|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 68084074311
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: PACE Senior Care Partners |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.61
|
| Rate for Payer: UHC Core |
$2.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.74
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$104.03
|
|
|
Service Code
|
NDC 68180065208
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.63 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$41.61
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$80.88
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.22
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.30
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.62
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.70
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.55
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Exchange |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.02
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$151.44
|
|
|
Service Code
|
NDC 50268028115
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$128.72
|
| Rate for Payer: Aetna Medicare |
$39.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.32
|
| Rate for Payer: BCBS Complete |
$60.58
|
| Rate for Payer: BCBS MAPPO |
$37.86
|
| Rate for Payer: BCBS Trust/PPO |
$124.50
|
| Rate for Payer: BCN Commercial |
$117.74
|
| Rate for Payer: BCN Medicare Advantage |
$37.86
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.86
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.72
|
| Rate for Payer: Nomi Health Commercial |
$124.18
|
| Rate for Payer: PACE Senior Care Partners |
$35.97
|
| Rate for Payer: PACE SWMI |
$37.86
|
| Rate for Payer: PHP Commercial |
$128.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.44
|
| Rate for Payer: Priority Health HMO/PPO |
$131.75
|
| Rate for Payer: Priority Health Medicare |
$38.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.46
|
| Rate for Payer: Railroad Medicare Medicare |
$37.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.27
|
| Rate for Payer: UHC Core |
$126.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.86
|
| Rate for Payer: UHC Exchange |
$37.86
|
| Rate for Payer: UHC Medicare Advantage |
$37.86
|
| Rate for Payer: VA VA |
$37.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.58
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 50268028111
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 68084074311
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.61
|
| Rate for Payer: UHC Core |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$88.85
|
|
|
Service Code
|
NDC 68084074321
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$79.96 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.77
|
| Rate for Payer: BCBS Complete |
$35.54
|
| Rate for Payer: BCBS MAPPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$73.04
|
| Rate for Payer: BCN Commercial |
$69.08
|
| Rate for Payer: BCN Medicare Advantage |
$22.21
|
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Cofinity Commercial |
$76.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.21
|
| Rate for Payer: Healthscope Commercial |
$79.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.52
|
| Rate for Payer: Nomi Health Commercial |
$72.86
|
| Rate for Payer: PACE Senior Care Partners |
$21.10
|
| Rate for Payer: PACE SWMI |
$22.21
|
| Rate for Payer: PHP Commercial |
$75.52
|
| Rate for Payer: PHP Medicare Advantage |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health HMO/PPO |
$77.30
|
| Rate for Payer: Priority Health Medicare |
$22.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.53
|
| Rate for Payer: Railroad Medicare Medicare |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC Core |
$74.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.21
|
| Rate for Payer: UHC Exchange |
$22.21
|
| Rate for Payer: UHC Medicare Advantage |
$22.21
|
| Rate for Payer: VA VA |
$22.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.64
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$5.86
|
|
|
Service Code
|
NDC 68084074333
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.83
|
| Rate for Payer: BCBS Complete |
$2.34
|
| Rate for Payer: BCBS MAPPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: BCN Medicare Advantage |
$1.46
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$5.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.98
|
| Rate for Payer: Nomi Health Commercial |
$4.81
|
| Rate for Payer: PACE Senior Care Partners |
$1.39
|
| Rate for Payer: PACE SWMI |
$1.46
|
| Rate for Payer: PHP Commercial |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$1.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.81
|
| Rate for Payer: Priority Health HMO/PPO |
$5.10
|
| Rate for Payer: Priority Health Medicare |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.16
|
| Rate for Payer: UHC Core |
$4.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.46
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UHC Medicare Advantage |
$1.46
|
| Rate for Payer: VA VA |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.40
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$104.03
|
|
|
Service Code
|
NDC 68180065208
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$93.63 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.92
|
| Rate for Payer: BCN Commercial |
$80.39
|
| Rate for Payer: Cash Price |
$83.22
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.22
|
| Rate for Payer: Healthscope Commercial |
$93.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.30
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.62
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.55
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.02
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$117.03
|
|
|
Service Code
|
NDC 68084074332
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$105.33 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: BCBS Trust/PPO |
