|
AMILORIDE 5 MG TABLET
|
Facility
IP
|
$196.65
|
|
|
Service Code
|
NDC 0574-0292-01
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna American Axle |
$127.82
|
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cofinity Commercial |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.32
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.15
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health SBD |
$123.89
|
| Rate for Payer: UMR Bronson Commercial |
$86.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.49
|
|
|
AMILORIDE 5 MG TABLET
|
Facility
IP
|
$411.84
|
|
|
Service Code
|
NDC 49884-117-01
|
| Hospital Charge Code |
391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$370.66 |
| Rate for Payer: Aetna American Axle |
$267.70
|
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.70
|
| Rate for Payer: Cash Price |
$329.47
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$354.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.47
|
| Rate for Payer: Healthscope Commercial |
$370.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.06
|
| Rate for Payer: PHP Commercial |
$350.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.29
|
| Rate for Payer: Priority Health SBD |
$259.46
|
| Rate for Payer: UMR Bronson Commercial |
$181.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.88
|
|
|
AMINO ACID 10 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$55.10
|
|
|
Service Code
|
NDC 0264-9341-55
|
| Hospital Charge Code |
108157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna American Axle |
$35.82
|
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cofinity Commercial |
$38.57
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.08
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.84
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.57
|
| Rate for Payer: Priority Health SBD |
$34.71
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.32
|
|
|
AMINOCAPROIC ACID 15 GM/250 ML NS INFUSION (OR)
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
NDC 9900-0001-94
|
| Hospital Charge Code |
155006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$176.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION
|
Facility
IP
|
$9,617.68
|
|
|
Service Code
|
NDC 49411-052-08
|
| Hospital Charge Code |
9062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,231.78 |
| Max. Negotiated Rate |
$8,655.91 |
| Rate for Payer: Aetna American Axle |
$6,251.49
|
| Rate for Payer: Aetna Commercial |
$8,175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,251.49
|
| Rate for Payer: Cash Price |
$7,694.14
|
| Rate for Payer: Cofinity Commercial |
$6,732.38
|
| Rate for Payer: Cofinity Commercial |
$8,271.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,694.14
|
| Rate for Payer: Healthscope Commercial |
$8,655.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,732.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,175.03
|
| Rate for Payer: PHP Commercial |
$8,175.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,732.38
|
| Rate for Payer: Priority Health SBD |
$6,059.14
|
| Rate for Payer: UMR Bronson Commercial |
$4,231.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,213.26
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.84
|
|
|
Service Code
|
NDC 0409-4346-16
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.19
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 0517-9120-01
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.84
|
|
|
Service Code
|
NDC 0409-4346-73
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.19
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 0517-9120-25
|
| Hospital Charge Code |
403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
AMINOCAPROIC ACID 250 MG/ML ORAL SOLUTION
|
Facility
IP
|
$61.56
|
|
|
Service Code
|
NDC 0409-4346-73
|
| Hospital Charge Code |
180367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna American Axle |
$40.01
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.33
|
| Rate for Payer: PHP Commercial |
$52.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$38.78
|
| Rate for Payer: UMR Bronson Commercial |
$27.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.17
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
IP
|
$1,131.32
|
|
|
Service Code
|
NDC 60219-1637-3
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.78 |
| Max. Negotiated Rate |
$1,018.19 |
| Rate for Payer: Aetna American Axle |
$735.36
|
| Rate for Payer: Aetna Commercial |
$961.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.36
|
| Rate for Payer: Cash Price |
$905.06
|
| Rate for Payer: Cofinity Commercial |
$791.92
|
| Rate for Payer: Cofinity Commercial |
$972.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.06
|
| Rate for Payer: Healthscope Commercial |
$1,018.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$848.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$961.62
|
| Rate for Payer: PHP Commercial |
$961.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.92
|
| Rate for Payer: Priority Health SBD |
$712.73
|
| Rate for Payer: UMR Bronson Commercial |
$497.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$848.49
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
IP
|
$2,217.34
|
|
|
Service Code
|
NDC 49411-050-30
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$975.63 |
| Max. Negotiated Rate |
$1,995.61 |
| Rate for Payer: Aetna American Axle |
$1,441.27
|
| Rate for Payer: Aetna Commercial |
$1,884.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.27
|
| Rate for Payer: Cash Price |
$1,773.87
|
| Rate for Payer: Cofinity Commercial |
$1,552.14
|
| Rate for Payer: Cofinity Commercial |
$1,906.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.87
|
| Rate for Payer: Healthscope Commercial |
$1,995.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,552.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,663.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,884.74
|
| Rate for Payer: PHP Commercial |
$1,884.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.14
|
| Rate for Payer: Priority Health SBD |
$1,396.92
|
| Rate for Payer: UMR Bronson Commercial |
$975.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,663.00
|
|
|
AMINOCAPROIC ACID 500 MG TABLET
|
Facility
IP
|
$615.94
|
|
|
Service Code
|
NDC 69680-115-30
|
| Hospital Charge Code |
9063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$554.35 |
| Rate for Payer: Aetna American Axle |
$400.36
|
| Rate for Payer: Aetna Commercial |
$523.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.36
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cofinity Commercial |
$529.71
|
| Rate for Payer: Cofinity Commercial |
$431.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.75
|
| Rate for Payer: Healthscope Commercial |
$554.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$523.55
|
| Rate for Payer: PHP Commercial |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.16
|
| Rate for Payer: Priority Health SBD |
$388.04
|
| Rate for Payer: UMR Bronson Commercial |
$271.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.96
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$157.33
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Aetna American Axle |
