Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GABAPENTIN 100 MG CAPSULE

Facility

$217.55

Service Code	NDC 60505011200
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$137.06
Max. Negotiated Rate	$195.79
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna New Business (MI Preferred)	$141.41
Rate for Payer: Cash Price	$174.04
Rate for Payer: Cofinity Advantage	$152.28
Rate for Payer: Cofinity Commercial	$187.09
Rate for Payer: Encore Health Key Benefits Commercial	$174.04
Rate for Payer: Healthscope Commercial	$195.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$184.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.16
Rate for Payer: PHP Commercial	$184.92
Rate for Payer: Priority Health SBD	$137.06

GABAPENTIN 100 MG CAPSULE

Facility

$183.30

Service Code	NDC 63739059110
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$115.48
Max. Negotiated Rate	$164.97
Rate for Payer: Aetna Commercial	$155.81
Rate for Payer: Aetna New Business (MI Preferred)	$119.14
Rate for Payer: Cash Price	$146.64
Rate for Payer: Cofinity Advantage	$128.31
Rate for Payer: Cofinity Commercial	$157.64
Rate for Payer: Encore Health Key Benefits Commercial	$146.64
Rate for Payer: Healthscope Commercial	$164.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$137.47
Rate for Payer: PHP Commercial	$155.81
Rate for Payer: Priority Health SBD	$115.48

GABAPENTIN 100 MG CAPSULE

Facility

$96.35

Service Code	NDC 67877022201
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$37.87
Max. Negotiated Rate	$86.72
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna Medicare	$48.17
Rate for Payer: Aetna New Business (MI Preferred)	$62.63
Rate for Payer: BCBS Complete	$38.54
Rate for Payer: Cash Price	$77.08
Rate for Payer: Cofinity Advantage	$67.44
Rate for Payer: Cofinity Commercial	$82.86
Rate for Payer: Encore Health Key Benefits Commercial	$77.08
Rate for Payer: Healthscope Commercial	$86.72
Rate for Payer: MI Amish Medical Board Commercial	$77.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.26
Rate for Payer: PHP Commercial	$81.90
Rate for Payer: Priority Health SBD	$60.70
Rate for Payer: UHC All Payor (Choice/PPO)	$62.63
Rate for Payer: UHC Core	$50.20
Rate for Payer: UHC Exchange	$37.87

GABAPENTIN 100 MG CAPSULE

Facility

$217.55

Service Code	NDC 60505011200
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$195.79
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna Medicare	$108.78
Rate for Payer: Aetna New Business (MI Preferred)	$141.41
Rate for Payer: BCBS Complete	$87.02
Rate for Payer: Cash Price	$174.04
Rate for Payer: Cofinity Advantage	$152.28
Rate for Payer: Cofinity Commercial	$187.09
Rate for Payer: Encore Health Key Benefits Commercial	$174.04
Rate for Payer: Healthscope Commercial	$195.79
Rate for Payer: MI Amish Medical Board Commercial	$174.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$184.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.16
Rate for Payer: PHP Commercial	$184.92
Rate for Payer: Priority Health SBD	$137.06
Rate for Payer: UHC All Payor (Choice/PPO)	$141.41
Rate for Payer: UHC Core	$113.34
Rate for Payer: UHC Exchange	$85.50

GABAPENTIN 100 MG CAPSULE

Facility

$51.70

Service Code	NDC 69097081307
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$32.57
Max. Negotiated Rate	$46.53
Rate for Payer: Aetna Commercial	$43.95
Rate for Payer: Aetna New Business (MI Preferred)	$33.60
Rate for Payer: Cash Price	$41.36
Rate for Payer: Cofinity Advantage	$36.19
Rate for Payer: Cofinity Commercial	$44.46
Rate for Payer: Encore Health Key Benefits Commercial	$41.36
Rate for Payer: Healthscope Commercial	$46.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.77
Rate for Payer: PHP Commercial	$43.95
Rate for Payer: Priority Health SBD	$32.57

