|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 16729014701
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.66
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: BCBS Trust/PPO |
$368.31
|
| Rate for Payer: BCN Commercial |
$348.69
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Nomi Health Commercial |
$369.98
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$392.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.06
|
| Rate for Payer: UHC Core |
$376.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
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 |
$0.58 |
| 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 |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$0.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$1.90
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: Nomi Health Commercial |
$2.00
|
| 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 Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.12
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| 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 Dual Complete DSNP |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| 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 |
$1.59 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$1.99
|
| Rate for Payer: BCN Commercial |
$1.89
|
| 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: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.59
|
| Rate for Payer: Priority Health HMO/PPO |
$2.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| 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
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$94.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.09
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: BCBS MAPPO |
$90.47
|
| Rate for Payer: BCBS Trust/PPO |
$297.52
|
| Rate for Payer: BCN Commercial |
$281.38
|
| Rate for Payer: BCN Medicare Advantage |
$90.47
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.47
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: PACE Senior Care Partners |
$85.95
|
| Rate for Payer: PACE SWMI |
$90.47
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: PHP Medicare Advantage |
$90.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$91.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.47
|
| Rate for Payer: Railroad Medicare Medicare |
$90.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.47
|
| Rate for Payer: UHC Exchange |
$90.47
|
| Rate for Payer: UHC Medicare Advantage |
$90.47
|
| Rate for Payer: VA VA |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 67877024201
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.83
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS MAPPO |
$15.86
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$49.33
|
| Rate for Payer: BCN Medicare Advantage |
$15.86
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: PACE Senior Care Partners |
$15.07
|
| Rate for Payer: PACE SWMI |
$15.86
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicare Advantage |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO |
$55.20
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.51
|
| Rate for Payer: Railroad Medicare Medicare |
$15.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.86
|
| Rate for Payer: UHC Exchange |
$15.86
|
| Rate for Payer: UHC Medicare Advantage |
$15.86
|
| Rate for Payer: VA VA |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 67877024201
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO |
$55.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: BCBS Trust/PPO |
$295.42
|
| Rate for Payer: BCN Commercial |
$279.68
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: Nomi Health Commercial |
$296.76
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO |
$314.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.47
|
| Rate for Payer: UHC Core |
$302.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$371.45
|
|
|
Service Code
|
NDC 00904663961
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$334.31 |
| Rate for Payer: Aetna Commercial |
$315.73
|
| Rate for Payer: BCBS Trust/PPO |
$303.21
|
| Rate for Payer: BCN Commercial |
$287.06
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$319.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Healthscope Commercial |
$334.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: PHP Commercial |
$315.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$323.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.88
|
| Rate for Payer: UHC Core |
$310.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.59
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 60687033811
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health HMO/PPO |
$3.56
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 50268063111
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 50268063111
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.84
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$371.45
|
|
|
Service Code
|
NDC 00904663961
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$334.31 |
| Rate for Payer: Aetna Commercial |
$315.73
|
| Rate for Payer: Aetna Medicare |
$96.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.08
|
| Rate for Payer: BCBS Complete |
$148.58
|
| Rate for Payer: BCBS MAPPO |
$92.86
|
| Rate for Payer: BCBS Trust/PPO |
$305.37
|
| Rate for Payer: BCN Commercial |
$288.80
|
| Rate for Payer: BCN Medicare Advantage |
$92.86
|
| Rate for Payer: Cash Price |
$297.16
|
| Rate for Payer: Cofinity Commercial |
$319.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.86
|
| Rate for Payer: Healthscope Commercial |
$334.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.73
|
| Rate for Payer: Nomi Health Commercial |
$304.59
|
| Rate for Payer: PACE Senior Care Partners |
$88.22
|
| Rate for Payer: PACE SWMI |
$92.86
|
| Rate for Payer: PHP Commercial |
$315.73
|
| Rate for Payer: PHP Medicare Advantage |
$92.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.44
|
| Rate for Payer: Priority Health HMO/PPO |
$323.16
|
| Rate for Payer: Priority Health Medicare |
$93.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.87
|
| Rate for Payer: Railroad Medicare Medicare |
$92.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.88
