|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$272.84
|
|
|
Service Code
|
NDC 00228285909
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$245.56 |
| Rate for Payer: Aetna American Axle |
$177.35
|
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.35
|
| Rate for Payer: Cash Price |
$218.27
|
| Rate for Payer: Cofinity Commercial |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.99
|
| 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: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.35
|
| Rate for Payer: Priority Health SBD |
$171.89
|
| Rate for Payer: UMR Bronson Commercial |
$120.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.63
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$154.40
|
|
|
Service Code
|
NDC 69097068105
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.94 |
| Max. Negotiated Rate |
$138.96 |
| Rate for Payer: Aetna American Axle |
$100.36
|
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.36
|
| Rate for Payer: Cash Price |
$123.52
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Cofinity Commercial |
$132.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.52
|
| Rate for Payer: Healthscope Commercial |
$138.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.24
|
| Rate for Payer: PHP Commercial |
$131.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.36
|
| Rate for Payer: Priority Health SBD |
$97.27
|
| Rate for Payer: UMR Bronson Commercial |
$67.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.80
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
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 Commercial |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.99
|
| 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: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.35
|
| Rate for Payer: Priority Health SBD |
$171.89
|
| 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
|
$2.66
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$158.63
|
|
|
Service Code
|
NDC 69238131309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$142.77 |
| Rate for Payer: Aetna American Axle |
$103.11
|
| Rate for Payer: Aetna Commercial |
$134.84
|
| Rate for Payer: Aetna Medicare |
$79.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.11
|
| Rate for Payer: BCBS Complete |
$63.45
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cofinity Commercial |
$111.04
|
| Rate for Payer: Cofinity Commercial |
$136.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.90
|
| Rate for Payer: Healthscope Commercial |
$142.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.84
|
| Rate for Payer: PHP Commercial |
$134.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.11
|
| Rate for Payer: Priority Health SBD |
$99.94
|
| Rate for Payer: UMR Bronson Commercial |
$58.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.97
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$158.63
|
|
|
Service Code
|
NDC 69238131309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$142.77 |
| Rate for Payer: Aetna American Axle |
$103.11
|
| Rate for Payer: Aetna Commercial |
$134.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.11
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cofinity Commercial |
$111.04
|
| Rate for Payer: Cofinity Commercial |
$136.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.90
|
| Rate for Payer: Healthscope Commercial |
$142.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.84
|
| Rate for Payer: PHP Commercial |
$134.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.11
|
| Rate for Payer: Priority Health SBD |
$99.94
|
| Rate for Payer: UMR Bronson Commercial |
$69.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.97
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 64980041309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| 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
|
$2.66
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$3,647.83
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,349.70 |
| Max. Negotiated Rate |
$3,283.05 |
| Rate for Payer: Aetna American Axle |
$2,371.09
|
| Rate for Payer: Aetna Commercial |
$3,100.66
|
| Rate for Payer: Aetna Medicare |
$1,823.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.09
|
| Rate for Payer: BCBS Complete |
$1,459.13
|
| Rate for Payer: Cash Price |
$2,918.26
|
| Rate for Payer: Cofinity Commercial |
$2,553.48
|
| Rate for Payer: Cofinity Commercial |
$3,137.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,553.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,918.26
|
| Rate for Payer: Healthscope Commercial |
$3,283.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,553.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,735.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,100.66
|
| Rate for Payer: PHP Commercial |
$3,100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,371.09
|
| Rate for Payer: Priority Health SBD |
$2,298.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,349.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,735.87
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$3,647.83
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,605.05 |
| Max. Negotiated Rate |
$3,283.05 |
| Rate for Payer: Aetna American Axle |
$2,371.09
|
| Rate for Payer: Aetna Commercial |
$3,100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,371.09
|
| Rate for Payer: Cash Price |
$2,918.26
|
| Rate for Payer: Cofinity Commercial |
$2,553.48
|
| Rate for Payer: Cofinity Commercial |
$3,137.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,553.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,918.26
|
| Rate for Payer: Healthscope Commercial |
$3,283.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,553.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,735.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,100.66
|
| Rate for Payer: PHP Commercial |
$3,100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,371.09
|
| Rate for Payer: Priority Health SBD |
$2,298.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,605.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,735.87
|
|
|
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 Commercial |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$174.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.13
|
| 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: PHP Commercial |
$172.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.98
|
| 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 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 Commercial |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,198.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| 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
|
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 Commercial |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,198.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| 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
|
$297.60
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.11 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna American Axle |
$193.44
|
| Rate for Payer: Aetna Commercial |
$252.96
|
| Rate for Payer: Aetna Medicare |
$148.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.44
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: PHP Commercial |
$252.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.44
|
| Rate for Payer: Priority Health SBD |
$187.49
|
| Rate for Payer: UMR Bronson Commercial |
$110.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.20
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$297.60
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.94 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna American Axle |
$193.44
|
| Rate for Payer: Aetna Commercial |
$252.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.44
|
| Rate for Payer: Cash Price |
$238.08
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.08
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.96
|
| Rate for Payer: PHP Commercial |
$252.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.44
|
| Rate for Payer: Priority Health SBD |
$187.49
|
| Rate for Payer: UMR Bronson Commercial |
$130.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.20
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$2.98
|
|
|
Service Code
|
NDC 60687047311
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
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 Commercial |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.52
|
| 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: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| 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 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 Commercial |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$138.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.52
|
| 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: PHP Commercial |
$136.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: UMR Bronson Commercial |
$59.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 69238131109
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
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 Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.67
|
| 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: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.48
|
| 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
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
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 Commercial |
$2,198.13
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,198.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: 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: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health SBD |
$1,978.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
