GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.17
|
|
Service Code
|
NDC 60687-591-01
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Senior |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.09
|
|
Service Code
|
NDC 65862-199-99
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: Dignity Health Senior |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.08
|
|
Service Code
|
NDC 67877-223-01
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Senior |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.08
|
|
Service Code
|
NDC 67877-223-01
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
Rate for Payer: Dignity Health Senior |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Senior |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 67877-223-05
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Senior |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.05
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 67877-223-05
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
Rate for Payer: Blue Shield of California Commercial |
$0.04
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
Rate for Payer: Dignity Health Senior |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Senior |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.05
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.20
|
|
Service Code
|
NDC 0904-6666-61
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.11
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
Rate for Payer: Dignity Health Senior |
$0.17
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Senior |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.15
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 45963-556-11
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: Dignity Health Senior |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 65162-102-50
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: Dignity Health Senior |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.11
|
|
Service Code
|
NDC 45963-556-11
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.11
|
|
Service Code
|
NDC 65162-102-50
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.20
|
|
Service Code
|
NDC 0904-6666-61
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.15 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
Rate for Payer: Heritage Provider Network Senior |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.15
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.11
|
|
Service Code
|
NDC 65162-102-10
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: Dignity Health Senior |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 60687-591-11
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Senior |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
OP
|
$0.17
|
|
Service Code
|
NDC 60687-591-01
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.11
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Senior |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.17
|
|
Service Code
|
NDC 60687-591-11
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
Rate for Payer: Heritage Provider Network Senior |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.13
|
|
GABAPENTIN 300 MG CAPSULE [18308]
|
Facility
IP
|
$0.11
|
|
Service Code
|
NDC 65162-102-10
|
Hospital Charge Code |
1712158
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
OP
|
$0.10
|
|
Service Code
|
NDC 65862-200-01
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
Rate for Payer: Dignity Health Senior |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
OP
|
$0.09
|
|
Service Code
|
NDC 67877-224-01
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: Dignity Health Senior |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
OP
|
$0.15
|
|
Service Code
|
NDC 65162-103-10
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
Rate for Payer: Blue Shield of California Commercial |
$0.09
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
Rate for Payer: Dignity Health Senior |
$0.13
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Senior |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.11
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
IP
|
$0.10
|
|
Service Code
|
NDC 65862-200-01
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.08
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
IP
|
$0.09
|
|
Service Code
|
NDC 67877-224-01
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
Rate for Payer: Cash Price |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Senior |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
OP
|
$0.25
|
|
Service Code
|
NDC 0904-6667-61
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
Rate for Payer: Blue Shield of California Commercial |
$0.16
|
Rate for Payer: Blue Shield of California EPN |
$0.15
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
Rate for Payer: Dignity Health Senior |
$0.21
|
Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
Rate for Payer: Heritage Provider Network Senior |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.19
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
IP
|
$0.15
|
|
Service Code
|
NDC 65162-103-10
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Senior |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.11
|
|
GABAPENTIN 400 MG CAPSULE [18307]
|
Facility
IP
|
$0.25
|
|
Service Code
|
NDC 0904-6667-61
|
Hospital Charge Code |
1711657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
Rate for Payer: Heritage Provider Network Senior |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.19
|
|