|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00143211250
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$386.16
|
|
|
Service Code
|
NDC 50268027915
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$347.54 |
| Rate for Payer: Aetna Commercial |
$328.24
|
| Rate for Payer: Aetna Medicare |
$100.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.67
|
| Rate for Payer: BCBS Complete |
$71.48
|
| Rate for Payer: BCBS MAPPO |
$96.54
|
| Rate for Payer: BCBS Trust/PPO |
$317.46
|
| Rate for Payer: BCN Commercial |
$317.46
|
| Rate for Payer: BCN Medicare Advantage |
$96.54
|
| Rate for Payer: Cash Price |
$308.93
|
| Rate for Payer: Cofinity Commercial |
$332.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.54
|
| Rate for Payer: Healthscope Commercial |
$347.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.62
|
| Rate for Payer: Mclaren Medicaid |
$68.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.37
|
| Rate for Payer: Meridian Medicaid |
$71.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.24
|
| Rate for Payer: Nomi Health Commercial |
$316.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.62
|
| Rate for Payer: PACE Senior Care Partners |
$91.71
|
| Rate for Payer: PACE SWMI |
$96.54
|
| Rate for Payer: PHP Commercial |
$328.24
|
| Rate for Payer: PHP Medicare Advantage |
$96.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$335.96
|
| Rate for Payer: Priority Health Medicare |
$97.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.77
|
| Rate for Payer: Railroad Medicare Medicare |
$96.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.82
|
| Rate for Payer: UHC Core |
$322.44
|
| Rate for Payer: UHC Exchange |
$96.54
|
| Rate for Payer: UHC Medicaid |
$68.08
|
| Rate for Payer: UHC Medicare Advantage |
$96.54
|
| Rate for Payer: UHCCP Medicaid |
$68.08
|
| Rate for Payer: VA VA |
$96.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.62
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
IP
|
$351.12
|
|
|
Service Code
|
NDC 00904043006
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.38 |
| Max. Negotiated Rate |
$316.01 |
| Rate for Payer: Aetna Commercial |
$298.45
|
| Rate for Payer: BCBS Trust/PPO |
$289.99
|
| Rate for Payer: BCN Commercial |
$289.99
|
| Rate for Payer: Cash Price |
$280.90
|
| Rate for Payer: Cofinity Commercial |
$301.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.90
|
| Rate for Payer: Healthscope Commercial |
$316.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.45
|
| Rate for Payer: Nomi Health Commercial |
$287.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.34
|
| Rate for Payer: PHP Commercial |
$298.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$305.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.99
|
| Rate for Payer: UHC Core |
$293.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.34
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$351.12
|
|
|
Service Code
|
NDC 00904043006
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$316.01 |
| Rate for Payer: Aetna Commercial |
$298.45
|
| Rate for Payer: Aetna Medicare |
$91.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.72
|
| Rate for Payer: BCBS Complete |
$64.99
|
| Rate for Payer: BCBS MAPPO |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$288.66
|
| Rate for Payer: BCN Commercial |
$288.66
|
| Rate for Payer: BCN Medicare Advantage |
$87.78
|
| Rate for Payer: Cash Price |
$280.90
|
| Rate for Payer: Cofinity Commercial |
$301.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$316.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.34
|
| Rate for Payer: Mclaren Medicaid |
$61.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.17
|
| Rate for Payer: Meridian Medicaid |
$64.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.45
|
| Rate for Payer: Nomi Health Commercial |
$287.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.34
|
| Rate for Payer: PACE Senior Care Partners |
$83.39
|
| Rate for Payer: PACE SWMI |
$87.78
|
| Rate for Payer: PHP Commercial |
$298.45
|
| Rate for Payer: PHP Medicare Advantage |
$87.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$305.47
|
| Rate for Payer: Priority Health Medicare |
$88.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.38
|
| Rate for Payer: Railroad Medicare Medicare |
$87.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.99
|
| Rate for Payer: UHC Core |
$293.19
|
| Rate for Payer: UHC Exchange |
$87.78
|
| Rate for Payer: UHC Medicaid |
$61.90
|
| Rate for Payer: UHC Medicare Advantage |
$87.78
|
| Rate for Payer: UHCCP Medicaid |
$61.90
|
| Rate for Payer: VA VA |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.34
|
|
|
DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$141.84
|
|
|
Service Code
|
NDC 68180065701
|
| Hospital Charge Code |
9902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.01 |
| Max. Negotiated Rate |
$127.66 |
| Rate for Payer: Aetna Commercial |
$120.56
|
| Rate for Payer: Aetna Medicare |
$36.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.33
|
| Rate for Payer: BCBS Complete |
$26.25
|
| Rate for Payer: BCBS MAPPO |
$35.46
|
| Rate for Payer: BCBS Trust/PPO |
$116.61
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: BCN Medicare Advantage |
