|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 60687072311
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.11
|
| Rate for Payer: Healthscope Whirlpool |
$4.23
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$965.26
|
|
|
Service Code
|
NDC 2324030
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.14 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: Aetna Medicare |
$357.14
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: BCBS Trust/PPO |
$795.85
|
| Rate for Payer: BCN Commercial |
$795.85
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.20
|
| Rate for Payer: Healthscope Commercial |
$936.30
|
| Rate for Payer: Healthscope Whirlpool |
$965.26
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$772.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$845.76
|
| Rate for Payer: Priority Health Narrow Network |
$676.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$445.44
|
|
|
Service Code
|
NDC 904704461
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.81 |
| Max. Negotiated Rate |
$445.44 |
| Rate for Payer: Aetna Commercial |
$400.90
|
| Rate for Payer: Aetna Medicare |
$164.81
|
| Rate for Payer: ASR ASR |
$432.08
|
| Rate for Payer: BCBS Complete |
$178.18
|
| Rate for Payer: BCBS Trust/PPO |
$367.27
|
| Rate for Payer: BCN Commercial |
$367.27
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$418.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Healthscope Commercial |
$432.08
|
| Rate for Payer: Healthscope Whirlpool |
$445.44
|
| Rate for Payer: Mclaren Commercial |
$400.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Nomi Health Commercial |
$365.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$390.29
|
| Rate for Payer: Priority Health Narrow Network |
$312.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.99
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 2324030
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$723.94 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: BCBS Trust/PPO |
$792.67
|
| Rate for Payer: BCN Commercial |
$792.67
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.20
|
| Rate for Payer: Healthscope Commercial |
$936.30
|
| Rate for Payer: Healthscope Whirlpool |
$965.26
|
| 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: Opus (Opus Packaging Group) HMA |
$723.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$119.15
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Aetna Commercial |
$107.23
|
| Rate for Payer: Aetna Medicare |
$44.08
|
| Rate for Payer: ASR ASR |
$115.57
|
| Rate for Payer: BCBS Complete |
$47.66
|
| Rate for Payer: BCBS Trust/PPO |
$98.24
|
| Rate for Payer: BCN Commercial |
$98.24
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$115.57
|
| Rate for Payer: Healthscope Whirlpool |
$119.14
|
| Rate for Payer: Mclaren Commercial |
$107.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.27
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: Priority Health Cigna 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 |
$104.85
|
|
|
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 |
$228.42 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$274.10
|
| Rate for Payer: ASR ASR |
$295.42
|
| Rate for Payer: BCBS Trust/PPO |
$250.10
|
| Rate for Payer: BCN Commercial |
$250.10
|
| 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 |
$295.42
|
| Rate for Payer: Healthscope Whirlpool |
$304.56
|
| 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: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.01
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$445.44
|
|
|
Service Code
|
NDC 904704461
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.08 |
| Max. Negotiated Rate |
$445.44 |
| Rate for Payer: Aetna Commercial |
$400.90
|
| Rate for Payer: ASR ASR |
$432.08
|
| Rate for Payer: BCBS Trust/PPO |
$365.80
|
| Rate for Payer: BCN Commercial |
$365.80
|
| Rate for Payer: Cash Price |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$418.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.35
|
| Rate for Payer: Healthscope Commercial |
$432.08
|
| Rate for Payer: Healthscope Whirlpool |
$445.44
|
| Rate for Payer: Mclaren Commercial |
$400.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.62
|
| Rate for Payer: Nomi Health Commercial |
$365.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.99
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$119.15
|
|
|
Service Code
|
NDC 57237001830
|
| Hospital Charge Code |
39276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$119.14 |
| Rate for Payer: Aetna Commercial |
$107.23
|
| Rate for Payer: ASR ASR |
$115.57
|
| Rate for Payer: BCBS Trust/PPO |
