|
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 Commercial |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.18
|
| 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: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.31
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| 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
|
$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 Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| 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: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| 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
|
$82.25
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 00904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.09
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
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 Commercial |
$355.65
|
| Rate for Payer: Cofinity Commercial |
$436.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.65
|
| 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: PHP Commercial |
$431.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.25
|
| 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
|
$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 Commercial |
$1,066.95
|
| Rate for Payer: Cofinity Commercial |
$1,310.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.95
|
| 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: PHP Commercial |
$1,295.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.74
|
| 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 Commercial |
$1,066.95
|
| Rate for Payer: Cofinity Commercial |
$1,310.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.95
|
| 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: PHP Commercial |
$1,295.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.74
|
| Rate for Payer: Priority Health SBD |
$960.25
|
| Rate for Payer: UMR Bronson Commercial |
$563.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.16
|
|
|
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 Commercial |
$1,530.25
|
| Rate for Payer: Cofinity Commercial |
$1,880.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,530.25
|
| 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: PHP Commercial |
$1,858.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.95
|
| 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
|
$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 Commercial |
$684.49
|
| Rate for Payer: Cofinity Commercial |
$840.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.49
|
| 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: PHP Commercial |
$831.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.60
|
| 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
|
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 Commercial |
$684.49
|
| Rate for Payer: Cofinity Commercial |
$840.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.49
|
| 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: PHP Commercial |
$831.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.60
|
| Rate for Payer: Priority Health SBD |
$616.04
|
| 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
|
OP
|
$2,186.07
|
|
|
Service Code
|
NDC 00071201247
|
| Hospital Charge Code |
29169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$808.85 |
| 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 Medicare |
$1,093.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.95
|
| Rate for Payer: BCBS Complete |
$874.43
|
| Rate for Payer: Cash Price |
$1,748.86
|
| Rate for Payer: Cofinity Commercial |
$1,530.25
|
| Rate for Payer: Cofinity Commercial |
$1,880.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,530.25
|
| 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: PHP Commercial |
$1,858.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.95
|
| Rate for Payer: Priority Health SBD |
$1,377.22
|
| Rate for Payer: UMR Bronson Commercial |
$808.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,639.55
|
|
|
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 Commercial |
$355.65
|
| Rate for Payer: Cofinity Commercial |
$436.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.65
|
| 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: PHP Commercial |
$431.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.25
|
| Rate for Payer: Priority Health SBD |
$320.08
|
| Rate for Payer: UMR Bronson Commercial |
$187.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.05
|
|
|
GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 42192060840
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.78
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| 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
|
$16.33
|
|
|
Service Code
|
NDC 42192060840
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
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 Commercial |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$22.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.55
|
| 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: PHP Commercial |
$22.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.23
|
| Rate for Payer: Priority Health SBD |
$16.70
|
| 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
|
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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.78
|
| 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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.78
|
| 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
|
$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 Commercial |
$18.55
|
| Rate for Payer: Cofinity Commercial |
$22.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.55
|
| 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: PHP Commercial |
$22.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.23
|
| 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/6 ML (6 ML) ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 42192060806
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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: PHP Commercial |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.78
|
| Rate for Payer: Priority Health SBD |
$9.48
|
| 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
|
$16.33
|
|
|
Service Code
|
NDC 42192060806
|
| Hospital Charge Code |
162013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
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 Commercial |
$411.25
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.25
|
| 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: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.88
|
| 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
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.25
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
