|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 60687058001
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 63739090210
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Advantage |
$138.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.31
|
| Rate for Payer: UHC Core |
$102.85
|
| Rate for Payer: UHC Exchange |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 63739090210
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Advantage |
$138.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 69097081307
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.60
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: UHC Exchange |
$20.32
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 49483060501
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Advantage |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.94
|
| Rate for Payer: UHC Core |
$41.63
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$137.13
|
| Rate for Payer: UHC Exchange |
$103.44
|
| Rate for Payer: UMR Bronson Commercial |
$97.38
|
| 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 |
$42.39 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 70010010801
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UMR Bronson Commercial |
$115.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 62756013702
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 71093012004
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 70010010801
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
NDC 60687058011
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.89
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 49483060501
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Advantage |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 71093012004
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 62756013702
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 69097081307
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$108.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.41
|
| Rate for Payer: UHC Core |
$113.34
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
NDC 60687058011
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 60687058001
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$977.84
|
|
|
Service Code
|
NDC 65162069890
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$880.06 |
| Rate for Payer: Aetna American Axle |
$635.60
|
| Rate for Payer: Aetna Commercial |
$831.16
|
| Rate for Payer: Aetna Medicare |
$488.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.60
|
| Rate for Payer: BCBS Complete |
$391.14
|
| Rate for Payer: Cash Price |
$782.27
|
| Rate for Payer: Cofinity Advantage |
$684.49
|
| Rate for Payer: Cofinity Commercial |
$840.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$782.27
|
| Rate for Payer: Healthscope Commercial |
$880.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$733.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$782.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$831.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$733.38
|
| Rate for Payer: PHP Commercial |
$831.16
|
| Rate for Payer: Priority Health SBD |
$616.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.60
|
| Rate for Payer: UHC Core |
$509.45
|
| Rate for Payer: UHC Exchange |
$384.29
|
| Rate for Payer: UMR Bronson Commercial |
$361.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$733.38
|
|
|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,524.21
|
|
|
Service Code
|
NDC 59762505007
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$670.65 |
| Max. Negotiated Rate |
$1,371.79 |
| Rate for Payer: Aetna American Axle |
$990.74
|
| Rate for Payer: Aetna Commercial |
$1,295.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.74
|
| Rate for Payer: Cash Price |
$1,219.37
|
| Rate for Payer: Cofinity Advantage |
$1,066.95
|
| Rate for Payer: Cofinity Commercial |
$1,310.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.37
|
| Rate for Payer: Healthscope Commercial |
$1,371.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,066.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,143.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,143.16
|
| Rate for Payer: PHP Commercial |
$1,295.58
|
| Rate for Payer: Priority Health SBD |
$960.25
|
| Rate for Payer: UMR Bronson Commercial |
$670.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.16
|
|
|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$508.07
|
|
|
Service Code
|
NDC 50383031147
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.99 |
| Max. Negotiated Rate |
$457.26 |
| Rate for Payer: Aetna American Axle |
$330.25
|
| Rate for Payer: Aetna Commercial |
$431.86
|
| Rate for Payer: Aetna Medicare |
$254.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.25
|
| Rate for Payer: BCBS Complete |
$203.23
|
| Rate for Payer: Cash Price |
$406.46
|
| Rate for Payer: Cofinity Advantage |
$355.65
|
| Rate for Payer: Cofinity Commercial |
$436.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.46
|
| Rate for Payer: Healthscope Commercial |
$457.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.05
|
| Rate for Payer: PHP Commercial |
$431.86
|
| Rate for Payer: Priority Health SBD |
$320.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.25
|
| Rate for Payer: UHC Core |
$264.70
|
| Rate for Payer: UHC Exchange |
$199.67
|
| Rate for Payer: UMR Bronson Commercial |
$187.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.05
|
|
