|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$692.07 |
| Rate for Payer: Aetna Commercial |
$532.21
|
| Rate for Payer: Aetna Medicare |
$413.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.92
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$397.17
|
| Rate for Payer: BCBS Trust/PPO |
$692.07
|
| Rate for Payer: BCN Commercial |
$626.48
|
| Rate for Payer: BCN Medicare Advantage |
$397.17
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cofinity Commercial |
$532.21
|
| Rate for Payer: Cofinity Commercial |
$571.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.03
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Nomi Health Commercial |
$476.60
|
| Rate for Payer: PACE SWMI |
$397.17
|
| Rate for Payer: PHP Commercial |
$556.04
|
| Rate for Payer: PHP Medicare Advantage |
$397.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.57
|
| Rate for Payer: Priority Health Medicare |
$397.17
|
| Rate for Payer: Priority Health Narrow Network |
$601.57
|
| Rate for Payer: Priority Health SBD |
$113.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.17
|
| Rate for Payer: UHC Medicare Advantage |
$397.17
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
| Rate for Payer: UMR Bronson Commercial |
$399.28
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,889.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$1,877.85 |
| Rate for Payer: Aetna Medicare |
$1,444.50
|
| Rate for Payer: BCBS Complete |
$1,155.60
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,328.94
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Medicare |
$373.50
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$3,102.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$1,240.80 |
| Max. Negotiated Rate |
$2,016.30 |
| Rate for Payer: Aetna Medicare |
$1,551.00
|
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS Complete |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
| Rate for Payer: UMR Bronson Commercial |
$715.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,426.92
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$729.05 |
| Rate for Payer: Aetna Commercial |
$134.31
|
| Rate for Payer: Aetna Medicare |
$104.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.33
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$100.23
|
| Rate for Payer: BCBS Trust/PPO |
$729.05
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: BCN Medicare Advantage |
$100.23
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$144.33
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Nomi Health Commercial |
$120.28
|
| Rate for Payer: PACE SWMI |
$100.23
|
| Rate for Payer: PHP Commercial |
$140.32
|
| Rate for Payer: PHP Medicare Advantage |
$100.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$100.23
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: Priority Health SBD |
$141.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.23
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$379.32 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.38
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$125.96
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$125.96
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$168.79
|
| Rate for Payer: Cofinity Commercial |
$181.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.26
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Nomi Health Commercial |
$151.15
|
| Rate for Payer: PACE SWMI |
$125.96
|
| Rate for Payer: PHP Commercial |
$176.34
|
| Rate for Payer: PHP Medicare Advantage |
$125.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.57
|
| Rate for Payer: Priority Health Medicare |
$125.96
|
| Rate for Payer: Priority Health Narrow Network |
$179.57
|
| Rate for Payer: Priority Health SBD |
$179.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.96
|
| Rate for Payer: UHC Medicare Advantage |
$125.96
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$493.43 |
| Rate for Payer: Aetna Commercial |
$201.86
|
| Rate for Payer: Aetna Medicare |
$156.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.92
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS MAPPO |
$150.64
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: BCN Commercial |
$227.73
|
| Rate for Payer: BCN Medicare Advantage |
$150.64
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$201.86
|
| Rate for Payer: Cofinity Commercial |
$216.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.17
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Nomi Health Commercial |
$180.77
|
| Rate for Payer: PACE SWMI |
$150.64
|
| Rate for Payer: PHP Commercial |
$210.90
|
| Rate for Payer: PHP Medicare Advantage |
$150.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.39
|
| Rate for Payer: Priority Health Medicare |
$150.64
|
| Rate for Payer: Priority Health Narrow Network |
$214.39
|
| Rate for Payer: Priority Health SBD |
$214.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.64
|
| Rate for Payer: UHC Medicare Advantage |
$150.64
|
| Rate for Payer: UHCCP Medicaid |
$101.18
|
| Rate for Payer: UMR Bronson Commercial |
$148.58
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$259.17
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.51
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS MAPPO |
$193.41
|
| Rate for Payer: BCBS Trust/PPO |
$399.39
|
| Rate for Payer: BCN Commercial |
$300.05
|
| Rate for Payer: BCN Medicare Advantage |
$193.41
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Cofinity Commercial |
$278.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.08
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Nomi Health Commercial |
$232.09
|
| Rate for Payer: PACE SWMI |
$193.41
|
| Rate for Payer: PHP Commercial |
$270.77
|
| Rate for Payer: PHP Medicare Advantage |
$193.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.37
|
| Rate for Payer: Priority Health Medicare |
$193.41
|
| Rate for Payer: Priority Health Narrow Network |
$276.37
|
| Rate for Payer: Priority Health SBD |
$276.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.41
|
| Rate for Payer: UHC Medicare Advantage |
$193.41
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
| Rate for Payer: UMR Bronson Commercial |
$195.50
|
|
|
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
|
$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
|
$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
|
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
|
$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
|
$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 |
$1,823.92
|
| 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
|
$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
|
$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
|
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
|
$154.40
|
|
|
Service Code
|
NDC 69097068105
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$138.96 |
| Rate for Payer: Aetna American Axle |
$100.36
|
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Aetna Medicare |
$77.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.36
|
| Rate for Payer: BCBS Complete |
$61.76
|
| 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 |
$57.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.80
|
|
|
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 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 |
$79.32
|
| 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
|
$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
|
$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
|
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 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 |
$75.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.28
|
|
|
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
|
|
