|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$1,404.48 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Aetna American Axle |
$2,074.80
|
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,074.80
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,234.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,234.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,394.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health SBD |
$2,010.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,404.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$1,181.04 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna American Axle |
$2,074.80
|
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,074.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,234.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,234.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,394.00
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Priority Health SBD |
$2,010.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,181.04
|
| Rate for Payer: VA VA |
$12,548.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.08
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.91
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Commercial |
$1,193.22
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.32
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$950.80 |
| Max. Negotiated Rate |
$1,711.53 |
| Rate for Payer: Aetna Commercial |
$1,592.67
|
| Rate for Payer: Aetna Medicare |
$1,236.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.67
|
| Rate for Payer: BCBS Complete |
$950.80
|
| Rate for Payer: BCBS MAPPO |
$1,188.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.56
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$1,711.53
|
| Rate for Payer: Cofinity Commercial |
$1,592.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.99
|
| Rate for Payer: Nomi Health Commercial |
$1,426.27
|
| Rate for Payer: PACE SWMI |
$1,188.56
|
| Rate for Payer: PHP Commercial |
$1,663.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.05
|
| Rate for Payer: Priority Health Medicare |
$1,188.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,093.42
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,098.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$1,015.24 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,360.42
|
| Rate for Payer: Aetna Medicare |
$1,055.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.42
|
| Rate for Payer: BCBS Complete |
$1,239.20
|
| Rate for Payer: BCBS MAPPO |
$1,015.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,015.24
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.95
|
| Rate for Payer: Cofinity Commercial |
$1,360.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,015.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.00
|
| Rate for Payer: Nomi Health Commercial |
$1,218.29
|
| Rate for Payer: PACE SWMI |
$1,015.24
|
| Rate for Payer: PHP Commercial |
$1,421.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,015.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.70
|
| Rate for Payer: Priority Health Medicare |
$1,015.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,015.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,015.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.08
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$873.49 |
| Max. Negotiated Rate |
$1,651.00 |
| Rate for Payer: Aetna Commercial |
$1,170.48
|
| Rate for Payer: Aetna Medicare |
$908.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.48
|
| Rate for Payer: BCBS Complete |
$1,016.00
|
| Rate for Payer: BCBS MAPPO |
$873.49
|
| Rate for Payer: BCN Medicare Advantage |
$873.49
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,257.83
|
| Rate for Payer: Cofinity Commercial |
$1,170.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.16
|
| Rate for Payer: Nomi Health Commercial |
$1,048.19
|
| Rate for Payer: PACE SWMI |
$873.49
|
| Rate for Payer: PHP Commercial |
$1,222.89
|
| Rate for Payer: PHP Medicare Advantage |
$873.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.00
|
| Rate for Payer: Priority Health Medicare |
$873.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.49
|
| Rate for Payer: UHC Medicare Advantage |
$873.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.40
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$654.57 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Aetna Commercial |
$877.12
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.12
|
| Rate for Payer: BCBS Complete |
$748.00
|
| Rate for Payer: BCBS MAPPO |
$654.57
|
| Rate for Payer: BCN Medicare Advantage |
$654.57
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$942.58
|
| Rate for Payer: Cofinity Commercial |
$877.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.30
|
| Rate for Payer: Nomi Health Commercial |
$785.48
|
| Rate for Payer: PACE SWMI |
$654.57
|
| Rate for Payer: PHP Commercial |
$916.40
|
| Rate for Payer: PHP Medicare Advantage |
$654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health Medicare |
$654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.57
|
| Rate for Payer: UHC Medicare Advantage |
$654.57
|
| Rate for Payer: UMR Bronson Commercial |
$860.20
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,711.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$1,630.51 |
