St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

QUETIAPINE 25 MG TAB

Facility

$1.00

Hospital Charge Code	41641859
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

QUETIAPINE 25 MG TAB

Facility

$1.00

Hospital Charge Code	41651859
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

QUETIAPINE 300 MG TAB

Facility

$26.00

Hospital Charge Code	41642944
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$20.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.00
Rate for Payer: Aetna Government	$13.00
Rate for Payer: Brighton Health Commercial	$19.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.68
Rate for Payer: Group Health Inc Commercial	$13.00
Rate for Payer: Group Health Inc Medicare	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.90

QUETIAPINE 300 MG TAB

Facility

$26.00

Hospital Charge Code	41652944
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$20.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.00
Rate for Payer: Aetna Government	$13.00
Rate for Payer: Brighton Health Commercial	$19.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.68
Rate for Payer: Group Health Inc Commercial	$13.00
Rate for Payer: Group Health Inc Medicare	$9.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.90

QUETIAPINE 400 MG TAB

Facility

$30.00

Hospital Charge Code	41654932
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

QUETIAPINE 400 MG TAB

Facility

$30.00

Hospital Charge Code	41644932
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

QUETIAPINE 50 MG TAB

Facility

$10.00

Hospital Charge Code	41644931
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

QUETIAPINE 50 MG TAB

Facility

$10.00

Hospital Charge Code	41654931
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

QUETIAPINE FUMARATE 100 MG PO TABS [21824]

Facility

$0.56

Service Code	NDC 00904664061
Hospital Charge Code	00904664061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

QUETIAPINE FUMARATE 100 MG PO TABS [21824]

Facility

$6.86

Service Code	NDC 67877025010
Hospital Charge Code	67877025010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$5.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.66
Rate for Payer: Group Health Inc Commercial	$3.43
Rate for Payer: Group Health Inc Medicare	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43
Rate for Payer: Hamaspik Choice Inc Medicare	$3.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.46

QUETIAPINE FUMARATE 100 MG PO TABS [21824]

Facility

$6.86

Service Code	NDC 67877025001
Hospital Charge Code	67877025001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$5.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.66
Rate for Payer: Group Health Inc Commercial	$3.43
Rate for Payer: Group Health Inc Medicare	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43
Rate for Payer: Hamaspik Choice Inc Medicare	$3.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.46

QUETIAPINE FUMARATE 100 MG PO TABS [21824]

Facility

$6.48

Service Code	NDC 60687034901
Hospital Charge Code	60687034901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.24
Rate for Payer: Aetna Government	$3.24
Rate for Payer: Brighton Health Commercial	$4.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.40
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.21

QUETIAPINE FUMARATE 200 MG PO TABS [21825]

Facility

$12.94

Service Code	NDC 65862049301
Hospital Charge Code	65862049301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.47
Rate for Payer: Aetna Government	$6.47
Rate for Payer: Brighton Health Commercial	$9.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.80
Rate for Payer: Group Health Inc Commercial	$6.47
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.47
Rate for Payer: Hamaspik Choice Inc Medicare	$6.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.41

QUETIAPINE FUMARATE 200 MG PO TABS [21825]

Facility

$1.14

Service Code	NDC 00904664161
Hospital Charge Code	00904664161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.74

QUETIAPINE FUMARATE 200 MG PO TABS [21825]

Facility

$12.95

Service Code	NDC 67877024601
Hospital Charge Code	67877024601
Hospital Revenue Code	250
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.47
Rate for Payer: Aetna Government	$6.47
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.80
Rate for Payer: Group Health Inc Commercial	$6.47
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.47
Rate for Payer: Hamaspik Choice Inc Medicare	$6.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.41

QUETIAPINE FUMARATE 200 MG PO TABS [21825]

Facility

$12.22

Service Code	NDC 60687036011
Hospital Charge Code	60687036011
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$9.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.11
Rate for Payer: Aetna Government	$6.11
Rate for Payer: Brighton Health Commercial	$9.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.31
Rate for Payer: Group Health Inc Commercial	$6.11
Rate for Payer: Group Health Inc Medicare	$4.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.11
Rate for Payer: Hamaspik Choice Inc Medicare	$6.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.94

QUETIAPINE FUMARATE 25 MG PO TABS [21823]

Facility

$4.00

Service Code	NDC 67877024210
Hospital Charge Code	67877024210
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

QUETIAPINE FUMARATE 25 MG PO TABS [21823]

Facility

$4.00

Service Code	NDC 67877024201
Hospital Charge Code	67877024201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

QUETIAPINE FUMARATE 25 MG PO TABS [21823]

Facility

$0.35

Service Code	NDC 00904663861
Hospital Charge Code	00904663861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

QUETIAPINE FUMARATE 300 MG PO TABS [29267]

Facility

$0.54

Service Code	NDC 00904664261
Hospital Charge Code	00904664261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

QUETIAPINE FUMARATE 300 MG PO TABS [29267]

Facility

$16.96

Service Code	NDC 16729014901
Hospital Charge Code	16729014901
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$13.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.48
Rate for Payer: Aetna Government	$8.48
Rate for Payer: Brighton Health Commercial	$12.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.53
Rate for Payer: Group Health Inc Commercial	$8.48
Rate for Payer: Group Health Inc Medicare	$5.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.48
Rate for Payer: Hamaspik Choice Inc Medicare	$8.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.03

QUETIAPINE FUMARATE 300 MG PO TABS [29267]

Facility

$10.15

Service Code	NDC 50268063415
Hospital Charge Code	50268063415
Hospital Revenue Code	250
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$8.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.07
Rate for Payer: Aetna Government	$5.07
Rate for Payer: Brighton Health Commercial	$7.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$5.07
Rate for Payer: Group Health Inc Medicare	$3.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.07
Rate for Payer: Hamaspik Choice Inc Medicare	$5.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.60

QUETIAPINE FUMARATE 300 MG PO TABS [29267]

Facility

$16.96

Service Code	NDC 29300015116
Hospital Charge Code	29300015116
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$13.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.48
Rate for Payer: Aetna Government	$8.48
Rate for Payer: Brighton Health Commercial	$12.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.53
Rate for Payer: Group Health Inc Commercial	$8.48
Rate for Payer: Group Health Inc Medicare	$5.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.48
Rate for Payer: Hamaspik Choice Inc Medicare	$8.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.03

QUETIAPINE FUMARATE 400 MG PO TABS [70398]

Facility

$19.74

Service Code	NDC 67877024801
Hospital Charge Code	67877024801
Hospital Revenue Code	250
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$15.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.87
Rate for Payer: Aetna Government	$9.87
Rate for Payer: Brighton Health Commercial	$14.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.43
Rate for Payer: Group Health Inc Commercial	$9.87
Rate for Payer: Group Health Inc Medicare	$6.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.87
Rate for Payer: Hamaspik Choice Inc Medicare	$9.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.83

QUETIAPINE FUMARATE 400 MG PO TABS [70398]

Facility

$1.68

Service Code	NDC 00904664361
Hospital Charge Code	00904664361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

Know your out-of-pocket cost for care.

All Charges