|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$178.60
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.81
|
| Rate for Payer: BCBS Complete |
$71.44
|
| Rate for Payer: BCBS MAPPO |
$44.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.83
|
| Rate for Payer: BCN Commercial |
$138.86
|
| Rate for Payer: BCN Medicare Advantage |
$44.65
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.65
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$146.45
|
| Rate for Payer: PACE Senior Care Partners |
$42.42
|
| Rate for Payer: PACE SWMI |
$44.65
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: PHP Medicare Advantage |
$44.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health HMO/PPO |
$155.38
|
| Rate for Payer: Priority Health Medicare |
$45.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.66
|
| Rate for Payer: Railroad Medicare Medicare |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.65
|
| Rate for Payer: UHC Exchange |
$44.65
|
| Rate for Payer: UHC Medicare Advantage |
$44.65
|
| Rate for Payer: VA VA |
$44.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 63739059110
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| 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 |
$73.32
|
| Rate for Payer: BCBS MAPPO |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| 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 |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.81
|
| Rate for Payer: Railroad Medicare Medicare |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Exchange |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
| Rate for Payer: VA VA |
$45.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.48
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$195.80 |
| 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 |
$87.02
|
| Rate for Payer: BCBS MAPPO |
$54.39
|
| Rate for Payer: BCBS Trust/PPO |
$178.85
|
| Rate for Payer: BCN Commercial |
$169.15
|
| 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 |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| 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 Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Medicare |
$54.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.76
|
| 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 Dual Complete DSNP |
$54.39
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
| Rate for Payer: VA VA |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$85.01
|
| Rate for Payer: BCN Commercial |
$80.39
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: PACE Senior Care Partners |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Medicare |
$26.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.85
|
| Rate for Payer: UHC Exchange |
$25.85
|
| Rate for Payer: UHC Medicare Advantage |
$25.85
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 63739023610
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna Commercial |
$195.76
|
| Rate for Payer: BCBS Trust/PPO |
$187.99
|
| Rate for Payer: BCN Commercial |
$177.98
|
| 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 |
$195.76
|
| Rate for Payer: Nomi Health Commercial |
$188.85
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health HMO/PPO |
$200.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.30
|
| 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
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.86 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| 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 |
$110.92
|
| Rate for Payer: BCBS MAPPO |
$69.32
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$215.60
|
| Rate for Payer: BCN Medicare Advantage |
$69.32
|
| 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 |
$69.32
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.32
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: PHP Medicare Advantage |
$69.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| Rate for Payer: Railroad Medicare Medicare |
$69.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.32
|
| Rate for Payer: UHC Exchange |
$69.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.32
|
| Rate for Payer: VA VA |
$69.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 60687059101
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.24 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Trust/PPO |
$226.36
|
| Rate for Payer: BCN Commercial |
$214.30
|
| 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 |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| 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 |
$207.98
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687059111
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.87
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: PACE Senior Care Partners |
$0.66
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2.42
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.86
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Exchange |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.70
|
| Rate for Payer: VA VA |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
NDC 63739023610
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna Commercial |
$195.76
|
| 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 |
$92.12
|
| Rate for Payer: BCBS MAPPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$189.33
|
| Rate for Payer: BCN Commercial |
$179.06
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.76
|
| Rate for Payer: Nomi Health Commercial |
$188.85
|
| Rate for Payer: PACE Senior Care Partners |
$54.70
|
| Rate for Payer: PACE SWMI |
$57.58
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: PHP Medicare Advantage |
$57.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health HMO/PPO |
$200.36
|
| Rate for Payer: Priority Health Medicare |
$58.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.30
|
| 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 Dual Complete DSNP |
$57.58
|
| Rate for Payer: UHC Exchange |
$57.58
|
| Rate for Payer: UHC Medicare Advantage |
$57.58
|
| Rate for Payer: VA VA |
$57.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.24 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Trust/PPO |
$226.36
|
| Rate for Payer: BCN Commercial |
$214.30
|
| 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 |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| 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 |
$207.98
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 60687059101
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.86 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| 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 |
$110.92
|
| Rate for Payer: BCBS MAPPO |
$69.32
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$215.60
|
| Rate for Payer: BCN Medicare Advantage |
$69.32
|
| 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 |
$69.32
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.32
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: PHP Medicare Advantage |
$69.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| Rate for Payer: Railroad Medicare Medicare |
$69.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.32
|
| Rate for Payer: UHC Exchange |
