|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$127.01
|
|
|
Service Code
|
NDC 60687072321
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$114.31 |
| Rate for Payer: Aetna Commercial |
$107.96
|
| Rate for Payer: Aetna Medicare |
$33.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.69
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$31.75
|
| Rate for Payer: BCBS Trust/PPO |
$104.41
|
| Rate for Payer: BCN Commercial |
$104.41
|
| Rate for Payer: BCN Medicare Advantage |
$31.75
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cofinity Commercial |
$109.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.75
|
| Rate for Payer: Healthscope Commercial |
$114.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.26
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.34
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.96
|
| Rate for Payer: Nomi Health Commercial |
$104.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.26
|
| Rate for Payer: PACE Senior Care Partners |
$30.16
|
| Rate for Payer: PACE SWMI |
$31.75
|
| Rate for Payer: PHP Commercial |
$107.96
|
| Rate for Payer: PHP Medicare Advantage |
$31.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$32.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.40
|
| Rate for Payer: Railroad Medicare Medicare |
$31.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.77
|
| Rate for Payer: UHC Core |
$106.05
|
| Rate for Payer: UHC Exchange |
$31.75
|
| Rate for Payer: UHC Medicaid |
$22.39
|
| Rate for Payer: UHC Medicare Advantage |
$31.75
|
| Rate for Payer: UHCCP Medicaid |
$22.39
|
| Rate for Payer: VA VA |
$31.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.26
|
|
|
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
|
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
|
$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
|
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
|
$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
|
IP
|
$1,721.84
|
|
|
Service Code
|
NDC 00002323560
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,198.40 |
| Max. Negotiated Rate |
$1,549.66 |
| Rate for Payer: Aetna Commercial |
$1,463.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.07
|
| Rate for Payer: BCN Commercial |
$1,422.07
|
| Rate for Payer: Cash Price |
$1,377.47
|
| 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: Lakeland Regional Health Systems Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,463.56
|
| Rate for Payer: Nomi Health Commercial |
$1,411.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,291.38
|
| Rate for Payer: PHP Commercial |
$1,463.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,498.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,198.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,515.22
|
| Rate for Payer: UHC Core |
$1,437.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.38
|
|
|
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
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$445.44
|
|
|
Service Code
|
NDC 00904704461
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.03 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$378.62
|
| Rate for Payer: BCBS Trust/PPO |
$367.89
|
| Rate for Payer: BCN Commercial |
$367.89
|
| Rate for Payer: Cash Price |
$356.35
|
| 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: Lakeland Regional Health Systems Commercial |
$334.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Nomi Health Commercial |
$365.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$387.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.99
|
| Rate for Payer: UHC Core |
$371.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$445.44
|
|
|
Service Code
|
NDC 00904704461
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$378.62
|
| Rate for Payer: Aetna Medicare |
$115.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.20
|
| Rate for Payer: BCBS Complete |
$82.45
|
| Rate for Payer: BCBS MAPPO |
$111.36
|
| Rate for Payer: BCBS Trust/PPO |
$366.20
|
| Rate for Payer: BCN Commercial |
$366.20
|
| Rate for Payer: BCN Medicare Advantage |
$111.36
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.08
|
| Rate for Payer: Mclaren Medicaid |
$78.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.93
|
| Rate for Payer: Meridian Medicaid |
$82.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Nomi Health Commercial |
$365.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: PACE Senior Care Partners |
$105.79
|
| Rate for Payer: PACE SWMI |
$111.36
|
| Rate for Payer: PHP Commercial |
$378.62
|
| Rate for Payer: PHP Medicare Advantage |
$111.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$387.53
|
| Rate for Payer: Priority Health Medicare |
$112.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.03
|
| Rate for Payer: Railroad Medicare Medicare |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.99
|
| Rate for Payer: UHC Core |
$371.94
|
| Rate for Payer: UHC Exchange |
$111.36
|
| Rate for Payer: UHC Medicaid |
$78.53
|
| Rate for Payer: UHC Medicare Advantage |
$111.36
|
| Rate for Payer: UHCCP Medicaid |
$78.53
|
| Rate for Payer: VA VA |
$111.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$119.15
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: BCBS Trust/PPO |
$98.41
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$119.15
|
|
|
Service Code
|
NDC 68180029506
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.23
|
| Rate for Payer: BCBS Complete |
$22.05
|
| Rate for Payer: BCBS MAPPO |
$29.79
|
| Rate for Payer: BCBS Trust/PPO |
$97.95
|
| Rate for Payer: BCN Commercial |
$97.95
|
| Rate for Payer: BCN Medicare Advantage |
$29.79
