|
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 |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
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 |
$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 Advantage |
$1,205.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.47
|
| Rate for Payer: Healthscope Commercial |
$1,549.66
|
| Rate for Payer: 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 Commercial |
$1,463.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,291.38
|
| Rate for Payer: PHP Commercial |
$1,463.56
|
| Rate for Payer: Priority Health SBD |
$1,084.76
|
| Rate for Payer: UMR Bronson Commercial |
$757.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.38
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$257.07
|
|
|
Service Code
|
NDC 43547037906
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna American Axle |
$167.10
|
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna Medicare |
$128.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: BCBS Complete |
$102.83
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$205.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.80
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.10
|
| Rate for Payer: UHC Core |
$133.93
|
| Rate for Payer: UHC Exchange |
$101.03
|
| Rate for Payer: UMR Bronson Commercial |
$95.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.80
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 60505299506
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Advantage |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.58
|
| Rate for Payer: UHC Core |
$135.12
|
| Rate for Payer: UHC Exchange |
$101.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$257.07
|
|
|
Service Code
|
NDC 43547037906
|
| 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 Advantage |
$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 Commercial |
$218.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.80
|
| Rate for Payer: PHP Commercial |
$218.51
|
| 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 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$445.44
|
|
|
Service Code
|
NDC 00904704461
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.99 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna American Axle |
$289.54
|
| Rate for Payer: Aetna Commercial |
$378.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.54
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Advantage |
$311.81
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health SBD |
$280.63
|
| Rate for Payer: UMR Bronson Commercial |
$195.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$304.56
|
|
|
Service Code
|
NDC 68180029509
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Advantage |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$134.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 27241009803
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Advantage |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.64
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UMR Bronson Commercial |
$34.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$304.56
|
|
|
Service Code
|
NDC 57237001890
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.69 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna Medicare |
$152.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: BCBS Complete |
$121.82
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Advantage |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.96
|
| Rate for Payer: UHC Core |
$158.68
|
| Rate for Payer: UHC Exchange |
$119.69
|
| Rate for Payer: UMR Bronson Commercial |
$112.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$490.08
|
|
|
Service Code
|
NDC 60687073401
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.64 |
| Max. Negotiated Rate |
$441.07 |
| Rate for Payer: Aetna American Axle |
$318.55
|
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.55
|
| Rate for Payer: Cash Price |
$392.06
|
| Rate for Payer: Cofinity Advantage |
$343.06
|
| Rate for Payer: Cofinity Commercial |
$421.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.06
|
| Rate for Payer: Healthscope Commercial |
$441.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.56
|
| Rate for Payer: PHP Commercial |
$416.57
|
| Rate for Payer: Priority Health SBD |
$308.75
|
| Rate for Payer: UMR Bronson Commercial |
$215.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.56
|
|
|
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 |
$164.81 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna American Axle |
$289.54
|
| Rate for Payer: Aetna Commercial |
$378.62
|
| Rate for Payer: Aetna Medicare |
$222.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.54
|
| Rate for Payer: BCBS Complete |
$178.18
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Advantage |
$311.81
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health SBD |
$280.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.54
|
| Rate for Payer: UHC Core |
$232.07
|
| Rate for Payer: UHC Exchange |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$164.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$714.24
|
|
|
Service Code
|
NDC 68084068301
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.27 |
| Max. Negotiated Rate |
$642.82 |
| Rate for Payer: Aetna American Axle |
$464.26
|
| Rate for Payer: Aetna Commercial |
$607.10
|
| Rate for Payer: Aetna Medicare |
$357.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.26
|
| Rate for Payer: BCBS Complete |
$285.70
|
| Rate for Payer: Cash Price |
$571.39
|
| Rate for Payer: Cofinity Advantage |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.68
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.26
|
| Rate for Payer: UHC Core |
$372.12
|
| Rate for Payer: UHC Exchange |
$280.70
|
| Rate for Payer: UMR Bronson Commercial |
$264.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$238.55
|
|
|
Service Code
|
NDC 27241009809
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$214.69 |
| Rate for Payer: Aetna American Axle |
$155.06
|
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: Aetna Medicare |
$119.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.06
|
| Rate for Payer: BCBS Complete |
$95.42
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Advantage |
$166.99
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$166.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health SBD |
$150.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.06
|
| Rate for Payer: UHC Core |
$124.28
|
