|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,234.09 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$1,570.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.12
|
| Rate for Payer: BCBS Complete |
$1,256.08
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Advantage |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,512.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,041.12
|
| Rate for Payer: UHC Core |
$1,636.04
|
| Rate for Payer: UHC Exchange |
$1,234.09
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,978.32 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.12
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Advantage |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$316.32
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.28 |
| Max. Negotiated Rate |
$284.69 |
| Rate for Payer: Aetna Commercial |
$268.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.61
|
| Rate for Payer: Cash Price |
$253.06
|
| Rate for Payer: Cofinity Advantage |
$221.42
|
| Rate for Payer: Cofinity Commercial |
$272.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.06
|
| Rate for Payer: Healthscope Commercial |
$284.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.24
|
| Rate for Payer: PHP Commercial |
$268.87
|
| Rate for Payer: Priority Health SBD |
$199.28
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$277.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.03 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna Medicare |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: BCBS Complete |
$110.98
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Advantage |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health SBD |
$174.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.34
|
| Rate for Payer: UHC Core |
$144.55
|
| Rate for Payer: UHC Exchange |
$109.03
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.09
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,052.91 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: Cash Price |
$2,606.87
|
| Rate for Payer: Cofinity Advantage |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,443.94
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,280.63 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna Medicare |
$1,629.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: BCBS Complete |
$1,303.44
|
| Rate for Payer: Cash Price |
$2,606.87
|
| Rate for Payer: Cofinity Advantage |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,606.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,443.94
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,118.08
|
| Rate for Payer: UHC Core |
$1,697.73
|
| Rate for Payer: UHC Exchange |
$1,280.63
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$277.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Advantage |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health SBD |
$174.79
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.80
|
| Rate for Payer: UHC Core |
$131.29
|
| Rate for Payer: UHC Exchange |
$99.04
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.09
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$277.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.03 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna Medicare |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: BCBS Complete |
$110.98
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Advantage |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health SBD |
$174.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.34
|
| Rate for Payer: UHC Core |
$144.55
|
| Rate for Payer: UHC Exchange |
$109.03
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,505.28 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: Aetna Medicare |
$1,915.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.66
|
| Rate for Payer: BCBS Complete |
$1,532.10
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Advantage |
$2,681.17
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,064.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: Priority Health SBD |
$2,413.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,489.66
|
| Rate for Payer: UHC Core |
$1,995.56
|
| Rate for Payer: UHC Exchange |
$1,505.28
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$277.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Advantage |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health SBD |
$174.79
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,413.05 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.66
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Advantage |
$2,681.17
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: Priority Health SBD |
$2,413.05
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.80
|
| Rate for Payer: UHC Core |
$131.29
|
| Rate for Payer: UHC Exchange |
$99.04
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Aetna Commercial |
$261.39
|
| Rate for Payer: Aetna Medicare |
$202.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.90
|
| Rate for Payer: BCBS Complete |
$132.41
|
| Rate for Payer: BCBS MAPPO |
$195.07
|
| Rate for Payer: BCN Commercial |
$331.16
|
| Rate for Payer: BCN Medicare Advantage |
$195.07
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cofinity Commercial |
$280.90
|
| Rate for Payer: Cofinity Commercial |
$261.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$360.88
|
| Rate for Payer: Healthscope Commercial |
$312.11
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.82
|
| Rate for Payer: Meridian Medicaid |
$132.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.48
|
| Rate for Payer: Nomi Health Commercial |
$234.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.25
|
| Rate for Payer: PACE SWMI |
$195.07
|
| Rate for Payer: PHP Medicare Advantage |
$195.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$403.49
|
| Rate for Payer: Priority Health Medicare |
$195.07
|
| Rate for Payer: Priority Health SBD |
$403.49
|
| Rate for Payer: Priority Health Tiered Network |
$403.49
|
| Rate for Payer: Railroad Medicare Medicare |
$195.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.06
|
| Rate for Payer: UHC Core |
$396.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$195.07
|
| Rate for Payer: UHC Exchange |
$396.06
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,169.28 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.40
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Advantage |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: Priority Health SBD |
$1,169.28
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$812.41 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$812.41
|
| Rate for Payer: BCN Commercial |
$812.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Advantage |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health SBD |
$1,169.28
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$179.75
|
| Rate for Payer: Aetna Medicare |
$139.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.16
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCBS MAPPO |
$134.14
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: BCN Medicare Advantage |
$134.14
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$193.16
|
| Rate for Payer: Cofinity Commercial |
$179.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.14
|
| Rate for Payer: Healthscope Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$214.62
|
| Rate for Payer: Mclaren Medicaid |
$86.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.85
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.52
|
| Rate for Payer: Nomi Health Commercial |
$160.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$134.14
|
| Rate for Payer: PHP Medicare Advantage |
$134.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$276.08
|
| Rate for Payer: Priority Health Medicare |
$134.14
|
| Rate for Payer: Priority Health SBD |
$276.08
|
| Rate for Payer: Priority Health Tiered Network |
$276.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.86
|
| Rate for Payer: UHC Core |
$269.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.14
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$179.75
|
| Rate for Payer: Aetna Medicare |
$139.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.16
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCBS MAPPO |
$134.14
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: BCN Medicare Advantage |
$134.14
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$193.16
|
| Rate for Payer: Cofinity Commercial |
$179.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.14
|
| Rate for Payer: Healthscope Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$214.62
|
| Rate for Payer: Mclaren Medicaid |
$86.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.85
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.52
|
| Rate for Payer: Nomi Health Commercial |
$160.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$134.14
|
| Rate for Payer: PHP Medicare Advantage |
$134.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$276.08
|
| Rate for Payer: Priority Health Medicare |
$134.14
|
| Rate for Payer: Priority Health SBD |
$276.08
|
| Rate for Payer: Priority Health Tiered Network |
$276.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.86
|
| Rate for Payer: UHC Core |
$269.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.14
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$878.25 |
| Rate for Payer: Aetna Commercial |
$284.82
|
| Rate for Payer: Aetna Medicare |
$221.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$212.55
|
| Rate for Payer: BCN Commercial |
$360.04
|
| Rate for Payer: BCN Medicare Advantage |
$212.55
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$306.07
|
| Rate for Payer: Cofinity Commercial |
$284.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$393.22
|
| Rate for Payer: Healthscope Commercial |
$340.08
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.18
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.90
|
| Rate for Payer: Nomi Health Commercial |
$255.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.25
|
| Rate for Payer: PACE SWMI |
$212.55
|
| Rate for Payer: PHP Medicare Advantage |
$212.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$438.69
|
| Rate for Payer: Priority Health Medicare |
$212.55
|
| Rate for Payer: Priority Health SBD |
$438.69
|
| Rate for Payer: Priority Health Tiered Network |
$438.69
|
| Rate for Payer: Railroad Medicare Medicare |
$212.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.77
|
| Rate for Payer: UHC Core |
$432.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.55
|
| Rate for Payer: UHC Exchange |
$432.77
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
