|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| 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: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| 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: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 72578004201
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.91
|
| Rate for Payer: UHC Core |
$129.78
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 72578004201
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 59651037801
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna Medicare |
$171.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.01
|
| Rate for Payer: UHC Core |
$178.76
|
| Rate for Payer: UHC Exchange |
$134.84
|
| Rate for Payer: UMR Bronson Commercial |
$126.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 68462012801
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna Medicare |
$171.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.01
|
| Rate for Payer: UHC Core |
$178.76
|
| Rate for Payer: UHC Exchange |
$134.84
|
| Rate for Payer: UMR Bronson Commercial |
$126.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 72578004001
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 72578004001
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 59651037801
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
ZONISAMIDE 25 MG CAPSULE
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 68462012801
|
| Hospital Charge Code |
36987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.01
|
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.01
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Advantage |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 68462012901
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.20
|
| Rate for Payer: UHC Core |
$209.36
|
| Rate for Payer: UHC Exchange |
$157.93
|
| Rate for Payer: UMR Bronson Commercial |
$148.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 59651037901
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.20
|
| Rate for Payer: UHC Core |
$209.36
|
| Rate for Payer: UHC Exchange |
$157.93
|
| Rate for Payer: UMR Bronson Commercial |
$148.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 59651037901
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 68462012901
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 72578004101
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.25
|
| Rate for Payer: UHC Core |
$144.47
|
| Rate for Payer: UHC Exchange |
$108.98
|
| Rate for Payer: UMR Bronson Commercial |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
ZONISAMIDE 50 MG CAPSULE
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 72578004101
|
| Hospital Charge Code |
36988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