$97.84
|
| Rate for Payer: BCN Commercial |
$97.84
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$115.57
|
| Rate for Payer: Healthscope Whirlpool |
$119.14
|
| Rate for Payer: Mclaren Commercial |
$107.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.27
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.85
|
|
|
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 |
$304.56 |
| Rate for Payer: Aetna Commercial |
$274.10
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: ASR ASR |
$295.42
|
| Rate for Payer: BCBS Complete |
$121.82
|
| Rate for Payer: BCBS Trust/PPO |
$251.11
|
| Rate for Payer: BCN Commercial |
$251.11
|
| 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 |
$295.42
|
| Rate for Payer: Healthscope Whirlpool |
$304.56
|
| Rate for Payer: Mclaren Commercial |
$274.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: Nomi Health Commercial |
$249.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.42
|
| Rate for Payer: Priority Health Cigna 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 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 |
$114.92 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: Aetna Medicare |
$42.52
|
| Rate for Payer: ASR ASR |
$111.47
|
| Rate for Payer: BCBS Complete |
$45.97
|
| Rate for Payer: BCBS Trust/PPO |
$94.75
|
| Rate for Payer: BCN Commercial |
$94.75
|
| Rate for Payer: Cash Price |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$108.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.93
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Whirlpool |
$114.92
|
| Rate for Payer: Mclaren Commercial |
$103.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.69
|
| Rate for Payer: Priority Health Narrow Network |
$80.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.13
|
|
|
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 |
$114.92 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: Aetna Medicare |
$42.52
|
| Rate for Payer: ASR ASR |
$111.47
|
| Rate for Payer: BCBS Complete |
$45.97
|
| Rate for Payer: BCBS Trust/PPO |
$94.75
|
| Rate for Payer: BCN Commercial |
$94.75
|
| Rate for Payer: Cash Price |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$108.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.93
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Whirlpool |
$114.92
|
| Rate for Payer: Mclaren Commercial |
$103.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.69
|
| Rate for Payer: Priority Health Narrow Network |
$80.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.13
|
|
|
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 |
$1.26 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.91
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.99
|
| 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
|
$114.92
|
|
|
Service Code
|
NDC 68180029606
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$114.92 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: ASR ASR |
$111.47
|
| Rate for Payer: BCBS Trust/PPO |
$94.37
|
| Rate for Payer: BCN Commercial |
$94.37
|
| Rate for Payer: Cash Price |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$108.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.93
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Whirlpool |
$114.92
|
| Rate for Payer: Mclaren Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.13
|
|
|
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 |
$86.19 |
| Max. Negotiated Rate |
$114.92 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: ASR ASR |
$111.47
|
| Rate for Payer: BCBS Trust/PPO |
$94.37
|
| Rate for Payer: BCN Commercial |
$94.37
|
| Rate for Payer: Cash Price |
$91.93
|
| Rate for Payer: Cofinity Commercial |
$108.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.93
|
| Rate for Payer: Healthscope Commercial |
$111.47
|
| Rate for Payer: Healthscope Whirlpool |
$114.92
|
| Rate for Payer: Mclaren Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.68
|
| Rate for Payer: Nomi Health Commercial |
$94.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.13
|
|
|
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 |
$37.94 |
| Max. Negotiated Rate |
$102.53 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: Aetna Medicare |
$37.94
|
| Rate for Payer: ASR ASR |
$99.45
|
| Rate for Payer: BCBS Complete |
$41.01
|
| Rate for Payer: BCBS Trust/PPO |
$84.53
|
| Rate for Payer: BCN Commercial |
$84.53
|
| 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 |
$99.45
|
| Rate for Payer: Healthscope Whirlpool |
$102.53
|
| Rate for Payer: Mclaren Commercial |
$92.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.15