| Max. Negotiated Rate |
$3,712.15 |
| Rate for Payer: Aetna Commercial |
$2,184.88
|
| Rate for Payer: Aetna Medicare |
$1,695.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,184.88
|
| Rate for Payer: BCBS Complete |
$2,284.40
|
| Rate for Payer: BCBS MAPPO |
$1,630.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,630.51
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cofinity Commercial |
$2,347.93
|
| Rate for Payer: Cofinity Commercial |
$2,184.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,630.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.04
|
| Rate for Payer: Nomi Health Commercial |
$1,956.61
|
| Rate for Payer: PACE SWMI |
$1,630.51
|
| Rate for Payer: PHP Commercial |
$2,282.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,630.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.15
|
| Rate for Payer: Priority Health Medicare |
$1,630.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,630.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,630.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,627.06
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,742.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,816.13 |
| Max. Negotiated Rate |
$6,982.30 |
| Rate for Payer: Aetna Commercial |
$2,433.61
|
| Rate for Payer: Aetna Medicare |
$1,888.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,615.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.61
|
| Rate for Payer: BCBS Complete |
$4,296.80
|
| Rate for Payer: BCBS MAPPO |
$1,816.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.13
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cofinity Commercial |
$2,615.23
|
| Rate for Payer: Cofinity Commercial |
$2,433.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,906.94
|
| Rate for Payer: Nomi Health Commercial |
$2,179.36
|
| Rate for Payer: PACE SWMI |
$1,816.13
|
| Rate for Payer: PHP Commercial |
$2,542.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,982.30
|
| Rate for Payer: Priority Health Medicare |
$1,816.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.13
|
| Rate for Payer: UMR Bronson Commercial |
$4,941.32
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$1,484.57 |
| Max. Negotiated Rate |
$2,643.55 |
| Rate for Payer: Aetna Commercial |
$1,989.32
|
| Rate for Payer: Aetna Medicare |
$1,543.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.32
|
| Rate for Payer: BCBS Complete |
$1,626.80
|
| Rate for Payer: BCBS MAPPO |
$1,484.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.57
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cofinity Commercial |
$2,137.78
|
| Rate for Payer: Cofinity Commercial |
$1,989.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,558.80
|
| Rate for Payer: Nomi Health Commercial |
$1,781.48
|
| Rate for Payer: PACE SWMI |
$1,484.57
|
| Rate for Payer: PHP Commercial |
$2,078.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,643.55
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,484.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,870.82
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$276.81 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Commercial |
$370.93
|
| Rate for Payer: Aetna Medicare |
$287.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.93
|
| Rate for Payer: BCBS Complete |
$468.40
|
| Rate for Payer: BCBS MAPPO |
$276.81
|
| Rate for Payer: BCN Medicare Advantage |
$276.81
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| Rate for Payer: Cofinity Commercial |
$370.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.65
|
| Rate for Payer: Nomi Health Commercial |
$332.17
|
| Rate for Payer: PACE SWMI |
$276.81
|
| Rate for Payer: PHP Commercial |
$387.53
|
| Rate for Payer: PHP Medicare Advantage |
$276.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
| Rate for Payer: Priority Health Medicare |
$276.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.81
|
| Rate for Payer: UHC Medicare Advantage |
$276.81
|
| Rate for Payer: UMR Bronson Commercial |
$538.66
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$1,452.12 |
| Max. Negotiated Rate |
$2,431.65 |
| Rate for Payer: Aetna Commercial |
$1,945.84
|
| Rate for Payer: Aetna Medicare |
$1,510.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,091.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.84
|
| Rate for Payer: BCBS Complete |
$1,496.40
|
| Rate for Payer: BCBS MAPPO |
$1,452.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,452.12
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cofinity Commercial |
$2,091.05
|
| Rate for Payer: Cofinity Commercial |
$1,945.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,452.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.73
|
| Rate for Payer: Nomi Health Commercial |
$1,742.54
|
| Rate for Payer: PACE SWMI |
$1,452.12
|
| Rate for Payer: PHP Commercial |
$2,032.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.65
|
| Rate for Payer: Priority Health Medicare |
$1,452.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,720.86
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$1,509.24 |
| Max. Negotiated Rate |
$2,538.25 |
| Rate for Payer: Aetna Commercial |
$2,022.38
|
| Rate for Payer: Aetna Medicare |
$1,569.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,022.38
|
| Rate for Payer: BCBS Complete |
$1,562.00
|
| Rate for Payer: BCBS MAPPO |
