Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

FUROSEMIDE 40 MG TABLET

Facility

$89.30

Service Code	NDC 69315011701
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$33.04
Max. Negotiated Rate	$80.37
Rate for Payer: Aetna American Axle	$58.05
Rate for Payer: Aetna Commercial	$75.91
Rate for Payer: Aetna Medicare	$44.65
Rate for Payer: Aetna New Business (MI Preferred)	$58.05
Rate for Payer: BCBS Complete	$35.72
Rate for Payer: Cash Price	$71.44
Rate for Payer: Cofinity Advantage	$62.51
Rate for Payer: Cofinity Commercial	$76.80
Rate for Payer: Encore Health Key Benefits Commercial	$71.44
Rate for Payer: Healthscope Commercial	$80.37
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$62.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$66.97
Rate for Payer: MI Amish Medical Board Commercial	$71.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.97
Rate for Payer: PHP Commercial	$75.91
Rate for Payer: Priority Health SBD	$56.26
Rate for Payer: UHC All Payor (Choice/PPO)	$58.05
Rate for Payer: UHC Core	$46.53
Rate for Payer: UHC Exchange	$35.09
Rate for Payer: UMR Bronson Commercial	$33.04
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$66.97

FUROSEMIDE 40 MG TABLET

Facility

$84.60

Service Code	NDC 43547040210
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna American Axle	$54.99
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna Medicare	$42.30
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: BCBS Complete	$33.84
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Advantage	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Encore Health Key Benefits Commercial	$67.68
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$59.22
Rate for Payer: Lakeland Regional Health Systems Commercial	$63.45
Rate for Payer: MI Amish Medical Board Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.45
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health SBD	$53.30
Rate for Payer: UHC All Payor (Choice/PPO)	$54.99
Rate for Payer: UHC Core	$44.08
Rate for Payer: UHC Exchange	$33.25
Rate for Payer: UMR Bronson Commercial	$31.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$63.45

FUROSEMIDE 40 MG TABLET

Facility

$199.75

Service Code	NDC 00904717861
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna American Axle	$129.84
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna Medicare	$99.88
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: BCBS Complete	$79.90
Rate for Payer: Cash Price	$159.80
Rate for Payer: Cofinity Advantage	$139.82
Rate for Payer: Cofinity Commercial	$171.78
Rate for Payer: Encore Health Key Benefits Commercial	$159.80
Rate for Payer: Healthscope Commercial	$179.78
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$139.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$149.81
Rate for Payer: MI Amish Medical Board Commercial	$159.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.81
Rate for Payer: PHP Commercial	$169.79
Rate for Payer: Priority Health SBD	$125.84
Rate for Payer: UHC All Payor (Choice/PPO)	$129.84
Rate for Payer: UHC Core	$104.07
Rate for Payer: UHC Exchange	$78.50
Rate for Payer: UMR Bronson Commercial	$73.91
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$149.81

FUROSEMIDE 40 MG TABLET

Facility

$115.15

Service Code	NDC 64980056301
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$50.67
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna American Axle	$74.85
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Advantage	$80.61
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$80.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.36
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health SBD	$72.54
Rate for Payer: UMR Bronson Commercial	$50.67
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.36

FUROSEMIDE 40 MG TABLET

Facility

$1.49

Service Code	NDC 51079007301
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna American Axle	$0.97
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Advantage	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Encore Health Key Benefits Commercial	$1.19
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1.04
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.12
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health SBD	$0.94
Rate for Payer: UMR Bronson Commercial	$0.66
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.12

FUROSEMIDE 40 MG TABLET

Facility

$148.05

Service Code	NDC 51079007320
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$54.78
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna American Axle	$96.23
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna Medicare	$74.03
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: BCBS Complete	$59.22
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Advantage	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.25
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$103.64
Rate for Payer: Lakeland Regional Health Systems Commercial	$111.04
Rate for Payer: MI Amish Medical Board Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.04
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health SBD	$93.27
Rate for Payer: UHC All Payor (Choice/PPO)	$96.23
Rate for Payer: UHC Core	$77.13
Rate for Payer: UHC Exchange	$58.18
Rate for Payer: UMR Bronson Commercial	$54.78
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$111.04

FUROSEMIDE 40 MG TABLET

Facility

$199.75

Service Code	NDC 00904717861
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$87.89
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna American Axle	$129.84
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: Cash Price	$159.80
Rate for Payer: Cofinity Advantage	$139.82
Rate for Payer: Cofinity Commercial	$171.78
Rate for Payer: Encore Health Key Benefits Commercial	$159.80
Rate for Payer: Healthscope Commercial	$179.78
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$139.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$149.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.81
Rate for Payer: PHP Commercial	$169.79
Rate for Payer: Priority Health SBD	$125.84
Rate for Payer: UMR Bronson Commercial	$87.89
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$149.81

