|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 60687-349-01
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$142.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.61
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.98
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 67877-250-01
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna American Axle |
$65.68
|
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.68
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.89
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.74
|
| Rate for Payer: Priority Health SBD |
$63.66
|
| Rate for Payer: UMR Bronson Commercial |
$44.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 60687-349-11
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 0904-6640-61
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.56 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna American Axle |
$204.68
|
| Rate for Payer: Aetna Commercial |
$267.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.68
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Commercial |
$220.43
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.66
|
| Rate for Payer: PHP Commercial |
$267.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.43
|
| Rate for Payer: Priority Health SBD |
$198.39
|
| Rate for Payer: UMR Bronson Commercial |
$138.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 0904-6641-61
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.22
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.88
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UMR Bronson Commercial |
$112.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$424.32
|
|
|
Service Code
|
NDC 63739-677-10
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.70 |
| Max. Negotiated Rate |
$381.89 |
| Rate for Payer: Aetna American Axle |
$275.81
|
| Rate for Payer: Aetna Commercial |
$360.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.81
|
| Rate for Payer: Cash Price |
$339.46
|
| Rate for Payer: Cofinity Commercial |
$297.02
|
| Rate for Payer: Cofinity Commercial |
$364.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.46
|
| Rate for Payer: Healthscope Commercial |
$381.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.67
|
| Rate for Payer: PHP Commercial |
$360.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.02
|
| Rate for Payer: Priority Health SBD |
$267.32
|
| Rate for Payer: UMR Bronson Commercial |
$186.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.24
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 47335-902-88
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$365.90 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Cofinity Commercial |
$284.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.58
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$178.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 67877-242-38
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.65
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$175.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$487.20
|
|
|
Service Code
|
NDC 60687-382-01
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$438.48 |
| Rate for Payer: Aetna American Axle |
$316.68
|
| Rate for Payer: Aetna Commercial |
$414.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.68
|
| Rate for Payer: Cash Price |
$389.76
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$438.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.12
|
| Rate for Payer: PHP Commercial |
$414.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.04
|
| Rate for Payer: Priority Health SBD |
$306.94
|
| Rate for Payer: UMR Bronson Commercial |
$214.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.40
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$350.88
|
|
|
Service Code
|
NDC 0904-6643-61
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$315.79 |
| Rate for Payer: Aetna American Axle |
$228.07
|
| Rate for Payer: Aetna Commercial |
$298.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.07
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$315.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.25
|
| Rate for Payer: PHP Commercial |
$298.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.62
|
| Rate for Payer: Priority Health SBD |
$221.05
|
| Rate for Payer: UMR Bronson Commercial |
$154.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.16
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 60687-382-11
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna American Axle |
$3.17
|
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.17
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$4.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$4.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.15
|
| Rate for Payer: PHP Commercial |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.42
|
| Rate for Payer: Priority Health SBD |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.66
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$428.64
|
|
|
Service Code
|
NDC 0904-6803-61
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$385.78 |
| Rate for Payer: Aetna American Axle |
$278.62
|
| Rate for Payer: Aetna Commercial |
$364.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.62
|
| Rate for Payer: Cash Price |
$342.91
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Commercial |
$368.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.91
|
| Rate for Payer: Healthscope Commercial |
$385.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.34
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.05
|
| Rate for Payer: Priority Health SBD |
$270.04
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.48
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$149.34
|
|
|
Service Code
|
NDC 68180-614-07
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Aetna American Axle |
$97.07
|
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: Cash Price |
$119.47
|
| Rate for Payer: Cofinity Commercial |
$104.54
|
| Rate for Payer: Cofinity Commercial |
$128.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.47
|
| Rate for Payer: Healthscope Commercial |
$134.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.94
|
| Rate for Payer: PHP Commercial |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.54
|
| Rate for Payer: Priority Health SBD |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.00
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,149.74
|
|
|
Service Code
|
NDC 0310-0282-60
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,385.89 |
| Max. Negotiated Rate |
$2,834.77 |
| Rate for Payer: Aetna American Axle |
$2,047.33
|
| Rate for Payer: Aetna Commercial |
$2,677.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.33
|
| Rate for Payer: Cash Price |
$2,519.79
|
| Rate for Payer: Cofinity Commercial |
$2,204.82
|
| Rate for Payer: Cofinity Commercial |
$2,708.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,519.79
|
| Rate for Payer: Healthscope Commercial |
$2,834.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,204.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,362.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,677.28
|
| Rate for Payer: PHP Commercial |
$2,677.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,204.82
|
| Rate for Payer: Priority Health SBD |
