|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$1,219.92
|
|
|
Service Code
|
NDC 0904-6745-61
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$1,097.93 |
| Rate for Payer: Aetna American Axle |
$792.95
|
| Rate for Payer: Aetna Commercial |
$1,036.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.95
|
| Rate for Payer: Cash Price |
$975.94
|
| Rate for Payer: Cofinity Commercial |
$1,049.13
|
| Rate for Payer: Cofinity Commercial |
$853.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.94
|
| Rate for Payer: Healthscope Commercial |
$1,097.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$853.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,036.93
|
| Rate for Payer: PHP Commercial |
$1,036.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.94
|
| Rate for Payer: Priority Health SBD |
$768.55
|
| Rate for Payer: UMR Bronson Commercial |
$536.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.94
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
IP
|
$3,724.79
|
|
|
Service Code
|
NDC 0024-4142-10
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,638.91 |
| Max. Negotiated Rate |
$3,352.31 |
| Rate for Payer: Aetna American Axle |
$2,421.11
|
| Rate for Payer: Aetna Commercial |
$3,166.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,421.11
|
| Rate for Payer: Cash Price |
$2,979.83
|
| Rate for Payer: Cofinity Commercial |
$2,607.35
|
| Rate for Payer: Cofinity Commercial |
$3,203.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,979.83
|
| Rate for Payer: Healthscope Commercial |
$3,352.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,607.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,793.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,166.07
|
| Rate for Payer: PHP Commercial |
$3,166.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,607.35
|
| Rate for Payer: Priority Health SBD |
$2,346.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,638.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,793.59
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
IP
|
$2,691.09
|
|
|
Service Code
|
NDC 0024-4142-60
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,184.08 |
| Max. Negotiated Rate |
$2,421.98 |
| Rate for Payer: Aetna American Axle |
$1,749.21
|
| Rate for Payer: Aetna Commercial |
$2,287.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,749.21
|
| Rate for Payer: Cash Price |
$2,152.87
|
| Rate for Payer: Cofinity Commercial |
$1,883.76
|
| Rate for Payer: Cofinity Commercial |
$2,314.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,152.87
|
| Rate for Payer: Healthscope Commercial |
$2,421.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,883.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,018.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,287.43
|
| Rate for Payer: PHP Commercial |
$2,287.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,883.76
|
| Rate for Payer: Priority Health SBD |
$1,695.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,184.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,018.32
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$52.44
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna American Axle |
$34.09
|
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.09
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$36.71
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.57
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.71
|
| Rate for Payer: Priority Health SBD |
$33.04
|
| Rate for Payer: UMR Bronson Commercial |
$23.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
DRUG-INDUCED SLEEP ENDOSCOPY, WITH DYNAMIC EVALUATION OF VELUM, PHARYNX, TONGUE BASE, AND LARYNX FOR EVALUATION OF SLEEP-DISORDERED BREATHING, FLEXIBLE, DIAGNOSTIC
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 42975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$97.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$95.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
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: 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 |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow Network |
$16.78
|
| Rate for Payer: Priority Health SBD |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.44
|
| Rate for Payer: Priority Health Narrow Network |
$67.44
|
| Rate for Payer: Priority Health SBD |
$67.44
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
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: 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 |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.82
|
| Rate for Payer: Priority Health Narrow Network |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$257.07
|
|
|
Service Code
|
NDC 43547-379-06
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna American Axle |
$167.10
|
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.66
|
| Rate for Payer: Healthscope Commercial |
$231.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.51
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.95
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: UMR Bronson Commercial |
$113.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.80
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$159.03
|
|
|
Service Code
|
NDC 68180-294-07
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$143.13 |
| Rate for Payer: Aetna American Axle |
$103.37
|
| Rate for Payer: Aetna Commercial |
$135.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.37
|
| Rate for Payer: Cash Price |
$127.22
|
| Rate for Payer: Cofinity Commercial |
$111.32
|
| Rate for Payer: Cofinity Commercial |
$136.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.22
|
| Rate for Payer: Healthscope Commercial |
$143.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.18
|
| Rate for Payer: PHP Commercial |
$135.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.32
|
| Rate for Payer: Priority Health SBD |
$100.19
|
| Rate for Payer: UMR Bronson Commercial |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.27
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 60505-2995-6
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.45
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$114.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 57237-017-60
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.09
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$1,721.84
|
|
|
Service Code
|
NDC 0002-3235-60
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$757.61 |
| Max. Negotiated Rate |
$1,549.66 |
| Rate for Payer: Aetna American Axle |
$1,119.20
|
| Rate for Payer: Aetna Commercial |
$1,463.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,377.47
|
| Rate for Payer: Cofinity Commercial |
$1,205.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.47
|
| Rate for Payer: Healthscope Commercial |
$1,549.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,205.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,463.56