FUROSEMIDE 40 MG TABLET

Facility

$115.15

Service Code	NDC 64980056301
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna American Axle	$74.85
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna Medicare	$57.58
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: BCBS Complete	$46.06
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Advantage	$80.61
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$80.61
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.36
Rate for Payer: MI Amish Medical Board Commercial	$92.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.36
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health SBD	$72.54
Rate for Payer: UHC All Payor (Choice/PPO)	$74.85
Rate for Payer: UHC Core	$59.99
Rate for Payer: UHC Exchange	$45.25
Rate for Payer: UMR Bronson Commercial	$42.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.36

FUROSEMIDE 40 MG TABLET

Facility

$89.30

Service Code	NDC 69315011701
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$39.29
Max. Negotiated Rate	$80.37
Rate for Payer: Aetna American Axle	$58.05
Rate for Payer: Aetna Commercial	$75.91
Rate for Payer: Aetna New Business (MI Preferred)	$58.05
Rate for Payer: Cash Price	$71.44
Rate for Payer: Cofinity Advantage	$62.51
Rate for Payer: Cofinity Commercial	$76.80
Rate for Payer: Encore Health Key Benefits Commercial	$71.44
Rate for Payer: Healthscope Commercial	$80.37
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$62.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$66.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.97
Rate for Payer: PHP Commercial	$75.91
Rate for Payer: Priority Health SBD	$56.26
Rate for Payer: UMR Bronson Commercial	$39.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$66.97

FUROSEMIDE 40 MG TABLET

Facility

$148.05

Service Code	NDC 51079007320
Hospital Charge Code	3295
Hospital Revenue Code	637
Min. Negotiated Rate	$65.14
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna American Axle	$96.23
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Advantage	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.25
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$103.64
Rate for Payer: Lakeland Regional Health Systems Commercial	$111.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.04
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health SBD	$93.27
Rate for Payer: UMR Bronson Commercial	$65.14
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$111.04

G1001 CDSM - EVICORE

Facility

$0.01

Service Code	CPT G1001
Hospital Charge Code	99000393
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1001 CDSM - EVICORE

Facility

$0.01

Service Code	CPT G1001
Hospital Charge Code	99000393
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1002 CDSM - MEDCURRENT

Facility

$0.01

Service Code	CPT G1002
Hospital Charge Code	99000394
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1002 CDSM - MEDCURRENT

Facility

$0.01

Service Code	CPT G1002
Hospital Charge Code	99000394
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1003 CDSM - MEDICALIS

Facility

$0.01

Service Code	CPT G1003
Hospital Charge Code	99000395
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1003 CDSM - MEDICALIS

Facility

$0.01

Service Code	CPT G1003
Hospital Charge Code	99000395
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1004 CDSM - NATIONAL DECISION SUPPORT COMPANY

Facility

$0.01

Service Code	CPT G1004
Hospital Charge Code	99000396
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1004 CDSM - NATIONAL DECISION SUPPORT COMPANY

Facility

$0.01

Service Code	CPT G1004
Hospital Charge Code	99000396
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1007 CDSM - AIM SPECIALITY HEALTH

Facility

$0.01

Service Code	CPT G1007
Hospital Charge Code	99000399
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1007 CDSM - AIM SPECIALITY HEALTH

Facility

$0.01

Service Code	CPT G1007
Hospital Charge Code	99000399
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1008 CDSM - CRANBERRY PEAK

Facility

$0.01

Service Code	CPT G1008
Hospital Charge Code	99000400
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1008 CDSM - CRANBERRY PEAK

Facility

$0.01

Service Code	CPT G1008
Hospital Charge Code	99000400
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1010 CDSM - STANSON

Facility

$0.01

Service Code	CPT G1010
Hospital Charge Code	99000402
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: BCBS Complete	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: MI Amish Medical Board Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1010 CDSM - STANSON

Facility

$0.01

Service Code	CPT G1010
Hospital Charge Code	99000402
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

G1011 CDSM - QUALIFIED TOOL NOT OTHERWISE SPECIFIED

Facility

$0.01

Service Code	CPT G1011
Hospital Charge Code	99000403
Hospital Revenue Code	990
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna American Axle	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna New Business (MI Preferred)	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cofinity Advantage	$0.01
Rate for Payer: Cofinity Commercial	$0.01
Rate for Payer: Encore Health Key Benefits Commercial	$0.01
Rate for Payer: Healthscope Commercial	$0.01
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$0.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$0.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01
Rate for Payer: PHP Commercial	$0.01
Rate for Payer: Priority Health SBD	$0.01
Rate for Payer: UMR Bronson Commercial	$0.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$0.01

Know your out-of-pocket cost for care.

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