$35.46
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cofinity Commercial |
$121.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.46
|
| Rate for Payer: Healthscope Commercial |
$127.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.38
|
| Rate for Payer: Mclaren Medicaid |
$25.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.23
|
| Rate for Payer: Meridian Medicaid |
$26.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.56
|
| Rate for Payer: Nomi Health Commercial |
$116.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.38
|
| Rate for Payer: PACE Senior Care Partners |
$33.69
|
| Rate for Payer: PACE SWMI |
$35.46
|
| Rate for Payer: PHP Commercial |
$120.56
|
| Rate for Payer: PHP Medicare Advantage |
$35.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.40
|
| Rate for Payer: Priority Health Medicare |
$35.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.72
|
| Rate for Payer: Railroad Medicare Medicare |
$35.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.82
|
| Rate for Payer: UHC Core |
$118.44
|
| Rate for Payer: UHC Exchange |
$35.46
|
| Rate for Payer: UHC Medicaid |
$25.01
|
| Rate for Payer: UHC Medicare Advantage |
$35.46
|
| Rate for Payer: UHCCP Medicaid |
$25.01
|
| Rate for Payer: VA VA |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.38
|
|
|
DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$141.84
|
|
|
Service Code
|
NDC 68180065701
|
| Hospital Charge Code |
9902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$127.66 |
| Rate for Payer: Aetna Commercial |
$120.56
|
| Rate for Payer: BCBS Trust/PPO |
$117.15
|
| Rate for Payer: BCN Commercial |
$117.15
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cofinity Commercial |
$121.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.47
|
| Rate for Payer: Healthscope Commercial |
$127.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.56
|
| Rate for Payer: Nomi Health Commercial |
$116.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.38
|
| Rate for Payer: PHP Commercial |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.82
|
| Rate for Payer: UHC Core |
$118.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.38
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$697.20
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$627.48 |
| Rate for Payer: Aetna Commercial |
$592.62
|
| Rate for Payer: Aetna Medicare |
$181.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.88
|
| Rate for Payer: BCBS Complete |
$129.05
|
| Rate for Payer: BCBS MAPPO |
$174.30
|
| Rate for Payer: BCBS Trust/PPO |
$573.17
|
| Rate for Payer: BCN Commercial |
$573.17
|
| Rate for Payer: BCN Medicare Advantage |
$174.30
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Cofinity Commercial |
$599.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$627.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.90
|
| Rate for Payer: Mclaren Medicaid |
$122.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.01
|
| Rate for Payer: Meridian Medicaid |
$129.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.62
|
| Rate for Payer: Nomi Health Commercial |
$571.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.90
|
| Rate for Payer: PACE Senior Care Partners |
$165.59
|
| Rate for Payer: PACE SWMI |
$174.30
|
| Rate for Payer: PHP Commercial |
$592.62
|
| Rate for Payer: PHP Medicare Advantage |
$174.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$606.56
|
| Rate for Payer: Priority Health Medicare |
$176.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$485.25
|
| Rate for Payer: Railroad Medicare Medicare |
$174.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$613.54
|
| Rate for Payer: UHC Core |
$582.16
|
| Rate for Payer: UHC Exchange |
$174.30
|
| Rate for Payer: UHC Medicaid |
$122.92
|
| Rate for Payer: UHC Medicare Advantage |
$174.30
|
| Rate for Payer: UHCCP Medicaid |
$122.92
|
| Rate for Payer: VA VA |
$174.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.90
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$697.20
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$485.25 |
| Max. Negotiated Rate |
$627.48 |
| Rate for Payer: Aetna Commercial |
$592.62
|
| Rate for Payer: BCBS Trust/PPO |
$575.82
|
| Rate for Payer: BCN Commercial |
$575.82
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Cofinity Commercial |
$599.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.76
|
| Rate for Payer: Healthscope Commercial |
$627.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.62
|
| Rate for Payer: Nomi Health Commercial |
$571.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.90
|
| Rate for Payer: PHP Commercial |
$592.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$606.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$485.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$613.54
|
| Rate for Payer: UHC Core |
$582.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.90
|
|
|
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 |
$37.94 |
| Max. Negotiated Rate |
$49.06 |
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$45.02
|
| Rate for Payer: BCN Commercial |
$45.02
|
| 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: Opus (Opus Packaging Group) HMA |
$40.88