|
| Rate for Payer: Nomi Health Commercial |
$84.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.90
|
| Rate for Payer: Priority Health Cigna 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 |
$90.22
|
|
|
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 |
$2.56 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Healthscope Whirlpool |
$3.42
|
| 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: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$965.26
|
|
|
Service Code
|
NDC 2327030
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$723.94 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: BCBS Trust/PPO |
$792.67
|
| Rate for Payer: BCN Commercial |
$792.67
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.20
|
| Rate for Payer: Healthscope Commercial |
$936.30
|
| Rate for Payer: Healthscope Whirlpool |
$965.26
|
| 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: Opus (Opus Packaging Group) HMA |
$723.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$102.53
|
|
|
Service Code
|
NDC 50268028813
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.90 |
| Max. Negotiated Rate |
$102.53 |
| Rate for Payer: Aetna Commercial |
$92.28
|
| Rate for Payer: ASR ASR |
$99.45
|
| Rate for Payer: BCBS Trust/PPO |
$84.20
|
| Rate for Payer: BCN Commercial |
$84.20
|
| 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 |
$99.45
|
| Rate for Payer: Healthscope Whirlpool |
$102.53
|
| 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: Opus (Opus Packaging Group) HMA |
$76.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.22
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$965.26
|
|
|
Service Code
|
NDC 2327030
|
| Hospital Charge Code |
39277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.14 |
| Max. Negotiated Rate |
$965.26 |
| Rate for Payer: Aetna Commercial |
$868.73
|
| Rate for Payer: Aetna Medicare |
$357.14
|
| Rate for Payer: ASR ASR |
$936.30
|
| Rate for Payer: BCBS Complete |
$386.10
|
| Rate for Payer: BCBS Trust/PPO |
$795.85
|
| Rate for Payer: BCN Commercial |
$795.85
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cofinity Commercial |
$907.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.20
|
| Rate for Payer: Healthscope Commercial |
$936.30
|
| Rate for Payer: Healthscope Whirlpool |
$965.26
|
| Rate for Payer: Mclaren Commercial |
$868.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$772.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.47
|
| Rate for Payer: Nomi Health Commercial |
$791.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$845.76
|
| Rate for Payer: Priority Health Narrow Network |
$676.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.43
|
|
|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$11,108.73
|
|
|
Service Code
|
MSDRG 149
|
| Min. Negotiated Rate |
$6,808.57 |
| Max. Negotiated Rate |
$11,108.73 |
| Rate for Payer: Aetna Medicare |
$7,166.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,958.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,958.65
|
| Rate for Payer: BCBS MAPPO |
$7,166.92
|
| Rate for Payer: BCN Medicare Advantage |
$7,166.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,166.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,166.92
|
| Rate for Payer: Mclaren Medicare |
$7,166.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,525.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,241.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,883.61
|
| Rate for Payer: PACE Medicare |
$6,808.57
|
| Rate for Payer: PACE SWMI |
$7,166.92
|
| Rate for Payer: PHP Commercial |
$7,883.61
|
| Rate for Payer: PHP Medicare Advantage |
$7,166.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,326.08
|
| Rate for Payer: Priority Health Medicare |
$7,166.92
|
| Rate for Payer: Priority Health Narrow Network |
$8,260.87
|
| Rate for Payer: Railroad Medicare Medicare |
$7,166.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,166.92
|
| Rate for Payer: UHC Exchange |
$11,108.73
|
| Rate for Payer: UHCCP DNSP |
$7,166.92
|
| Rate for Payer: VA VA |
$7,166.92
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$17,468.88
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$10,365.29 |
| Max. Negotiated Rate |
$17,468.88 |
| Rate for Payer: Aetna Medicare |
$10,910.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,638.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,638.54
|
| Rate for Payer: BCBS MAPPO |
$10,910.83
|
| Rate for Payer: BCN Medicare Advantage |
$10,910.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,910.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,910.83
|