$69.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.32
|
| Rate for Payer: VA VA |
$69.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$205.26
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$195.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.86
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 60687059111
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$84.41
|
| Rate for Payer: BCN Commercial |
$79.91
|
| Rate for Payer: Cash Price |
$82.72
|
| 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: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00904666761
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$211.95
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.15
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 67877022401
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$38.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.27
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: BCBS MAPPO |
$37.01
|
| Rate for Payer: BCBS Trust/PPO |
$121.71
|
| Rate for Payer: BCN Commercial |
$115.11
|
| Rate for Payer: BCN Medicare Advantage |
$37.01
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.01
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: PACE Senior Care Partners |
$35.16
|
| Rate for Payer: PACE SWMI |
$37.01
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Medicare |
$37.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| Rate for Payer: Railroad Medicare Medicare |
$37.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.01
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$37.01
|
| Rate for Payer: VA VA |
$37.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: BCBS Trust/PPO |
$195.67
|
| Rate for Payer: BCN Commercial |
$185.24
|
| Rate for Payer: Cash Price |
$191.76
|
| 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: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.74
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.80
|
| Rate for Payer: Priority Health HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 67877022401
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.23 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.85
|
| Rate for Payer: BCN Commercial |
$114.41
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$121.40
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health HMO/PPO |
$128.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.28
|
| Rate for Payer: UHC Core |
$123.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00904666761
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$222.52
|
| Rate for Payer: BCN Commercial |
$210.67
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 63739090410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$243.62
|
| Rate for Payer: BCN Commercial |
$230.64
|
| 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: Healthscope Commercial |
$268.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 63739090410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$268.60 |
| 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 |
$119.38
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$232.04
|
| 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 |
$268.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| 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 Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| 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 Dual Complete DSNP |
$74.61
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna Medicare |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.91
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$197.06
|
| Rate for Payer: BCN Commercial |
$186.37
|
| Rate for Payer: BCN Medicare Advantage |
$59.92
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.92
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.74
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: PACE Senior Care Partners |
$56.93
|
| Rate for Payer: PACE SWMI |
$59.92
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: PHP Medicare Advantage |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.80
|
| Rate for Payer: Priority Health HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Medicare |
$60.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.60
|
| Rate for Payer: Railroad Medicare Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.92
|
| Rate for Payer: UHC Exchange |
$59.92
|
| Rate for Payer: UHC Medicare Advantage |
$59.92
|
| Rate for Payer: VA VA |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: BCBS Trust/PPO |
$26.20
|
| Rate for Payer: BCBS Trust/PPO |
$104.81
|
| Rate for Payer: BCBS Trust/PPO |
$78.61
|
| Rate for Payer: BCN Commercial |
$24.81
|
| Rate for Payer: BCN Commercial |
$99.23
|
| Rate for Payer: BCN Commercial |
$74.42
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Healthscope Commercial |
$86.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health HMO/PPO |
$83.78
|
| Rate for Payer: Priority Health HMO/PPO |
$27.93
|
| Rate for Payer: Priority Health HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: UHC Core |
$80.41
|
| Rate for Payer: UHC Core |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna Medicare |
$33.38
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.09
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Complete |
$51.36
|
| Rate for Payer: BCBS Complete |
$38.52
|
| Rate for Payer: BCBS MAPPO |
$24.08
|
| Rate for Payer: BCBS MAPPO |
$32.10
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$105.56
|
| Rate for Payer: BCBS Trust/PPO |
$79.17
|
| Rate for Payer: BCN Commercial |
$24.96
|
| Rate for Payer: BCN Commercial |
$74.87
|
| Rate for Payer: BCN Commercial |
$99.83
|
| Rate for Payer: BCN Medicare Advantage |
$32.10
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.08
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.10
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Healthscope Commercial |
$86.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: PACE Senior Care Partners |
$22.87
|
| Rate for Payer: PACE Senior Care Partners |
$30.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PACE SWMI |
$32.10
|
| Rate for Payer: PACE SWMI |
$24.08
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: PHP Medicare Advantage |
$24.08
|
| Rate for Payer: PHP Medicare Advantage |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health HMO/PPO |
$83.78
|
| Rate for Payer: Priority Health HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health HMO/PPO |
$27.93
|
| Rate for Payer: Priority Health Medicare |
$32.42
|
| Rate for Payer: Priority Health Medicare |
$24.32
|
| Rate for Payer: Priority Health Medicare |
$8.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: Railroad Medicare Medicare |
$24.08
|
| Rate for Payer: Railroad Medicare Medicare |
$32.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$80.41
|
| Rate for Payer: UHC Core |
$26.80
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$8.02
|
| Rate for Payer: UHC Exchange |
$32.10
|
| Rate for Payer: UHC Exchange |
$24.08
|
| Rate for Payer: UHC Medicare Advantage |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$24.08
|
| Rate for Payer: VA VA |
$8.02
|
| Rate for Payer: VA VA |
$24.08
|
| Rate for Payer: VA VA |
$32.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
