|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$320.41
|
| Rate for Payer: Aetna Medicare |
$312.50
|
| Rate for Payer: BCBS Complete |
$165.28
|
| Rate for Payer: BCN Commercial |
$426.28
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Mclaren Medicaid |
$157.41
|
| Rate for Payer: Meridian Medicaid |
$165.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.12
|
| Rate for Payer: UHC Medicaid |
$157.41
|
| Rate for Payer: UHCCP Medicaid |
$157.41
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$446.61
|
| Rate for Payer: Aetna Medicare |
$432.00
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCN Commercial |
$594.09
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Mclaren Medicaid |
$220.46
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$547.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$547.87
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$447.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna Commercial |
$449.62
|
| Rate for Payer: Aetna Medicare |
$447.00
|
| Rate for Payer: BCN Commercial |
$661.82
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.33
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Medicare |
$1,488.00
|
| Rate for Payer: BCBS Complete |
$1,190.40
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.00
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$576.75 |
| Rate for Payer: Aetna Medicare |
$384.50
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.75
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$1,202.25 |
| Rate for Payer: Aetna Medicare |
$801.50
|
| Rate for Payer: Aetna Medicare |
$1,597.50
|
| Rate for Payer: BCBS Complete |
$641.20
|
| Rate for Payer: BCBS Complete |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,282.40
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,396.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.25
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCN Commercial |
$157.36
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Mclaren Medicaid |
$56.87
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.11
|
| Rate for Payer: UHC Medicaid |
$56.87
|
| Rate for Payer: UHCCP Medicaid |
$56.87
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$147.36
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Mclaren Medicaid |
$71.14
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.33
|
| Rate for Payer: UHC Medicaid |
$71.14
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$249.75 |
| Rate for Payer: Aetna Commercial |
$172.27
|
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Mclaren Medicaid |
$85.41
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$218.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.15
|
| Rate for Payer: UHC Medicaid |
$85.41
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Medicare |
$219.00
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCN Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Mclaren Medicaid |
$109.48
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.13
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$553.62 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$581.25
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,581.55
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Mclaren Medicaid |
$553.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: Meridian Medicaid |
$581.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$863.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicaid |
$553.62
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: UHCCP Medicaid |
$553.62
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.75 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: BCBS Trust/PPO |
$371.12
|
| Rate for Payer: BCN Commercial |
$371.12
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.01
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$390.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Core |
$375.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna Medicare |
$116.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.42
|
| Rate for Payer: BCBS Complete |
$83.17
|
| Rate for Payer: BCBS MAPPO |
$112.34
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$369.41
|
| Rate for Payer: BCN Medicare Advantage |
$112.34
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.34
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Mclaren Medicaid |
$79.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.95
|
| Rate for Payer: Meridian Medicaid |
$83.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Nomi Health Commercial |
$368.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.01
|
| Rate for Payer: PACE Senior Care Partners |
$106.72
|
| Rate for Payer: PACE SWMI |
$112.34
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: PHP Medicare Advantage |
$112.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$390.93
|
| Rate for Payer: Priority Health Medicare |
$113.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.75
|
| Rate for Payer: Railroad Medicare Medicare |
$112.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Core |
$375.21
|
| Rate for Payer: UHC Exchange |
$112.34
|
| Rate for Payer: UHC Medicaid |
$79.22
|
| Rate for Payer: UHC Medicare Advantage |
$112.34
|
| Rate for Payer: UHCCP Medicaid |
$79.22
|
| Rate for Payer: VA VA |
$112.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,185.57 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.48
|
| Rate for Payer: BCN Commercial |
$2,593.48
|
| Rate for Payer: Cash Price |
$2,512.15
|
| 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: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$574.88 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: Aetna Medicare |
$847.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,019.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,019.00
|
| Rate for Payer: BCBS Complete |
$603.58
|
| Rate for Payer: BCBS MAPPO |
$815.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,680.71
|
| Rate for Payer: BCN Commercial |
$2,680.71
|
| Rate for Payer: BCN Medicare Advantage |
$815.20
|
| Rate for Payer: Cash Price |
$2,608.65
|
| Rate for Payer: Cofinity Commercial |
$2,804.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,608.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$815.20
|
| Rate for Payer: Healthscope Commercial |
$2,934.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,445.61
|
| Rate for Payer: Mclaren Medicaid |
$574.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$855.96
|
| Rate for Payer: Meridian Medicaid |
$603.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$937.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$896.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,771.69
|
| Rate for Payer: Nomi Health Commercial |
$2,673.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,445.61
|
| Rate for Payer: PACE Senior Care Partners |
$774.44
|
| Rate for Payer: PACE SWMI |
$815.20
|
| Rate for Payer: PHP Commercial |
$2,771.69
|
| Rate for Payer: PHP Medicare Advantage |
$815.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Medicare |
$823.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,269.52
|
| Rate for Payer: Railroad Medicare Medicare |
$815.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,869.51
|
| Rate for Payer: UHC Core |
$2,722.78
|
| Rate for Payer: UHC Exchange |
$815.20
|
| Rate for Payer: UHC Medicaid |
$574.88
|
| Rate for Payer: UHC Medicare Advantage |
$815.20
|
| Rate for Payer: UHCCP Medicaid |
$574.88
|
| Rate for Payer: VA VA |
$815.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,445.61
