Bronson Methodist Hospital

All Charges

Charge

Type

Price

ZONISAMIDE 100 MG CAPSULE

Facility IP

$324.90

Service Code	NDC 59651-380-01
Hospital Charge Code	27780
Hospital Revenue Code	637
Min. Negotiated Rate	$142.96
Max. Negotiated Rate	$292.41
Rate for Payer: Aetna American Axle	$211.18
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: 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 Multiplan/Beech St/PHCS	$276.16
Rate for Payer: PHP Commercial	$276.16
Rate for Payer: Priority Health Cigna Priority Health	$227.43
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 IP

$324.90

Service Code	NDC 69097-861-07
Hospital Charge Code	27780
Hospital Revenue Code	637
Min. Negotiated Rate	$142.96
Max. Negotiated Rate	$292.41
Rate for Payer: Aetna American Axle	$211.18
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: 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 Multiplan/Beech St/PHCS	$276.16
Rate for Payer: PHP Commercial	$276.16
Rate for Payer: Priority Health Cigna Priority Health	$227.43
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 IP

$324.90

Service Code	NDC 68462-130-01
Hospital Charge Code	27780
Hospital Revenue Code	637
Min. Negotiated Rate	$142.96
Max. Negotiated Rate	$292.41
Rate for Payer: Aetna American Axle	$211.18
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: 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 Multiplan/Beech St/PHCS	$276.16
Rate for Payer: PHP Commercial	$276.16
Rate for Payer: Priority Health Cigna Priority Health	$227.43
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 25 MG CAPSULE

Facility IP

$343.10

Service Code	NDC 68462-128-01
Hospital Charge Code	36987
Hospital Revenue Code	637
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$308.79
Rate for Payer: Aetna American Axle	$223.02
Rate for Payer: Aetna Commercial	$291.64
Rate for Payer: Aetna New Business (MI Preferred)	$223.02
Rate for Payer: Cash Price	$274.48
Rate for Payer: Cofinity Commercial	$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 Multiplan/Beech St/PHCS	$291.64
Rate for Payer: PHP Commercial	$291.64
Rate for Payer: Priority Health Cigna Priority Health	$240.17
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 59651-378-01
Hospital Charge Code	36987
Hospital Revenue Code	637
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$308.79
Rate for Payer: Aetna American Axle	$223.02
Rate for Payer: Aetna Commercial	$291.64
Rate for Payer: Aetna New Business (MI Preferred)	$223.02
Rate for Payer: Cash Price	$274.48
Rate for Payer: Cofinity Commercial	$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 Multiplan/Beech St/PHCS	$291.64
Rate for Payer: PHP Commercial	$291.64
Rate for Payer: Priority Health Cigna Priority Health	$240.17
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 IP

$401.85

Service Code	NDC 68462-129-01
Hospital Charge Code	36988
Hospital Revenue Code	637
Min. Negotiated Rate	$176.81
Max. Negotiated Rate	$361.66
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 Commercial	$345.59
Rate for Payer: Cofinity Commercial	$281.30
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.66
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 Multiplan/Beech St/PHCS	$341.57
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health Cigna Priority Health	$281.30
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 59651-379-01
Hospital Charge Code	36988
Hospital Revenue Code	637
Min. Negotiated Rate	$176.81
Max. Negotiated Rate	$361.66
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 Commercial	$281.30
Rate for Payer: Cofinity Commercial	$345.59
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.66
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 Multiplan/Beech St/PHCS	$341.57
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health Cigna Priority Health	$281.30
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

Price Transparency.