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.94
|
| 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
|
|
|
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 |
$9.61 |
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$44.81
|
| Rate for Payer: BCN Commercial |
$44.81
|
| 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: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Nomi Health Commercial |
$44.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.88
|
| 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 Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.42
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.94
|
| 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 Exchange |
$13.63
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHC Medicare Advantage |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$2,932.61
|
|
|
Service Code
|
APR-DRG 7703
|
| Min. Negotiated Rate |
$2,792.96 |
| Max. Negotiated Rate |
$2,932.61 |
| Rate for Payer: BCBS Complete |
$2,932.61
|
| Rate for Payer: Mclaren Medicaid |
$2,792.96
|
| Rate for Payer: Meridian Medicaid |
$2,932.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,792.96
|
| Rate for Payer: UHC Medicaid |
$2,792.96
|
| Rate for Payer: UHCCP Medicaid |
$2,792.96
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$9,900.52
|
|
|
Service Code
|
APR-DRG 7704
|
| Min. Negotiated Rate |
$9,429.06 |
| Max. Negotiated Rate |
$9,900.52 |
| Rate for Payer: BCBS Complete |
$9,900.52
|
| Rate for Payer: Mclaren Medicaid |
$9,429.06
|
| Rate for Payer: Meridian Medicaid |
$9,900.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,429.06
|
| Rate for Payer: UHC Medicaid |
$9,429.06
|
| Rate for Payer: UHCCP Medicaid |
$9,429.06
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$1,690.58
|
|
|
Service Code
|
APR-DRG 7701
|
| Min. Negotiated Rate |
$1,610.07 |
| Max. Negotiated Rate |
$1,690.58 |
| Rate for Payer: BCBS Complete |
$1,690.58
|
| Rate for Payer: Mclaren Medicaid |
$1,610.07
|
| Rate for Payer: Meridian Medicaid |
$1,690.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,610.07
|
| Rate for Payer: UHC Medicaid |
$1,610.07
|
| Rate for Payer: UHCCP Medicaid |
$1,610.07
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$2,163.31
|
|
|
Service Code
|
APR-DRG 7702
|
| Min. Negotiated Rate |
$2,060.29 |
| Max. Negotiated Rate |
$2,163.31 |
| Rate for Payer: BCBS Complete |
$2,163.31
|
| Rate for Payer: Mclaren Medicaid |
$2,060.29
|
| Rate for Payer: Meridian Medicaid |
$2,163.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,060.29
|
| Rate for Payer: UHC Medicaid |
$2,060.29
|
| Rate for Payer: UHCCP Medicaid |
$2,060.29
|
|
|
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 |
$12.00 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
|
|
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 |
$9.00 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 60687072311
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.39
|
| 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: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
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 |
$1.39 |
| 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 |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$6.49
|
| 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: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| 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 Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.49
|
| 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 Exchange |
$1.97
|
| Rate for Payer: UHC Medicaid |
$1.39
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: UHCCP Medicaid |
$1.39
|
| 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
|
$507.84
|
|
|
Service Code
|
NDC 00904704361
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.53 |
| Max. Negotiated Rate |
$457.06 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna Medicare |
$132.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.70
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$126.96
|
| Rate for Payer: BCBS Trust/PPO |
$417.50
|
| Rate for Payer: BCN Commercial |
$417.50
|
| Rate for Payer: BCN Medicare Advantage |
$126.96
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$436.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.96
|
| Rate for Payer: Healthscope Commercial |
$457.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.88
|
| Rate for Payer: Mclaren Medicaid |
$89.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.31
|
| Rate for Payer: Meridian Medicaid |
$94.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$416.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.88
|
| Rate for Payer: PACE Senior Care Partners |
$120.61
|
| Rate for Payer: PACE SWMI |
$126.96
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: PHP Medicare Advantage |
$126.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$441.82
|
| Rate for Payer: Priority Health Medicare |
$128.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.46
|
| Rate for Payer: Railroad Medicare Medicare |
$126.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.90
|
| Rate for Payer: UHC Core |
$424.05
|
| Rate for Payer: UHC Exchange |
$126.96
|
