Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

ZOLMITRIPTAN 5 MG TABLET

Facility

$22.22

Service Code	NDC 27241-022-38
Hospital Charge Code	22219
Hospital Revenue Code	637
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna American Axle	$14.44
Rate for Payer: Aetna Commercial	$18.89
Rate for Payer: Aetna New Business (MI Preferred)	$14.44
Rate for Payer: Cash Price	$17.78
Rate for Payer: Cofinity Commercial	$15.55
Rate for Payer: Cofinity Commercial	$19.11
Rate for Payer: Encore Health Key Benefits Commercial	$17.78
Rate for Payer: Healthscope Commercial	$20.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$15.55
Rate for Payer: Lakeland Regional Health Systems Commercial	$16.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.89
Rate for Payer: PHP Commercial	$18.89
Rate for Payer: Priority Health Cigna Priority Health	$15.55
Rate for Payer: Priority Health SBD	$14.00
Rate for Payer: UMR Bronson Commercial	$9.78
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$16.66

ZOLPIDEM 5 MG TABLET

Facility

$134.75

Service Code	NDC 51079-724-20
Hospital Charge Code	11701
Hospital Revenue Code	637
Min. Negotiated Rate	$59.29
Max. Negotiated Rate	$121.28
Rate for Payer: Aetna American Axle	$87.59
Rate for Payer: Aetna Commercial	$114.54
Rate for Payer: Aetna New Business (MI Preferred)	$87.59
Rate for Payer: Cash Price	$107.80
Rate for Payer: Cofinity Commercial	$115.88
Rate for Payer: Cofinity Commercial	$94.32
Rate for Payer: Encore Health Key Benefits Commercial	$107.80
Rate for Payer: Healthscope Commercial	$121.28
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$94.32
Rate for Payer: Lakeland Regional Health Systems Commercial	$101.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.54
Rate for Payer: PHP Commercial	$114.54
Rate for Payer: Priority Health Cigna Priority Health	$94.32
Rate for Payer: Priority Health SBD	$84.89
Rate for Payer: UMR Bronson Commercial	$59.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$101.06

ZOLPIDEM 5 MG TABLET

Facility

$192.50

Service Code	NDC 68084-189-01
Hospital Charge Code	11701
Hospital Revenue Code	637
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$173.25
Rate for Payer: Aetna American Axle	$125.12
Rate for Payer: Aetna Commercial	$163.62
Rate for Payer: Aetna New Business (MI Preferred)	$125.12
Rate for Payer: Cash Price	$154.00
Rate for Payer: Cofinity Commercial	$134.75
Rate for Payer: Cofinity Commercial	$165.55
Rate for Payer: Encore Health Key Benefits Commercial	$154.00
Rate for Payer: Healthscope Commercial	$173.25
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$134.75
Rate for Payer: Lakeland Regional Health Systems Commercial	$144.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$163.62
Rate for Payer: PHP Commercial	$163.62
Rate for Payer: Priority Health Cigna Priority Health	$134.75
Rate for Payer: Priority Health SBD	$121.28
Rate for Payer: UMR Bronson Commercial	$84.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$144.38

ZOLPIDEM 5 MG TABLET

Facility

$11.03

Service Code	NDC 0904-6082-61
Hospital Charge Code	11701
Hospital Revenue Code	637
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna American Axle	$7.17
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Aetna New Business (MI Preferred)	$7.17
Rate for Payer: Cash Price	$8.82
Rate for Payer: Cofinity Commercial	$7.72
Rate for Payer: Cofinity Commercial	$9.49
Rate for Payer: Encore Health Key Benefits Commercial	$8.82
Rate for Payer: Healthscope Commercial	$9.93
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$7.72
Rate for Payer: Lakeland Regional Health Systems Commercial	$8.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9.38
Rate for Payer: PHP Commercial	$9.38
Rate for Payer: Priority Health Cigna Priority Health	$7.72
Rate for Payer: Priority Health SBD	$6.95
Rate for Payer: UMR Bronson Commercial	$4.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$8.27

ZOLPIDEM 5 MG TABLET

Facility

$1.35

Service Code	NDC 51079-724-01
Hospital Charge Code	11701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.22
Rate for Payer: Aetna American Axle	$0.88
Rate for Payer: Aetna Commercial	$1.15
Rate for Payer: Aetna New Business (MI Preferred)	$0.88
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cofinity Commercial	$0.95
Rate for Payer: Cofinity Commercial	$1.16
Rate for Payer: Encore Health Key Benefits Commercial	$1.08
Rate for Payer: Healthscope Commercial	$1.22
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.95
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.15
Rate for Payer: PHP Commercial	$1.15
Rate for Payer: Priority Health Cigna Priority Health	$0.95
Rate for Payer: Priority Health SBD	$0.85
Rate for Payer: UMR Bronson Commercial	$0.59
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.01

ZOLPIDEM 5 MG TABLET

Facility

$1.93

Service Code	NDC 68084-189-11
Hospital Charge Code	11701
Hospital Revenue Code	637
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna American Axle	$1.25
Rate for Payer: Aetna Commercial	$1.64
Rate for Payer: Aetna New Business (MI Preferred)	$1.25
Rate for Payer: Cash Price	$1.54
Rate for Payer: Cofinity Commercial	$1.35
Rate for Payer: Cofinity Commercial	$1.66
Rate for Payer: Encore Health Key Benefits Commercial	$1.54
Rate for Payer: Healthscope Commercial	$1.74
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1.35
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.64
Rate for Payer: PHP Commercial	$1.64
Rate for Payer: Priority Health Cigna Priority Health	$1.35
Rate for Payer: Priority Health SBD	$1.22
Rate for Payer: UMR Bronson Commercial	$0.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.45

ZONISAMIDE 100 MG CAPSULE

Facility

$247.20

Service Code	NDC 60687-230-01
Hospital Charge Code	27780
Hospital Revenue Code	637
Min. Negotiated Rate	$108.77
Max. Negotiated Rate	$222.48
Rate for Payer: Aetna American Axle	$160.68
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: Encore Health Key Benefits Commercial	$197.76
Rate for Payer: Healthscope Commercial	$222.48
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$173.04
Rate for Payer: Lakeland Regional Health Systems Commercial	$185.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$210.12
Rate for Payer: PHP Commercial	$210.12
Rate for Payer: Priority Health Cigna Priority Health	$173.04
Rate for Payer: Priority Health SBD	$155.74
Rate for Payer: UMR Bronson Commercial	$108.77
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$185.40

ZONISAMIDE 100 MG CAPSULE

Facility

$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 100 MG CAPSULE

Facility

$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

$2.48

Service Code	NDC 60687-230-11
Hospital Charge Code	27780
Hospital Revenue Code	637
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.23
Rate for Payer: Aetna American Axle	$1.61
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: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.23
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1.74
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.11
Rate for Payer: PHP Commercial	$2.11
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.56
Rate for Payer: UMR Bronson Commercial	$1.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.86

ZONISAMIDE 100 MG CAPSULE

Facility

$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 25 MG CAPSULE

Facility

$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	$295.07
Rate for Payer: Cofinity Commercial	$240.17
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

$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

$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	$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

ZONISAMIDE 50 MG CAPSULE

Facility

$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

Know your out-of-pocket cost for care.

All Charges