|
G1020 CURBSIDES CDSM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1020
|
| Hospital Charge Code |
99000422
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1020 CURBSIDES CDSM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1020
|
| Hospital Charge Code |
99000422
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
G1021 EHEALTHLINES CDSM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1021
|
| Hospital Charge Code |
99000423
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
G1021 EHEALTHLINES CDSM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1021
|
| Hospital Charge Code |
99000423
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1022 INTERMOUNTAINS CDSM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1022
|
| Hospital Charge Code |
99000424
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1022 INTERMOUNTAINS CDSM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1022
|
| Hospital Charge Code |
99000424
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
G1023 PERSICIVAS CDSM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1023
|
| Hospital Charge Code |
99000425
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1023 PERSICIVAS CDSM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1023
|
| Hospital Charge Code |
99000425
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 67877022201
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.26 |
| Max. Negotiated Rate |
$96.35 |
| Rate for Payer: Aetna Commercial |
$86.72
|
| Rate for Payer: ASR ASR |
$93.46
|
| Rate for Payer: BCBS Trust/PPO |
$79.12
|
| Rate for Payer: BCN Commercial |
$79.12
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$93.46
|
| Rate for Payer: Healthscope Whirlpool |
$96.35
|
| Rate for Payer: Mclaren Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.79
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Medicare |
$80.84
|
| Rate for Payer: ASR ASR |
$211.94
|
| Rate for Payer: BCBS Complete |
$87.40
|
| Rate for Payer: BCBS Trust/PPO |
$180.15
|
| Rate for Payer: BCN Commercial |
$180.15
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$205.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$211.94
|
| Rate for Payer: Healthscope Whirlpool |
$218.50
|
| Rate for Payer: Mclaren Commercial |
$196.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Nomi Health Commercial |
$179.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.45
|
| Rate for Payer: Priority Health Narrow Network |
$153.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.28
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687058011
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 63739059110
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$70.43
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$156.94
|
| Rate for Payer: BCN Commercial |
$156.94
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 63739059110
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$156.32
|
| Rate for Payer: BCN Commercial |
$156.32
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
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 |
$96.35 |
| Rate for Payer: Aetna Commercial |
$86.72
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: ASR ASR |
$93.46
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.44
|
| Rate for Payer: BCN Commercial |
$79.44
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$93.46
|
| Rate for Payer: Healthscope Whirlpool |
$96.35
|
| Rate for Payer: Mclaren Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.42
|
| Rate for Payer: Priority Health Narrow Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.79
|
|
|
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 |
$289.05 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: ASR ASR |
$280.38
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: BCBS Trust/PPO |
$238.32
|
| Rate for Payer: BCN Commercial |
$238.32
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.38
|
| Rate for Payer: Healthscope Whirlpool |
$289.05
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.27
|
| Rate for Payer: Priority Health Narrow Network |
$202.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna Commercial |
$236.88
|
| Rate for Payer: ASR ASR |
$255.30
|
| Rate for Payer: BCBS Trust/PPO |
$216.14
|
| Rate for Payer: BCN Commercial |
$216.14
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$247.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$255.30
|
| Rate for Payer: Healthscope Whirlpool |
$263.20
|
| Rate for Payer: Mclaren Commercial |
$236.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Nomi Health Commercial |
$215.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.62
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 904666561
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna Commercial |
$236.88
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: ASR ASR |
$255.30
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: BCBS Trust/PPO |
$217.01
|
| Rate for Payer: BCN Commercial |
$217.01
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$247.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$255.30
|
| Rate for Payer: Healthscope Whirlpool |
$263.20
|
| Rate for Payer: Mclaren Commercial |
$236.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Nomi Health Commercial |
$215.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.62
|
| Rate for Payer: Priority Health Narrow Network |
$184.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.62
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 60687058011
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Whirlpool |
$2.89
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Nomi Health Commercial |
$2.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.53
|
| Rate for Payer: Priority Health Narrow Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 60687058001
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.79 |
| Max. Negotiated Rate |
$289.05 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: ASR ASR |
$280.38
|
| Rate for Payer: BCBS Trust/PPO |
$237.37
|
| Rate for Payer: BCN Commercial |
$237.37
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.38
|
| Rate for Payer: Healthscope Whirlpool |
$289.05
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
GABAPENTIN 100 MG CAPSULE
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
NDC 60505011200
|
| Hospital Charge Code |
18309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.88 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: ASR ASR |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$179.43
|
| Rate for Payer: BCN Commercial |
$179.43
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cofinity Commercial |
$205.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$211.94
|
| Rate for Payer: Healthscope Whirlpool |
$218.50
|
| Rate for Payer: Mclaren Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.72
|
| Rate for Payer: Nomi Health Commercial |
$179.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.28
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$122.67
|
| Rate for Payer: Aetna Medicare |
$50.43
|
| Rate for Payer: ASR ASR |
$132.21
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: BCBS Trust/PPO |
$112.38
|
| Rate for Payer: BCN Commercial |
$112.38
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$128.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$132.21
|
| Rate for Payer: Healthscope Whirlpool |
$136.30
|
| Rate for Payer: Mclaren Commercial |
$122.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$119.43
|
| Rate for Payer: Priority Health Narrow Network |
$95.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.94
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Trust/PPO |
$250.88
|
| Rate for Payer: BCN Commercial |
$250.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 904666661
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: Aetna Medicare |
$113.03
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS Trust/PPO |
$251.88
|
| Rate for Payer: BCN Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.68
|
| Rate for Payer: Priority Health Narrow Network |
$214.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 63739090310
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna Commercial |
$249.57
|
| Rate for Payer: ASR ASR |
$268.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.72
|
| Rate for Payer: BCN Commercial |
$227.72
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$260.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Healthscope Whirlpool |
$277.30
|
| Rate for Payer: Mclaren Commercial |
$249.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.02
|
|
|
GABAPENTIN 300 MG CAPSULE
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877022301
|
| Hospital Charge Code |
18308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$122.67
|
| Rate for Payer: ASR ASR |
$132.21
|
| Rate for Payer: BCBS Trust/PPO |
$111.93
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$128.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$132.21
|
| Rate for Payer: Healthscope Whirlpool |
$136.30
|
| Rate for Payer: Mclaren Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.94
|
|