|
| Rate for Payer: PHP Commercial |
$1,463.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.29
|
| Rate for Payer: Priority Health SBD |
$1,084.76
|
| Rate for Payer: UMR Bronson Commercial |
$757.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.38
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 57237-018-90
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.11
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.50
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 0002-3240-30
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.71 |
| Max. Negotiated Rate |
$868.73 |
| Rate for Payer: Aetna American Axle |
$627.42
|
| Rate for Payer: Aetna Commercial |
$820.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.42
|
| Rate for Payer: Cash Price |
$772.21
|
| Rate for Payer: Cofinity Commercial |
$675.68
|
| Rate for Payer: Cofinity Commercial |
$830.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$868.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.47
|
| Rate for Payer: PHP Commercial |
$820.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.68
|
| Rate for Payer: Priority Health SBD |
$608.11
|
| Rate for Payer: UMR Bronson Commercial |
$424.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.94
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-734-11
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna American Axle |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.86
|
| Rate for Payer: Cash Price |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.74
|
| Rate for Payer: PHP Commercial |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.08
|
| Rate for Payer: Priority Health SBD |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.30
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$121.70
|
|
|
Service Code
|
NDC 66993-663-30
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna American Axle |
$79.10
|
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.10
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Cofinity Commercial |
$85.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.44
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.19
|
| Rate for Payer: Priority Health SBD |
$76.67
|
| Rate for Payer: UMR Bronson Commercial |
$53.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$714.24
|
|
|
Service Code
|
NDC 68084-683-01
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.27 |
| Max. Negotiated Rate |
$642.82 |
| Rate for Payer: Aetna American Axle |
$464.26
|
| Rate for Payer: Aetna Commercial |
$607.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.26
|
| Rate for Payer: Cash Price |
$571.39
|
| Rate for Payer: Cofinity Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$607.10
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.97
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UMR Bronson Commercial |
$314.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$349.44
|
|
|
Service Code
|
NDC 0904-6453-61
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Aetna American Axle |
$227.14
|
| Rate for Payer: Aetna Commercial |
$297.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.14
|
| Rate for Payer: Cash Price |
$279.55
|
| Rate for Payer: Cofinity Commercial |
$244.61
|
| Rate for Payer: Cofinity Commercial |
$300.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.55
|
| Rate for Payer: Healthscope Commercial |
$314.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.02
|
| Rate for Payer: PHP Commercial |
$297.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.61
|
| Rate for Payer: Priority Health SBD |
$220.15
|
| Rate for Payer: UMR Bronson Commercial |
$153.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$439.68
|
|
|
Service Code
|
NDC 0904-7044-61
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.46 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna American Axle |
$285.79
|
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Commercial |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.73
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.78
|
| Rate for Payer: Priority Health SBD |
$277.00
|
| Rate for Payer: UMR Bronson Commercial |
$193.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.76
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$439.68
|
|
|
Service Code
|
NDC 60687-734-01
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.46 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna American Axle |
$285.79
|
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Commercial |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.73
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.78
|
| Rate for Payer: Priority Health SBD |
$277.00
|
| Rate for Payer: UMR Bronson Commercial |
$193.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.76
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$394.56
|
|
|
Service Code
|
NDC 0904-6454-61
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.61 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna American Axle |
$256.46
|
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.46
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$276.19
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.38
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.19
|
| Rate for Payer: Priority Health SBD |
$248.57
|
| Rate for Payer: UMR Bronson Commercial |
$173.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 51991-748-90
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna American Axle |
$155.06
|
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.06
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Commercial |
$166.98
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.84
|
| Rate for Payer: Healthscope Commercial |
$214.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.77
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.98
|
| Rate for Payer: Priority Health SBD |
$150.29
|
| Rate for Payer: UMR Bronson Commercial |
$104.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 60687-745-11
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.63
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.99
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$426.24
|
|
|
Service Code
|
NDC 60687-745-01
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna American Axle |
$277.06
|
| Rate for Payer: Aetna Commercial |
$362.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.06
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Commercial |
$298.37
|
| Rate for Payer: Cofinity Commercial |
$366.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$383.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.30
|
| Rate for Payer: PHP Commercial |
$362.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.37
|
| Rate for Payer: Priority Health SBD |
$268.53
|
| Rate for Payer: UMR Bronson Commercial |
$187.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.68
|
|
