GABAPENTIN 100 MG PO CAPS [18309]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 67877022205
|
Hospital Charge Code |
67877022205
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
Rate for Payer: Aetna Government |
$0.27
|
Rate for Payer: Brighton Health Commercial |
$0.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
Rate for Payer: Group Health Inc Commercial |
$0.27
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
GABAPENTIN 100 MG PO CAPS [18309]
|
Facility
|
OP
|
$0.58
|
|
Service Code
|
NDC 60687058001
|
Hospital Charge Code |
60687058001
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$0.47 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
Rate for Payer: Aetna Government |
$0.29
|
Rate for Payer: Brighton Health Commercial |
$0.44
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
Rate for Payer: Group Health Inc Commercial |
$0.29
|
Rate for Payer: Group Health Inc Medicare |
$0.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.38
|
|
GABAPENTIN 100 MG PO CAPS [18309]
|
Facility
|
OP
|
$0.11
|
|
Service Code
|
NDC 63739090210
|
Hospital Charge Code |
63739090210
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
Rate for Payer: Aetna Government |
$0.05
|
Rate for Payer: Brighton Health Commercial |
$0.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
Rate for Payer: Group Health Inc Commercial |
$0.05
|
Rate for Payer: Group Health Inc Medicare |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
GABAPENTIN 100 MG PO CAPS [18309]
|
Facility
|
OP
|
$0.54
|
|
Service Code
|
NDC 67877022201
|
Hospital Charge Code |
67877022201
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
Rate for Payer: Aetna Government |
$0.27
|
Rate for Payer: Brighton Health Commercial |
$0.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
Rate for Payer: Group Health Inc Commercial |
$0.27
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
GABAPENTIN 100 MG PO CAPS [18309]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 69097081312
|
Hospital Charge Code |
69097081312
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
Rate for Payer: Aetna Government |
$0.27
|
Rate for Payer: Brighton Health Commercial |
$0.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
Rate for Payer: Group Health Inc Commercial |
$0.27
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
GABAPENTIN 300 MG CAP
|
Facility
|
OP
|
$0.16
|
|
Hospital Charge Code |
41644074
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
Rate for Payer: Aetna Government |
$0.08
|
Rate for Payer: Brighton Health Commercial |
$0.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
Rate for Payer: Group Health Inc Commercial |
$0.08
|
Rate for Payer: Group Health Inc Medicare |
$0.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
GABAPENTIN 300 MG CAP
|
Facility
|
OP
|
$0.16
|
|
Hospital Charge Code |
41654074
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.13 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
Rate for Payer: Aetna Government |
$0.08
|
Rate for Payer: Brighton Health Commercial |
$0.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
Rate for Payer: Group Health Inc Commercial |
$0.08
|
Rate for Payer: Group Health Inc Medicare |
$0.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.34
|
|
Service Code
|
NDC 67877022301
|
Hospital Charge Code |
67877022301
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.33
|
|
Service Code
|
NDC 67877022310
|
Hospital Charge Code |
67877022310
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.33
|
|
Service Code
|
NDC 51224011960
|
Hospital Charge Code |
51224011960
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.33
|
|
Service Code
|
NDC 67877022305
|
Hospital Charge Code |
67877022305
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$0.20
|
|
Service Code
|
NDC 63739090310
|
Hospital Charge Code |
63739090310
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
Rate for Payer: Brighton Health Commercial |
$0.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
Rate for Payer: Group Health Inc Commercial |
$0.10
|
Rate for Payer: Group Health Inc Medicare |
$0.07
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.33
|
|
Service Code
|
NDC 51224011950
|
Hospital Charge Code |
51224011950
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$1.33
|
|
Service Code
|
NDC 45963055650
|
Hospital Charge Code |
45963055650
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
GABAPENTIN 300 MG PO CAPS [18308]
|
Facility
|
OP
|
$0.20
|
|
Service Code
|
NDC 00904666661
|
Hospital Charge Code |
00904666661
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
Rate for Payer: Brighton Health Commercial |
$0.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
Rate for Payer: Group Health Inc Commercial |
$0.10
|
Rate for Payer: Group Health Inc Medicare |
$0.07
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
GABAPENTIN 400 MG CAP
|
Facility
|
OP
|
$0.24
|
|
Hospital Charge Code |
41654075
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
Rate for Payer: Aetna Government |
$0.12
|
Rate for Payer: Brighton Health Commercial |
$0.18
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
Rate for Payer: Group Health Inc Commercial |
$0.12
|
Rate for Payer: Group Health Inc Medicare |
$0.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
GABAPENTIN 400 MG CAP
|
Facility
|
OP
|
$0.24
|
|
Hospital Charge Code |
41644075
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
Rate for Payer: Aetna Government |
$0.12
|
Rate for Payer: Brighton Health Commercial |
$0.18
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
Rate for Payer: Group Health Inc Commercial |
$0.12
|
Rate for Payer: Group Health Inc Medicare |
$0.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
GABAPENTIN 400 MG PO CAPS [18307]
|
Facility
|
OP
|
