|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.46
|
| Rate for Payer: UHC Core |
$1.17
|
| Rate for Payer: UHC Exchange |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Advantage |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.15
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 16571072001
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: BCBS Complete |
$145.70
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.76
|
| Rate for Payer: UHC Core |
$189.77
|
| Rate for Payer: UHC Exchange |
$143.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$363.85
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$327.46 |
| Rate for Payer: Aetna American Axle |
$236.50
|
| Rate for Payer: Aetna Commercial |
$309.27
|
| Rate for Payer: Aetna Medicare |
$181.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.50
|
| Rate for Payer: BCBS Complete |
$145.54
|
| Rate for Payer: Cash Price |
$291.08
|
| Rate for Payer: Cofinity Advantage |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$312.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.08
|
| Rate for Payer: Healthscope Commercial |
$327.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.89
|
| Rate for Payer: PHP Commercial |
$309.27
|
| Rate for Payer: Priority Health SBD |
$229.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.50
|
| Rate for Payer: UHC Core |
$189.57
|
| Rate for Payer: UHC Exchange |
$142.99
|
| Rate for Payer: UMR Bronson Commercial |
$134.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.89
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$363.85
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.09 |
| Max. Negotiated Rate |
$327.46 |
| Rate for Payer: Aetna American Axle |
$236.50
|
| Rate for Payer: Aetna Commercial |
$309.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.50
|
| Rate for Payer: Cash Price |
$291.08
|
| Rate for Payer: Cofinity Advantage |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$312.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.08
|
| Rate for Payer: Healthscope Commercial |
$327.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.89
|
| Rate for Payer: PHP Commercial |
$309.27
|
| Rate for Payer: Priority Health SBD |
$229.23
|
| Rate for Payer: UMR Bronson Commercial |
$160.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.89
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 16571072001
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 47335090288
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.26
|
| Rate for Payer: UHC Core |
$211.81
|
| Rate for Payer: UHC Exchange |
$159.77
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 67877024238
|
| 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 |
$339.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$339.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health SBD |
$251.69
|
| Rate for Payer: UMR Bronson Commercial |
$175.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Exchange |
$158.85
|
| Rate for Payer: UMR Bronson Commercial |
$149.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.81 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Aetna Medicare |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$319.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health SBD |
$251.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.68
|
| Rate for Payer: UHC Core |
$208.14
|
| Rate for Payer: UHC Exchange |
$157.00
|
| Rate for Payer: UMR Bronson Commercial |
$147.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Advantage |
$282.94
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 47335090288
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$365.89 |
| 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 Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| 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 Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| 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 400 MG TABLET
|
Facility
|
IP
|
$5.18
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Advantage |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.88
|
| Rate for Payer: PHP Commercial |
$4.40
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 00904664361
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna American Axle |
$306.07
|
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$245.33
|
| Rate for Payer: UHC Exchange |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$174.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.16
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$470.88
|
|
|
Service Code
|
NDC 00904664361
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.19 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna American Axle |
$306.07
|
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UMR Bronson Commercial |
$207.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.16
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$517.92
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.63 |
| Max. Negotiated Rate |
$466.13 |
| Rate for Payer: Aetna American Axle |
$336.65
|
| Rate for Payer: Aetna Commercial |
$440.23
|
| Rate for Payer: Aetna Medicare |
$258.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.65
|
| Rate for Payer: BCBS Complete |
$207.17
|
| Rate for Payer: Cash Price |
$414.34
|
| Rate for Payer: Cofinity Advantage |
$362.54
|
| Rate for Payer: Cofinity Commercial |
$445.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.34
|
| Rate for Payer: Healthscope Commercial |
$466.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.44
|
| Rate for Payer: PHP Commercial |
$440.23
|
| Rate for Payer: Priority Health SBD |
$326.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.65
|
| Rate for Payer: UHC Core |
$269.84
|
| Rate for Payer: UHC Exchange |
$203.54
|
| Rate for Payer: UMR Bronson Commercial |
$191.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.44
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$517.92
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$466.13 |
| Rate for Payer: Aetna American Axle |
$336.65
|
| Rate for Payer: Aetna Commercial |
$440.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.65
|