|
| Rate for Payer: UHC Core |
$310.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.86
|
| Rate for Payer: UHC Exchange |
$92.86
|
| Rate for Payer: UHC Medicare Advantage |
$92.86
|
| Rate for Payer: VA VA |
$92.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.59
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687033811
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health HMO/PPO |
$3.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$104.50
|
|
|
Service Code
|
NDC 50268063115
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$85.30
|
| Rate for Payer: BCN Commercial |
$80.76
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cofinity Commercial |
$89.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.60
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.83
|
| Rate for Payer: Nomi Health Commercial |
$85.69
|
| Rate for Payer: PHP Commercial |
$88.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.92
|
| Rate for Payer: Priority Health HMO/PPO |
$90.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.96
|
| Rate for Payer: UHC Core |
$87.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.38
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 60687033801
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna Medicare |
$106.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.66
|
| Rate for Payer: BCBS Complete |
$163.40
|
| Rate for Payer: BCBS MAPPO |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$335.83
|
| Rate for Payer: BCN Commercial |
$317.61
|
| Rate for Payer: BCN Medicare Advantage |
$102.12
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.12
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: PACE Senior Care Partners |
$97.02
|
| Rate for Payer: PACE SWMI |
$102.12
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: PHP Medicare Advantage |
$102.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.52
|
| Rate for Payer: Priority Health HMO/PPO |
$355.39
|
| Rate for Payer: Priority Health Medicare |
$103.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.69
|
| Rate for Payer: Railroad Medicare Medicare |
$102.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.48
|
| Rate for Payer: UHC Core |
$341.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.12
|
| Rate for Payer: UHC Exchange |
$102.12
|
| Rate for Payer: UHC Medicare Advantage |
$102.12
|
| Rate for Payer: VA VA |
$102.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
OP
|
$104.50
|
|
|
Service Code
|
NDC 50268063115
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$88.83
|
| Rate for Payer: Aetna Medicare |
$27.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.66
|
| Rate for Payer: BCBS Complete |
$41.80
|
| Rate for Payer: BCBS MAPPO |
$26.12
|
| Rate for Payer: BCBS Trust/PPO |
$85.91
|
| Rate for Payer: BCN Commercial |
$81.25
|
| Rate for Payer: BCN Medicare Advantage |
$26.12
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cofinity Commercial |
$89.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.12
|
| Rate for Payer: Healthscope Commercial |
$94.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.83
|
| Rate for Payer: Nomi Health Commercial |
$85.69
|
| Rate for Payer: PACE Senior Care Partners |
$24.82
|
| Rate for Payer: PACE SWMI |
$26.12
|
| Rate for Payer: PHP Commercial |
$88.83
|
| Rate for Payer: PHP Medicare Advantage |
$26.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.92
|
| Rate for Payer: Priority Health HMO/PPO |
$90.92
|
| Rate for Payer: Priority Health Medicare |
$26.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.02
|
| Rate for Payer: Railroad Medicare Medicare |
$26.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.96
|
| Rate for Payer: UHC Core |
$87.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.12
|
| Rate for Payer: UHC Exchange |
$26.12
|
| Rate for Payer: UHC Medicare Advantage |
$26.12
|
| Rate for Payer: VA VA |
$26.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.38
|
|
|
QUETIAPINE 50 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 60687033801
|
| Hospital Charge Code |
70397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: BCBS Trust/PPO |
$333.46
|
| Rate for Payer: BCN Commercial |
$315.69
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.52
|
| Rate for Payer: Priority Health HMO/PPO |
$355.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.48
|
| Rate for Payer: UHC Core |
$341.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,861.81
|
|
|
Service Code
|
NDC 00310028160
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,860.18 |
| Max. Negotiated Rate |
$2,575.63 |
| Rate for Payer: Aetna Commercial |
$2,432.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,336.10
|
| Rate for Payer: BCN Commercial |
$2,211.61
|
| Rate for Payer: Cash Price |
$2,289.45
|
| Rate for Payer: Cofinity Commercial |
$2,461.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,289.45
|
| Rate for Payer: Healthscope Commercial |
$2,575.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,146.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,432.54
|
| Rate for Payer: Nomi Health Commercial |
$2,346.68
|
| Rate for Payer: PHP Commercial |
$2,432.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2,489.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,917.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,518.39
|
| Rate for Payer: UHC Core |
$2,389.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,146.36
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,861.81
|
|
|
Service Code
|
NDC 00310028160
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$679.68 |
| Max. Negotiated Rate |
$2,575.63 |
| Rate for Payer: Aetna Commercial |
$2,432.54
|
| Rate for Payer: Aetna Medicare |
$744.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.32
|
| Rate for Payer: BCBS Complete |
$1,144.72
|
| Rate for Payer: BCBS MAPPO |
$715.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,352.69
|
| Rate for Payer: BCN Commercial |
$2,225.06
|
| Rate for Payer: BCN Medicare Advantage |
$715.45
|
| Rate for Payer: Cash Price |
$2,289.45
|
| Rate for Payer: Cofinity Commercial |
$2,461.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,289.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.45
