|
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
|
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 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 |
$2.24
|
| 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 |
$2.24
|
|
|
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
|
$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
|
$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
|
$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 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
|
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 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
|
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
|
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
|
$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
|
$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
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 69238131109
|
| Hospital Charge Code |
42163
|
|
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 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
|
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
|
$131.13
|
|
|
Service Code
|
NDC 72205001290
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna American Axle |
$85.23
|
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity 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 |
$57.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.35
|
|
|
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
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
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 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 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
|
$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
|
$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
|
$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
|
|