| Rate for Payer: Mclaren Medicare |
$10,910.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,456.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,547.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,001.91
|
| Rate for Payer: PACE Medicare |
$10,365.29
|
| Rate for Payer: PACE SWMI |
$10,910.83
|
| Rate for Payer: PHP Commercial |
$12,001.91
|
| Rate for Payer: PHP Medicare Advantage |
$10,910.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,468.88
|
| Rate for Payer: Priority Health Medicare |
$10,910.83
|
| Rate for Payer: Priority Health Narrow Network |
$13,975.11
|
| Rate for Payer: Railroad Medicare Medicare |
$10,910.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,910.83
|
| Rate for Payer: UHC Exchange |
$16,911.79
|
| Rate for Payer: UHCCP DNSP |
$10,910.83
|
| Rate for Payer: VA VA |
$10,910.83
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$29,090.54
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$16,152.26 |
| Max. Negotiated Rate |
$29,090.54 |
| Rate for Payer: Aetna Medicare |
$17,002.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,252.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,252.97
|
| Rate for Payer: BCBS MAPPO |
$17,002.38
|
| Rate for Payer: BCN Medicare Advantage |
$17,002.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,002.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,002.38
|
| Rate for Payer: Mclaren Medicare |
$17,002.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,852.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,552.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,702.62
|
| Rate for Payer: PACE Medicare |
$16,152.26
|
| Rate for Payer: PACE SWMI |
$17,002.38
|
| Rate for Payer: PHP Commercial |
$18,702.62
|
| Rate for Payer: PHP Medicare Advantage |
$17,002.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,090.54
|
| Rate for Payer: Priority Health Medicare |
$17,002.38
|
| Rate for Payer: Priority Health Narrow Network |
$23,272.43
|
| Rate for Payer: Railroad Medicare Medicare |
$17,002.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,002.38
|
| Rate for Payer: UHC Exchange |
$26,353.69
|
| Rate for Payer: UHCCP DNSP |
$17,002.38
|
| Rate for Payer: VA VA |
$17,002.38
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$11,616.58
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$7,119.84 |
| Max. Negotiated Rate |
$11,616.58 |
| Rate for Payer: Aetna Medicare |
$7,494.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,368.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,368.21
|
| Rate for Payer: BCBS MAPPO |
$7,494.57
|
| Rate for Payer: BCN Medicare Advantage |
$7,494.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,494.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,494.57
|
| Rate for Payer: Mclaren Medicare |
$7,494.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,869.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,618.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,244.03
|
| Rate for Payer: PACE Medicare |
$7,119.84
|
| Rate for Payer: PACE SWMI |
$7,494.57
|
| Rate for Payer: PHP Commercial |
$8,244.03
|
| Rate for Payer: PHP Medicare Advantage |
$7,494.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,951.20
|
| Rate for Payer: Priority Health Medicare |
$7,494.57
|
| Rate for Payer: Priority Health Narrow Network |
$8,760.96
|
| Rate for Payer: Railroad Medicare Medicare |
$7,494.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,494.57
|
| Rate for Payer: UHC Exchange |
$11,616.58
|
| Rate for Payer: UHCCP DNSP |
$7,494.57
|
| Rate for Payer: VA VA |
$7,494.57
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$5,144.87
|
|
|
Service Code
|
APR-DRG 1102
|
| Min. Negotiated Rate |
$4,651.58 |
| Max. Negotiated Rate |
$5,144.87 |
| Rate for Payer: BCBS Complete |
$5,144.87
|
| Rate for Payer: Mclaren Medicaid |
$4,899.88
|
| Rate for Payer: Meridian Medicaid |
$5,144.87
|
| Rate for Payer: PHP Medicaid |
$4,651.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,899.88
|
| Rate for Payer: UHC Medicaid |
$4,899.88
|
| Rate for Payer: UHCCP Medicaid |
$4,899.88
|
|
|
EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES
|
Facility
|
IP
|
$9,680.49
|
|
|
Service Code
|
APR-DRG 1103
|
| Min. Negotiated Rate |
$8,752.32 |
| Max. Negotiated Rate |
$9,680.49 |
| Rate for Payer: BCBS Complete |
$9,680.49
|
| Rate for Payer: Mclaren Medicaid |
$9,219.52
|
| Rate for Payer: Meridian Medicaid |
$9,680.49
|
| Rate for Payer: PHP Medicaid |
$8,752.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,219.52
|
| Rate for Payer: UHC Medicaid |
$9,219.52
|
| Rate for Payer: UHCCP Medicaid |
$9,219.52
|
|