| Rate for Payer: UHC Medicaid |
$89.53
|
| Rate for Payer: UHC Medicare Advantage |
$126.96
|
| Rate for Payer: UHCCP Medicaid |
$89.53
|
| Rate for Payer: VA VA |
$126.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.88
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 68180029407
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$26.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.73
|
| Rate for Payer: BCBS Complete |
$18.79
|
| Rate for Payer: BCBS MAPPO |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$83.46
|
| Rate for Payer: BCN Medicare Advantage |
$25.38
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.38
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.65
|
| Rate for Payer: Meridian Medicaid |
$18.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PACE Senior Care Partners |
$24.11
|
| Rate for Payer: PACE SWMI |
$25.38
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.32
|
| Rate for Payer: Priority Health Medicare |
$25.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.66
|
| Rate for Payer: Railroad Medicare Medicare |
$25.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.34
|
| Rate for Payer: UHC Core |
$84.77
|
| Rate for Payer: UHC Exchange |
$25.38
|
| Rate for Payer: UHC Medicaid |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$25.38
|
| Rate for Payer: UHCCP Medicaid |
$17.90
|
| Rate for Payer: VA VA |
$25.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$236.60
|
|
|
Service Code
|
NDC 68084067521
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.67 |
| Max. Negotiated Rate |
$212.94 |
| Rate for Payer: Aetna Commercial |
$201.11
|
| Rate for Payer: BCBS Trust/PPO |
$195.41
|
| Rate for Payer: BCN Commercial |
$195.41
|
| 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: Healthscope Commercial |
$212.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.11
|
| Rate for Payer: Nomi Health Commercial |
$194.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.45
|
| Rate for Payer: PHP Commercial |
$201.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.21
|
| Rate for Payer: UHC Core |
$197.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.45
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 60687072311
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: Meridian Medicaid |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
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 |
$41.71 |
| 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 |
$43.79
|
| Rate for Payer: BCBS MAPPO |
$59.15
|
| Rate for Payer: BCBS Trust/PPO |
$194.51
|
| Rate for Payer: BCN Commercial |
$194.51
|
| 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: Mclaren Medicaid |
$41.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.11
|
| Rate for Payer: Meridian Medicaid |
$43.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.11
|
| Rate for Payer: Nomi Health Commercial |
$194.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.45
|
| 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 Choice Medicaid |
$41.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.84
|
| Rate for Payer: Priority Health Medicare |
$59.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.67
|
| 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 Exchange |
$59.15
|
| Rate for Payer: UHC Medicaid |
$41.71
|
| Rate for Payer: UHC Medicare Advantage |
$59.15
|
| Rate for Payer: UHCCP Medicaid |
$41.71
|
| Rate for Payer: VA VA |
$59.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.45
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$115.35
|
|
|
Service Code
|
NDC 00904704304
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Aetna Commercial |
$98.05
|
| Rate for Payer: Aetna Medicare |
$29.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.05
|
| Rate for Payer: BCBS Complete |
$21.35
|
| Rate for Payer: BCBS MAPPO |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$94.83
|
| Rate for Payer: BCN Commercial |
$94.83
|
| Rate for Payer: BCN Medicare Advantage |
$28.84
|
| 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: Health Alliance Plan Medicare Advantage |
$28.84
|
| Rate for Payer: Healthscope Commercial |
$103.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.51
|
| Rate for Payer: Mclaren Medicaid |
$20.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.28
|
| Rate for Payer: Meridian Medicaid |
$21.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.05
|
| Rate for Payer: Nomi Health Commercial |
$94.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.51
|
| Rate for Payer: PACE Senior Care Partners |
$27.40
|
| Rate for Payer: PACE SWMI |
$28.84
|
| Rate for Payer: PHP Commercial |
$98.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.35
|
| Rate for Payer: Priority Health Medicare |
$29.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.28
|
| Rate for Payer: Railroad Medicare Medicare |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.51
|
| Rate for Payer: UHC Core |
$96.32
|
| Rate for Payer: UHC Exchange |
$28.84
|
| Rate for Payer: UHC Medicaid |
$20.34
|
| Rate for Payer: UHC Medicare Advantage |
$28.84
|
| Rate for Payer: UHCCP Medicaid |
$20.34
|
| Rate for Payer: VA VA |
$28.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.51
|
|
