|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$4.14
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Medicare |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.61
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$4.14
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.61
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$7,670.10
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,832.16 |
| Max. Negotiated Rate |
$6,903.09 |
| Rate for Payer: Aetna Commercial |
$6,519.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,985.56
|
| Rate for Payer: Cash Price |
$6,136.08
|
| Rate for Payer: Cofinity Commercial |
$5,369.07
|
| Rate for Payer: Cofinity Commercial |
$6,596.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,369.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,136.08
|
| Rate for Payer: Healthscope Commercial |
$6,903.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,519.58
|
| Rate for Payer: PHP Commercial |
$6,519.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,985.56
|
| Rate for Payer: Priority Health SBD |
$4,832.16
|
|
