|
PR EEG,ALL NIGHT RECORD
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 95827
|
| Min. Negotiated Rate |
$538.00 |
| Max. Negotiated Rate |
$874.25 |
| Rate for Payer: Aetna Medicare |
$672.50
|
| Rate for Payer: BCBS Complete |
$538.00
|
| Rate for Payer: Cash Price |
$1,076.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.25
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$278.20 |
| Rate for Payer: Aetna Commercial |
$258.26
|
| Rate for Payer: Aetna Medicare |
$192.73
|
| Rate for Payer: BCBS Complete |
$171.20
|
| Rate for Payer: BCBS MAPPO |
$192.73
|
| Rate for Payer: BCN Medicare Advantage |
$192.73
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$277.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.73
|
| Rate for Payer: Healthscope Commercial |
$231.28
|
| Rate for Payer: Healthscope Whirlpool |
$231.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.37
|
| Rate for Payer: Nomi Health Commercial |
$231.28
|
| Rate for Payer: PACE SWMI |
$192.73
|
| Rate for Payer: PHP Medicare Advantage |
$192.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.20
|
| Rate for Payer: Priority Health Medicare |
$192.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.73
|
| Rate for Payer: UHC Medicare Advantage |
$192.73
|
| Rate for Payer: UHCCP DNSP |
$192.73
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$338.13 |
| Rate for Payer: Aetna Commercial |
$314.65
|
| Rate for Payer: Aetna Medicare |
$234.81
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$234.81
|
| Rate for Payer: BCN Medicare Advantage |
$234.81
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$338.13
|
| Rate for Payer: Cofinity Commercial |
$314.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.81
|
| Rate for Payer: Healthscope Commercial |
$281.77
|
| Rate for Payer: Healthscope Whirlpool |
$281.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.55
|
| Rate for Payer: Nomi Health Commercial |
$281.77
|
| Rate for Payer: PACE SWMI |
$234.81
|
| Rate for Payer: PHP Medicare Advantage |
$234.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$234.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.81
|
| Rate for Payer: UHC Medicare Advantage |
$234.81
|
| Rate for Payer: UHCCP DNSP |
$234.81
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$345.15 |
| Rate for Payer: Aetna Commercial |
$317.61
|
| Rate for Payer: Aetna Medicare |
$237.02
|
| Rate for Payer: BCBS Complete |
$212.40
|
| Rate for Payer: BCBS MAPPO |
$237.02
|
| Rate for Payer: BCN Medicare Advantage |
$237.02
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$341.31
|
| Rate for Payer: Cofinity Commercial |
$317.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.02
|
| Rate for Payer: Healthscope Commercial |
$284.42
|
| Rate for Payer: Healthscope Whirlpool |
$284.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.87
|
| Rate for Payer: Nomi Health Commercial |
$284.42
|
| Rate for Payer: PACE SWMI |
$237.02
|
| Rate for Payer: PHP Medicare Advantage |
$237.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health Medicare |
$237.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.02
|
| Rate for Payer: UHC Medicare Advantage |
$237.02
|
| Rate for Payer: UHCCP DNSP |
$237.02
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$399.37
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: BCBS Complete |
$265.60
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$429.18
|
| Rate for Payer: Cofinity Commercial |
$399.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$357.65
|
| Rate for Payer: Healthscope Whirlpool |
$357.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Nomi Health Commercial |
$357.65
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.60
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$394.55 |
| Rate for Payer: Aetna Commercial |
$363.84
|
| Rate for Payer: Aetna Medicare |
$271.52
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS MAPPO |
$271.52
|
| Rate for Payer: BCN Medicare Advantage |
$271.52
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$363.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.52
|
| Rate for Payer: Healthscope Commercial |
$325.82
|
| Rate for Payer: Healthscope Whirlpool |
$325.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.10
|
| Rate for Payer: Nomi Health Commercial |
$325.82
|
| Rate for Payer: PACE SWMI |
$271.52
|
| Rate for Payer: PHP Medicare Advantage |
$271.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health Medicare |
$271.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.52
|
| Rate for Payer: UHC Medicare Advantage |
$271.52
|
| Rate for Payer: UHCCP DNSP |
$271.52
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$335.60 |
| Max. Negotiated Rate |
$545.35 |
| Rate for Payer: Aetna Commercial |
