|
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 25 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 67877024238
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| 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 Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| 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 |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$147.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
QUETIAPINE 25 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
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 |
$339.58
|
| 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: Cofinity Medicare Advantage |
$279.65
|
| 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 |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| 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
|
$361.90
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
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 |
$365.90 |
| 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 |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.26
|
| 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
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 47335090288
|
| Hospital Charge Code |
21823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$365.90 |
| 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 Commercial |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$345.57
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.26
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$463.68
|
|
|
Service Code
|
NDC 00904664361
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna Medicare |
$231.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: BCBS Complete |
$185.47
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.39
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UMR Bronson Commercial |
$171.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.79 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$255.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: BCBS Complete |
$204.10
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$463.68
|
|
|
Service Code
|
NDC 00904664361
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.02 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.39
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UMR Bronson Commercial |
$204.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 60687038211
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
QUETIAPINE 400 MG TABLET
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
NDC 60687038201
|
| Hospital Charge Code |
70398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.51 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$224.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,149.74
|
|
|
Service Code
|
NDC 00310028260
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,165.40 |
| 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 Medicare |
$1,574.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.33
|
| Rate for Payer: BCBS Complete |
$1,259.90
|
| 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: Cofinity Medicare Advantage |
$2,204.82
|
| 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 Commercial |
$2,677.28
|
| Rate for Payer: PHP Commercial |
$2,677.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.33
|
| Rate for Payer: Priority Health SBD |
$1,984.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,362.30
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,149.74
|
|
|
Service Code
|
NDC 00310028260
|
| 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: Cofinity Medicare Advantage |
$2,204.82
|
| 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 Commercial |
$2,677.28
|
| Rate for Payer: PHP Commercial |
$2,677.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.33
|
| 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 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$433.92
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Cofinity Commercial |
$303.74
|
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna Medicare |
$216.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: BCBS Complete |
$173.57
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.05
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$160.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$152.19
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna American Axle |
$98.92
|
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.92
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$106.53
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health SBD |
$95.88
|
| Rate for Payer: UMR Bronson Commercial |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$152.19
|
|
|
Service Code
|
NDC 68180061407
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna American Axle |
$98.92
|
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Aetna Medicare |
$76.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.92
|
| Rate for Payer: BCBS Complete |
$60.88
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$106.53
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health SBD |
$95.88
|
| Rate for Payer: UMR Bronson Commercial |
$56.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$433.92
|
|
|
Service Code
|
NDC 00904680361
|
| Hospital Charge Code |
82089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna American Axle |
$282.05
|
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.05
|
| Rate for Payer: Cash Price |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$373.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.14
|
| Rate for Payer: Healthscope Commercial |
$390.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.83
|
| Rate for Payer: PHP Commercial |
$368.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.05
|
| Rate for Payer: Priority Health SBD |
$273.37
|
| Rate for Payer: UMR Bronson Commercial |
$190.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.44
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.69 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna American Axle |
$305.14
|
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna Medicare |
$234.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: BCBS Complete |
$187.78
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
| Rate for Payer: UMR Bronson Commercial |
$173.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.08
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$469.44
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna American Axle |
$305.14
|
| Rate for Payer: Aetna Commercial |
$399.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.14
|
| Rate for Payer: Cash Price |
$375.55
|
| Rate for Payer: Cofinity Commercial |
$328.61
|
| Rate for Payer: Cofinity Commercial |
$403.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.55
|
| Rate for Payer: Healthscope Commercial |
$422.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.02
|
| Rate for Payer: PHP Commercial |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.14
|
| Rate for Payer: Priority Health SBD |
$295.75
|
| Rate for Payer: UMR Bronson Commercial |
$206.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.08
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$220.02
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$198.02 |
| Rate for Payer: Aetna American Axle |
$143.01
|
| Rate for Payer: Aetna Commercial |
$187.02
|
| Rate for Payer: Aetna Medicare |
$110.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.01
|
| Rate for Payer: BCBS Complete |
$88.01
|
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.02
|
| Rate for Payer: Healthscope Commercial |
$198.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.02
|
| Rate for Payer: PHP Commercial |
$187.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.01
|
| Rate for Payer: Priority Health SBD |
$138.61
|
| Rate for Payer: UMR Bronson Commercial |
$81.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.02
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$220.02
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$198.02 |
| Rate for Payer: Aetna American Axle |
$143.01
|
| Rate for Payer: Aetna Commercial |
$187.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.01
|
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.02
|
| Rate for Payer: Healthscope Commercial |
$198.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.02
|
| Rate for Payer: PHP Commercial |
$187.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.01
|
| Rate for Payer: Priority Health SBD |
$138.61
|
| Rate for Payer: UMR Bronson Commercial |
$96.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.02
|
|
