|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna American Axle |
$1.95
|
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.95
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Advantage |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.55
|
| Rate for Payer: Priority Health SBD |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.95
|
| Rate for Payer: UHC Core |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.25
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna American Axle |
$1.95
|
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.95
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Advantage |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.55
|
| Rate for Payer: Priority Health SBD |
$1.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.25
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 64980041309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.86
|
| Rate for Payer: UHC Core |
$93.67
|
| Rate for Payer: UHC Exchange |
$70.65
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$203.04
|
|
|
Service Code
|
NDC 67877046590
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$182.74 |
| Rate for Payer: Aetna American Axle |
$131.98
|
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.98
|
| Rate for Payer: BCBS Complete |
$81.22
|
| Rate for Payer: Cash Price |
$162.43
|
| Rate for Payer: Cofinity Advantage |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$174.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.43
|
| Rate for Payer: Healthscope Commercial |
$182.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.28
|
| Rate for Payer: PHP Commercial |
$172.58
|
| Rate for Payer: Priority Health SBD |
$127.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.98
|
| Rate for Payer: UHC Core |
$105.78
|
| Rate for Payer: UHC Exchange |
$79.79
|
| Rate for Payer: UMR Bronson Commercial |
$75.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.28
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.00
|
| Rate for Payer: UHC Core |
$156.30
|
| Rate for Payer: UHC Exchange |
$117.90
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$203.04
|
|
|
Service Code
|
NDC 67877046590
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$182.74 |
| Rate for Payer: Aetna American Axle |
$131.98
|
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.98
|
| Rate for Payer: Cash Price |
$162.43
|
| Rate for Payer: Cofinity Advantage |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$174.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.43
|
| Rate for Payer: Healthscope Commercial |
$182.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.28
|
| Rate for Payer: PHP Commercial |
$172.58
|
| Rate for Payer: Priority Health SBD |
$127.92
|
| Rate for Payer: UMR Bronson Commercial |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.28
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$272.84
|
|
|
Service Code
|
NDC 00228285909
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$245.56 |
| Rate for Payer: Aetna American Axle |
$177.35
|
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$136.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.35
|
| Rate for Payer: BCBS Complete |
$109.14
|
| Rate for Payer: Cash Price |
$218.27
|
| Rate for Payer: Cofinity Advantage |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$245.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.63
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health SBD |
$171.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.35
|
| Rate for Payer: UHC Core |
$142.15
|
| Rate for Payer: UHC Exchange |
$107.23
|
| Rate for Payer: UMR Bronson Commercial |
$100.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.63
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna American Axle |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Advantage |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.00
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$153.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.47 |
| Max. Negotiated Rate |
$144.67 |
| Rate for Payer: Aetna American Axle |
$104.48
|
| Rate for Payer: Aetna Commercial |
$136.63
|
| Rate for Payer: Aetna Medicare |
$80.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.48
|
| Rate for Payer: BCBS Complete |
$64.30
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Advantage |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$144.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.56
|
| Rate for Payer: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.48
|
| Rate for Payer: UHC Core |
$83.75
|
| Rate for Payer: UHC Exchange |
$63.17
|
| Rate for Payer: UMR Bronson Commercial |
$59.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,161.87 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna American Axle |
$2,041.12
|
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$1,570.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.12
|
| Rate for Payer: BCBS Complete |
$1,256.08
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Advantage |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,198.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,512.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,041.12
|
| Rate for Payer: UHC Core |
$1,636.04
|
| Rate for Payer: UHC Exchange |
$1,234.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna American Axle |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$1.81
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,381.68 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna American Axle |
$2,041.12
|
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.12
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Advantage |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,198.13
|
| 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: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,381.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Advantage |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.00
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$181.31
|
| Rate for Payer: UHC Exchange |
$136.76
|
| Rate for Payer: UMR Bronson Commercial |
$128.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$144.67 |
| Rate for Payer: Aetna American Axle |
$104.48
|
| Rate for Payer: Aetna Commercial |
$136.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.48
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Advantage |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$144.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.56
|
| Rate for Payer: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: UMR Bronson Commercial |
$70.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,205.68 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna American Axle |
$2,118.08
|
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna Medicare |
$1,629.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: BCBS Complete |
$1,303.44
|
| Rate for Payer: Cash Price |
$2,606.87
|
| Rate for Payer: Cofinity Advantage |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,281.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,443.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,606.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,443.94
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,118.08
|
| Rate for Payer: UHC Core |
$1,697.73
|
| Rate for Payer: UHC Exchange |
$1,280.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,205.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,443.94
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$131.13
|
|
|
Service Code
|
NDC 72205001290
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna American Axle |
$85.23
|
| 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 Advantage |
$91.79
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.35
|
| Rate for Payer: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health SBD |
$82.61
|
| Rate for Payer: UMR Bronson Commercial |
$57.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.35
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 69097067805
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$63.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$181.89
|
|
|
Service Code
|
NDC 69238131109
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna American Axle |
$118.23
|
| Rate for Payer: Aetna Commercial |
$154.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.23
|
| Rate for Payer: Cash Price |
$145.51
|
| Rate for Payer: Cofinity Advantage |
$127.32
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.42
|
| Rate for Payer: PHP Commercial |
$154.61
|
| Rate for Payer: Priority Health SBD |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$80.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.42
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,381.68 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna American Axle |
$2,041.12
|
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,041.12
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Advantage |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,198.13
|
| 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: Opus (Opus Packaging Group) HMA |
$2,355.14
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,381.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,433.78 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna American Axle |
$2,118.08
|
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: Cash Price |
$2,606.87
|
| Rate for Payer: Cofinity Advantage |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,281.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,443.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,443.94
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,433.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,443.94
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 69097067805
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$57.53
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.48
|
| Rate for Payer: UHC Core |
$74.93
|
| Rate for Payer: UHC Exchange |
$56.52
|
| Rate for Payer: UMR Bronson Commercial |
$53.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