|
| Rate for Payer: Healthscope Commercial |
$2,575.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,146.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,432.54
|
| Rate for Payer: Nomi Health Commercial |
$2,346.68
|
| Rate for Payer: PACE Senior Care Partners |
$679.68
|
| Rate for Payer: PACE SWMI |
$715.45
|
| Rate for Payer: PHP Commercial |
$2,432.54
|
| Rate for Payer: PHP Medicare Advantage |
$715.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,860.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2,489.77
|
| Rate for Payer: Priority Health Medicare |
$722.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,917.41
|
| Rate for Payer: Railroad Medicare Medicare |
$715.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,518.39
|
| Rate for Payer: UHC Core |
$2,389.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.45
|
| Rate for Payer: UHC Exchange |
$715.45
|
| Rate for Payer: UHC Medicare Advantage |
$715.45
|
| Rate for Payer: VA VA |
$715.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,146.36
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$316.32
|
|
|
Service Code
|
NDC 00904680261
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$284.69 |
| Rate for Payer: Aetna Commercial |
$268.87
|
| Rate for Payer: Aetna Medicare |
$82.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.85
|
| Rate for Payer: BCBS Complete |
$126.53
|
| Rate for Payer: BCBS MAPPO |
$79.08
|
| Rate for Payer: BCBS Trust/PPO |
$260.05
|
| Rate for Payer: BCN Commercial |
$245.94
|
| Rate for Payer: BCN Medicare Advantage |
$79.08
|
| Rate for Payer: Cash Price |
$253.06
|
| Rate for Payer: Cofinity Commercial |
$272.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.08
|
| Rate for Payer: Healthscope Commercial |
$284.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.87
|
| Rate for Payer: Nomi Health Commercial |
$259.38
|
| Rate for Payer: PACE Senior Care Partners |
$75.13
|
| Rate for Payer: PACE SWMI |
$79.08
|
| Rate for Payer: PHP Commercial |
$268.87
|
| Rate for Payer: PHP Medicare Advantage |
$79.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.61
|
| Rate for Payer: Priority Health HMO/PPO |
$275.20
|
| Rate for Payer: Priority Health Medicare |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.93
|
| Rate for Payer: Railroad Medicare Medicare |
$79.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.36
|
| Rate for Payer: UHC Core |
$264.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.08
|
| Rate for Payer: UHC Exchange |
$79.08
|
| Rate for Payer: UHC Medicare Advantage |
$79.08
|
| Rate for Payer: VA VA |
$79.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.24
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$316.32
|
|
|
Service Code
|
NDC 00904680261
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.61 |
| Max. Negotiated Rate |
$284.69 |
| Rate for Payer: Aetna Commercial |
$268.87
|
| Rate for Payer: BCBS Trust/PPO |
$258.21
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$253.06
|
| Rate for Payer: Cofinity Commercial |
$272.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.06
|
| Rate for Payer: Healthscope Commercial |
$284.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.87
|
| Rate for Payer: Nomi Health Commercial |
$259.38
|
| Rate for Payer: PHP Commercial |
$268.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.61
|
| Rate for Payer: Priority Health HMO/PPO |
$275.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.36
|
| Rate for Payer: UHC Core |
$264.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.24
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 68180061307
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$34.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.97
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: BCBS MAPPO |
$32.77
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$101.93
|
| Rate for Payer: BCN Medicare Advantage |
$32.77
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: PACE Senior Care Partners |
$31.14
|
| Rate for Payer: PACE SWMI |
$32.77
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: PHP Medicare Advantage |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health HMO/PPO |
$114.06
|
| Rate for Payer: Priority Health Medicare |
$33.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.84
|
| Rate for Payer: Railroad Medicare Medicare |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.37
|
| Rate for Payer: UHC Core |
$109.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.77
|
| Rate for Payer: UHC Exchange |
$32.77
|
| Rate for Payer: UHC Medicare Advantage |
$32.77
|
| Rate for Payer: VA VA |
$32.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 68180061307
|
| Hospital Charge Code |
96233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.22 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: BCBS Trust/PPO |
$107.02
|
| Rate for Payer: BCN Commercial |
$101.31
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health HMO/PPO |
$114.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.37
|
| Rate for Payer: UHC Core |
$109.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.35
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$75.48
|
| Rate for Payer: BCBS Trust/PPO |
$248.21
|
| Rate for Payer: BCN Commercial |
$234.74
|
| Rate for Payer: BCN Medicare Advantage |
$75.48
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.48
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: Nomi Health Commercial |
$247.57
|
| Rate for Payer: PACE Senior Care Partners |
$71.71
|
| Rate for Payer: PACE SWMI |
$75.48
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: PHP Medicare Advantage |
$75.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health HMO/PPO |
$262.67
|
| Rate for Payer: Priority Health Medicare |
$76.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.29
|
| Rate for Payer: Railroad Medicare Medicare |
$75.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.69
|
| Rate for Payer: UHC Core |
$252.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.48
|
| Rate for Payer: UHC Exchange |
$75.48
|
| Rate for Payer: UHC Medicare Advantage |
$75.48
|
| Rate for Payer: VA VA |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