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,269.52 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,693.10
|
| Rate for Payer: BCN Commercial |
$2,693.10
|
| Rate for Payer: Cash Price |
$2,608.65
|
| Rate for Payer: Cofinity Commercial |
$2,804.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,608.65
|
| Rate for Payer: Healthscope Commercial |
$2,934.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,445.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,771.69
|
| Rate for Payer: Nomi Health Commercial |
$2,673.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,445.61
|
| Rate for Payer: PHP Commercial |
$2,771.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,269.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,869.51
|
| Rate for Payer: UHC Core |
$2,722.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,445.61
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$553.62 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$581.25
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,581.55
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Mclaren Medicaid |
$553.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: Meridian Medicaid |
$581.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$863.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicaid |
$553.62
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: UHCCP Medicaid |
$553.62
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$316.32
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.16 |
| Max. Negotiated Rate |
$284.69 |
| Rate for Payer: Aetna Commercial |
$268.87
|
| Rate for Payer: BCBS Trust/PPO |
$261.25
|
| Rate for Payer: BCN Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$253.06
|
| 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: Lakeland Regional Health Systems Commercial |
$237.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.87
|
| Rate for Payer: Nomi Health Commercial |
$259.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.24
|
| Rate for Payer: PHP Commercial |
$268.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.36
|
| Rate for Payer: UHC Core |
$264.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.24
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$316.32
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$284.69 |
| Rate for Payer: Aetna Commercial |
$268.87
|
| Rate for Payer: Aetna Medicare |
$82.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.85
|
| Rate for Payer: BCBS Complete |
$58.55
|
| Rate for Payer: BCBS MAPPO |
$79.08
|
| Rate for Payer: BCBS Trust/PPO |
$260.05
|
| Rate for Payer: BCN Commercial |
$260.05
|
| Rate for Payer: BCN Medicare Advantage |
$79.08
|
| Rate for Payer: Cash Price |
$253.06
|
| Rate for Payer: Cofinity Commercial |
$272.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.08
|
| Rate for Payer: Healthscope Commercial |
$284.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.24
|
| Rate for Payer: Mclaren Medicaid |
$55.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.03
|
| Rate for Payer: Meridian Medicaid |
$58.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.87
|
| Rate for Payer: Nomi Health Commercial |
$259.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.24
|
| Rate for Payer: PACE Senior Care Partners |
$75.13
|
| Rate for Payer: PACE SWMI |
$79.08
|
| Rate for Payer: PHP Commercial |
$268.87
|
| Rate for Payer: PHP Medicare Advantage |
$79.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.20
|
| Rate for Payer: Priority Health Medicare |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.16
|
| Rate for Payer: Railroad Medicare Medicare |
$79.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.36
|
| Rate for Payer: UHC Core |
$264.13
|
| Rate for Payer: UHC Exchange |
$79.08
|
| Rate for Payer: UHC Medicaid |
$55.77
|
| Rate for Payer: UHC Medicare Advantage |
$79.08
|
| Rate for Payer: UHCCP Medicaid |
$55.77
|
| Rate for Payer: VA VA |
$79.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.24
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,185.57 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.48
|
| Rate for Payer: BCN Commercial |
$2,593.48
|
| Rate for Payer: Cash Price |
$2,512.15
|
| 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: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$553.62 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$581.25
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,581.55
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Mclaren Medicaid |
$553.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: Meridian Medicaid |
$581.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$863.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicaid |
$553.62
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: UHCCP Medicaid |
$553.62
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,185.57 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.48
|
| Rate for Payer: BCN Commercial |
$2,593.48
|
| Rate for Payer: Cash Price |
$2,512.15
|
| 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: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,185.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.39 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$208.13
|
| Rate for Payer: BCN Commercial |
$208.13
|
| Rate for Payer: Cash Price |
$201.60
|
| 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: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$181.89
|
|
|
Service Code
|
NDC 69238131109
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: BCBS Trust/PPO |
$150.22
|
| Rate for Payer: BCN Commercial |
$150.22
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Commercial |
$156.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.51
|
| Rate for Payer: Healthscope Commercial |
$163.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: Nomi Health Commercial |
$149.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.42
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.06
|
| Rate for Payer: UHC Core |
$151.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$181.89
|
|
|
Service Code
|
NDC 69238131109
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: Aetna Medicare |
$47.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.84
|
| Rate for Payer: BCBS Complete |
$33.67
|
| Rate for Payer: BCBS MAPPO |
$45.47
|
| Rate for Payer: BCBS Trust/PPO |
$149.53
|
| Rate for Payer: BCN Commercial |
$149.53
|
| Rate for Payer: BCN Medicare Advantage |
$45.47
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Commercial |
$156.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.47
|
| Rate for Payer: Healthscope Commercial |
$163.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Mclaren Medicaid |
$32.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.75
|
| Rate for Payer: Meridian Medicaid |
$33.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: Nomi Health Commercial |
$149.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.42
|
| Rate for Payer: PACE Senior Care Partners |
$43.20
|
| Rate for Payer: PACE SWMI |
$45.47
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: PHP Medicare Advantage |
$45.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.24
|
| Rate for Payer: Priority Health Medicare |
$45.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.06
|
| Rate for Payer: UHC Core |
$151.88
|
| Rate for Payer: UHC Exchange |
$45.47
|
| Rate for Payer: UHC Medicaid |
$32.07
|
| Rate for Payer: UHC Medicare Advantage |
$45.47
|
| Rate for Payer: UHCCP Medicaid |
$32.07
|
| Rate for Payer: VA VA |
$45.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