$1,509.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.24
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cofinity Commercial |
$2,173.31
|
| Rate for Payer: Cofinity Commercial |
$2,022.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,584.70
|
| Rate for Payer: Nomi Health Commercial |
$1,811.09
|
| Rate for Payer: PACE SWMI |
$1,509.24
|
| Rate for Payer: PHP Commercial |
$2,112.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,538.25
|
| Rate for Payer: Priority Health Medicare |
$1,509.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,509.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,509.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,796.30
|
|
|
PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$1,676.35 |
| Rate for Payer: Aetna Commercial |
$1,024.19
|
| Rate for Payer: Aetna Medicare |
$794.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.19
|
| Rate for Payer: BCBS Complete |
$1,031.60
|
| Rate for Payer: BCBS MAPPO |
$764.32
|
| Rate for Payer: BCN Medicare Advantage |
$764.32
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,100.62
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.54
|
| Rate for Payer: Nomi Health Commercial |
$917.18
|
| Rate for Payer: PACE SWMI |
$764.32
|
| Rate for Payer: PHP Commercial |
$1,070.05
|
| Rate for Payer: PHP Medicare Advantage |
$764.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health Medicare |
$764.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.32
|
| Rate for Payer: UHC Medicare Advantage |
$764.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,186.34
|
|
|
PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$923.59 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,237.61
|
| Rate for Payer: Aetna Medicare |
$960.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.61
|
| Rate for Payer: BCBS Complete |
$1,190.00
|
| Rate for Payer: BCBS MAPPO |
$923.59
|
| Rate for Payer: BCN Medicare Advantage |
$923.59
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.97
|
| Rate for Payer: Cofinity Commercial |
$1,237.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.77
|
| Rate for Payer: Nomi Health Commercial |
$1,108.31
|
| Rate for Payer: PACE SWMI |
$923.59
|
| Rate for Payer: PHP Commercial |
$1,293.03
|
| Rate for Payer: PHP Medicare Advantage |
$923.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health Medicare |
$923.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.59
|
| Rate for Payer: UHC Medicare Advantage |
$923.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.50
|
|
|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$843.41 |
| Max. Negotiated Rate |
$1,910.35 |
| Rate for Payer: Aetna Commercial |
$1,130.17
|
| Rate for Payer: Aetna Medicare |
$877.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.17
|
| Rate for Payer: BCBS Complete |
$1,175.60
|
| Rate for Payer: BCBS MAPPO |
$843.41
|
| Rate for Payer: BCN Medicare Advantage |
$843.41
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cofinity Commercial |
$1,214.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.58
|
| Rate for Payer: Nomi Health Commercial |
$1,012.09
|
| Rate for Payer: PACE SWMI |
$843.41
|
| Rate for Payer: PHP Commercial |
$1,180.77
|
| Rate for Payer: PHP Medicare Advantage |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.35
|
| Rate for Payer: Priority Health Medicare |
$843.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.41
|
| Rate for Payer: UHC Medicare Advantage |
$843.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,351.94
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$1,294.33 |
| Rate for Payer: Aetna Commercial |
$1,204.45
|
| Rate for Payer: Aetna Medicare |
$934.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$898.84
|
| Rate for Payer: BCN Medicare Advantage |
$898.84
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,294.33
|
| Rate for Payer: Cofinity Commercial |
$1,204.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.78
|
| Rate for Payer: Nomi Health Commercial |
$1,078.61
|
| Rate for Payer: PACE SWMI |
$898.84
|
| Rate for Payer: PHP Commercial |
$1,258.38
|
| Rate for Payer: PHP Medicare Advantage |
$898.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$898.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.84
|
| Rate for Payer: UHC Medicare Advantage |
$898.84
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$658.80 |
| Max. Negotiated Rate |
$1,281.67 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.67
|
| Rate for Payer: BCBS Complete |
$658.80
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Commercial |
$1,246.07
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.55
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UMR Bronson Commercial |
$757.62
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$940.40 |
| Max. Negotiated Rate |
$1,555.17 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare |
$1,123.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.17
|
| Rate for Payer: BCBS Complete |
$940.40
|
| Rate for Payer: BCBS MAPPO |
$1,079.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.98
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,555.17
|
| Rate for Payer: Cofinity Commercial |
$1,447.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.98
|
| Rate for Payer: Nomi Health Commercial |
$1,295.98
|
| Rate for Payer: PACE SWMI |
$1,079.98
