|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$2,186.07
|
|
|
Service Code
|
NDC 00071201247
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$1,967.46 |
| Rate for Payer: Aetna American Axle |
$1,420.95
|
| Rate for Payer: Aetna Commercial |
$1,858.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.95
|
| Rate for Payer: Cash Price |
$1,748.86
|
| Rate for Payer: Cofinity Advantage |
$1,530.25
|
| Rate for Payer: Cofinity Commercial |
$1,880.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,748.86
|
| Rate for Payer: Healthscope Commercial |
$1,967.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,530.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,639.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,858.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,639.55
|
| Rate for Payer: PHP Commercial |
$1,858.16
|
| Rate for Payer: Priority Health SBD |
$1,377.22
|
| Rate for Payer: UMR Bronson Commercial |
$961.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,639.55
|
|
|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$508.07
|
|
|
Service Code
|
NDC 50383031147
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.55 |
| Max. Negotiated Rate |
$457.26 |
| Rate for Payer: Aetna American Axle |
$330.25
|
| Rate for Payer: Aetna Commercial |
$431.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.25
|
| 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: 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: UMR Bronson Commercial |
$223.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.05
|
|
|
GABAPENTIN 250 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$977.84
|
|
|
Service Code
|
NDC 65162069890
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$430.25 |
| Max. Negotiated Rate |
$880.06 |
| Rate for Payer: Aetna American Axle |
$635.60
|
| Rate for Payer: Aetna Commercial |
$831.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.60
|
| 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: 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: UMR Bronson Commercial |
$430.25
|
| 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
|
$1,524.21
|
|
|
Service Code
|
NDC 59762505007
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$563.96 |
| 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 Medicare |
$762.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.74
|
| Rate for Payer: BCBS Complete |
$609.68
|
| 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: MI Amish Medical Board Commercial |
$1,219.37
|
| 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: UHC All Payor (Choice/PPO) |
$990.74
|
| Rate for Payer: UHC Core |
$794.11
|
| Rate for Payer: UHC Exchange |
$599.01
|
| Rate for Payer: UMR Bronson Commercial |
$563.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.16
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.07
|
|
|
Service Code
|
NDC 81033012406
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna American Axle |
$9.80
|
| Rate for Payer: Aetna Commercial |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cofinity Advantage |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$12.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.30
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
NDC 42192060806
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
NDC 42192060806
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.76
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.07
|
|
|
Service Code
|
NDC 81033012406
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna American Axle |
$9.80
|
| Rate for Payer: Aetna Commercial |
$12.81
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cofinity Advantage |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$12.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.30
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Core |
$7.85
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.07
|
|
|
Service Code
|
NDC 81033012444
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna American Axle |
$9.80
|
| Rate for Payer: Aetna Commercial |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cofinity Advantage |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$12.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.30
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$26.50
|
|
|
Service Code
|
NDC 09900001137
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Aetna American Axle |
$17.23
|
| Rate for Payer: Aetna Commercial |
$22.52
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.23
|
| Rate for Payer: BCBS Complete |
$10.60
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cofinity Advantage |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$23.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.88
|
| Rate for Payer: PHP Commercial |
$22.52
|
| Rate for Payer: Priority Health SBD |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$13.81
|
| Rate for Payer: UHC Exchange |
$10.41
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.88
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
NDC 42192060840
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.76
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.07
|
|
|
Service Code
|
NDC 81033012444
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna American Axle |
$9.80
|
| Rate for Payer: Aetna Commercial |
$12.81
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cofinity Advantage |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$12.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.30
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Core |
$7.85
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 50383031106
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna American Axle |
$9.78
|
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 50383031109
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna American Axle |
$9.78
|
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 50383031109
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna American Axle |
$9.78
|
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.78
|
| Rate for Payer: UHC Core |
$7.84
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 50383031106
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna American Axle |
$9.78
|
| Rate for Payer: Aetna Commercial |
$12.79
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.78
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$13.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.78
|
| Rate for Payer: UHC Core |
$7.84
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
NDC 42192060840
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$26.50
|
|
|
Service Code
|
NDC 09900001137
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$23.85 |
| Rate for Payer: Aetna American Axle |
$17.23
|
| Rate for Payer: Aetna Commercial |
$22.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.23
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cofinity Advantage |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$23.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.88
|
| Rate for Payer: PHP Commercial |
$22.52
|
| Rate for Payer: Priority Health SBD |
$16.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.88
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 63739023610
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.33 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna American Axle |
$149.69
|
| Rate for Payer: Aetna Commercial |
$195.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.69
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Advantage |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.72
|
| Rate for Payer: PHP Commercial |
$195.75
|
| Rate for Payer: Priority Health SBD |
$145.09
|
| Rate for Payer: UMR Bronson Commercial |
$101.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$587.50
|
|
|
Service Code
|
NDC 67877022305
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna American Axle |
$381.88
|
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.88
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Advantage |
$411.25
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health SBD |
$370.12
|
| Rate for Payer: UMR Bronson Commercial |
$258.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 70010010901
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 70010010901
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$587.50
|
|
|
Service Code
|
NDC 67877022305
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna American Axle |
$381.88
|
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: Aetna Medicare |
$293.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.88
|
| Rate for Payer: BCBS Complete |
$235.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Advantage |
$411.25
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health SBD |
$370.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.88
|
| Rate for Payer: UHC Core |
$306.09
|
| Rate for Payer: UHC Exchange |
$230.89
|
| Rate for Payer: UMR Bronson Commercial |
$217.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