$507.14
|
| Rate for Payer: Aetna Medicare |
$378.46
|
| Rate for Payer: BCBS Complete |
$335.60
|
| Rate for Payer: BCBS MAPPO |
$378.46
|
| Rate for Payer: BCN Medicare Advantage |
$378.46
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$544.98
|
| Rate for Payer: Cofinity Commercial |
$507.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.46
|
| Rate for Payer: Healthscope Commercial |
$454.15
|
| Rate for Payer: Healthscope Whirlpool |
$454.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.38
|
| Rate for Payer: Nomi Health Commercial |
$454.15
|
| Rate for Payer: PACE SWMI |
$378.46
|
| Rate for Payer: PHP Medicare Advantage |
$378.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.35
|
| Rate for Payer: Priority Health Medicare |
$378.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.46
|
| Rate for Payer: UHC Medicare Advantage |
$378.46
|
| Rate for Payer: UHCCP DNSP |
$378.46
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$571.92 |
| Rate for Payer: Aetna Commercial |
$532.21
|
| Rate for Payer: Aetna Medicare |
$397.17
|
| Rate for Payer: BCBS Complete |
$347.20
|
| Rate for Payer: BCBS MAPPO |
$397.17
|
| 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 |
$571.92
|
| Rate for Payer: Cofinity Commercial |
$532.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.17
|
| Rate for Payer: Healthscope Commercial |
$476.60
|
| Rate for Payer: Healthscope Whirlpool |
$476.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.03
|
| Rate for Payer: Nomi Health Commercial |
$476.60
|
| Rate for Payer: PACE SWMI |
$397.17
|
| Rate for Payer: PHP Medicare Advantage |
$397.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health Medicare |
$397.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.17
|
| Rate for Payer: UHC Medicare Advantage |
$397.17
|
| Rate for Payer: UHCCP DNSP |
$397.17
|
|
|
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
|
|
|
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
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$622.40 |
| Max. Negotiated Rate |
$1,011.40 |
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: Aetna Medicare |
$1,551.00
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS Complete |
$1,240.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$144.33 |
| Rate for Payer: Aetna Commercial |
$134.31
|
| Rate for Payer: Aetna Medicare |
$100.23
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$100.23
|
| 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 |
$134.31
|
| Rate for Payer: Cofinity Commercial |
$144.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.23
|
| Rate for Payer: Healthscope Commercial |
$120.28
|
| Rate for Payer: Healthscope Whirlpool |
$120.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: Nomi Health Commercial |
$120.28
|
| Rate for Payer: PACE SWMI |
$100.23
|
| Rate for Payer: PHP Medicare Advantage |
$100.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$100.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.23
|
| Rate for Payer: UHCCP DNSP |
$100.23
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$181.38 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$125.96
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$125.96
|
| 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 |
$181.38
|
| Rate for Payer: Cofinity Commercial |
$168.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$151.15
|
| Rate for Payer: Healthscope Whirlpool |
$151.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.26
|
| Rate for Payer: Nomi Health Commercial |
$151.15
|
| Rate for Payer: PACE SWMI |
$125.96
|
| Rate for Payer: PHP Medicare Advantage |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$125.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.96
|
| Rate for Payer: UHC Medicare Advantage |
$125.96
|
| Rate for Payer: UHCCP DNSP |
$125.96
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$216.92 |
| Rate for Payer: Aetna Commercial |
$201.86
|
| Rate for Payer: Aetna Medicare |
$150.64
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS MAPPO |
$150.64
|
| 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 |
$216.92
|
| Rate for Payer: Cofinity Commercial |
$201.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.64
|
| Rate for Payer: Healthscope Commercial |
$180.77
|
| Rate for Payer: Healthscope Whirlpool |
$180.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.17
|
| Rate for Payer: Nomi Health Commercial |
$180.77
|
| Rate for Payer: PACE SWMI |
$150.64
|
| Rate for Payer: PHP Medicare Advantage |
$150.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health Medicare |
$150.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.64
|
| Rate for Payer: UHC Medicare Advantage |
$150.64
|
