Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$101.52

Service Code	NDC 68180029407
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$86.29
Rate for Payer: Aetna New Business (MI Preferred)	$65.99
Rate for Payer: Cash Price	$81.22
Rate for Payer: Cofinity Advantage	$71.06
Rate for Payer: Cofinity Commercial	$87.31
Rate for Payer: Encore Health Key Benefits Commercial	$81.22
Rate for Payer: Healthscope Commercial	$91.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.14
Rate for Payer: PHP Commercial	$86.29
Rate for Payer: Priority Health SBD	$63.96

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$159.03

Service Code	NDC 27241009706
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$143.13
Rate for Payer: Aetna Commercial	$135.18
Rate for Payer: Aetna Medicare	$79.52
Rate for Payer: Aetna New Business (MI Preferred)	$103.37
Rate for Payer: BCBS Complete	$63.61
Rate for Payer: Cash Price	$127.22
Rate for Payer: Cofinity Advantage	$111.32
Rate for Payer: Cofinity Commercial	$136.77
Rate for Payer: Encore Health Key Benefits Commercial	$127.22
Rate for Payer: Healthscope Commercial	$143.13
Rate for Payer: MI Amish Medical Board Commercial	$127.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.27
Rate for Payer: PHP Commercial	$135.18
Rate for Payer: Priority Health SBD	$100.19
Rate for Payer: UHC All Payor (Choice/PPO)	$103.37
Rate for Payer: UHC Core	$82.85
Rate for Payer: UHC Exchange	$62.50

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$159.03

Service Code	NDC 27241009706
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$100.19
Max. Negotiated Rate	$143.13
Rate for Payer: Aetna Commercial	$135.18
Rate for Payer: Aetna New Business (MI Preferred)	$103.37
Rate for Payer: Cash Price	$127.22
Rate for Payer: Cofinity Advantage	$111.32
Rate for Payer: Cofinity Commercial	$136.77
Rate for Payer: Encore Health Key Benefits Commercial	$127.22
Rate for Payer: Healthscope Commercial	$143.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.27
Rate for Payer: PHP Commercial	$135.18
Rate for Payer: Priority Health SBD	$100.19

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$115.35

Service Code	NDC 00904704304
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$72.67
Max. Negotiated Rate	$103.81
Rate for Payer: Aetna Commercial	$98.05
Rate for Payer: Aetna New Business (MI Preferred)	$74.98
Rate for Payer: Cash Price	$92.28
Rate for Payer: Cofinity Advantage	$80.75
Rate for Payer: Cofinity Commercial	$99.20
Rate for Payer: Encore Health Key Benefits Commercial	$92.28
Rate for Payer: Healthscope Commercial	$103.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.51
Rate for Payer: PHP Commercial	$98.05
Rate for Payer: Priority Health SBD	$72.67

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$1,721.84

Service Code	NDC 00002323560
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$1,084.76
Max. Negotiated Rate	$1,549.66
Rate for Payer: Aetna Commercial	$1,463.56
Rate for Payer: Aetna New Business (MI Preferred)	$1,119.20
Rate for Payer: Cash Price	$1,377.47
Rate for Payer: Cofinity Advantage	$1,205.29
Rate for Payer: Cofinity Commercial	$1,480.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,377.47
Rate for Payer: Healthscope Commercial	$1,549.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,463.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,291.38
Rate for Payer: PHP Commercial	$1,463.56
Rate for Payer: Priority Health SBD	$1,084.76

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$101.52

Service Code	NDC 68180029407
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$91.37
Rate for Payer: Aetna Commercial	$86.29
Rate for Payer: Aetna Medicare	$50.76
Rate for Payer: Aetna New Business (MI Preferred)	$65.99
Rate for Payer: BCBS Complete	$40.61
Rate for Payer: Cash Price	$81.22
Rate for Payer: Cofinity Advantage	$71.06
Rate for Payer: Cofinity Commercial	$87.31
Rate for Payer: Encore Health Key Benefits Commercial	$81.22
Rate for Payer: Healthscope Commercial	$91.37
Rate for Payer: MI Amish Medical Board Commercial	$81.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.14
Rate for Payer: PHP Commercial	$86.29
Rate for Payer: Priority Health SBD	$63.96
Rate for Payer: UHC All Payor (Choice/PPO)	$65.99
Rate for Payer: UHC Core	$52.89
Rate for Payer: UHC Exchange	$39.90

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$4.24

Service Code	NDC 60687072311
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare	$2.12
Rate for Payer: Aetna New Business (MI Preferred)	$2.76
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.39
Rate for Payer: Cofinity Advantage	$2.97
Rate for Payer: Cofinity Commercial	$3.65
Rate for Payer: Encore Health Key Benefits Commercial	$3.39
Rate for Payer: Healthscope Commercial	$3.82
Rate for Payer: MI Amish Medical Board Commercial	$3.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.18
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health SBD	$2.67
Rate for Payer: UHC All Payor (Choice/PPO)	$2.76
Rate for Payer: UHC Core	$2.21
Rate for Payer: UHC Exchange	$1.67