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.79
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Mclaren Medicaid |
$21.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.28
|
| Rate for Payer: Meridian Medicaid |
$22.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PACE Senior Care Partners |
$28.30
|
| Rate for Payer: PACE SWMI |
$29.79
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: PHP Medicare Advantage |
$29.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: Railroad Medicare Medicare |
$29.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: UHC Exchange |
$29.79
|
| Rate for Payer: UHC Medicaid |
$21.01
|
| Rate for Payer: UHC Medicare Advantage |
$29.79
|
| Rate for Payer: UHCCP Medicaid |
$21.01
|
| Rate for Payer: VA VA |
$29.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$119.15
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.23
|
| Rate for Payer: BCBS Complete |
$22.05
|
| Rate for Payer: BCBS MAPPO |
$29.79
|
| Rate for Payer: BCBS Trust/PPO |
$97.95
|
| Rate for Payer: BCN Commercial |
$97.95
|
| Rate for Payer: BCN Medicare Advantage |
$29.79
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.79
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Mclaren Medicaid |
$21.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.28
|
| Rate for Payer: Meridian Medicaid |
$22.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PACE Senior Care Partners |
$28.30
|
| Rate for Payer: PACE SWMI |
$29.79
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: PHP Medicare Advantage |
$29.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: Railroad Medicare Medicare |
$29.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: UHC Exchange |
$29.79
|
| Rate for Payer: UHC Medicaid |
$21.01
|
| Rate for Payer: UHC Medicare Advantage |
$29.79
|
| Rate for Payer: UHCCP Medicaid |
$21.01
|
| Rate for Payer: VA VA |
$29.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$119.15
|
|
|
Service Code
|
NDC 68180029506
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: BCBS Trust/PPO |
$98.41
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$238.55
|
|
|
Service Code
|
NDC 68180029609
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$214.69 |
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: Aetna Medicare |
$62.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.55
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS MAPPO |
$59.64
|
| Rate for Payer: BCBS Trust/PPO |
$196.11
|
| Rate for Payer: BCN Commercial |
$196.11
|
| Rate for Payer: BCN Medicare Advantage |
$59.64
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.64
|
| Rate for Payer: Healthscope Commercial |
$214.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: Mclaren Medicaid |
$42.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$44.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Nomi Health Commercial |
$195.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PACE Senior Care Partners |
$56.66
|
| Rate for Payer: PACE SWMI |
$59.64
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: PHP Medicare Advantage |
$59.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.54
|
| Rate for Payer: Priority Health Medicare |
$60.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.03
|
| Rate for Payer: Railroad Medicare Medicare |
$59.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.92
|
| Rate for Payer: UHC Core |
$199.19
|
| Rate for Payer: UHC Exchange |
$59.64
|
| Rate for Payer: UHC Medicaid |
$42.06
|
| Rate for Payer: UHC Medicare Advantage |
$59.64
|
| Rate for Payer: UHCCP Medicaid |
$42.06
|
| Rate for Payer: VA VA |
$59.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$390.72
|
|
|
Service Code
|
NDC 00904704561
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.94 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: BCBS Trust/PPO |
$322.70
|
| Rate for Payer: BCN Commercial |
$322.70
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.83
|
| Rate for Payer: UHC Core |
$326.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$114.92
|
|
|
Service Code
|
NDC 68180029606
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: BCBS Complete |
$21.27
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS Trust/PPO |
$94.48
|
| Rate for Payer: BCN Commercial |
$94.48
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.73
|
| Rate for Payer: Healthscope Commercial |
$103.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Mclaren Medicaid |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.29
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$99.98
|
| Rate for Payer: Priority Health Medicare |
$29.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.98
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.13
|
| Rate for Payer: UHC Core |
$95.96
|
| Rate for Payer: UHC Exchange |
$28.73
|
| Rate for Payer: UHC Medicaid |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHCCP Medicaid |
$20.26
|
| Rate for Payer: VA VA |
$28.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$390.72
|
|
|
Service Code
|
NDC 00904704561
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna Medicare |
$101.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.10
|
| Rate for Payer: BCBS Complete |
$72.32
|
| Rate for Payer: BCBS MAPPO |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$321.21
|
| Rate for Payer: BCN Commercial |
$321.21
|
| Rate for Payer: BCN Medicare Advantage |
$97.68
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.68
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Mclaren Medicaid |
$68.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.56
|
| Rate for Payer: Meridian Medicaid |