$95.53
|
| Rate for Payer: BCN Commercial |
$90.44
|
| Rate for Payer: Cash Price |
$93.62
|
| Rate for Payer: Cofinity Commercial |
$100.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.62
|
| Rate for Payer: Healthscope Commercial |
$105.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.48
|
| Rate for Payer: Nomi Health Commercial |
$95.96
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.07
|
| Rate for Payer: Priority Health HMO/PPO |
$101.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.99
|
| Rate for Payer: UHC Core |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.77
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$151.44
|
|
|
Service Code
|
NDC 50268028115
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$128.72
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$117.03
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.15
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.72
|
| Rate for Payer: Nomi Health Commercial |
$124.18
|
| Rate for Payer: PHP Commercial |
$128.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.44
|
| Rate for Payer: Priority Health HMO/PPO |
$131.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.27
|
| Rate for Payer: UHC Core |
$126.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.58
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 50268028111
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.49
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$136.80
|
|
|
Service Code
|
NDC 68180065701
|
| Hospital Charge Code |
9902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare |
$35.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.75
|
| Rate for Payer: BCBS Complete |
$54.72
|
| Rate for Payer: BCBS MAPPO |
$34.20
|
| Rate for Payer: BCBS Trust/PPO |
$112.46
|
| Rate for Payer: BCN Commercial |
$106.36
|
| Rate for Payer: BCN Medicare Advantage |
$34.20
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$117.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.20
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: Nomi Health Commercial |
$112.18
|
| Rate for Payer: PACE Senior Care Partners |
$32.49
|
| Rate for Payer: PACE SWMI |
$34.20
|
| Rate for Payer: PHP Commercial |
$116.28
|
| Rate for Payer: PHP Medicare Advantage |
$34.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: Priority Health HMO/PPO |
$119.02
|
| Rate for Payer: Priority Health Medicare |
$34.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.66
|
| Rate for Payer: Railroad Medicare Medicare |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.38
|
| Rate for Payer: UHC Core |
$114.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.20
|
| Rate for Payer: UHC Exchange |
$34.20
|
| Rate for Payer: UHC Medicare Advantage |
$34.20
|
| Rate for Payer: VA VA |
$34.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.60
|
|
|
DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$136.80
|
|
|
Service Code
|
NDC 68180065701
|
| Hospital Charge Code |
9902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$123.12 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: BCBS Trust/PPO |
$111.67
|
| Rate for Payer: BCN Commercial |
$105.72
|
| Rate for Payer: Cash Price |
$109.44
|
| Rate for Payer: Cofinity Commercial |
$117.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$123.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.28
|
| Rate for Payer: Nomi Health Commercial |
$112.18
|
| Rate for Payer: PHP Commercial |
$116.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.92
|
| Rate for Payer: Priority Health HMO/PPO |
$119.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.38
|
| Rate for Payer: UHC Core |
$114.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.60
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.41 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: Aetna Medicare |
$171.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$263.42
|
| Rate for Payer: BCBS MAPPO |
$164.64
|
| Rate for Payer: BCBS Trust/PPO |
$541.40
|
| Rate for Payer: BCN Commercial |
$512.03
|
| Rate for Payer: BCN Medicare Advantage |
$164.64
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.64
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: Nomi Health Commercial |
$540.02
|
| Rate for Payer: PACE Senior Care Partners |
$156.41
|
| Rate for Payer: PACE SWMI |
$164.64
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: PHP Medicare Advantage |
$164.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health HMO/PPO |
$572.95
|
| Rate for Payer: Priority Health Medicare |
$166.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.24
|
| Rate for Payer: Railroad Medicare Medicare |
$164.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.53
|
| Rate for Payer: UHC Core |
$549.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.64
|
| Rate for Payer: UHC Exchange |
$164.64
|
| Rate for Payer: UHC Medicare Advantage |
$164.64
|
| Rate for Payer: VA VA |
$164.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.06 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: BCBS Trust/PPO |
$537.58
|
| Rate for Payer: BCN Commercial |
$508.94
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: Nomi Health Commercial |
$540.02
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health HMO/PPO |
$572.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$441.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.53
|
| Rate for Payer: UHC Core |
$549.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$54.51
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$49.06 |
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Aetna Medicare |
$14.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.03
|
| Rate for Payer: BCBS Complete |
$21.80
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$44.81
|
| Rate for Payer: BCN Commercial |
$42.38
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Nomi Health Commercial |
$44.70
|