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$7.15

Service Code	NDC 68084068311
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna New Business (MI Preferred)	$4.65
Rate for Payer: Cash Price	$5.72
Rate for Payer: Cofinity Advantage	$5.00
Rate for Payer: Cofinity Commercial	$6.15
Rate for Payer: Encore Health Key Benefits Commercial	$5.72
Rate for Payer: Healthscope Commercial	$6.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.36
Rate for Payer: PHP Commercial	$6.08
Rate for Payer: Priority Health SBD	$4.50

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$7.15

Service Code	NDC 68084068311
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare	$3.58
Rate for Payer: Aetna New Business (MI Preferred)	$4.65
Rate for Payer: BCBS Complete	$2.86
Rate for Payer: Cash Price	$5.72
Rate for Payer: Cofinity Advantage	$5.00
Rate for Payer: Cofinity Commercial	$6.15
Rate for Payer: Encore Health Key Benefits Commercial	$5.72
Rate for Payer: Healthscope Commercial	$6.43
Rate for Payer: MI Amish Medical Board Commercial	$5.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.36
Rate for Payer: PHP Commercial	$6.08
Rate for Payer: Priority Health SBD	$4.50
Rate for Payer: UHC All Payor (Choice/PPO)	$4.65
Rate for Payer: UHC Core	$3.73
Rate for Payer: UHC Exchange	$2.81

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$714.24

Service Code	NDC 68084068301
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$280.70
Max. Negotiated Rate	$642.82
Rate for Payer: Aetna Commercial	$607.10
Rate for Payer: Aetna Medicare	$357.12
Rate for Payer: Aetna New Business (MI Preferred)	$464.26
Rate for Payer: BCBS Complete	$285.70
Rate for Payer: Cash Price	$571.39
Rate for Payer: Cofinity Advantage	$499.97
Rate for Payer: Cofinity Commercial	$614.25
Rate for Payer: Encore Health Key Benefits Commercial	$571.39
Rate for Payer: Healthscope Commercial	$642.82
Rate for Payer: MI Amish Medical Board Commercial	$571.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$607.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.68
Rate for Payer: PHP Commercial	$607.10
Rate for Payer: Priority Health SBD	$449.97
Rate for Payer: UHC All Payor (Choice/PPO)	$464.26
Rate for Payer: UHC Core	$372.12
Rate for Payer: UHC Exchange	$280.70

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$445.44

Service Code	NDC 00904704461
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$280.63
Max. Negotiated Rate	$400.90
Rate for Payer: Aetna Commercial	$378.62
Rate for Payer: Aetna New Business (MI Preferred)	$289.54
Rate for Payer: Cash Price	$356.35
Rate for Payer: Cofinity Advantage	$311.81
Rate for Payer: Cofinity Commercial	$383.08
Rate for Payer: Encore Health Key Benefits Commercial	$356.35
Rate for Payer: Healthscope Commercial	$400.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.08
Rate for Payer: PHP Commercial	$378.62
Rate for Payer: Priority Health SBD	$280.63

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$445.44

Service Code	NDC 00904704461
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$175.06
Max. Negotiated Rate	$400.90
Rate for Payer: Aetna Commercial	$378.62
Rate for Payer: Aetna Medicare	$222.72
Rate for Payer: Aetna New Business (MI Preferred)	$289.54
Rate for Payer: BCBS Complete	$178.18
Rate for Payer: Cash Price	$356.35
Rate for Payer: Cofinity Advantage	$311.81
Rate for Payer: Cofinity Commercial	$383.08
Rate for Payer: Encore Health Key Benefits Commercial	$356.35
Rate for Payer: Healthscope Commercial	$400.90
Rate for Payer: MI Amish Medical Board Commercial	$356.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.08
Rate for Payer: PHP Commercial	$378.62
Rate for Payer: Priority Health SBD	$280.63
Rate for Payer: UHC All Payor (Choice/PPO)	$289.54
Rate for Payer: UHC Core	$232.07
Rate for Payer: UHC Exchange	$175.06

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$205.16

Service Code	NDC 71335201705
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$184.64
Rate for Payer: Aetna Commercial	$174.39
Rate for Payer: Aetna New Business (MI Preferred)	$133.35
Rate for Payer: Cash Price	$164.13
Rate for Payer: Cofinity Advantage	$143.61
Rate for Payer: Cofinity Commercial	$176.44
Rate for Payer: Encore Health Key Benefits Commercial	$164.13
Rate for Payer: Healthscope Commercial	$184.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.87
Rate for Payer: PHP Commercial	$174.39
Rate for Payer: Priority Health SBD	$129.25