| Rate for Payer: Cash Price |
$414.34
|
| Rate for Payer: Cofinity Advantage |
$362.54
|
| Rate for Payer: Cofinity Commercial |
$445.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.34
|
| Rate for Payer: Healthscope Commercial |
$466.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.44
|
| Rate for Payer: PHP Commercial |
$440.23
|
| Rate for Payer: Priority Health SBD |
$326.29
|
| Rate for Payer: UMR Bronson Commercial |
$227.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.44
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$5.18
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Aetna Medicare |
$2.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: Cash Price |
$4.14
|
| Rate for Payer: Cofinity Advantage |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$4.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.88
|
| Rate for Payer: PHP Commercial |
$4.40
|
| Rate for Payer: Priority Health SBD |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$2.70
|
| Rate for Payer: UHC Exchange |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.88
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$180.69
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna American Axle |
$117.45
|
| Rate for Payer: Aetna Commercial |
$153.59
|
| Rate for Payer: Aetna Medicare |
$90.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.45
|
| Rate for Payer: BCBS Complete |
$72.28
|
| Rate for Payer: Cash Price |
$144.55
|
| Rate for Payer: Cofinity Advantage |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$155.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.55
|
| Rate for Payer: Healthscope Commercial |
$162.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.52
|
| Rate for Payer: PHP Commercial |
$153.59
|
| Rate for Payer: Priority Health SBD |
$113.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.45
|
| Rate for Payer: UHC Core |
$94.14
|
| Rate for Payer: UHC Exchange |
$71.01
|
| Rate for Payer: UMR Bronson Commercial |
$66.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.52
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,350.87
|
|
|
Service Code
|
NDC 00310028260
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,239.82 |
| Max. Negotiated Rate |
$3,015.78 |
| Rate for Payer: Aetna American Axle |
$2,178.07
|
| Rate for Payer: Aetna Commercial |
$2,848.24
|
| Rate for Payer: Aetna Medicare |
$1,675.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,178.07
|
| Rate for Payer: BCBS Complete |
$1,340.35
|
| Rate for Payer: Cash Price |
$2,680.70
|
| Rate for Payer: Cofinity Advantage |
$2,345.61
|
| Rate for Payer: Cofinity Commercial |
$2,881.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,680.70
|
| Rate for Payer: Healthscope Commercial |
$3,015.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,345.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,513.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,680.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,848.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,513.15
|
| Rate for Payer: PHP Commercial |
$2,848.24
|
| Rate for Payer: Priority Health SBD |
$2,111.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,178.07
|
| Rate for Payer: UHC Core |
$1,745.80
|
| Rate for Payer: UHC Exchange |
$1,316.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,239.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,513.15
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$180.69
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna American Axle |
$117.45
|
| Rate for Payer: Aetna Commercial |
$153.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.45
|
| Rate for Payer: Cash Price |
$144.55
|
| Rate for Payer: Cofinity Advantage |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$155.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.55
|
| Rate for Payer: Healthscope Commercial |
$162.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.52
|
| Rate for Payer: PHP Commercial |
$153.59
|
| Rate for Payer: Priority Health SBD |
$113.83
|
| Rate for Payer: UMR Bronson Commercial |
$79.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.52
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$425.76
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Advantage |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.32
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UMR Bronson Commercial |
$187.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,350.87
|
|
|
Service Code
|
NDC 00310028260
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,474.38 |
| Max. Negotiated Rate |
$3,015.78 |
| Rate for Payer: Aetna American Axle |
$2,178.07
|
| Rate for Payer: Aetna Commercial |
$2,848.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,178.07
|
| Rate for Payer: Cash Price |
$2,680.70
|
| Rate for Payer: Cofinity Advantage |
$2,345.61
|
| Rate for Payer: Cofinity Commercial |
$2,881.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,680.70
|
| Rate for Payer: Healthscope Commercial |
$3,015.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,345.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,513.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,848.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,513.15
|
| Rate for Payer: PHP Commercial |
$2,848.24
|
| Rate for Payer: Priority Health SBD |
$2,111.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,474.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,513.15
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$425.76
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna American Axle |
$276.74
|
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna Medicare |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: BCBS Complete |
$170.30
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Advantage |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.32
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health SBD |
$268.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.74
|
| Rate for Payer: UHC Core |
$221.82
|
| Rate for Payer: UHC Exchange |
$167.32
|
| Rate for Payer: UMR Bronson Commercial |
$157.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.32
|
|