| Rate for Payer: UHCCP DNSP |
$150.64
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$278.51 |
| Rate for Payer: Aetna Commercial |
$259.17
|
| Rate for Payer: Aetna Medicare |
$193.41
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$193.41
|
| 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 |
$278.51
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.41
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Healthscope Whirlpool |
$232.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.08
|
| Rate for Payer: Nomi Health Commercial |
$232.09
|
| Rate for Payer: PACE SWMI |
$193.41
|
| Rate for Payer: PHP Medicare Advantage |
$193.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health Medicare |
$193.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.41
|
| Rate for Payer: UHC Medicare Advantage |
$193.41
|
| Rate for Payer: UHCCP DNSP |
$193.41
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.49 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Trust/PPO |
$349.14
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Trust/PPO |
$350.86
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.41
|
| Rate for Payer: Priority Health Narrow Network |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.48 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$144.67
|
| Rate for Payer: ASR ASR |
$155.92
|
| Rate for Payer: ASR Commercial |
$155.92
|
| Rate for Payer: BCBS Trust/PPO |
$130.99
|
| Rate for Payer: BCN Commercial |
$124.62
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.92
|
| Rate for Payer: Mclaren Commercial |
$144.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.45
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$144.67
|
| Rate for Payer: Aetna Medicare |
$80.37
|
| Rate for Payer: ASR ASR |
$155.92
|
| Rate for Payer: ASR Commercial |
$155.92
|
| Rate for Payer: BCBS Complete |
$64.30
|
| Rate for Payer: BCBS Trust/PPO |
$131.63
|
| Rate for Payer: BCN Commercial |
$124.62
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.92
|
| Rate for Payer: Mclaren Commercial |
$144.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.84
|
| Rate for Payer: Priority Health Narrow Network |
$112.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.45
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$265.44 |
| Rate for Payer: Aetna Commercial |
$238.90
|
| Rate for Payer: ASR ASR |
$257.48
|
| Rate for Payer: ASR Commercial |
$257.48
|
| Rate for Payer: BCBS Trust/PPO |
$216.31
|
| Rate for Payer: BCN Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$249.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Whirlpool |
$257.48
|
| Rate for Payer: Mclaren Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Nomi Health Commercial |
$217.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.59
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.26 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$354.82
|
| Rate for Payer: ASR ASR |
$382.42
|
| Rate for Payer: ASR Commercial |
$382.42
|
| Rate for Payer: BCBS Trust/PPO |
$321.27
|
| Rate for Payer: BCN Commercial |
$305.66
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$370.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$394.25
|
| Rate for Payer: Healthscope Whirlpool |
$382.42
|
| Rate for Payer: Mclaren Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.94
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$354.82
|
| Rate for Payer: Aetna Medicare |
$197.12
|
| Rate for Payer: ASR ASR |
$382.42
|
| Rate for Payer: ASR Commercial |
$382.42
|
| Rate for Payer: BCBS Complete |
$157.70
|
| Rate for Payer: BCBS Trust/PPO |
$322.85
|
| Rate for Payer: BCN Commercial |
$305.66
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$370.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$394.25
|
| Rate for Payer: Healthscope Whirlpool |
$382.42
|
| Rate for Payer: Mclaren Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.44
|
| Rate for Payer: Priority Health Narrow Network |
$276.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.94
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$265.44 |
| Rate for Payer: Aetna Commercial |
$238.90
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: ASR ASR |
$257.48
|
| Rate for Payer: ASR Commercial |
$257.48
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: BCBS Trust/PPO |
$217.37
|
| Rate for Payer: BCN Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$249.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Whirlpool |
$257.48
|
| Rate for Payer: Mclaren Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Nomi Health Commercial |
$217.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.58
|
| Rate for Payer: Priority Health Narrow Network |
$186.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.59
|
|