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$304.56

Service Code	NDC 68180029509
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$119.69
Max. Negotiated Rate	$274.10
Rate for Payer: Aetna Commercial	$258.88
Rate for Payer: Aetna Medicare	$152.28
Rate for Payer: Aetna New Business (MI Preferred)	$197.96
Rate for Payer: BCBS Complete	$121.82
Rate for Payer: Cash Price	$243.65
Rate for Payer: Cofinity Advantage	$213.19
Rate for Payer: Cofinity Commercial	$261.92
Rate for Payer: Encore Health Key Benefits Commercial	$243.65
Rate for Payer: Healthscope Commercial	$274.10
Rate for Payer: MI Amish Medical Board Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.42
Rate for Payer: PHP Commercial	$258.88
Rate for Payer: Priority Health SBD	$191.87
Rate for Payer: UHC All Payor (Choice/PPO)	$197.96
Rate for Payer: UHC Core	$158.68
Rate for Payer: UHC Exchange	$119.69

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$205.16

Service Code	NDC 71335201705
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$80.63
Max. Negotiated Rate	$184.64
Rate for Payer: Aetna Commercial	$174.39
Rate for Payer: Aetna Medicare	$102.58
Rate for Payer: Aetna New Business (MI Preferred)	$133.35
Rate for Payer: BCBS Complete	$82.06
Rate for Payer: Cash Price	$164.13
Rate for Payer: Cofinity Advantage	$143.61
Rate for Payer: Cofinity Commercial	$176.44
Rate for Payer: Encore Health Key Benefits Commercial	$164.13
Rate for Payer: Healthscope Commercial	$184.64
Rate for Payer: MI Amish Medical Board Commercial	$164.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.87
Rate for Payer: PHP Commercial	$174.39
Rate for Payer: Priority Health SBD	$129.25
Rate for Payer: UHC All Payor (Choice/PPO)	$133.35
Rate for Payer: UHC Core	$106.89
Rate for Payer: UHC Exchange	$80.63

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$304.56

Service Code	NDC 57237001890
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$119.69
Max. Negotiated Rate	$274.10
Rate for Payer: Aetna Commercial	$258.88
Rate for Payer: Aetna Medicare	$152.28
Rate for Payer: Aetna New Business (MI Preferred)	$197.96
Rate for Payer: BCBS Complete	$121.82
Rate for Payer: Cash Price	$243.65
Rate for Payer: Cofinity Advantage	$213.19
Rate for Payer: Cofinity Commercial	$261.92
Rate for Payer: Encore Health Key Benefits Commercial	$243.65
Rate for Payer: Healthscope Commercial	$274.10
Rate for Payer: MI Amish Medical Board Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.42
Rate for Payer: PHP Commercial	$258.88
Rate for Payer: Priority Health SBD	$191.87
Rate for Payer: UHC All Payor (Choice/PPO)	$197.96
Rate for Payer: UHC Core	$158.68
Rate for Payer: UHC Exchange	$119.69

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$714.24

Service Code	NDC 68084068301
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$449.97
Max. Negotiated Rate	$642.82
Rate for Payer: Aetna Commercial	$607.10
Rate for Payer: Aetna New Business (MI Preferred)	$464.26
Rate for Payer: Cash Price	$571.39
Rate for Payer: Cofinity Advantage	$499.97
Rate for Payer: Cofinity Commercial	$614.25
Rate for Payer: Encore Health Key Benefits Commercial	$571.39
Rate for Payer: Healthscope Commercial	$642.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$607.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.68
Rate for Payer: PHP Commercial	$607.10
Rate for Payer: Priority Health SBD	$449.97

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$304.56

Service Code	NDC 68180029509
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$191.87
Max. Negotiated Rate	$274.10
Rate for Payer: Aetna Commercial	$258.88
Rate for Payer: Aetna New Business (MI Preferred)	$197.96
Rate for Payer: Cash Price	$243.65
Rate for Payer: Cofinity Advantage	$213.19
Rate for Payer: Cofinity Commercial	$261.92
Rate for Payer: Encore Health Key Benefits Commercial	$243.65
Rate for Payer: Healthscope Commercial	$274.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.42
Rate for Payer: PHP Commercial	$258.88
Rate for Payer: Priority Health SBD	$191.87

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$304.56

Service Code	NDC 57237001890
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$191.87
Max. Negotiated Rate	$274.10
Rate for Payer: Aetna Commercial	$258.88
Rate for Payer: Aetna New Business (MI Preferred)	$197.96
Rate for Payer: Cash Price	$243.65
Rate for Payer: Cofinity Advantage	$213.19
Rate for Payer: Cofinity Commercial	$261.92
Rate for Payer: Encore Health Key Benefits Commercial	$243.65
Rate for Payer: Healthscope Commercial	$274.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.42
Rate for Payer: PHP Commercial	$258.88
Rate for Payer: Priority Health SBD	$191.87

