|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$76.30
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$68.67 |
| Rate for Payer: Aetna American Axle |
$49.60
|
| Rate for Payer: Aetna Commercial |
$64.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.60
|
| Rate for Payer: Cash Price |
$61.04
|
| Rate for Payer: Cofinity Commercial |
$53.41
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.04
|
| Rate for Payer: Healthscope Commercial |
$68.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.86
|
| Rate for Payer: PHP Commercial |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.60
|
| Rate for Payer: Priority Health SBD |
$48.07
|
| Rate for Payer: UMR Bronson Commercial |
$33.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.22
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 57896085401
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna Medicare |
$72.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| Rate for Payer: BCBS Complete |
$57.96
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.18
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$53.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 57896085401
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.18
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$63.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG TABLET
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 50268085911
|
| Hospital Charge Code |
6745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna American Axle |
$0.99
|
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.61
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.22
|
| Rate for Payer: Healthscope Commercial |
$1.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: PHP Commercial |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.99
|
| Rate for Payer: Priority Health SBD |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$0.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.15
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$94.50
|
|
|
Service Code
|
NDC 10006070012
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna Medicare |
$47.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.32
|
| Rate for Payer: PHP Commercial |
$80.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.54
|
| Rate for Payer: UMR Bronson Commercial |
$34.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$176.40
|
|
|
Service Code
|
NDC 37864090901
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna Medicare |
$88.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: BCBS Complete |
$70.56
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$65.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 10006073017
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$94.50
|
|
|
Service Code
|
NDC 10006070012
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Aetna American Axle |
$61.42
|
| Rate for Payer: Aetna Commercial |
$80.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.42
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$66.15
|
| Rate for Payer: Cofinity Commercial |
$81.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.60
|
| Rate for Payer: Healthscope Commercial |
$85.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.32
|
| Rate for Payer: PHP Commercial |
$80.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.42
|
| Rate for Payer: Priority Health SBD |
$59.54
|
| Rate for Payer: UMR Bronson Commercial |
$41.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.88
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
IP
|
$176.40
|
|
|
Service Code
|
NDC 37864090901
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna American Axle |
$114.66
|
| Rate for Payer: Aetna Commercial |
$149.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.66
|
| Rate for Payer: Cash Price |
$141.12
|
| Rate for Payer: Cofinity Commercial |
$123.48
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.12
|
| Rate for Payer: Healthscope Commercial |
$158.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.94
|
| Rate for Payer: PHP Commercial |
$149.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.66
|
| Rate for Payer: Priority Health SBD |
$111.13
|
| Rate for Payer: UMR Bronson Commercial |
$77.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.30
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 10006073017
|
| Hospital Charge Code |
6748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
OP
|
$21.55
|
|
|
Service Code
|
NDC 09900000367
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
QUETIAPINE 100MG/ML TOPICAL GEL CUSTOM
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
NDC 09900000367
|
| Hospital Charge Code |
161484
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.16
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 60687034911
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
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: Cofinity Medicare Advantage |
$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 Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| 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 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.53 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$198.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 60687034901
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
QUETIAPINE 100 MG TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 67877025001
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
IP
|
$303.05
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$272.74 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Commercial |
$212.14
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$133.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
QUETIAPINE 200 MG TABLET
|
Facility
|
OP
|
$303.05
|
|
|
Service Code
|
NDC 00904664161
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.13 |
| Max. Negotiated Rate |
$272.74 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna Medicare |
$151.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Commercial |
$212.14
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$112.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
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 Commercial |
$254.98
|
| Rate for Payer: Cofinity Commercial |
$313.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.98
|
| 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 |
$254.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.76
|
| 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 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 Commercial |
$254.98
|
| Rate for Payer: Cofinity Commercial |
$313.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.98
|
| 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 |
$254.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.76
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| 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
|
$424.32
|
|
|
Service Code
|
NDC 63739067710
|
| Hospital Charge Code |
21825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$381.89 |
| Rate for Payer: Aetna American Axle |
$275.81
|
| Rate for Payer: Aetna Commercial |
$360.67
|
| Rate for Payer: Aetna Medicare |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.81
|
| Rate for Payer: BCBS Complete |
$169.73
|
| Rate for Payer: Cash Price |
$339.46
|
| Rate for Payer: Cofinity Commercial |
$297.02
|
| Rate for Payer: Cofinity Commercial |
$364.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.02
|
| 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 Commercial |
$360.67
|
| Rate for Payer: PHP Commercial |
$360.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.81
|
| Rate for Payer: Priority Health SBD |
$267.32
|
| Rate for Payer: UMR Bronson Commercial |
$157.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.24
|
|
