|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$405.73 |
| Rate for Payer: Aetna Commercial |
$258.26
|
| Rate for Payer: Aetna Medicare |
$200.44
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS MAPPO |
$192.73
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: BCN Commercial |
$299.07
|
| Rate for Payer: BCN Medicare Advantage |
$192.73
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cofinity Commercial |
$277.53
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.73
|
| Rate for Payer: Mclaren Medicaid |
$129.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.37
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Nomi Health Commercial |
$231.28
|
| Rate for Payer: PACE SWMI |
$192.73
|
| Rate for Payer: PHP Medicare Advantage |
$192.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.20
|
| Rate for Payer: Priority Health HMO/PPO |
$275.91
|
| Rate for Payer: Priority Health Medicare |
$194.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.73
|
| Rate for Payer: UHC Exchange |
$192.73
|
| Rate for Payer: UHC Medicare Advantage |
$192.73
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$364.06 |
| Rate for Payer: Aetna Commercial |
$314.65
|
| Rate for Payer: Aetna Medicare |
$244.20
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$234.81
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: BCN Commercial |
$364.06
|
| Rate for Payer: BCN Medicare Advantage |
$234.81
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$314.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.81
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.55
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Nomi Health Commercial |
$281.77
|
| Rate for Payer: PACE SWMI |
$234.81
|
| Rate for Payer: PHP Medicare Advantage |
$234.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Medicare |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.81
|
| Rate for Payer: UHC Exchange |
$234.81
|
| Rate for Payer: UHC Medicare Advantage |
$234.81
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$365.53 |
| Rate for Payer: Aetna Commercial |
$317.61
|
| Rate for Payer: Aetna Medicare |
$246.50
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$237.02
|
| Rate for Payer: BCBS Trust/PPO |
$282.64
|
| Rate for Payer: BCN Commercial |
$365.53
|
| Rate for Payer: BCN Medicare Advantage |
$237.02
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$341.31
|
| Rate for Payer: Cofinity Commercial |
$317.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.02
|
| Rate for Payer: Mclaren Medicaid |
$159.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.87
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Nomi Health Commercial |
$284.42
|
| Rate for Payer: PACE SWMI |
$237.02
|
| Rate for Payer: PHP Medicare Advantage |
$237.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Medicare |
$239.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.02
|
| Rate for Payer: UHC Exchange |
$237.02
|
| Rate for Payer: UHC Medicare Advantage |
$237.02
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$460.34 |
| Rate for Payer: Aetna Commercial |
$399.37
|
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: BCBS Complete |
$210.01
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$460.34
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$429.18
|
| Rate for Payer: Cofinity Commercial |
$399.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Mclaren Medicaid |
$200.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$210.01
|
| Rate for Payer: Nomi Health Commercial |
$357.65
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.60
|
| Rate for Payer: Priority Health HMO/PPO |
$421.11
|
| Rate for Payer: Priority Health Medicare |
$301.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$298.04
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$200.01
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$182.33 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$363.84
|
| Rate for Payer: Aetna Medicare |
$282.38
|
| Rate for Payer: BCBS Complete |
$191.45
|
| Rate for Payer: BCBS MAPPO |
$271.52
|
| Rate for Payer: BCBS Trust/PPO |
$476.00
|
| Rate for Payer: BCN Commercial |
$418.30
|
| Rate for Payer: BCN Medicare Advantage |
$271.52
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$363.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.52
|
| Rate for Payer: Mclaren Medicaid |
$182.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.10
|
| Rate for Payer: Meridian Medicaid |
$191.45
|
| Rate for Payer: Nomi Health Commercial |
$325.82
|
| Rate for Payer: PACE SWMI |
$271.52
|
| Rate for Payer: PHP Medicare Advantage |
$271.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health HMO/PPO |
$386.28
|
| Rate for Payer: Priority Health Medicare |
$274.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.52
|
| Rate for Payer: UHC Exchange |
$271.52
|
| Rate for Payer: UHC Medicare Advantage |
$271.52
|
| Rate for Payer: UHCCP Medicaid |
$182.33
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$254.11 |
| Max. Negotiated Rate |
$585.43 |
| Rate for Payer: Aetna Commercial |
$507.14
|
| Rate for Payer: Aetna Medicare |
$393.60
|
| Rate for Payer: BCBS Complete |
$266.82
|
| Rate for Payer: BCBS MAPPO |
$378.46
|
| Rate for Payer: BCBS Trust/PPO |
$530.41
|
| Rate for Payer: BCN Commercial |
$585.43
|
| Rate for Payer: BCN Medicare Advantage |
$378.46
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$544.98
|
| Rate for Payer: Cofinity Commercial |
$507.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.46
|
| Rate for Payer: Mclaren Medicaid |
$254.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.38
|
| Rate for Payer: Meridian Medicaid |
$266.82
|
| Rate for Payer: Nomi Health Commercial |
$454.15
|
| Rate for Payer: PACE SWMI |
$378.46
|
| Rate for Payer: PHP Medicare Advantage |
$378.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.35
|
| Rate for Payer: Priority Health HMO/PPO |
$539.61
|
| Rate for Payer: Priority Health Medicare |
$382.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.46
|
| Rate for Payer: UHC Exchange |
$378.46
|
| Rate for Payer: UHC Medicare Advantage |
$378.46
|
| Rate for Payer: UHCCP Medicaid |
$254.11
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$692.07 |
| Rate for Payer: Aetna Commercial |
$532.21
|
| Rate for Payer: Aetna Medicare |
$413.06
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$397.17
|
| Rate for Payer: BCBS Trust/PPO |
$692.07
|
| Rate for Payer: BCN Commercial |
$626.48
|
| Rate for Payer: BCN Medicare Advantage |
$397.17
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cofinity Commercial |
$571.92
|
| Rate for Payer: Cofinity Commercial |
$532.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.17
|
| Rate for Payer: Mclaren Medicaid |
$53.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.03
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Nomi Health Commercial |
$476.60
|
| Rate for Payer: PACE SWMI |
$397.17
|
| Rate for Payer: PHP Medicare Advantage |
$397.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health HMO/PPO |
$113.98
|
| Rate for Payer: Priority Health Medicare |
$401.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.17
|
| Rate for Payer: UHC Exchange |
$397.17
|
| Rate for Payer: UHC Medicare Advantage |
$397.17
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,889.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$1,877.85 |
| Rate for Payer: Aetna Medicare |
$1,444.50
|
| Rate for Payer: BCBS Complete |
$1,155.60
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.85
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Medicare |
$373.50