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$714.24

Service Code	NDC 68084069201
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$449.97
Max. Negotiated Rate	$642.82
Rate for Payer: Aetna Commercial	$607.10
Rate for Payer: Aetna New Business (MI Preferred)	$464.26
Rate for Payer: Cash Price	$571.39
Rate for Payer: Cofinity Advantage	$499.97
Rate for Payer: Cofinity Commercial	$614.25
Rate for Payer: Encore Health Key Benefits Commercial	$571.39
Rate for Payer: Healthscope Commercial	$642.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$607.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.68
Rate for Payer: PHP Commercial	$607.10
Rate for Payer: Priority Health SBD	$449.97

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$114.92

Service Code	NDC 68180029606
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$72.40
Max. Negotiated Rate	$103.43
Rate for Payer: Aetna Commercial	$97.68
Rate for Payer: Aetna New Business (MI Preferred)	$74.70
Rate for Payer: Cash Price	$91.94
Rate for Payer: Cofinity Advantage	$80.44
Rate for Payer: Cofinity Commercial	$98.83
Rate for Payer: Encore Health Key Benefits Commercial	$91.94
Rate for Payer: Healthscope Commercial	$103.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.19
Rate for Payer: PHP Commercial	$97.68
Rate for Payer: Priority Health SBD	$72.40

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$3.42

Service Code	NDC 50268028811
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna Commercial	$2.91
Rate for Payer: Aetna Medicare	$1.71
Rate for Payer: Aetna New Business (MI Preferred)	$2.22
Rate for Payer: BCBS Complete	$1.37
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Advantage	$2.39
Rate for Payer: Cofinity Commercial	$2.94
Rate for Payer: Encore Health Key Benefits Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.08
Rate for Payer: MI Amish Medical Board Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.56
Rate for Payer: PHP Commercial	$2.91
Rate for Payer: Priority Health SBD	$2.15
Rate for Payer: UHC All Payor (Choice/PPO)	$2.22
Rate for Payer: UHC Core	$1.78
Rate for Payer: UHC Exchange	$1.34

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$114.92

Service Code	NDC 57237001930
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$103.43
Rate for Payer: Aetna Commercial	$97.68
Rate for Payer: Aetna Medicare	$57.46
Rate for Payer: Aetna New Business (MI Preferred)	$74.70
Rate for Payer: BCBS Complete	$45.97
Rate for Payer: Cash Price	$91.94
Rate for Payer: Cofinity Advantage	$80.44
Rate for Payer: Cofinity Commercial	$98.83
Rate for Payer: Encore Health Key Benefits Commercial	$91.94
Rate for Payer: Healthscope Commercial	$103.43
Rate for Payer: MI Amish Medical Board Commercial	$91.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.19
Rate for Payer: PHP Commercial	$97.68
Rate for Payer: Priority Health SBD	$72.40
Rate for Payer: UHC All Payor (Choice/PPO)	$74.70
Rate for Payer: UHC Core	$59.87
Rate for Payer: UHC Exchange	$45.16

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$7.15

Service Code	NDC 68084069211
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare	$3.58
Rate for Payer: Aetna New Business (MI Preferred)	$4.65
Rate for Payer: BCBS Complete	$2.86
Rate for Payer: Cash Price	$5.72
Rate for Payer: Cofinity Advantage	$5.00
Rate for Payer: Cofinity Commercial	$6.15
Rate for Payer: Encore Health Key Benefits Commercial	$5.72
Rate for Payer: Healthscope Commercial	$6.43
Rate for Payer: MI Amish Medical Board Commercial	$5.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.36
Rate for Payer: PHP Commercial	$6.08
Rate for Payer: Priority Health SBD	$4.50
Rate for Payer: UHC All Payor (Choice/PPO)	$4.65
Rate for Payer: UHC Core	$3.73
Rate for Payer: UHC Exchange	$2.81

DULOXETINE 60 MG CAPSULE,DELAYED RELEASE

Facility

$102.53

Service Code	NDC 50268028813
Hospital Charge Code	39277
Hospital Revenue Code	637
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$92.28
Rate for Payer: Aetna Commercial	$87.15
Rate for Payer: Aetna New Business (MI Preferred)	$66.64
Rate for Payer: Cash Price	$82.02
Rate for Payer: Cofinity Advantage	$71.77
Rate for Payer: Cofinity Commercial	$88.18
Rate for Payer: Encore Health Key Benefits Commercial	$82.02
Rate for Payer: Healthscope Commercial	$92.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.90
Rate for Payer: PHP Commercial	$87.15
Rate for Payer: Priority Health SBD	$64.59

Know your out-of-pocket cost for care.

All Charges