|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$68.29
|
|
|
Service Code
|
NDC 63323013011
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$68.29 |
| Rate for Payer: Aetna Commercial |
$61.46
|
| Rate for Payer: Aetna Medicare |
$34.14
|
| Rate for Payer: ASR ASR |
$66.24
|
| Rate for Payer: ASR Commercial |
$66.24
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS Trust/PPO |
$55.92
|
| Rate for Payer: BCN Commercial |
$52.95
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cofinity Commercial |
$64.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.63
|
| Rate for Payer: Healthscope Commercial |
$68.29
|
| Rate for Payer: Healthscope Whirlpool |
$66.24
|
| Rate for Payer: Mclaren Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.05
|
| Rate for Payer: Nomi Health Commercial |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.84
|
| Rate for Payer: Priority Health Narrow Network |
$47.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.10
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$68.29
|
|
|
Service Code
|
NDC 63323013013
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$68.29 |
| Rate for Payer: Aetna Commercial |
$61.46
|
| Rate for Payer: ASR ASR |
$66.24
|
| Rate for Payer: ASR Commercial |
$66.24
|
| Rate for Payer: BCBS Trust/PPO |
$55.65
|
| Rate for Payer: BCN Commercial |
$52.95
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cofinity Commercial |
$64.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.63
|
| Rate for Payer: Healthscope Commercial |
$68.29
|
| Rate for Payer: Healthscope Whirlpool |
$66.24
|
| Rate for Payer: Mclaren Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.05
|
| Rate for Payer: Nomi Health Commercial |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.10
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$51.42
|
|
|
Service Code
|
NDC 66794023741
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$51.42 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Aetna Medicare |
$25.71
|
| Rate for Payer: ASR ASR |
$49.88
|
| Rate for Payer: ASR Commercial |
$49.88
|
| Rate for Payer: BCBS Complete |
$20.57
|
| Rate for Payer: BCBS Trust/PPO |
$42.11
|
| Rate for Payer: BCN Commercial |
$39.87
|
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Cofinity Commercial |
$48.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.14
|
| Rate for Payer: Healthscope Commercial |
$51.42
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Mclaren Commercial |
$46.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.71
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.05
|
| Rate for Payer: Priority Health Narrow Network |
$36.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$63.39
|
|
|
Service Code
|
NDC 68382091001
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$63.39 |
| Rate for Payer: Aetna Commercial |
$57.05
|
| Rate for Payer: Aetna Medicare |
$31.70
|
| Rate for Payer: ASR ASR |
$61.49
|
| Rate for Payer: ASR Commercial |
$61.49
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.91
|
| Rate for Payer: BCN Commercial |
$49.15
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$63.39
|
| Rate for Payer: Healthscope Whirlpool |
$61.49
|
| Rate for Payer: Mclaren Commercial |
$57.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.88
|
| Rate for Payer: Nomi Health Commercial |
$51.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.54
|
| Rate for Payer: Priority Health Narrow Network |
$44.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.78
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$51.42
|
|
|
Service Code
|
NDC 66794023741
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$51.42 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: ASR ASR |
$49.88
|
| Rate for Payer: ASR Commercial |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$41.90
|
| Rate for Payer: BCN Commercial |
$39.87
|
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Cofinity Commercial |
$48.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.14
|
| Rate for Payer: Healthscope Commercial |
$51.42
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Mclaren Commercial |
$46.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.71
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
NDC 67457043710
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: ASR ASR |
$66.93
|
| Rate for Payer: ASR Commercial |
$66.93
|
| Rate for Payer: BCBS Trust/PPO |
$56.23
|
| Rate for Payer: BCN Commercial |
$53.50
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$64.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Healthscope Whirlpool |
$66.93
|
| Rate for Payer: Mclaren Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.72
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$63.39
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$63.39 |
| Rate for Payer: Aetna Commercial |
$57.05
|
| Rate for Payer: ASR ASR |
$61.49
|
| Rate for Payer: ASR Commercial |
$61.49
|
| Rate for Payer: BCBS Trust/PPO |
$51.66
|
| Rate for Payer: BCN Commercial |
$49.15
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$63.39
|
| Rate for Payer: Healthscope Whirlpool |
$61.49
|
| Rate for Payer: Mclaren Commercial |
$57.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.88
|
| Rate for Payer: Nomi Health Commercial |
$51.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.78
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$63.39
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$63.39 |
| Rate for Payer: Aetna Commercial |
$57.05
|
| Rate for Payer: ASR ASR |
$61.49
|
| Rate for Payer: ASR Commercial |
$61.49
|
| Rate for Payer: BCBS Trust/PPO |
$51.66
|
| Rate for Payer: BCN Commercial |
$49.15
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$63.39
|
| Rate for Payer: Healthscope Whirlpool |
$61.49
|
| Rate for Payer: Mclaren Commercial |
$57.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.88
|
| Rate for Payer: Nomi Health Commercial |
$51.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.78
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$63.39
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$63.39 |
| Rate for Payer: Aetna Commercial |
$57.05
|
| Rate for Payer: Aetna Medicare |
$31.70
|
| Rate for Payer: ASR ASR |
$61.49
|
| Rate for Payer: ASR Commercial |
$61.49
|
| Rate for Payer: BCBS Complete |
$25.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.91
|
| Rate for Payer: BCN Commercial |
$49.15
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.71
|
| Rate for Payer: Healthscope Commercial |
$63.39
|
| Rate for Payer: Healthscope Whirlpool |
$61.49
|
| Rate for Payer: Mclaren Commercial |
$57.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.88
|
| Rate for Payer: Nomi Health Commercial |
$51.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.54
|
| Rate for Payer: Priority Health Narrow Network |
$44.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.78
|
|
|
DRUG TEST PRESUMPTIVE READ BY INSTR ASSISTED DIRECT OPTICAL OBS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS G0478
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow Network |
$16.78
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.44
|
| Rate for Payer: Priority Health Narrow Network |