$102.26
|
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.26
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cofinity Commercial |
$110.13
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Healthscope Commercial |
$141.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.73
|
| Rate for Payer: PHP Commercial |
$133.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.13
|
| Rate for Payer: Priority Health SBD |
$99.12
|
| Rate for Payer: UMR Bronson Commercial |
$69.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.00
|
|
|
AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$31.15
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
113386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.48
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.80
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
AMIODARONE 100 MG TABLET
|
Facility
IP
|
$373.35
|
|
|
Service Code
|
NDC 0245-0144-01
|
| Hospital Charge Code |
36959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$336.02 |
| Rate for Payer: Aetna American Axle |
$242.68
|
| Rate for Payer: Aetna Commercial |
$317.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.68
|
| Rate for Payer: Cash Price |
$298.68
|
| Rate for Payer: Cofinity Commercial |
$261.34
|
| Rate for Payer: Cofinity Commercial |
$321.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.68
|
| Rate for Payer: Healthscope Commercial |
$336.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.35
|
| Rate for Payer: PHP Commercial |
$317.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.34
|
| Rate for Payer: Priority Health SBD |
$235.21
|
| Rate for Payer: UMR Bronson Commercial |
$164.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.01
|
|
|
AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV
|
Facility
IP
|
$68.98
|
|
|
Service Code
|
HCPCS J0283
|
| Hospital Charge Code |
152869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna American Axle |
$44.84
|
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Commercial |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.63
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.29
|
| Rate for Payer: Priority Health SBD |
$43.46
|
| Rate for Payer: UMR Bronson Commercial |
$30.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.74
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084-371-11
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.59
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.42
|
| Rate for Payer: Priority Health SBD |
$206.48
|
| Rate for Payer: UMR Bronson Commercial |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$197.40
|
|
|
Service Code
|
NDC 0245-0147-60
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.79
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.18
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$2.01
|
|
|
Service Code
|
NDC 0245-0147-89
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.61
|
| Rate for Payer: Healthscope Commercial |
$1.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.41
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$200.45
|
|
|
Service Code
|
NDC 0245-0147-01
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$180.40 |
| Rate for Payer: Aetna American Axle |
$130.29
|
| Rate for Payer: Aetna Commercial |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.29
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$140.32
|
| Rate for Payer: Cofinity Commercial |
$172.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$180.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.38
|
| Rate for Payer: PHP Commercial |
$170.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.32
|
| Rate for Payer: Priority Health SBD |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$88.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.34
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$242.52
|
|
|
Service Code
|
NDC 51672-4025-4
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$218.27 |
| Rate for Payer: Aetna American Axle |
$157.64
|
| Rate for Payer: Aetna Commercial |
$206.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.64
|
| Rate for Payer: Cash Price |
$194.02
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Cofinity Commercial |
$208.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.02
|
| Rate for Payer: Healthscope Commercial |
$218.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.14
|
| Rate for Payer: PHP Commercial |
$206.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.76
|
| Rate for Payer: Priority Health SBD |
$152.79
|
| Rate for Payer: UMR Bronson Commercial |
$106.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.89
|
|
|
AMIODARONE 200 MG TABLET
|
Facility
IP
|
$327.75
|
|
|
Service Code
|
NDC 68084-371-01
|
| Hospital Charge Code |
9066
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$294.98 |
| Rate for Payer: Aetna American Axle |
$213.04
|
| Rate for Payer: Aetna Commercial |
$278.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.04
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cofinity Commercial |
$229.42
|
| Rate for Payer: Cofinity Commercial |
$281.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.20
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.59
|
| Rate for Payer: PHP Commercial |
$278.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.42
|
| Rate for Payer: Priority Health SBD |
$206.48
|
| Rate for Payer: UMR Bronson Commercial |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.81
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$15.90
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
9065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna American Axle |
$18.67
|
| Rate for Payer: Aetna American Axle |
$15.24
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$17.99
|
| Rate for Payer: Aetna American Axle |
$8.57
|
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.52
|
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$13.67
|
| Rate for Payer: Cofinity Commercial |
$9.23
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$11.87
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$24.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.52
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$24.41
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: PHP Commercial |
$11.21
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.23
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$8.31
|
| Rate for Payer: Priority Health SBD |
$14.77
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$17.43
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$5.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
|
AMIODARONE 50 MG/ML IV (CODE)
|
Facility
IP
|
$55.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
163703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: Aetna American Axle |
$36.24
|
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$47.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.39
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$47.39
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.45
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: Priority Health SBD |
$35.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.81
|
|