|
| Rate for Payer: PHP Commercial |
$1,511.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health Medicare |
$1,079.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.46
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$1,548.73 |
| Rate for Payer: Aetna Commercial |
$1,441.18
|
| Rate for Payer: Aetna Medicare |
$1,118.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,548.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.18
|
| Rate for Payer: BCBS Complete |
$796.40
|
| Rate for Payer: BCBS MAPPO |
$1,075.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,075.51
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,548.73
|
| Rate for Payer: Cofinity Commercial |
$1,441.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,075.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.29
|
| Rate for Payer: Nomi Health Commercial |
$1,290.61
|
| Rate for Payer: PACE SWMI |
$1,075.51
|
| Rate for Payer: PHP Commercial |
$1,505.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.15
|
| Rate for Payer: Priority Health Medicare |
$1,075.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,075.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,075.51
|
| Rate for Payer: UMR Bronson Commercial |
$915.86
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$794.40 |
| Max. Negotiated Rate |
$1,542.44 |
| Rate for Payer: Aetna Commercial |
$1,435.33
|
| Rate for Payer: Aetna Medicare |
$1,113.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,542.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.33
|
| Rate for Payer: BCBS Complete |
$794.40
|
| Rate for Payer: BCBS MAPPO |
$1,071.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.14
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,542.44
|
| Rate for Payer: Cofinity Commercial |
$1,435.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.70
|
| Rate for Payer: Nomi Health Commercial |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,071.14
|
| Rate for Payer: PHP Commercial |
$1,499.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.90
|
| Rate for Payer: Priority Health Medicare |
$1,071.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.14
|
| Rate for Payer: UMR Bronson Commercial |
$913.56
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$607.54 |
| Max. Negotiated Rate |
$1,389.70 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$631.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.10
|
| Rate for Payer: BCBS Complete |
$855.20
|
| Rate for Payer: BCBS MAPPO |
$607.54
|
| Rate for Payer: BCN Medicare Advantage |
$607.54
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$874.86
|
| Rate for Payer: Cofinity Commercial |
$814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.92
|
| Rate for Payer: Nomi Health Commercial |
$729.05
|
| Rate for Payer: PACE SWMI |
$607.54
|
| Rate for Payer: PHP Commercial |
$850.56
|
| Rate for Payer: PHP Medicare Advantage |
$607.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.70
|
| Rate for Payer: Priority Health Medicare |
$607.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.54
|
| Rate for Payer: UHC Medicare Advantage |
$607.54
|
| Rate for Payer: UMR Bronson Commercial |
$983.48
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$1,144.56 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,533.71
|
| Rate for Payer: Aetna Medicare |
$1,190.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,533.71
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$1,144.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.56
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,648.17
|
| Rate for Payer: Cofinity Commercial |
$1,533.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.79
|
| Rate for Payer: Nomi Health Commercial |
$1,373.47
|
| Rate for Payer: PACE SWMI |
$1,144.56
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$1,144.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,424.62
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$864.20 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$1,158.03
|
| Rate for Payer: Aetna Medicare |
$898.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.03
|
| Rate for Payer: BCBS Complete |
$1,434.40
|
| Rate for Payer: BCBS MAPPO |
$864.20
|
| Rate for Payer: BCN Medicare Advantage |
$864.20
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.45
|
| Rate for Payer: Cofinity Commercial |
$1,158.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.41
|
| Rate for Payer: Nomi Health Commercial |
$1,037.04
|
| Rate for Payer: PACE SWMI |
$864.20
|
| Rate for Payer: PHP Commercial |
$1,209.88
|
| Rate for Payer: PHP Medicare Advantage |
$864.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health Medicare |
$864.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.20
|
| Rate for Payer: UHC Medicare Advantage |
$864.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,649.56
|
|
|
PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.80
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna American Axle |
$17.42
|
| Rate for Payer: Aetna Commercial |
$22.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.42
|
| Rate for Payer: Cash Price |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.44
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.78
|
| Rate for Payer: PHP Commercial |
$22.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.10
|
|
