|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$237.50
|
|
|
Service Code
|
NDC 50268081615
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Advantage |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.12
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health SBD |
$149.62
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$237.50
|
|
|
Service Code
|
NDC 50268081615
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.34 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna Medicare |
$118.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: BCBS Complete |
$95.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Advantage |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.12
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.38
|
| Rate for Payer: UHC Core |
$123.74
|
| Rate for Payer: UHC Exchange |
$93.34
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.19
|
| Rate for Payer: UHC Core |
$169.27
|
| Rate for Payer: UHC Exchange |
$127.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$254.88
|
|
|
Service Code
|
NDC 60687023001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.67
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Advantage |
$178.42
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health SBD |
$160.57
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$8,061.19
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,078.55 |
| Max. Negotiated Rate |
$7,255.07 |
| Rate for Payer: Aetna Commercial |
$6,852.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,239.77
|
| Rate for Payer: Cash Price |
$6,448.95
|
| Rate for Payer: Cofinity Advantage |
$5,642.83
|
| Rate for Payer: Cofinity Commercial |
$6,932.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,448.95
|
| Rate for Payer: Healthscope Commercial |
$7,255.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,852.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,045.89
|
| Rate for Payer: PHP Commercial |
$6,852.01
|
| Rate for Payer: Priority Health SBD |
$5,078.55
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.33
|
| Rate for Payer: UHC Exchange |
$1.00
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$8,061.19
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,168.05 |
| Max. Negotiated Rate |
$7,255.07 |
| Rate for Payer: Aetna Commercial |
$6,852.01
|
| Rate for Payer: Aetna Medicare |
$4,030.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,239.77
|
| Rate for Payer: BCBS Complete |
$3,224.48
|
| Rate for Payer: Cash Price |
$6,448.95
|
| Rate for Payer: Cofinity Advantage |
$5,642.83
|
| Rate for Payer: Cofinity Commercial |
$6,932.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,448.95
|
| Rate for Payer: Healthscope Commercial |
$7,255.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,448.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,852.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,045.89
|
| Rate for Payer: PHP Commercial |
$6,852.01
|
| Rate for Payer: Priority Health SBD |
$5,078.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,239.77
|
| Rate for Payer: UHC Core |
$4,199.88
|
| Rate for Payer: UHC Exchange |
$3,168.05
|
|