GABAPENTIN 100 MG CAPSULE

Facility

$183.30

Service Code	NDC 63739059110
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$72.04
Max. Negotiated Rate	$164.97
Rate for Payer: Aetna Commercial	$155.81
Rate for Payer: Aetna Medicare	$91.65
Rate for Payer: Aetna New Business (MI Preferred)	$119.14
Rate for Payer: BCBS Complete	$73.32
Rate for Payer: Cash Price	$146.64
Rate for Payer: Cofinity Advantage	$128.31
Rate for Payer: Cofinity Commercial	$157.64
Rate for Payer: Encore Health Key Benefits Commercial	$146.64
Rate for Payer: Healthscope Commercial	$164.97
Rate for Payer: MI Amish Medical Board Commercial	$146.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$137.47
Rate for Payer: PHP Commercial	$155.81
Rate for Payer: Priority Health SBD	$115.48
Rate for Payer: UHC All Payor (Choice/PPO)	$119.14
Rate for Payer: UHC Core	$95.50
Rate for Payer: UHC Exchange	$72.04

GABAPENTIN 100 MG CAPSULE

Facility

$96.35

Service Code	NDC 67877022201
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$60.70
Max. Negotiated Rate	$86.72
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$62.63
Rate for Payer: Cash Price	$77.08
Rate for Payer: Cofinity Advantage	$67.44
Rate for Payer: Cofinity Commercial	$82.86
Rate for Payer: Encore Health Key Benefits Commercial	$77.08
Rate for Payer: Healthscope Commercial	$86.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.26
Rate for Payer: PHP Commercial	$81.90
Rate for Payer: Priority Health SBD	$60.70

GABAPENTIN 100 MG CAPSULE

Facility

$352.50

Service Code	NDC 67877022205
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$222.07
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Advantage	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.38
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health SBD	$222.07

GABAPENTIN 100 MG CAPSULE

Facility

$263.20

Service Code	NDC 00904666561
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$103.44
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna Medicare	$131.60
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: BCBS Complete	$105.28
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Advantage	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Encore Health Key Benefits Commercial	$210.56
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: MI Amish Medical Board Commercial	$210.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.40
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health SBD	$165.82
Rate for Payer: UHC All Payor (Choice/PPO)	$171.08
Rate for Payer: UHC Core	$137.13
Rate for Payer: UHC Exchange	$103.44

GABAPENTIN 100 MG CAPSULE

Facility

$352.50

Service Code	NDC 67877022205
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$138.53
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna Medicare	$176.25
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: BCBS Complete	$141.00
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Advantage	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: MI Amish Medical Board Commercial	$282.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.38
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health SBD	$222.07
Rate for Payer: UHC All Payor (Choice/PPO)	$229.12
Rate for Payer: UHC Core	$183.65
Rate for Payer: UHC Exchange	$138.53

GABAPENTIN 100 MG CAPSULE

Facility

$51.70

Service Code	NDC 69097081307
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$46.53
Rate for Payer: Aetna Commercial	$43.95
Rate for Payer: Aetna Medicare	$25.85
Rate for Payer: Aetna New Business (MI Preferred)	$33.60
Rate for Payer: BCBS Complete	$20.68
Rate for Payer: Cash Price	$41.36
Rate for Payer: Cofinity Advantage	$36.19
Rate for Payer: Cofinity Commercial	$44.46
Rate for Payer: Encore Health Key Benefits Commercial	$41.36
Rate for Payer: Healthscope Commercial	$46.53
Rate for Payer: MI Amish Medical Board Commercial	$41.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.77
Rate for Payer: PHP Commercial	$43.95
Rate for Payer: Priority Health SBD	$32.57
Rate for Payer: UHC All Payor (Choice/PPO)	$33.60
Rate for Payer: UHC Core	$26.94
Rate for Payer: UHC Exchange	$20.32

GABAPENTIN 100 MG CAPSULE

Facility

$263.20

Service Code	NDC 00904666561
Hospital Charge Code	18309
Hospital Revenue Code	637
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Advantage	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Encore Health Key Benefits Commercial	$210.56
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.40
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health SBD	$165.82

GABAPENTIN 300 MG CAPSULE

Facility

$230.30

Service Code	NDC 63739023610
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$207.27
Rate for Payer: Aetna Commercial	$195.75
Rate for Payer: Aetna New Business (MI Preferred)	$149.69
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Advantage	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$172.72
Rate for Payer: PHP Commercial	$195.75
Rate for Payer: Priority Health SBD	$145.09