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
|
|
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 |
$1,240.80
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
|
|
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 |
$729.05 |
| Rate for Payer: Aetna Commercial |
$134.31
|
| Rate for Payer: Aetna Medicare |
$104.24
|
| 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 |
$134.31
|
| Rate for Payer: Cofinity Commercial |
$144.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.23
|
| 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: 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 |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$101.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.23
|
| Rate for Payer: UHC Exchange |
$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 |
$379.32 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| 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: 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: 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 |
$179.57
|
| Rate for Payer: Priority Health Medicare |
$127.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.96
|
| Rate for Payer: UHC Exchange |
$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 |
$493.43 |
| Rate for Payer: Aetna Commercial |
$201.86
|
| Rate for Payer: Aetna Medicare |
$156.67
|
| 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: 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: 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 |
$214.39
|
| Rate for Payer: Priority Health Medicare |
$152.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.64
|
| Rate for Payer: UHC Exchange |
$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 |
$399.39 |
| Rate for Payer: Aetna Commercial |
$259.17
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| 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: 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: 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 |
$276.37
|
| Rate for Payer: Priority Health Medicare |
$195.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.41
|
| Rate for Payer: UHC Exchange |
$193.41
|
| Rate for Payer: UHC Medicare Advantage |
$193.41
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.39
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: BCBS MAPPO |
$114.71
|
| Rate for Payer: BCBS Trust/PPO |
$377.22
|
| Rate for Payer: BCN Commercial |
$356.76
|
| Rate for Payer: BCN Medicare Advantage |
$114.71
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.71
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: PACE Senior Care Partners |
$108.98
|
| Rate for Payer: PACE SWMI |
$114.71
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: PHP Medicare Advantage |
$114.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.43
|
| Rate for Payer: Railroad Medicare Medicare |
$114.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.71
|
| Rate for Payer: UHC Exchange |
$114.71
|
| Rate for Payer: UHC Medicare Advantage |
$114.71
|
| Rate for Payer: VA VA |
$114.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.80 |
| 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 |
$1,256.08
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,441.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| 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 Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| 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 Dual Complete DSNP |
$785.05
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| 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
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,041.12 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.34
|
| Rate for Payer: BCN Commercial |
$2,426.74
|
| 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| 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
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.25 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$374.56
|
| Rate for Payer: BCN Commercial |
$354.60
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,119.53 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,661.80
|
| Rate for Payer: BCN Commercial |
$2,519.95
|
| 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: PHP Commercial |
$2,771.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,119.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,184.74
|
| 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 150 MG CAPSULE
|
Facility
|
OP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$774.44 |
| 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 |
$1,304.32
|
| Rate for Payer: BCBS MAPPO |
$815.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,680.71
|
| Rate for Payer: BCN Commercial |
$2,535.28
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$855.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$937.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,771.69
|
| Rate for Payer: Nomi Health Commercial |
$2,673.86
|
| 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 Cigna Priority Health |
$2,119.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Medicare |
$823.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,184.74
|
| 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 Dual Complete DSNP |
$815.20
|
| Rate for Payer: UHC Exchange |
$815.20
|
| Rate for Payer: UHC Medicare Advantage |
$815.20
|
| Rate for Payer: VA VA |
$815.20
|
| 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 |
$745.80 |
| 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 |
$1,256.08
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,441.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| 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 Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| 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 Dual Complete DSNP |
$785.05
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$270.72
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna Medicare |
$70.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.60
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: BCBS MAPPO |
$67.68
|
| Rate for Payer: BCBS Trust/PPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$210.48
|
| Rate for Payer: BCN Medicare Advantage |
$67.68
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PACE Senior Care Partners |
$64.30
|
| Rate for Payer: PACE SWMI |
$67.68
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: PHP Medicare Advantage |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Medicare |
$68.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: Railroad Medicare Medicare |
$67.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.68
|
| Rate for Payer: UHC Exchange |
$67.68
|
| Rate for Payer: UHC Medicare Advantage |
$67.68
|
| Rate for Payer: VA VA |
$67.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,041.12 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.34
|
| Rate for Payer: BCN Commercial |
$2,426.74
|
| 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| 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 25 MG CAPSULE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: BCBS Trust/PPO |
$220.99
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.09 |
| Max. Negotiated Rate |
$346.28 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: BCBS Trust/PPO |
$314.07
|
| Rate for Payer: BCN Commercial |
$297.33
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health HMO/PPO |
$334.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.58
|
| Rate for Payer: UHC Core |
$321.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
