|
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
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
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 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
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
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 50 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
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 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
|
$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 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 |
$53.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
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 Commercial |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,281.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: 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: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.08
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| 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
|
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 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 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 Commercial |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,281.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: 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: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.08
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| 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
|
$131.13
|
|
|
Service Code
|
NDC 72205001290
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna American Axle |
$85.23
|
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna Medicare |
$65.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: BCBS Complete |
$52.45
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: 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: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.23
|
| Rate for Payer: Priority Health SBD |
$82.61
|
| Rate for Payer: UMR Bronson Commercial |
$48.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.35
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,695.07 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna American Axle |
$2,504.09
|
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,696.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,889.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,695.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,889.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna American Axle |
$256.26
|
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$197.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.26
|
| Rate for Payer: BCBS Complete |
$157.70
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health SBD |
$248.38
|
| Rate for Payer: UMR Bronson Commercial |
$145.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.69
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,425.40 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna American Axle |
$2,504.09
|
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna Medicare |
$1,926.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: BCBS Complete |
$1,540.98
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,696.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,889.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,889.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$152.28
|
|
|
Service Code
|
NDC 69238131209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$137.05 |
| Rate for Payer: Aetna American Axle |
$98.98
|
| Rate for Payer: Aetna Commercial |
$129.44
|
| Rate for Payer: Aetna Medicare |
$76.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.98
|
| Rate for Payer: BCBS Complete |
$60.91
|
| Rate for Payer: Cash Price |
$121.82
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$130.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.82
|
| Rate for Payer: Healthscope Commercial |
$137.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.44
|
| Rate for Payer: PHP Commercial |
$129.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.98
|
| Rate for Payer: Priority Health SBD |
$95.94
|
| Rate for Payer: UMR Bronson Commercial |
$56.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.21
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 64980041209
|
| Hospital Charge Code |
42164
|
|
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 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.47 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna American Axle |
$256.26
|
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.26
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health SBD |
$248.38
|
| Rate for Payer: UMR Bronson Commercial |
$173.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.69
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 64980041209
|
| Hospital Charge Code |
42164
|
|
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 75 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 67877046490
|
| Hospital Charge Code |
42164
|
|
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 75 MG CAPSULE
|
Facility
|
IP
|
$152.28
|
|
|
Service Code
|
NDC 69238131209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$137.05 |
| Rate for Payer: Aetna American Axle |
$98.98
|
| Rate for Payer: Aetna Commercial |
$129.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.98
|
| Rate for Payer: Cash Price |
$121.82
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$130.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.82
|
| Rate for Payer: Healthscope Commercial |
$137.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.44
|
| Rate for Payer: PHP Commercial |
$129.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.98
|
| Rate for Payer: Priority Health SBD |
$95.94
|
| Rate for Payer: UMR Bronson Commercial |
$67.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.21
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 67877046490
|
| Hospital Charge Code |
42164
|
|
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
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,413.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$211.74 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Medicare |
$220.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.73
|
| Rate for Payer: BCBS Complete |
$565.20
|
| Rate for Payer: BCBS MAPPO |
$211.74
|
| Rate for Payer: BCN Medicare Advantage |
$211.74
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cofinity Commercial |
$304.91
|
| Rate for Payer: Cofinity Commercial |
$283.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.33
|
| Rate for Payer: Nomi Health Commercial |
$254.09
|
| Rate for Payer: PACE SWMI |
$211.74
|
| Rate for Payer: PHP Commercial |
$296.44
|
| Rate for Payer: PHP Medicare Advantage |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.45
|
| Rate for Payer: Priority Health Medicare |
$211.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.74
|
| Rate for Payer: UHC Medicare Advantage |
$211.74
|
| Rate for Payer: UMR Bronson Commercial |
$649.98
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$666.74 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna American Axle |
$1,171.30
|
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,261.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,351.50
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: UMR Bronson Commercial |
$666.74
|
| Rate for Payer: VA VA |
$1,850.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,351.50
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.83
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$144.65
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.88
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Commercial |
$202.51
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
| Rate for Payer: UMR Bronson Commercial |
$828.92
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$792.88 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna American Axle |
$1,171.30
|
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,261.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,351.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
| Rate for Payer: UMR Bronson Commercial |
$792.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,351.50
|
|