$67.44
|
|
|
DRUG TEST(S), PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS G0477
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.82
|
| Rate for Payer: Priority Health Narrow Network |
$12.82
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: ASR ASR |
$98.47
|
| Rate for Payer: ASR Commercial |
$98.47
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: BCBS Trust/PPO |
$83.13
|
| Rate for Payer: BCN Commercial |
$78.71
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Healthscope Whirlpool |
$98.47
|
| Rate for Payer: Mclaren Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.95
|
| Rate for Payer: Priority Health Narrow Network |
$71.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.34
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.99 |
| Max. Negotiated Rate |
$101.52 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: ASR ASR |
$98.47
|
| Rate for Payer: ASR Commercial |
$98.47
|
| Rate for Payer: BCBS Trust/PPO |
$82.73
|
| Rate for Payer: BCN Commercial |
$78.71
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$101.52
|
| Rate for Payer: Healthscope Whirlpool |
$98.47
|
| Rate for Payer: Mclaren Commercial |
$91.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.34
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$119.14
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Aetna Commercial |
$107.23
|
| Rate for Payer: ASR ASR |
$115.57
|
| Rate for Payer: ASR Commercial |
$115.57
|
| Rate for Payer: BCBS Trust/PPO |
$97.09
|
| Rate for Payer: BCN Commercial |
$92.37
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$111.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.31
|
| Rate for Payer: Healthscope Commercial |
$119.14
|
| Rate for Payer: Healthscope Whirlpool |
$115.57
|
| Rate for Payer: Mclaren Commercial |
$107.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.27
|
| Rate for Payer: Nomi Health Commercial |
$97.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.84
|
|
|
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 |
$197.96 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$274.10
|
| Rate for Payer: ASR ASR |
$295.42
|
| Rate for Payer: ASR Commercial |
$295.42
|
| Rate for Payer: BCBS Trust/PPO |
$248.19
|
| Rate for Payer: BCN Commercial |
$236.13
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Healthscope Whirlpool |
$295.42
|
| Rate for Payer: Mclaren Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Nomi Health Commercial |
$249.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.01
|
|
|
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 |
$121.82 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$274.10
|
| Rate for Payer: Aetna Medicare |
$152.28
|
| Rate for Payer: ASR ASR |
$295.42
|
| Rate for Payer: ASR Commercial |
$295.42
|
| Rate for Payer: BCBS Complete |
$121.82
|
| Rate for Payer: BCBS Trust/PPO |
$249.40
|
| Rate for Payer: BCN Commercial |
$236.13
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Healthscope Whirlpool |
$295.42
|
| Rate for Payer: Mclaren Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Nomi Health Commercial |
$249.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.86
|
| Rate for Payer: Priority Health Narrow Network |
$213.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.01
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$119.14
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.66 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Aetna Commercial |
$107.23
|
| Rate for Payer: Aetna Medicare |
$59.57
|
| Rate for Payer: ASR ASR |
$115.57
|
| Rate for Payer: ASR Commercial |
$115.57
|
| Rate for Payer: BCBS Complete |
$47.66
|
| Rate for Payer: BCBS Trust/PPO |
$97.56
|
| Rate for Payer: BCN Commercial |
$92.37
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$111.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.31
|
| Rate for Payer: Healthscope Commercial |
$119.14
|
| Rate for Payer: Healthscope Whirlpool |
$115.57
|
| Rate for Payer: Mclaren Commercial |
$107.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.27
|
| Rate for Payer: Nomi Health Commercial |
$97.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.39
|
| Rate for Payer: Priority Health Narrow Network |
$83.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.84
|
|
|
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 |
$627.42 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Trust/PPO |
$786.59
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
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 |
$386.10 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: Aetna Medicare |
$482.63
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: BCBS Trust/PPO |
$790.45
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.76
|
| Rate for Payer: Priority Health Narrow Network |
$676.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
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 |
$627.42 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Trust/PPO |
$786.59
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
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 |
$386.10 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: Aetna Medicare |
$482.63
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: ASR Commercial |
$936.30
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: BCBS Trust/PPO |
$790.45
|
| Rate for Payer: BCN Commercial |
$748.37
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.21
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Whirlpool |
$936.30
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.76
|
| Rate for Payer: Priority Health Narrow Network |
$676.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$3.42
|
|
|
Service Code
|
NDC 50268028811
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: ASR Commercial |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.32
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.00
|
| Rate for Payer: Priority Health Narrow Network |
$2.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$3.42
|
|
|
Service Code
|
NDC 50268028811
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: ASR Commercial |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.32
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$102.53
|
|
|
Service Code
|
NDC 50268028813
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$102.53 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: Aetna Medicare |
$51.26
|
| Rate for Payer: ASR ASR |
$99.45
|
| Rate for Payer: ASR Commercial |
$99.45
|
| Rate for Payer: BCBS Complete |
$41.01
|
| Rate for Payer: BCBS Trust/PPO |
$83.96
|
| Rate for Payer: BCN Commercial |
$79.49
|
| Rate for Payer: Cash Price |
$82.02
|
| Rate for Payer: Cofinity Commercial |
$96.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.02
|
| Rate for Payer: Healthscope Commercial |
$102.53
|
| Rate for Payer: Healthscope Whirlpool |
$99.45
|
| Rate for Payer: Mclaren Commercial |
$92.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.15
|
| Rate for Payer: Nomi Health Commercial |
$84.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.84
|
| Rate for Payer: Priority Health Narrow Network |
$71.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.23
|
|
