for Payer: UHC Medicare Advantage |
$74.81
|
| Rate for Payer: UHCCP Medicaid |
$52.76
|
| Rate for Payer: VA VA |
$74.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 60687033811
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: BCBS MAPPO |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.70
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$0.82
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.86
|
| Rate for Payer: Meridian Medicaid |
$0.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.80
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.47
|
| Rate for Payer: PACE Senior Care Partners |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.82
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$0.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.86
|
| Rate for Payer: Priority Health Medicare |
$0.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.75
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.82
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$217.38
|
|
|
Service Code
|
NDC 50268063115
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna Commercial |
$184.77
|
| Rate for Payer: Aetna Medicare |
$56.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.93
|
| Rate for Payer: BCBS Complete |
$40.24
|
| Rate for Payer: BCBS MAPPO |
$54.34
|
| Rate for Payer: BCBS Trust/PPO |
$178.71
|
| Rate for Payer: BCN Commercial |
$178.71
|
| Rate for Payer: BCN Medicare Advantage |
$54.34
|
| Rate for Payer: Cash Price |
$173.90
|
| Rate for Payer: Cofinity Commercial |
$186.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$195.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.03
|
| Rate for Payer: Mclaren Medicaid |
$38.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.06
|
| Rate for Payer: Meridian Medicaid |
$40.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.77
|
| Rate for Payer: Nomi Health Commercial |
$178.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.03
|
| Rate for Payer: PACE Senior Care Partners |
$51.63
|
| Rate for Payer: PACE SWMI |
$54.34
|
| Rate for Payer: PHP Commercial |
$184.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.12
|
| Rate for Payer: Priority Health Medicare |
$54.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.30
|
| Rate for Payer: Railroad Medicare Medicare |
$54.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.29
|
| Rate for Payer: UHC Core |
$181.51
|
| Rate for Payer: UHC Exchange |
$54.34
|
| Rate for Payer: UHC Medicaid |
$38.32
|
| Rate for Payer: UHC Medicare Advantage |
$54.34
|
| Rate for Payer: UHCCP Medicaid |
$38.32
|
| Rate for Payer: VA VA |
$54.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.03
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$312.48
|
|
|
Service Code
|
NDC 00904680261
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.65
|
| Rate for Payer: BCBS Complete |
$57.84
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$256.89
|
| Rate for Payer: BCN Commercial |
$256.89
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.36
|
| Rate for Payer: Mclaren Medicaid |
$55.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Meridian Medicaid |
$57.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: Nomi Health Commercial |
$256.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.36
|
| Rate for Payer: PACE Senior Care Partners |
$74.21
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.86
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.49
|
| Rate for Payer: Railroad Medicare Medicare |
$78.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.98
|
| Rate for Payer: UHC Core |
$260.92
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UHC Medicaid |
$55.09
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$55.09
|
| Rate for Payer: VA VA |
$78.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.36
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,044.51
|
|
|
Service Code
|
NDC 00310028160
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,118.98 |
| Max. Negotiated Rate |
$2,740.06 |
| Rate for Payer: Aetna Commercial |
$2,587.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,514.46
|
| Rate for Payer: BCN Commercial |
$2,514.46
|
| Rate for Payer: Cash Price |
$2,435.61
|
| Rate for Payer: Cofinity Commercial |
$2,618.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,435.61
|
| Rate for Payer: Healthscope Commercial |
$2,740.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,283.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,587.83
|
| Rate for Payer: Nomi Health Commercial |
$2,496.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,283.38
|
| Rate for Payer: PHP Commercial |
$2,587.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,648.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,118.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,679.17
|
| Rate for Payer: UHC Core |
$2,542.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,283.38
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$153.33
|
|
|
Service Code
|
NDC 68180061307
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$130.33
|
| Rate for Payer: Aetna Medicare |
$39.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.92
|
| Rate for Payer: BCBS Complete |
$28.38
|
| Rate for Payer: BCBS MAPPO |
$38.33
|
| Rate for Payer: BCBS Trust/PPO |
$126.05
|
| Rate for Payer: BCN Commercial |
$126.05
|
| Rate for Payer: BCN Medicare Advantage |
$38.33
|
| Rate for Payer: Cash Price |
$122.66
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.33
|
| Rate for Payer: Healthscope Commercial |
