|
G1023 PERSICIVAS CDSM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1023
|
| Hospital Charge Code |
99000425
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
G1023 PERSICIVAS CDSM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1023
|
| Hospital Charge Code |
99000425
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.19 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: BCBS Trust/PPO |
$217.38
|
| Rate for Payer: BCN Commercial |
$217.38
|
| Rate for Payer: Cash Price |
$210.56
|
| 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: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Nomi Health Commercial |
$215.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.62
|
| Rate for Payer: UHC Core |
$219.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: BCBS Trust/PPO |
$79.58
|
| Rate for Payer: BCN Commercial |
$79.58
|
| Rate for Payer: Cash Price |
$77.08
|
| 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: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 63739059110
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: BCBS Trust/PPO |
$151.39
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: Cash Price |
$146.64
|
| 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: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$17.83
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$79.21
|
| Rate for Payer: BCN Commercial |
$79.21
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Mclaren Medicaid |
$16.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$17.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PACE Senior Care Partners |
$22.88
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Medicare |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicaid |
$16.99
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$16.99
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.98
|
| Rate for Payer: BCBS Complete |
$40.27
|
| Rate for Payer: BCBS MAPPO |
$54.39
|
| Rate for Payer: BCBS Trust/PPO |
$178.85
|
| Rate for Payer: BCN Commercial |
$178.85
|
| Rate for Payer: BCN Medicare Advantage |
$54.39
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.39
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Mclaren Medicaid |
$38.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.11
|
| Rate for Payer: Meridian Medicaid |
$40.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PACE Senior Care Partners |
$51.67
|
| Rate for Payer: PACE SWMI |
$54.39
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: PHP Medicare Advantage |
$54.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Medicare |
$54.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.41
|
| Rate for Payer: Railroad Medicare Medicare |
$54.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$38.35
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
| Rate for Payer: UHCCP Medicaid |
$38.35
|
| Rate for Payer: VA VA |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$68.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.25
|
| Rate for Payer: BCBS Complete |
$48.72
|
| Rate for Payer: BCBS MAPPO |
$65.80
|
| Rate for Payer: BCBS Trust/PPO |
$216.38
|
| Rate for Payer: BCN Commercial |
$216.38
|
| Rate for Payer: BCN Medicare Advantage |
$65.80
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Mclaren Medicaid |
$46.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.09
|
| Rate for Payer: Meridian Medicaid |
$48.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Nomi Health Commercial |
$215.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PACE Senior Care Partners |
$62.51
|
| Rate for Payer: PACE SWMI |
$65.80
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.98
|
| Rate for Payer: Priority Health Medicare |
$66.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.19
|
| Rate for Payer: Railroad Medicare Medicare |
$65.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.62
|
| Rate for Payer: UHC Core |
$219.77
|
| Rate for Payer: UHC Exchange |
$65.80
|
| Rate for Payer: UHC Medicaid |
$46.40
|
| Rate for Payer: UHC Medicare Advantage |
$65.80
|
| Rate for Payer: UHCCP Medicaid |
$46.40
|
| Rate for Payer: VA VA |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.41 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: BCBS Trust/PPO |
$179.67
|
| Rate for Payer: BCN Commercial |
$179.67
|
| Rate for Payer: Cash Price |
$174.04
|
| 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: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 63739090210
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$51.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.69
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: BCBS MAPPO |
$49.35
|
| Rate for Payer: BCBS Trust/PPO |
$162.28
|
| Rate for Payer: BCN Commercial |
$162.28
|
| Rate for Payer: BCN Medicare Advantage |
$49.35
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Mclaren Medicaid |
$34.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.82
|
| Rate for Payer: Meridian Medicaid |
$36.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PACE Senior Care Partners |
$46.88
|
| Rate for Payer: PACE SWMI |
$49.35
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: PHP Medicare Advantage |
$49.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Medicare |
$49.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.39
|
| Rate for Payer: Railroad Medicare Medicare |
$49.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: UHC Exchange |
$49.35
|
| Rate for Payer: UHC Medicaid |
$34.80
|
| Rate for Payer: UHC Medicare Advantage |
$49.35
|
| Rate for Payer: UHCCP Medicaid |
$34.80
|
| Rate for Payer: VA VA |
$49.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 63739059110
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 63739090210
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: BCBS Trust/PPO |
$163.03
|
| Rate for Payer: BCN Commercial |
$163.03
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Nomi Health Commercial |
$161.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.71
|
| Rate for Payer: UHC Core |
$164.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$56.55
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$251.15
|
| Rate for Payer: BCN Medicare Advantage |
$76.38
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Mclaren Medicaid |
$53.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: Meridian Medicaid |
$56.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PACE Senior Care Partners |
$72.56
|
| Rate for Payer: PACE SWMI |
$76.38
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: PHP Medicare Advantage |
$76.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: Railroad Medicare Medicare |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicaid |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| Rate for Payer: UHCCP Medicaid |
$53.86
|
| Rate for Payer: VA VA |
$76.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 60687059101
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$86.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$274.33
|
| Rate for Payer: BCN Commercial |
$274.33
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Mclaren Medicaid |
$58.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.60
|
| Rate for Payer: Meridian Medicaid |
$61.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Medicare |
