|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$3,102.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$1,240.80 |
| Max. Negotiated Rate |
$2,016.30 |
| Rate for Payer: Aetna Medicare |
$1,551.00
|
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS Complete |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,011.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$14,759.00 |
| Rate for Payer: Aetna Commercial |
$134.31
|
| Rate for Payer: Aetna Medicare |
$104.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.33
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$100.23
|
| Rate for Payer: BCBS Trust/PPO |
$729.05
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: BCN Medicare Advantage |
$100.23
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$144.33
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.23
|
| Rate for Payer: Healthscope Commercial |
$185.43
|
| Rate for Payer: Healthscope Commercial |
$160.37
|
| Rate for Payer: Mclaren Medicaid |
$67.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,759.00
|
| Rate for Payer: Nomi Health Commercial |
$120.28
|
| Rate for Payer: PACE SWMI |
$100.23
|
| Rate for Payer: PHP Medicare Advantage |
$100.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$100.23
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: Priority Health SBD |
$141.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.23
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$19,350.00 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.38
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$125.96
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$125.96
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$181.38
|
| Rate for Payer: Cofinity Commercial |
$168.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$201.54
|
| Rate for Payer: Healthscope Commercial |
$233.03
|
| Rate for Payer: Mclaren Medicaid |
$84.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.26
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,350.00
|
| Rate for Payer: Nomi Health Commercial |
$151.15
|
| Rate for Payer: PACE SWMI |
$125.96
|
| Rate for Payer: PHP Medicare Advantage |
$125.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.57
|
| Rate for Payer: Priority Health Medicare |
$125.96
|
| Rate for Payer: Priority Health Narrow Network |
$179.57
|
| Rate for Payer: Priority Health SBD |
$179.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.96
|
| Rate for Payer: UHC Medicare Advantage |
$125.96
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$22,844.00 |
| Rate for Payer: Aetna Commercial |
$201.86
|
| Rate for Payer: Aetna Medicare |
$156.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.92
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS MAPPO |
$150.64
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: BCN Commercial |
$227.73
|
| Rate for Payer: BCN Medicare Advantage |
$150.64
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$216.92
|
| Rate for Payer: Cofinity Commercial |
$201.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.64
|
| Rate for Payer: Healthscope Commercial |
$241.02
|
| Rate for Payer: Healthscope Commercial |
$278.68
|
| Rate for Payer: Mclaren Medicaid |
$101.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.17
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,844.00
|
| Rate for Payer: Nomi Health Commercial |
$180.77
|
| Rate for Payer: PACE SWMI |
$150.64
|
| Rate for Payer: PHP Medicare Advantage |
$150.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.39
|
| Rate for Payer: Priority Health Medicare |
$150.64
|
| Rate for Payer: Priority Health Narrow Network |
$214.39
|
| Rate for Payer: Priority Health SBD |
$214.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.64
|
| Rate for Payer: UHC Medicare Advantage |
$150.64
|
| Rate for Payer: UHCCP Medicaid |
$101.18
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$29,921.00 |
| Rate for Payer: Aetna Commercial |
$259.17
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.51
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS MAPPO |
$193.41
|
| Rate for Payer: BCBS Trust/PPO |
$399.39
|
| Rate for Payer: BCN Commercial |
$300.05
|
| Rate for Payer: BCN Medicare Advantage |
$193.41
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$278.51
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.41
|
| Rate for Payer: Healthscope Commercial |
$309.46
|
| Rate for Payer: Healthscope Commercial |
$357.81
|
| Rate for Payer: Mclaren Medicaid |
$129.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.08
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,921.00
|
| Rate for Payer: Nomi Health Commercial |
$232.09
|
| Rate for Payer: PACE SWMI |
$193.41
|
| Rate for Payer: PHP Medicare Advantage |
$193.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.37
|
| Rate for Payer: Priority Health Medicare |
$193.41
|
| Rate for Payer: Priority Health Narrow Network |
$276.37
|
| Rate for Payer: Priority Health SBD |
$276.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.41
|
| Rate for Payer: UHC Medicare Advantage |
$193.41
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$3,647.83
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,298.13 |
| Max. Negotiated Rate |
$3,283.05 |
| Rate for Payer: Aetna Commercial |
$3,100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.09
|
| Rate for Payer: Cash Price |
$2,918.26
|
| Rate for Payer: Cofinity Commercial |
$2,553.48
|
| Rate for Payer: Cofinity Commercial |
$3,137.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,553.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,918.26
|
| Rate for Payer: Healthscope Commercial |
$3,283.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,100.66
|
| Rate for Payer: PHP Commercial |
$3,100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,371.09
|
| Rate for Payer: Priority Health SBD |
$2,298.13
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$3,133.87
|
|
|
Service Code
|
NDC 00071101568
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,253.55 |
| Max. Negotiated Rate |
$2,820.48 |
| Rate for Payer: Aetna Commercial |
$2,663.79
|
| Rate for Payer: Aetna Medicare |
$1,566.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,037.02
|
| Rate for Payer: BCBS Complete |
$1,253.55
|
| Rate for Payer: Cash Price |
$2,507.10
|
| Rate for Payer: Cofinity Commercial |
$2,193.71
|
| Rate for Payer: Cofinity Commercial |
$2,695.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,193.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,507.10
|
| Rate for Payer: Healthscope Commercial |
$2,820.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,663.79
|
| Rate for Payer: PHP Commercial |
$2,663.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.02
|
| Rate for Payer: Priority Health SBD |
$1,974.34
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$3,647.83
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,459.13 |
| Max. Negotiated Rate |
$3,283.05 |
| Rate for Payer: Aetna Commercial |
$3,100.66
|
| Rate for Payer: Aetna Medicare |
$1,823.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.09
|
| Rate for Payer: BCBS Complete |
$1,459.13
|