$138.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.00
|
| Rate for Payer: Mclaren Medicaid |
$27.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.25
|
| Rate for Payer: Meridian Medicaid |
$28.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.33
|
| Rate for Payer: Nomi Health Commercial |
$125.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.00
|
| Rate for Payer: PACE Senior Care Partners |
$36.42
|
| Rate for Payer: PACE SWMI |
$38.33
|
| Rate for Payer: PHP Commercial |
$130.33
|
| Rate for Payer: PHP Medicare Advantage |
$38.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.40
|
| Rate for Payer: Priority Health Medicare |
$38.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.72
|
| Rate for Payer: Railroad Medicare Medicare |
$38.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.93
|
| Rate for Payer: UHC Core |
$128.03
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UHC Medicaid |
$27.03
|
| Rate for Payer: UHC Medicare Advantage |
$38.33
|
| Rate for Payer: UHCCP Medicaid |
$27.03
|
| Rate for Payer: VA VA |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.00
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,044.51
|
|
|
Service Code
|
NDC 00310028160
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$536.75 |
| Max. Negotiated Rate |
$2,740.06 |
| Rate for Payer: Aetna Commercial |
$2,587.83
|
| Rate for Payer: Aetna Medicare |
$791.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$951.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$951.41
|
| Rate for Payer: BCBS Complete |
$563.54
|
| Rate for Payer: BCBS MAPPO |
$761.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,502.89
|
| Rate for Payer: BCN Commercial |
$2,502.89
|
| Rate for Payer: BCN Medicare Advantage |
$761.13
|
| Rate for Payer: Cash Price |
$2,435.61
|
| Rate for Payer: Cofinity Commercial |
$2,618.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,435.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.13
|
| Rate for Payer: Healthscope Commercial |
$2,740.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,283.38
|
| Rate for Payer: Mclaren Medicaid |
$536.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$799.18
|
| Rate for Payer: Meridian Medicaid |
$563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$875.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$837.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,587.83
|
| Rate for Payer: Nomi Health Commercial |
$2,496.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,283.38
|
| Rate for Payer: PACE Senior Care Partners |
$723.07
|
| Rate for Payer: PACE SWMI |
$761.13
|
| Rate for Payer: PHP Commercial |
$2,587.83
|
| Rate for Payer: PHP Medicare Advantage |
$761.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$536.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,648.72
|
| Rate for Payer: Priority Health Medicare |
$768.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,118.98
|
| Rate for Payer: Railroad Medicare Medicare |
$761.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,679.17
|
| Rate for Payer: UHC Core |
$2,542.17
|
| Rate for Payer: UHC Exchange |
$761.13
|
| Rate for Payer: UHC Medicaid |
$536.75
|
| Rate for Payer: UHC Medicare Advantage |
$761.13
|
| Rate for Payer: UHCCP Medicaid |
$536.75
|
| Rate for Payer: VA VA |
$761.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,283.38
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$153.33
|
|
|
Service Code
|
NDC 68180061307
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.72 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$130.33
|
| Rate for Payer: BCBS Trust/PPO |
$126.64
|
| Rate for Payer: BCN Commercial |
$126.64
|
| Rate for Payer: Cash Price |
$122.66
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.66
|
| Rate for Payer: Healthscope Commercial |
$138.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.33
|
| Rate for Payer: Nomi Health Commercial |
$125.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.00
|
| Rate for Payer: PHP Commercial |
$130.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.93
|
| Rate for Payer: UHC Core |
$128.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.00
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$312.48
|
|
|
Service Code
|
NDC 00904680261
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.49 |
| Max. Negotiated Rate |
$281.23 |
| Rate for Payer: Aetna Commercial |
$265.61
|
| Rate for Payer: BCBS Trust/PPO |
$258.08
|
| Rate for Payer: BCN Commercial |
$258.08
|
| Rate for Payer: Cash Price |
$249.98
|
| Rate for Payer: Cofinity Commercial |
$268.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.98
|
| Rate for Payer: Healthscope Commercial |
$281.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.61
|
| Rate for Payer: Nomi Health Commercial |
$256.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.36
|
| Rate for Payer: PHP Commercial |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.98
|
| Rate for Payer: UHC Core |
$260.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.36
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$55.53
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$246.63
|
| Rate for Payer: BCN Commercial |
$246.63
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$52.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: Meridian Medicaid |
$55.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Exchange |
$75.00
|
| Rate for Payer: UHC Medicaid |
$52.89
|
| Rate for Payer: UHC Medicare Advantage |
$75.00
|
| Rate for Payer: UHCCP Medicaid |
$52.89
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
