|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$247.20
|
|
|
Service Code
|
NDC 60687023001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$222.48 |
| Rate for Payer: Aetna Commercial |
$210.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.68
|
| Rate for Payer: Cash Price |
$197.76
|
| Rate for Payer: Cofinity Commercial |
$173.04
|
| Rate for Payer: Cofinity Commercial |
$212.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.76
|
| Rate for Payer: Healthscope Commercial |
$222.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.12
|
| Rate for Payer: PHP Commercial |
$210.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.68
|
| Rate for Payer: Priority Health SBD |
$155.74
|
|
|
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 |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| 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 |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$7,670.10
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,068.04 |
| Max. Negotiated Rate |
$6,903.09 |
| Rate for Payer: Aetna Commercial |
$6,519.58
|
| Rate for Payer: Aetna Medicare |
$3,835.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,985.56
|
| Rate for Payer: BCBS Complete |
$3,068.04
|
| 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
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| 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
|
|