$84.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.26
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: UHC Exchange |
$83.42
|
| Rate for Payer: UHC Medicaid |
$58.83
|
| Rate for Payer: UHC Medicare Advantage |
$83.42
|
| Rate for Payer: UHCCP Medicaid |
$58.83
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 00904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.63 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$252.31
|
| Rate for Payer: BCN Commercial |
$252.31
|
| Rate for Payer: Cash Price |
$244.40
|
| 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: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
NDC 60687059111
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: Nomi Health Commercial |
$2.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.50
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 60687059101
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.26 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: BCBS Trust/PPO |
$275.60
|
| Rate for Payer: BCN Commercial |
$275.60
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
NDC 63739023610
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna Commercial |
$195.75
|
| Rate for Payer: Aetna Medicare |
$59.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.97
|
| Rate for Payer: BCBS Complete |
$42.63
|
| Rate for Payer: BCBS MAPPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$189.33
|
| Rate for Payer: BCN Commercial |
$189.33
|
| Rate for Payer: BCN Medicare Advantage |
$57.58
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.58
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Mclaren Medicaid |
$40.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.45
|
| Rate for Payer: Meridian Medicaid |
$42.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.75
|
| Rate for Payer: Nomi Health Commercial |
$188.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.72
|
| Rate for Payer: PACE Senior Care Partners |
$54.70
|
| Rate for Payer: PACE SWMI |
$57.58
|
| Rate for Payer: PHP Commercial |
$195.75
|
| Rate for Payer: PHP Medicare Advantage |
$57.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.36
|
| Rate for Payer: Priority Health Medicare |
$58.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.29
|
| Rate for Payer: Railroad Medicare Medicare |
$57.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.66
|
| Rate for Payer: UHC Core |
$192.30
|
| Rate for Payer: UHC Exchange |
$57.58
|
| Rate for Payer: UHC Medicaid |
$40.60
|
| Rate for Payer: UHC Medicare Advantage |
$57.58
|
| Rate for Payer: UHCCP Medicaid |
$40.60
|
| Rate for Payer: VA VA |
$57.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 63739023610
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.29 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna Commercial |
$195.75
|
| Rate for Payer: BCBS Trust/PPO |
$190.20
|
| Rate for Payer: BCN Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$184.24
|
| 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: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.75
|
| Rate for Payer: Nomi Health Commercial |
$188.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.72
|
| Rate for Payer: PHP Commercial |
$195.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.66
|
| Rate for Payer: UHC Core |
$192.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
NDC 60687059111
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna Commercial |
$2.84
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.04
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.75
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.50
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.84
|
| Rate for Payer: Nomi Health Commercial |
$2.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.50
|
| Rate for Payer: PACE Senior Care Partners |
$0.79
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.91
|
| Rate for Payer: Priority Health Medicare |
$0.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicaid |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.50
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.86 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$112.57
|
| Rate for Payer: BCN Commercial |
$112.57
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$35.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.59
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS MAPPO |
$34.08
|
| Rate for Payer: BCBS Trust/PPO |
$112.05
|
| Rate for Payer: BCN Commercial |
$112.05
|
| Rate for Payer: BCN Medicare Advantage |
$34.08
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.08
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Mclaren Medicaid |
$24.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$25.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PACE Senior Care Partners |
$32.37
|
| Rate for Payer: PACE SWMI |
$34.08
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Medicare |
$34.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.86
|
| Rate for Payer: Railroad Medicare Medicare |
$34.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: UHC Exchange |
$34.08
|
| Rate for Payer: UHC Medicaid |
$24.03
|
| Rate for Payer: UHC Medicare Advantage |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$24.03
|
| Rate for Payer: VA VA |
$34.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.89 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.66
|
| Rate for Payer: BCBS Complete |
$51.33
|
| Rate for Payer: BCBS MAPPO |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$227.97
|
| Rate for Payer: BCN Medicare Advantage |
$69.33
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.33
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Mclaren Medicaid |
$48.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: Meridian Medicaid |
$51.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.33
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: PHP Medicare Advantage |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: Railroad Medicare Medicare |
$69.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UHC Medicaid |
$48.89
|
| Rate for Payer: UHC Medicare Advantage |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$48.89
|
| Rate for Payer: VA VA |
$69.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.00 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: BCBS Trust/PPO |
$229.02
|
| Rate for Payer: BCN Commercial |
$229.02
|
| Rate for Payer: Cash Price |
$221.84
|
| 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: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 63739090410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.27
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$245.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.61
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.61
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Mclaren Medicaid |
$52.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PACE Senior Care Partners |
$70.88
|
| Rate for Payer: PACE SWMI |
$74.61
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.72
|
| Rate for Payer: Railroad Medicare Medicare |
$74.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicaid |
$52.62
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: UHCCP Medicaid |
$52.62
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