GABAPENTIN 300 MG CAPSULE

Facility

$587.50

Service Code	NDC 67877022305
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$370.12
Max. Negotiated Rate	$528.75
Rate for Payer: Aetna Commercial	$499.38
Rate for Payer: Aetna New Business (MI Preferred)	$381.88
Rate for Payer: Cash Price	$470.00
Rate for Payer: Cofinity Advantage	$411.25
Rate for Payer: Cofinity Commercial	$505.25
Rate for Payer: Encore Health Key Benefits Commercial	$470.00
Rate for Payer: Healthscope Commercial	$528.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$440.62
Rate for Payer: PHP Commercial	$499.38
Rate for Payer: Priority Health SBD	$370.12

GABAPENTIN 300 MG CAPSULE

Facility

$587.50

Service Code	NDC 67877022305
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$230.89
Max. Negotiated Rate	$528.75
Rate for Payer: Aetna Commercial	$499.38
Rate for Payer: Aetna Medicare	$293.75
Rate for Payer: Aetna New Business (MI Preferred)	$381.88
Rate for Payer: BCBS Complete	$235.00
Rate for Payer: Cash Price	$470.00
Rate for Payer: Cofinity Advantage	$411.25
Rate for Payer: Cofinity Commercial	$505.25
Rate for Payer: Encore Health Key Benefits Commercial	$470.00
Rate for Payer: Healthscope Commercial	$528.75
Rate for Payer: MI Amish Medical Board Commercial	$470.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$499.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$440.62
Rate for Payer: PHP Commercial	$499.38
Rate for Payer: Priority Health SBD	$370.12
Rate for Payer: UHC All Payor (Choice/PPO)	$381.88
Rate for Payer: UHC Core	$306.09
Rate for Payer: UHC Exchange	$230.89

GABAPENTIN 300 MG CAPSULE

Facility

$277.30

Service Code	NDC 63739090310
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70

GABAPENTIN 300 MG CAPSULE

Facility

$305.50

Service Code	NDC 00904666661
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$120.06
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna Medicare	$152.75
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: BCBS Complete	$122.20
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Advantage	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: MI Amish Medical Board Commercial	$244.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health SBD	$192.47
Rate for Payer: UHC All Payor (Choice/PPO)	$198.57
Rate for Payer: UHC Core	$159.17
Rate for Payer: UHC Exchange	$120.06

GABAPENTIN 300 MG CAPSULE

Facility

$103.40

Service Code	NDC 50228018001
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$40.64
Max. Negotiated Rate	$93.06
Rate for Payer: Aetna Commercial	$87.89
Rate for Payer: Aetna Medicare	$51.70
Rate for Payer: Aetna New Business (MI Preferred)	$67.21
Rate for Payer: BCBS Complete	$41.36
Rate for Payer: Cash Price	$82.72
Rate for Payer: Cofinity Advantage	$72.38
Rate for Payer: Cofinity Commercial	$88.92
Rate for Payer: Encore Health Key Benefits Commercial	$82.72
Rate for Payer: Healthscope Commercial	$93.06
Rate for Payer: MI Amish Medical Board Commercial	$82.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.55
Rate for Payer: PHP Commercial	$87.89
Rate for Payer: Priority Health SBD	$65.14
Rate for Payer: UHC All Payor (Choice/PPO)	$67.21
Rate for Payer: UHC Core	$53.87
Rate for Payer: UHC Exchange	$40.64

GABAPENTIN 300 MG CAPSULE

Facility

$103.40

Service Code	NDC 50228018001
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$65.14
Max. Negotiated Rate	$93.06
Rate for Payer: Aetna Commercial	$87.89
Rate for Payer: Aetna New Business (MI Preferred)	$67.21
Rate for Payer: Cash Price	$82.72
Rate for Payer: Cofinity Advantage	$72.38
Rate for Payer: Cofinity Commercial	$88.92
Rate for Payer: Encore Health Key Benefits Commercial	$82.72
Rate for Payer: Healthscope Commercial	$93.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.55
Rate for Payer: PHP Commercial	$87.89
Rate for Payer: Priority Health SBD	$65.14

