St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

QUETIAPINE FUMARATE 50 MG PO TABS [70397]

Facility

$6.19

Service Code	NDC 50268063115
Hospital Charge Code	50268063115
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.09
Rate for Payer: Aetna Government	$3.09
Rate for Payer: Brighton Health Commercial	$4.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.21
Rate for Payer: Group Health Inc Commercial	$3.09
Rate for Payer: Group Health Inc Medicare	$2.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.09
Rate for Payer: Hamaspik Choice Inc Medicare	$3.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.02

QUETIAPINE FUMARATE 50 MG PO TABS [70397]

Facility

$0.56

Service Code	NDC 00904663961
Hospital Charge Code	00904663961
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 50 MG PO TABS [70397]

Facility

$6.40

Service Code	NDC 47335090318
Hospital Charge Code	47335090318
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$5.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.20
Rate for Payer: Aetna Government	$3.20
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.35
Rate for Payer: Group Health Inc Commercial	$3.20
Rate for Payer: Group Health Inc Medicare	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.16

QUETIAPINE FUMARATE 50 MG PO TABS [70397]

Facility

$6.57

Service Code	NDC 67877024910
Hospital Charge Code	67877024910
Hospital Revenue Code	250
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$5.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.28
Rate for Payer: Aetna Government	$3.28
Rate for Payer: Brighton Health Commercial	$4.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.47
Rate for Payer: Group Health Inc Commercial	$3.28
Rate for Payer: Group Health Inc Medicare	$2.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.28
Rate for Payer: Hamaspik Choice Inc Medicare	$3.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27

QUICKCAT EXTRATION CATHETER

Facility

$900.00

Hospital Charge Code	66522000
Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

QUICKCLOT 4X4 HEMOSTAT DRESSING

Facility

$36.00

Hospital Charge Code	66573449
Hospital Revenue Code	272
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$28.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.00
Rate for Payer: Aetna Government	$18.00
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.48
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00

QUICKDRIVE MINI BATTERY SURGICAL

Facility

$473.60

Hospital Charge Code	64905199
Hospital Revenue Code	270
Min. Negotiated Rate	$165.76
Max. Negotiated Rate	$378.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.80
Rate for Payer: Aetna Government	$236.80
Rate for Payer: Brighton Health Commercial	$355.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.05
Rate for Payer: Group Health Inc Commercial	$236.80
Rate for Payer: Group Health Inc Medicare	$165.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.80
Rate for Payer: Hamaspik Choice Inc Medicare	$236.80

QUICK PRESSURE MONITOR SET

Facility

$268.72

Hospital Charge Code	64905396
Hospital Revenue Code	270
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$214.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$147.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.36
Rate for Payer: Aetna Government	$134.36
Rate for Payer: Brighton Health Commercial	$201.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$214.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.73
Rate for Payer: Group Health Inc Commercial	$134.36
Rate for Payer: Group Health Inc Medicare	$94.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.36
Rate for Payer: Hamaspik Choice Inc Medicare	$134.36

QUICKSET KIT 16CC

Facility

$10,687.50

Hospital Charge Code	64905896
Hospital Revenue Code	270
Min. Negotiated Rate	$3,740.62
Max. Negotiated Rate	$8,550.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,878.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,343.75
Rate for Payer: Aetna Government	$5,343.75
Rate for Payer: Brighton Health Commercial	$8,015.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,267.50
Rate for Payer: Group Health Inc Commercial	$5,343.75
Rate for Payer: Group Health Inc Medicare	$3,740.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,343.75
Rate for Payer: Hamaspik Choice Inc Medicare	$5,343.75

QUICK VUE ONE STEP HCG CONTROL

Facility

$527.40

Hospital Charge Code	64902979
Hospital Revenue Code	270
Min. Negotiated Rate	$184.59
Max. Negotiated Rate	$421.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$263.70
Rate for Payer: Aetna Government	$263.70
Rate for Payer: Brighton Health Commercial	$395.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$421.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$358.63
Rate for Payer: Group Health Inc Commercial	$263.70
Rate for Payer: Group Health Inc Medicare	$184.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$263.70
Rate for Payer: Hamaspik Choice Inc Medicare	$263.70

QUIETAPINE XR TABLET 150 MG

Facility

$16.00

Hospital Charge Code	41656028
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

QUIETAPINE XR TABLET 150MG

Facility

$16.00

Hospital Charge Code	41646028
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

