|
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 Commercial |
$343.06
|
| Rate for Payer: Cofinity Commercial |
$421.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.06
|
| 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: PHP Commercial |
$416.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.55
|
| 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
|
$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 Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| 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: PHP Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: Priority Health SBD |
$3.09
|
| 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
|
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 Commercial |
$311.81
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.81
|
| 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: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.54
|
| 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
|
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 Commercial |
$311.81
|
| Rate for Payer: Cofinity Commercial |
$383.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.81
|
| 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: PHP Commercial |
$378.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.54
|
| Rate for Payer: Priority Health SBD |
$280.63
|
| Rate for Payer: UMR Bronson Commercial |
$164.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.08
|
|
|
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 Commercial |
$80.44
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.44
|
| 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: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.70
|
| 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 Commercial |
$166.99
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.99
|
| 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: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.06
|
| 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
|
$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 Commercial |
$80.44
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.44
|
| 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: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.70
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| 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
|
$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 Commercial |
$675.68
|
| Rate for Payer: Cofinity Commercial |
$830.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.68
|
| 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: PHP Commercial |
$820.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: Priority Health SBD |
$608.11
|
| 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
|
OP
|
$380.64
|
|
|
Service Code
|
NDC 00904704561
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna Medicare |
$190.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: BCBS Complete |
$152.26
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Commercial |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.42
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UMR Bronson Commercial |
$140.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
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 Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.97
|
| 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: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.26
|
| 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
|
$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 Commercial |
$80.44
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.44
|
| 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: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.70
|
| 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
|
$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 Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| 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: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| 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
|
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 Commercial |
$297.36
|
| Rate for Payer: Cofinity Commercial |
$365.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.36
|
| 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: PHP Commercial |
$361.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.12
|
| Rate for Payer: Priority Health SBD |
$267.62
|
| 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
|
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 Commercial |
$80.44
|
| Rate for Payer: Cofinity Commercial |
$98.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.44
|
| 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: PHP Commercial |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.70
|
| Rate for Payer: Priority Health SBD |
$72.40
|
| 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
|
$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 Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.97
|
| 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: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.26
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| 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
|
$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 Commercial |
$166.99
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.99
|
| 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: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.06
|
| Rate for Payer: Priority Health SBD |
$150.29
|
| 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
|
$380.64
|
|
|
Service Code
|
NDC 00904704561
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Aetna American Axle |
$247.42
|
| Rate for Payer: Aetna Commercial |
$323.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.42
|
| Rate for Payer: Cash Price |
$304.51
|
| Rate for Payer: Cofinity Commercial |
$266.45
|
| Rate for Payer: Cofinity Commercial |
$327.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.51
|
| Rate for Payer: Healthscope Commercial |
$342.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$323.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.42
|
| Rate for Payer: Priority Health SBD |
$239.80
|
| Rate for Payer: UMR Bronson Commercial |
$167.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.48
|
|
|
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 Commercial |
$297.36
|
| Rate for Payer: Cofinity Commercial |
$365.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.36
|
| 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: PHP Commercial |
$361.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.12
|
| 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
|
$85.50
|
|
|
Service Code
|
NDC 27241009903
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna American Axle |
$55.58
|
| Rate for Payer: Aetna Commercial |
$72.67
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.58
|
| Rate for Payer: BCBS Complete |
$34.20
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Cofinity Commercial |
$73.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$76.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.67
|
| Rate for Payer: PHP Commercial |
$72.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.58
|
| Rate for Payer: Priority Health SBD |
$53.87
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.12
|
|
|
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 Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| 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: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| 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
|
$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 Commercial |
$675.68
|
| Rate for Payer: Cofinity Commercial |
$830.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.68
|
| 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: PHP Commercial |
$820.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| 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 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$85.50
|
|
|
Service Code
|
NDC 27241009903
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna American Axle |
$55.58
|
| Rate for Payer: Aetna Commercial |
$72.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.58
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Cofinity Commercial |
$73.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$76.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.67
|
| Rate for Payer: PHP Commercial |
$72.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.58
|
| Rate for Payer: Priority Health SBD |
$53.87
|
| Rate for Payer: UMR Bronson Commercial |
$37.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.12
|
|
|
DUODERM CGF DRESSING 4X4
|
Facility
|
OP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
150727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
DUODERM CGF DRESSING 4X4
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
150727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
DUODERM CGF DRESSING EXTRA THIN 4X4
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
150728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