| Rate for Payer: UHC Exchange |
$93.75
|
| Rate for Payer: UMR Bronson Commercial |
$88.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
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 |
$52.43 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna American Axle |
$77.45
|
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.45
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Advantage |
$83.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health SBD |
$75.06
|
| Rate for Payer: UMR Bronson Commercial |
$52.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 27241009809
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$214.69 |
| 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 Advantage |
$166.99
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$166.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PHP Commercial |
$202.77
|
| 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 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 27241009803
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: BCBS Complete |
$31.81
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Advantage |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.64
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.69
|
| Rate for Payer: UHC Core |
$41.43
|
| Rate for Payer: UHC Exchange |
$31.25
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$965.26
|
|
|
Service Code
|
NDC 00002324030
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.15 |
| Max. Negotiated Rate |
$868.73 |
| Rate for Payer: Aetna American Axle |
$627.42
|
| Rate for Payer: Aetna Commercial |
$820.47
|
| Rate for Payer: Aetna Medicare |
$482.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.42
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: Cash Price |
$772.21
|
| Rate for Payer: Cofinity Advantage |
$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 |
$723.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$772.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.95
|
| Rate for Payer: PHP Commercial |
$820.47
|
| Rate for Payer: Priority Health SBD |
$608.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.42
|
| Rate for Payer: UHC Core |
$502.90
|
| Rate for Payer: UHC Exchange |
$379.35
|
| Rate for Payer: UMR Bronson Commercial |
$357.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 00002324030
|
| 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 Advantage |
$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 |
$723.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.95
|
| Rate for Payer: PHP Commercial |
$820.47
|
| 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 |
$723.95
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$304.56
|
|
|
Service Code
|
NDC 57237001890
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Advantage |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$134.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$714.24
|
|
|
Service Code
|
NDC 68084068301
|
| 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 Advantage |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: 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 Commercial |
$607.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.68
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UMR Bronson Commercial |
$314.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$4.91
|
|
|
Service Code
|
NDC 60687073411
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna American Axle |
$3.19
|
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Advantage |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.68
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health SBD |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.19
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.68
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$304.56
|
|
|
Service Code
|
NDC 68180029509
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.69 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna Medicare |
$152.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: BCBS Complete |
$121.82
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Advantage |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.96
|
| Rate for Payer: UHC Core |
$158.68
|
| Rate for Payer: UHC Exchange |
$119.69
|
| Rate for Payer: UMR Bronson Commercial |
$112.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
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 |
$44.09 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna American Axle |
$77.45
|
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.45
|
| Rate for Payer: BCBS Complete |
$47.66
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Advantage |
$83.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health SBD |
$75.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.45
|
| Rate for Payer: UHC Core |
$62.08
|
| Rate for Payer: UHC Exchange |
$46.83
|
| Rate for Payer: UMR Bronson Commercial |
$44.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$490.08
|
|
|
Service Code
|
NDC 60687073401
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.33 |
| Max. Negotiated Rate |
$441.07 |
| Rate for Payer: Aetna American Axle |
$318.55
|
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Aetna Medicare |
$245.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.55
|
| Rate for Payer: BCBS Complete |
$196.03
|
| Rate for Payer: Cash Price |
$392.06
|
| Rate for Payer: Cofinity Advantage |
$343.06
|
| Rate for Payer: Cofinity Commercial |
$421.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.06
|
| Rate for Payer: Healthscope Commercial |
$441.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.56
|
| Rate for Payer: PHP Commercial |
$416.57
|
| Rate for Payer: Priority Health SBD |
$308.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.55
|
| Rate for Payer: UHC Core |
$255.33
|
| Rate for Payer: UHC Exchange |
$192.60
|
| Rate for Payer: UMR Bronson Commercial |
$181.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.56
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4.91
|
|
|
Service Code
|
NDC 60687073411
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna American Axle |
$3.19
|
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.19
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cofinity Advantage |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$4.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.68
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health SBD |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.68
|
|