QUIETAPINE XR TABLET 200 MG

Facility

$18.00

Hospital Charge Code	41646029
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

QUIETAPINE XR TABLET 200 MG

Facility

$18.00

Hospital Charge Code	41656029
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

QUIETAPINE XR TABLET 300 MG

Facility

$23.00

Hospital Charge Code	41646030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$18.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.50
Rate for Payer: Aetna Government	$11.50
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.64
Rate for Payer: Group Health Inc Commercial	$11.50
Rate for Payer: Group Health Inc Medicare	$8.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.95

QUIETAPINE XR TABLET 300 MG

Facility

$23.00

Hospital Charge Code	41656030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$18.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.50
Rate for Payer: Aetna Government	$11.50
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.64
Rate for Payer: Group Health Inc Commercial	$11.50
Rate for Payer: Group Health Inc Medicare	$8.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.95

QUIETAPINE XR TABLET 400 MG

Facility

$27.00

Hospital Charge Code	41656031
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$21.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.50
Rate for Payer: Aetna Government	$13.50
Rate for Payer: Brighton Health Commercial	$20.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.36
Rate for Payer: Group Health Inc Commercial	$13.50
Rate for Payer: Group Health Inc Medicare	$9.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.50
Rate for Payer: Hamaspik Choice Inc Medicare	$13.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.55

QUIETAPINE XR TABLET 400 MG

Facility

$27.00

Hospital Charge Code	41646031
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$21.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.50
Rate for Payer: Aetna Government	$13.50
Rate for Payer: Brighton Health Commercial	$20.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.36
Rate for Payer: Group Health Inc Commercial	$13.50
Rate for Payer: Group Health Inc Medicare	$9.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.50
Rate for Payer: Hamaspik Choice Inc Medicare	$13.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.55

QUINIDINE GLUCONATE 324 MG TAB CR

Facility

$1.78

Hospital Charge Code	41642968
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

QUINIDINE GLUCONATE 324 MG TAB CR

Facility

$1.78

Hospital Charge Code	41652968
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

QUINIDINE GLUCONATE 80 MG/ML INJ

Facility

$35.56

Hospital Charge Code	41642581
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$28.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.78
Rate for Payer: Aetna Government	$17.78
Rate for Payer: Brighton Health Commercial	$26.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.18
Rate for Payer: Group Health Inc Commercial	$17.78
Rate for Payer: Group Health Inc Medicare	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.78
Rate for Payer: Hamaspik Choice Inc Medicare	$17.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.11

QUINIDINE GLUCONATE 80 MG/ML INJ

Facility

$35.56

Hospital Charge Code	41652581
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$28.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.78
Rate for Payer: Aetna Government	$17.78
Rate for Payer: Brighton Health Commercial	$26.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.18
Rate for Payer: Group Health Inc Commercial	$17.78
Rate for Payer: Group Health Inc Medicare	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.78
Rate for Payer: Hamaspik Choice Inc Medicare	$17.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.11

QUINIDINE GLUCONATE ER 324 MG PO TBCR [12197]

Facility

$15.30

Service Code	NDC 51407028801
Hospital Charge Code	51407028801
Hospital Revenue Code	250
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$12.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.65
Rate for Payer: Aetna Government	$7.65
Rate for Payer: Brighton Health Commercial	$11.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.40
Rate for Payer: Group Health Inc Commercial	$7.65
Rate for Payer: Group Health Inc Medicare	$5.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.65
Rate for Payer: Hamaspik Choice Inc Medicare	$7.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.94

QUINIDINE GLUCONATE ER 324 MG PO TBCR [12197]

Facility

$9.06

Service Code	NDC 53489014101
Hospital Charge Code	53489014101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$7.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.53
Rate for Payer: Aetna Government	$4.53
Rate for Payer: Brighton Health Commercial	$6.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.16
Rate for Payer: Group Health Inc Commercial	$4.53
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53
Rate for Payer: Hamaspik Choice Inc Medicare	$4.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.89

QUINIDINE SULFATE 200 MG PO TABS [6777]

Facility

$15.09

Service Code	NDC 42806051330
Hospital Charge Code	42806051330
Hospital Revenue Code	250
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$12.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.54
Rate for Payer: Aetna Government	$7.54
Rate for Payer: Brighton Health Commercial	$11.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$7.54
Rate for Payer: Group Health Inc Medicare	$5.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.54
Rate for Payer: Hamaspik Choice Inc Medicare	$7.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.81

Know your out-of-pocket cost for care.

All Charges