GABAPENTIN 300 MG CAPSULE

Facility

$230.30

Service Code	NDC 63739023610
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$90.51
Max. Negotiated Rate	$207.27
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: Aetna Commercial	$195.75
Rate for Payer: Aetna Medicare	$115.15
Rate for Payer: Aetna New Business (MI Preferred)	$149.69
Rate for Payer: BCBS Complete	$92.12
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Advantage	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: MI Amish Medical Board Commercial	$184.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$172.72
Rate for Payer: PHP Commercial	$195.75
Rate for Payer: Priority Health SBD	$145.09
Rate for Payer: UHC All Payor (Choice/PPO)	$149.69
Rate for Payer: UHC Core	$119.99
Rate for Payer: UHC Exchange	$90.51

GABAPENTIN 300 MG CAPSULE

Facility

$305.50

Service Code	NDC 00904666661
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$192.47
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna New Business (MI Preferred)	$198.57
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Advantage	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Encore Health Key Benefits Commercial	$244.40
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$229.12
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health SBD	$192.47

GABAPENTIN 300 MG CAPSULE

Facility

$277.30

Service Code	NDC 63739090310
Hospital Charge Code	18308
Hospital Revenue Code	637
Min. Negotiated Rate	$108.98
Max. Negotiated Rate	$249.57
Rate for Payer: Aetna Commercial	$235.71
Rate for Payer: Aetna Medicare	$138.65
Rate for Payer: Aetna New Business (MI Preferred)	$180.25
Rate for Payer: BCBS Complete	$110.92
Rate for Payer: Cash Price	$221.84
Rate for Payer: Cofinity Advantage	$194.11
Rate for Payer: Cofinity Commercial	$238.48
Rate for Payer: Encore Health Key Benefits Commercial	$221.84
Rate for Payer: Healthscope Commercial	$249.57
Rate for Payer: MI Amish Medical Board Commercial	$221.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.97
Rate for Payer: PHP Commercial	$235.71
Rate for Payer: Priority Health SBD	$174.70
Rate for Payer: UHC All Payor (Choice/PPO)	$180.25
Rate for Payer: UHC Core	$144.47
Rate for Payer: UHC Exchange	$108.98

GABAPENTIN 400 MG CAPSULE

Facility

$150.40

Service Code	NDC 67877022401
Hospital Charge Code	18307
Hospital Revenue Code	637
Min. Negotiated Rate	$94.75
Max. Negotiated Rate	$135.36
Rate for Payer: Aetna Commercial	$127.84
Rate for Payer: Aetna New Business (MI Preferred)	$97.76
Rate for Payer: Cash Price	$120.32
Rate for Payer: Cofinity Advantage	$105.28
Rate for Payer: Cofinity Commercial	$129.34
Rate for Payer: Encore Health Key Benefits Commercial	$120.32
Rate for Payer: Healthscope Commercial	$135.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.80
Rate for Payer: PHP Commercial	$127.84
Rate for Payer: Priority Health SBD	$94.75

GABAPENTIN 400 MG CAPSULE

Facility

$239.70

Service Code	NDC 63739098410
Hospital Charge Code	18307
Hospital Revenue Code	637
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$203.75
Rate for Payer: Aetna New Business (MI Preferred)	$155.81
Rate for Payer: Cash Price	$191.76
Rate for Payer: Cofinity Advantage	$167.79
Rate for Payer: Cofinity Commercial	$206.14
Rate for Payer: Encore Health Key Benefits Commercial	$191.76
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$179.78
Rate for Payer: PHP Commercial	$203.75
Rate for Payer: Priority Health SBD	$151.01

GABAPENTIN 400 MG CAPSULE

Facility

$366.60

Service Code	NDC 00904666761
Hospital Charge Code	18307
Hospital Revenue Code	637
Min. Negotiated Rate	$230.96
Max. Negotiated Rate	$329.94
Rate for Payer: Aetna Commercial	$311.61
Rate for Payer: Aetna New Business (MI Preferred)	$238.29
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cofinity Advantage	$256.62
Rate for Payer: Cofinity Commercial	$315.28
Rate for Payer: Encore Health Key Benefits Commercial	$293.28
Rate for Payer: Healthscope Commercial	$329.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$274.95
Rate for Payer: PHP Commercial	$311.61
Rate for Payer: Priority Health SBD	$230.96

Know your out-of-pocket cost for care.

All Charges