$1.60
|
|
Service Code
|
NDC 65862020005
|
Hospital Charge Code |
65862020005
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$1.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
Rate for Payer: Aetna Government |
$0.80
|
Rate for Payer: Brighton Health Commercial |
$1.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.28
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
Rate for Payer: Group Health Inc Commercial |
$0.80
|
Rate for Payer: Group Health Inc Medicare |
$0.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
GABAPENTIN 400 MG PO CAPS [18307]
|
Facility
|
OP
|
$1.61
|
|
Service Code
|
NDC 67877022405
|
Hospital Charge Code |
67877022405
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$1.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
Rate for Payer: Aetna Government |
$0.80
|
Rate for Payer: Brighton Health Commercial |
$1.21
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
Rate for Payer: Group Health Inc Commercial |
$0.80
|
Rate for Payer: Group Health Inc Medicare |
$0.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
GABAPENTIN 400 MG PO CAPS [18307]
|
Facility
|
OP
|
$1.61
|
|
Service Code
|
NDC 67877022410
|
Hospital Charge Code |
67877022410
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$1.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
Rate for Payer: Aetna Government |
$0.80
|
Rate for Payer: Brighton Health Commercial |
$1.21
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
Rate for Payer: Group Health Inc Commercial |
$0.80
|
Rate for Payer: Group Health Inc Medicare |
$0.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
GABAPENTIN 400 MG PO CAPS [18307]
|
Facility
|
OP
|
$0.25
|
|
Service Code
|
NDC 00904666761
|
Hospital Charge Code |
00904666761
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
Rate for Payer: Aetna Government |
$0.12
|
Rate for Payer: Brighton Health Commercial |
$0.18
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
Rate for Payer: Group Health Inc Commercial |
$0.12
|
Rate for Payer: Group Health Inc Medicare |
$0.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
GABEPENTIN (NEURONTIN), SERUM
|
Facility
|
OP
|
$54.18
|
|
Service Code
|
HCPCS 80171
|
Hospital Charge Code |
40609812
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$15.17 |
Max. Negotiated Rate |
$43.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.67
|
Rate for Payer: Aetna Government |
$21.67
|
Rate for Payer: Affinity Essential Plan 1&2 |
$15.17
|
Rate for Payer: Affinity Essential Plan 3&4 |
$15.17
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.17
|
Rate for Payer: Brighton Health Commercial |
$40.64
|
Rate for Payer: Cash Price |
$21.67
|
Rate for Payer: Cash Price |
$21.67
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.67
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.84
|
Rate for Payer: Elderplan Medicare Advantage |
$21.67
|
Rate for Payer: EmblemHealth Commercial |
$21.67
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$18.42
|
Rate for Payer: Fidelis Essential Plan QHP |
$19.29
|
Rate for Payer: Fidelis Medicare Advantage |
$21.67
|
Rate for Payer: Fidelis Qualified Health Plan |
$19.29
|
Rate for Payer: Group Health Inc Commercial |
$21.67
|
Rate for Payer: Group Health Inc Medicare |
$21.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.67
|
Rate for Payer: Healthfirst Medicare Advantage |
$21.67
|
Rate for Payer: Healthfirst QHP |
$21.67
|
Rate for Payer: Humana Medicare |
$22.10
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$21.67
|
Rate for Payer: United Healthcare Commercial |
$16.28
|
Rate for Payer: United Healthcare Medicare Advantage |
$21.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.34
|
Rate for Payer: Wellcare Medicare |
$19.50
|
|
GABEPENTIN (NEURONTIN), SERUM
|
Facility
|
IP
|
$54.18
|
|
Service Code
|
HCPCS 80171
|
Hospital Charge Code |
40609812
|
Hospital Revenue Code
|
301
|
Rate for Payer: Cash Price |
$21.67
|
|
GAD-65 AUTOANTIBODY
|
Facility
|
IP
|
$58.93
|
|
Service Code
|
HCPCS 86341
|
Hospital Charge Code |
40729342
|
Hospital Revenue Code
|
300
|
Rate for Payer: Cash Price |
$23.57
|
|
GAD-65 AUTOANTIBODY
|
Facility
|
OP
|
$58.93
|
|
Service Code
|
HCPCS 86341
|
Hospital Charge Code |
40729342
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$16.50 |
Max. Negotiated Rate |
$44.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.41
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.57
|
Rate for Payer: Aetna Government |
$23.57
|
Rate for Payer: Affinity Essential Plan 1&2 |
$16.50
|
Rate for Payer: Affinity Essential Plan 3&4 |
$16.50
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.50
|
Rate for Payer: Brighton Health Commercial |
$44.20
|
Rate for Payer: Cash Price |
$23.57
|
Rate for Payer: Cash Price |
$23.57
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.45
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.61
|
Rate for Payer: Elderplan Medicare Advantage |
$23.57
|
Rate for Payer: EmblemHealth Commercial |
$23.57
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$20.03
|
Rate for Payer: Fidelis Essential Plan QHP |
$20.98
|
Rate for Payer: Fidelis Medicare Advantage |
$23.57
|
Rate for Payer: Fidelis Qualified Health Plan |
$20.98
|
Rate for Payer: Group Health Inc Commercial |
$23.57
|
Rate for Payer: Group Health Inc Medicare |
$23.57
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$23.57
|
Rate for Payer: Healthfirst Medicare Advantage |
$23.57
|
Rate for Payer: Healthfirst QHP |
$23.57
|
Rate for Payer: Humana Medicare |
$24.04
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$23.57
|
Rate for Payer: United Healthcare Commercial |
$25.06
|
Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.57
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.86
|
Rate for Payer: Wellcare Medicare |
$21.21
|
|