| Rate for Payer: PACE Senior Care Partners |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.43
|
| Rate for Payer: Priority Health HMO/PPO |
$47.42
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.52
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.97
|
| Rate for Payer: UHC Core |
$45.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.63
|
| Rate for Payer: UHC Exchange |
$13.63
|
| Rate for Payer: UHC Medicare Advantage |
$13.63
|
| Rate for Payer: VA VA |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$54.51
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$49.06 |
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$44.50
|
| Rate for Payer: BCN Commercial |
$42.13
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Nomi Health Commercial |
$44.70
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.43
|
| Rate for Payer: Priority Health HMO/PPO |
$47.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.97
|
| Rate for Payer: UHC Core |
$45.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DRUG TEST PRESUMPTIVE READ BY INSTR ASSISTED DIRECT OPTICAL OBS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS G0478
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$16.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.78
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO |
$67.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.44
|
|
|
DRUG TEST(S), PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS G0477
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO |
$12.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.82
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 68084067511
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.47
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$6.13
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.97
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$500.64
|
|
|
Service Code
|
NDC 00904704361
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.90 |
| Max. Negotiated Rate |
$450.58 |
| Rate for Payer: Aetna Commercial |
$425.54
|
| Rate for Payer: Aetna Medicare |
$130.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.45
|
| Rate for Payer: BCBS Complete |
$200.26
|
| Rate for Payer: BCBS MAPPO |
$125.16
|
| Rate for Payer: BCBS Trust/PPO |
$411.58
|
| Rate for Payer: BCN Commercial |
$389.25
|
| Rate for Payer: BCN Medicare Advantage |
$125.16
|
| Rate for Payer: Cash Price |
$400.51
|
| Rate for Payer: Cofinity Commercial |
$430.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.16
|
| Rate for Payer: Healthscope Commercial |
$450.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.54
|
| Rate for Payer: Nomi Health Commercial |
$410.52
|
| Rate for Payer: PACE Senior Care Partners |
$118.90
|
| Rate for Payer: PACE SWMI |
$125.16
|
| Rate for Payer: PHP Commercial |
$425.54
|
| Rate for Payer: PHP Medicare Advantage |
$125.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.42
|
| Rate for Payer: Priority Health HMO/PPO |
$435.56
|
| Rate for Payer: Priority Health Medicare |
$126.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.43
|
| Rate for Payer: Railroad Medicare Medicare |
$125.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.56
|
| Rate for Payer: UHC Core |
$418.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.16
|
| Rate for Payer: UHC Exchange |
$125.16
|
| Rate for Payer: UHC Medicare Advantage |
$125.16
|
| Rate for Payer: VA VA |
$125.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.48
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 68084067511
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$115.35
|
|
|
Service Code
|
NDC 00904704304
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Aetna Commercial |
$98.05
|
| Rate for Payer: BCBS Trust/PPO |
$94.16
|
| Rate for Payer: BCN Commercial |
$89.14
|
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Cofinity Commercial |
$99.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.28
|
| Rate for Payer: Healthscope Commercial |
$103.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.05
|
| Rate for Payer: Nomi Health Commercial |
$94.59
|
| Rate for Payer: PHP Commercial |
$98.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.98
|
| Rate for Payer: Priority Health HMO/PPO |
$100.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.51
|
| Rate for Payer: UHC Core |
$96.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.51
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$236.60
|
|
|
Service Code
|
NDC 68084067521
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$212.94 |
| Rate for Payer: Aetna Commercial |
$201.11
|
| Rate for Payer: Aetna Medicare |
$61.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.94
|
| Rate for Payer: BCBS Complete |
$94.64
|
| Rate for Payer: BCBS MAPPO |
$59.15
|
| Rate for Payer: BCBS Trust/PPO |
$194.51
|
| Rate for Payer: BCN Commercial |
$183.96
|
| Rate for Payer: BCN Medicare Advantage |
$59.15
|
| Rate for Payer: Cash Price |
$189.28
|
| Rate for Payer: Cofinity Commercial |
$203.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.15
|
| Rate for Payer: Healthscope Commercial |
$212.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.11
|
| Rate for Payer: Nomi Health Commercial |
$194.01
|
| Rate for Payer: PACE Senior Care Partners |
$56.19
|
| Rate for Payer: PACE SWMI |
$59.15
|
| Rate for Payer: PHP Commercial |
$201.11
|
| Rate for Payer: PHP Medicare Advantage |
$59.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.79
|
| Rate for Payer: Priority Health HMO/PPO |
$205.84
|
| Rate for Payer: Priority Health Medicare |
$59.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.52
|
| Rate for Payer: Railroad Medicare Medicare |
$59.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.21
|
| Rate for Payer: UHC Core |
$197.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.15
|
| Rate for Payer: UHC Exchange |
$59.15
|
| Rate for Payer: UHC Medicare Advantage |
$59.15
|
| Rate for Payer: VA VA |
$59.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.45
|
|