| Rate for Payer: Cash Price |
$2,918.26
|
| Rate for Payer: Cofinity Commercial |
$2,553.48
|
| Rate for Payer: Cofinity Commercial |
$3,137.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,553.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,918.26
|
| Rate for Payer: Healthscope Commercial |
$3,283.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,100.66
|
| Rate for Payer: PHP Commercial |
$3,100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,371.09
|
| Rate for Payer: Priority Health SBD |
$2,298.13
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$3,133.87
|
|
|
Service Code
|
NDC 00071101568
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,974.34 |
| Max. Negotiated Rate |
$2,820.48 |
| Rate for Payer: Aetna Commercial |
$2,663.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,037.02
|
| Rate for Payer: Cash Price |
$2,507.10
|
| Rate for Payer: Cofinity Commercial |
$2,193.71
|
| Rate for Payer: Cofinity Commercial |
$2,695.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,193.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,507.10
|
| Rate for Payer: Healthscope Commercial |
$2,820.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,663.79
|
| Rate for Payer: PHP Commercial |
$2,663.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.02
|
| Rate for Payer: Priority Health SBD |
$1,974.34
|
|
|
PREGABALIN 20 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,934.10
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
161926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,218.48 |
| Max. Negotiated Rate |
$1,740.69 |
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Aetna Commercial |
$1,294.41
|
| Rate for Payer: Aetna Commercial |
$3,552.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,716.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.16
|
| Rate for Payer: Cash Price |
$1,547.28
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cash Price |
$3,343.39
|
| Rate for Payer: Cofinity Commercial |
$2,925.47
|
| Rate for Payer: Cofinity Commercial |
$3,594.15
|
| Rate for Payer: Cofinity Commercial |
$1,663.33
|
| Rate for Payer: Cofinity Commercial |
$1,309.63
|
| Rate for Payer: Cofinity Commercial |
$1,065.98
|
| Rate for Payer: Cofinity Commercial |
$1,353.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,353.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,925.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,547.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,343.39
|
| Rate for Payer: Healthscope Commercial |
$1,370.55
|
| Rate for Payer: Healthscope Commercial |
$1,740.69
|
| Rate for Payer: Healthscope Commercial |
$3,761.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,643.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,552.35
|
| Rate for Payer: PHP Commercial |
$1,294.41
|
| Rate for Payer: PHP Commercial |
$1,643.98
|
| Rate for Payer: PHP Commercial |
$3,552.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,257.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,716.51
|
| Rate for Payer: Priority Health SBD |
$2,632.92
|
| Rate for Payer: Priority Health SBD |
$959.38
|
| Rate for Payer: Priority Health SBD |
$1,218.48
|
|
|
PREGABALIN 20 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,522.83
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
161926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$1,370.55 |
| Rate for Payer: Aetna Commercial |
$1,294.41
|
| Rate for Payer: Aetna Commercial |
$3,552.35
|
| Rate for Payer: Aetna Commercial |
$1,643.98
|
| Rate for Payer: Aetna Medicare |
$2,089.62
|
| Rate for Payer: Aetna Medicare |
$761.42
|
| Rate for Payer: Aetna Medicare |
$967.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,716.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.16
|
| Rate for Payer: BCBS Complete |
$773.64
|
| Rate for Payer: BCBS Complete |
$609.13
|
| Rate for Payer: BCBS Complete |
$1,671.70
|
| Rate for Payer: Cash Price |
$3,343.39
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cash Price |
$1,547.28
|
| Rate for Payer: Cofinity Commercial |
$3,594.15
|
| Rate for Payer: Cofinity Commercial |
$1,309.63
|
| Rate for Payer: Cofinity Commercial |
$1,065.98
|
| Rate for Payer: Cofinity Commercial |
$1,663.33
|
| Rate for Payer: Cofinity Commercial |
$1,353.87
|
| Rate for Payer: Cofinity Commercial |
$2,925.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,353.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,925.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,547.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,343.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.26
|
| Rate for Payer: Healthscope Commercial |
$1,740.69
|
| Rate for Payer: Healthscope Commercial |
$1,370.55
|
| Rate for Payer: Healthscope Commercial |
$3,761.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,643.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,552.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.41
|
| Rate for Payer: PHP Commercial |
$1,643.98
|
| Rate for Payer: PHP Commercial |
$1,294.41
|
| Rate for Payer: PHP Commercial |
$3,552.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,716.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,257.16
|
| Rate for Payer: Priority Health SBD |
$2,632.92
|
| Rate for Payer: Priority Health SBD |
$1,218.48
|
| Rate for Payer: Priority Health SBD |
$959.38
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$131.13
|
|
|
Service Code
|
NDC 72205001190
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna Medicare |
$65.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: BCBS Complete |
$52.45
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.46
|
| Rate for Payer: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.23
|
| Rate for Payer: Priority Health SBD |
$82.61
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,256.08 |
| 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 Commercial |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,198.13
|
| 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
|
|
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 Commercial |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,198.13
|
| 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$131.13
|
|
|
Service Code
|
NDC 72205001190
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.61 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.46
|
| Rate for Payer: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.23
|
| Rate for Payer: Priority Health SBD |
$82.61
|
|
|
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 Commercial |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,281.01
|
| 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: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.08
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,303.44 |
| 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 Commercial |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,281.01
|
| 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: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.08
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.39 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