$1,984.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,385.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,362.30
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$458.40
|
|
|
Service Code
|
NDC 0904-6804-61
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.70 |
| Max. Negotiated Rate |
$412.56 |
| Rate for Payer: Aetna American Axle |
$297.96
|
| Rate for Payer: Aetna Commercial |
$389.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.96
|
| Rate for Payer: Cash Price |
$366.72
|
| Rate for Payer: Cofinity Commercial |
$320.88
|
| Rate for Payer: Cofinity Commercial |
$394.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.72
|
| Rate for Payer: Healthscope Commercial |
$412.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.64
|
| Rate for Payer: PHP Commercial |
$389.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.88
|
| Rate for Payer: Priority Health SBD |
$288.79
|
| Rate for Payer: UMR Bronson Commercial |
$201.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.80
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$189.24
|
|
|
Service Code
|
NDC 68180-615-07
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$170.32 |
| Rate for Payer: Aetna American Axle |
$123.01
|
| Rate for Payer: Aetna Commercial |
$160.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.01
|
| Rate for Payer: Cash Price |
$151.39
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.39
|
| Rate for Payer: Healthscope Commercial |
$170.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.85
|
| Rate for Payer: PHP Commercial |
$160.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.47
|
| Rate for Payer: Priority Health SBD |
$119.22
|
| Rate for Payer: UMR Bronson Commercial |
$83.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.93
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$209.76
|
|
|
Service Code
|
NDC 16729-096-12
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.29 |
| Max. Negotiated Rate |
$188.78 |
| Rate for Payer: Aetna American Axle |
$136.34
|
| Rate for Payer: Aetna Commercial |
$178.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.34
|
| Rate for Payer: Cash Price |
$167.81
|
| Rate for Payer: Cofinity Commercial |
$146.83
|
| Rate for Payer: Cofinity Commercial |
$180.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.81
|
| Rate for Payer: Healthscope Commercial |
$188.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.30
|
| Rate for Payer: PHP Commercial |
$178.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.83
|
| Rate for Payer: Priority Health SBD |
$132.15
|
| Rate for Payer: UMR Bronson Commercial |
$92.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.32
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,041.96
|
|
|
Service Code
|
NDC 0310-0283-60
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,778.46 |
| Max. Negotiated Rate |
$3,637.76 |
| Rate for Payer: Aetna American Axle |
$2,627.27
|
| Rate for Payer: Aetna Commercial |
$3,435.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.27
|
| Rate for Payer: Cash Price |
$3,233.57
|
| Rate for Payer: Cofinity Commercial |
$2,829.37
|
| Rate for Payer: Cofinity Commercial |
$3,476.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.57
|
| Rate for Payer: Healthscope Commercial |
$3,637.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,435.67
|
| Rate for Payer: PHP Commercial |
$3,435.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,829.37
|
| Rate for Payer: Priority Health SBD |
$2,546.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,778.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.47
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 68180-612-07
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.70
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$295.20
|
|
|
Service Code
|
NDC 0904-6801-61
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.89 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: Aetna American Axle |
$191.88
|
| Rate for Payer: Aetna Commercial |
$250.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.88
|
| Rate for Payer: Cash Price |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$253.87
|
| Rate for Payer: Cofinity Commercial |
$206.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.16
|
| Rate for Payer: Healthscope Commercial |
$265.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.92
|
| Rate for Payer: PHP Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.64
|
| Rate for Payer: Priority Health SBD |
$185.98
|
| Rate for Payer: UMR Bronson Commercial |
$129.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.40
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,686.98
|
|
|
Service Code
|
NDC 0310-0280-60
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$742.27 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna American Axle |
$1,096.54
|
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,265.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.89
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
| Rate for Payer: UMR Bronson Commercial |
$742.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,265.24
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,858.88
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$817.91 |
| Max. Negotiated Rate |
$1,672.99 |
| Rate for Payer: Aetna American Axle |
$1,208.27
|
| Rate for Payer: Aetna Commercial |
$1,580.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.27
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cofinity Commercial |
$1,301.22
|
| Rate for Payer: Cofinity Commercial |
$1,598.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,487.10
|
| Rate for Payer: Healthscope Commercial |
$1,672.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,301.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,394.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,580.05
|
| Rate for Payer: PHP Commercial |
$1,580.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.22
|
| Rate for Payer: Priority Health SBD |
$1,171.09
|
| Rate for Payer: UMR Bronson Commercial |
$817.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,394.16
|
|
|
QUINIDINE SULFATE 300 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 0185-1047-01
|
| Hospital Charge Code |
6778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$290.70
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
RABEPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,964.37
|
|
|
Service Code
|
NDC 62856-243-30
|
| Hospital Charge Code |
25896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$864.32 |
| Max. Negotiated Rate |
$1,767.93 |
| Rate for Payer: Aetna American Axle |
$1,276.84
|
| Rate for Payer: Aetna Commercial |
$1,669.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.84
|
| Rate for Payer: Cash Price |
$1,571.50
|
| Rate for Payer: Cofinity Commercial |
$1,375.06
|
| Rate for Payer: Cofinity Commercial |
$1,689.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.50
|
| Rate for Payer: Healthscope Commercial |
$1,767.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.71
|
| Rate for Payer: PHP Commercial |
$1,669.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,375.06
|
| Rate for Payer: Priority Health SBD |
$1,237.55
|
| Rate for Payer: UMR Bronson Commercial |
$864.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.28
|
|