$72.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PACE Senior Care Partners |
$92.80
|
| Rate for Payer: PACE SWMI |
$97.68
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: PHP Medicare Advantage |
$97.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.93
|
| Rate for Payer: Priority Health Medicare |
$98.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.94
|
| Rate for Payer: Railroad Medicare Medicare |
$97.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.83
|
| Rate for Payer: UHC Core |
$326.25
|
| Rate for Payer: UHC Exchange |
$97.68
|
| Rate for Payer: UHC Medicaid |
$68.88
|
| Rate for Payer: UHC Medicare Advantage |
$97.68
|
| Rate for Payer: UHCCP Medicaid |
$68.88
|
| Rate for Payer: VA VA |
$97.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$114.92
|
|
|
Service Code
|
NDC 68180029606
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$94.91
|
| Rate for Payer: BCN Commercial |
$94.91
|
| Rate for Payer: Cash Price |
$91.94
|
| 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: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$99.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.13
|
| Rate for Payer: UHC Core |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 68180029609
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.03 |
| Max. Negotiated Rate |
$214.69 |
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: BCBS Trust/PPO |
$197.02
|
| Rate for Payer: BCN Commercial |
$197.02
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.84
|
| Rate for Payer: Healthscope Commercial |
$214.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Nomi Health Commercial |
$195.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.92
|
| Rate for Payer: UHC Core |
$199.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$114.92
|
|
|
Service Code
|
NDC 57237001930
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$94.91
|
| Rate for Payer: BCN Commercial |
$94.91
|
| Rate for Payer: Cash Price |
$91.94
|
| 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: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$99.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.13
|
| Rate for Payer: UHC Core |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$114.92
|
|
|
Service Code
|
NDC 57237001930
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna Medicare |
$29.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.91
|
| Rate for Payer: BCBS Complete |
$21.27
|
| Rate for Payer: BCBS MAPPO |
$28.73
|
| Rate for Payer: BCBS Trust/PPO |
$94.48
|
| Rate for Payer: BCN Commercial |
$94.48
|
| Rate for Payer: BCN Medicare Advantage |
$28.73
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.73
|
| Rate for Payer: Healthscope Commercial |
$103.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Mclaren Medicaid |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.17
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.29
|
| Rate for Payer: PACE SWMI |
$28.73
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: PHP Medicare Advantage |
$28.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$99.98
|
| Rate for Payer: Priority Health Medicare |
$29.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.98
|
| Rate for Payer: Railroad Medicare Medicare |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.13
|
| Rate for Payer: UHC Core |
$95.96
|
| Rate for Payer: UHC Exchange |
$28.73
|
| Rate for Payer: UHC Medicaid |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$28.73
|
| Rate for Payer: UHCCP Medicaid |
$20.26
|
| Rate for Payer: VA VA |
$28.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DUODERM CGF DRESSING 4X4
|
Facility
|
OP
|
$8.12
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
150727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare |
$2.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$2.03
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: BCN Medicare Advantage |
$2.03
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: Mclaren Medicaid |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.13
|
| Rate for Payer: Meridian Medicaid |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Nomi Health Commercial |
$6.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PACE Senior Care Partners |
$1.93
|
| Rate for Payer: PACE SWMI |
$2.03
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$2.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.06
|
| Rate for Payer: Priority Health Medicare |
$2.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.15
|
| Rate for Payer: UHC Core |
$6.78
|
| Rate for Payer: UHC Exchange |
$2.03
|
| Rate for Payer: UHC Medicaid |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$2.03
|
| Rate for Payer: UHCCP Medicaid |
$1.43
|
| Rate for Payer: VA VA |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.09
|
|
|
DUODERM CGF DRESSING 4X4
|
Facility
|
IP
|
$8.12
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
150727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.71
|
| Rate for Payer: BCN Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Nomi Health Commercial |
$6.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.15
|
| Rate for Payer: UHC Core |
$6.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.09
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$4,964.46
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$4,728.05 |
| Max. Negotiated Rate |
$4,964.46 |
| Rate for Payer: BCBS Complete |
$4,964.46
|
| Rate for Payer: Mclaren Medicaid |
$4,728.05
|
| Rate for Payer: Meridian Medicaid |
$4,964.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,728.05
|
| Rate for Payer: UHC Medicaid |
$4,728.05
|
| Rate for Payer: UHCCP Medicaid |
$4,728.05
|
|
