|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$182.16
|
|
|
Service Code
|
NDC 00228289203
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$163.94 |
| Rate for Payer: Aetna American Axle |
$118.40
|
| Rate for Payer: Aetna Commercial |
$154.84
|
| Rate for Payer: Aetna Medicare |
$91.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.40
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cofinity Advantage |
$127.51
|
| Rate for Payer: Cofinity Commercial |
$156.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.73
|
| Rate for Payer: Healthscope Commercial |
$163.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.62
|
| Rate for Payer: PHP Commercial |
$154.84
|
| Rate for Payer: Priority Health SBD |
$114.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.40
|
| Rate for Payer: UHC Core |
$94.91
|
| Rate for Payer: UHC Exchange |
$71.59
|
| Rate for Payer: UMR Bronson Commercial |
$67.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.62
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$424.80
|
|
|
Service Code
|
NDC 60687074501
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$382.32 |
| Rate for Payer: Aetna American Axle |
$276.12
|
| Rate for Payer: Aetna Commercial |
$361.08
|
| Rate for Payer: Aetna Medicare |
$212.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.12
|
| Rate for Payer: BCBS Complete |
$169.92
|
| Rate for Payer: Cash Price |
$339.84
|
| Rate for Payer: Cofinity Advantage |
$297.36
|
| Rate for Payer: Cofinity Commercial |
$365.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.84
|
| Rate for Payer: Healthscope Commercial |
$382.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.60
|
| Rate for Payer: PHP Commercial |
$361.08
|
| Rate for Payer: Priority Health SBD |
$267.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.12
|
| Rate for Payer: UHC Core |
$221.32
|
| Rate for Payer: UHC Exchange |
$166.95
|
| Rate for Payer: UMR Bronson Commercial |
$157.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.60
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$714.24
|
|
|
Service Code
|
NDC 68084069201
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 68180029609
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$238.55
|
|
|
Service Code
|
NDC 68180029609
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$114.92
|
|
|
Service Code
|
NDC 68180029606
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna American Axle |
$74.70
|
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna Medicare |
$57.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.70
|
| Rate for Payer: BCBS Complete |
$45.97
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Advantage |
$80.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.70
|
| Rate for Payer: UHC Core |
$59.87
|
| Rate for Payer: UHC Exchange |
$45.16
|
| Rate for Payer: UMR Bronson Commercial |
$42.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 27241009903
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 60687074511
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
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 |
$171.92 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna American Axle |
$253.97
|
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Advantage |
$273.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$273.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health SBD |
$246.15
|
| Rate for Payer: UMR Bronson Commercial |
$171.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
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 |
$144.57 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna American Axle |
$253.97
|
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna Medicare |
$195.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| Rate for Payer: BCBS Complete |
$156.29
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Advantage |
$273.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$273.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health SBD |
$246.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.97
|
| Rate for Payer: UHC Core |
$203.57
|
| Rate for Payer: UHC Exchange |
$153.55
|
| Rate for Payer: UMR Bronson Commercial |
$144.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.04
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$182.16
|
|
|
Service Code
|
NDC 00228289203
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.15 |
| Max. Negotiated Rate |
$163.94 |
| Rate for Payer: Aetna American Axle |
$118.40
|
| Rate for Payer: Aetna Commercial |
$154.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.40
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cofinity Advantage |
$127.51
|
| Rate for Payer: Cofinity Commercial |
$156.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.73
|
| Rate for Payer: Healthscope Commercial |
$163.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.62
|
| Rate for Payer: PHP Commercial |
$154.84
|
| Rate for Payer: Priority Health SBD |
$114.76
|
| Rate for Payer: UMR Bronson Commercial |
$80.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.62
|
|
|
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 |
$42.52 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna American Axle |
$74.70
|
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna Medicare |
$57.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.70
|
| Rate for Payer: BCBS Complete |
$45.97
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Advantage |
$80.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.70
|
| Rate for Payer: UHC Core |
$59.87
|
| Rate for Payer: UHC Exchange |
$45.16
|
| Rate for Payer: UMR Bronson Commercial |
$42.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 27241009903
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$714.24
|
|
|
Service Code
|
NDC 68084069201
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$965.26
|
|
|
Service Code
|
NDC 00002327030
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$114.92
|
|
|
Service Code
|
NDC 68180029606
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna American Axle |
$74.70
|
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.70
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Advantage |
$80.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| Rate for Payer: UMR Bronson Commercial |
$50.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 51991074890
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 60687074511
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$424.80
|
|
|
Service Code
|
NDC 60687074501
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.91 |
| Max. Negotiated Rate |
$382.32 |
| Rate for Payer: Aetna American Axle |
$276.12
|
| Rate for Payer: Aetna Commercial |
$361.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.12
|
| Rate for Payer: Cash Price |
$339.84
|
| Rate for Payer: Cofinity Advantage |
$297.36
|
| Rate for Payer: Cofinity Commercial |
$365.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.84
|
| Rate for Payer: Healthscope Commercial |
$382.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.60
|
| Rate for Payer: PHP Commercial |
$361.08
|
| Rate for Payer: Priority Health SBD |
$267.62
|
| Rate for Payer: UMR Bronson Commercial |
$186.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.60
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$238.55
|
|
|
Service Code
|
NDC 51991074890
|
| Hospital Charge Code |
39277
|
|
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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$114.92
|
|
|
Service Code
|
NDC 57237001930
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$103.43 |
| Rate for Payer: Aetna American Axle |
$74.70
|
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.70
|
| Rate for Payer: Cash Price |
$91.94
|
| Rate for Payer: Cofinity Advantage |
$80.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| Rate for Payer: UMR Bronson Commercial |
$50.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.19
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 00002327030
|
| Hospital Charge Code |
39277
|
|
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
|
|
|
DUODERM CGF DRESSING 4X4
|
Facility
|
OP
|
$8.12
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
150727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna American Axle |
$5.28
|
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Advantage |
$5.68
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: Priority Health SBD |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC Core |
$4.23
|
| Rate for Payer: UHC Exchange |
$3.19
|
| Rate for Payer: UMR Bronson Commercial |
$3.00
|
| 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 |
$3.57 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna American Axle |
$5.28
|
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Advantage |
$5.68
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: Priority Health SBD |
$5.12
|
| Rate for Payer: UMR Bronson Commercial |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.09
|
|
|
DUODERM CGF DRESSING EXTRA THIN 4X4
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
150728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna American Axle |
$4.75
|
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.75
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.84
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.47
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health SBD |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.47
|
|
