|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,336.10 |
| Rate for Payer: Aetna Commercial |
$1,144.63
|
| Rate for Payer: Aetna Medicare |
$888.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.05
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$854.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| Rate for Payer: BCN Medicare Advantage |
$854.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cofinity Commercial |
$1,144.63
|
| Rate for Payer: Cofinity Commercial |
$1,230.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.91
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Nomi Health Commercial |
$1,025.04
|
| Rate for Payer: PACE SWMI |
$854.20
|
| Rate for Payer: PHP Commercial |
$1,195.88
|
| Rate for Payer: PHP Medicare Advantage |
$854.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,401.41
|
| Rate for Payer: Priority Health Medicare |
$854.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,401.41
|
| Rate for Payer: Priority Health SBD |
$1,401.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.20
|
| Rate for Payer: UHC Medicare Advantage |
$854.20
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,653.24
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.09 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,058.21
|
| Rate for Payer: Aetna Medicare |
$821.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.18
|
| Rate for Payer: BCBS Complete |
$569.19
|
| Rate for Payer: BCBS MAPPO |
$789.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| Rate for Payer: BCN Medicare Advantage |
$789.71
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,058.21
|
| Rate for Payer: Cofinity Commercial |
$1,137.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.20
|
| Rate for Payer: Meridian Medicaid |
$569.19
|
| Rate for Payer: Nomi Health Commercial |
$947.65
|
| Rate for Payer: PACE SWMI |
$789.71
|
| Rate for Payer: PHP Commercial |
$1,105.59
|
| Rate for Payer: PHP Medicare Advantage |
$789.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.09
|
| Rate for Payer: Priority Health Medicare |
$789.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,297.09
|
| Rate for Payer: Priority Health SBD |
$1,297.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.71
|
| Rate for Payer: UHC Medicare Advantage |
$789.71
|
| Rate for Payer: UHCCP Medicaid |
$542.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.80
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$599.17 |
| Max. Negotiated Rate |
$1,433.97 |
| Rate for Payer: Aetna Commercial |
$1,171.66
|
| Rate for Payer: Aetna Medicare |
$909.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.09
|
| Rate for Payer: BCBS Complete |
$629.13
|
| Rate for Payer: BCBS MAPPO |
$874.37
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| Rate for Payer: BCN Medicare Advantage |
$874.37
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,171.66
|
| Rate for Payer: Cofinity Commercial |
$1,259.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.09
|
| Rate for Payer: Meridian Medicaid |
$629.13
|
| Rate for Payer: Nomi Health Commercial |
$1,049.24
|
| Rate for Payer: PACE SWMI |
$874.37
|
| Rate for Payer: PHP Commercial |
$1,224.12
|
| Rate for Payer: PHP Medicare Advantage |
$874.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.97
|
| Rate for Payer: Priority Health Medicare |
$874.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.97
|
| Rate for Payer: Priority Health SBD |
$1,433.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.37
|
| Rate for Payer: UHC Medicare Advantage |
$874.37
|
| Rate for Payer: UHCCP Medicaid |
$599.17
|
| Rate for Payer: UMR Bronson Commercial |
$708.86
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 00115165901
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 69292053001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 69292053001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.42
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00603548221
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 00115165901
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$130.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$220.40
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna American Axle |
$143.26
|
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.26
|
| Rate for Payer: Priority Health SBD |
$138.85
|
| Rate for Payer: UMR Bronson Commercial |
$96.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00603548221
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 23155011001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$220.40
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna American Axle |
$143.26
|
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna Medicare |
$110.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: BCBS Complete |
$88.16
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.26
|
| Rate for Payer: Priority Health SBD |
$138.85
|
| Rate for Payer: UMR Bronson Commercial |
$81.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155011001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.86
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.49
|
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna American Axle |
$17.17
|
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Medicare |
$13.21
|
| Rate for Payer: Aetna Medicare |
$9.94
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.17
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.79
|
| Rate for Payer: BCN Commercial |
$9.79
|
| Rate for Payer: BCN Commercial |
$9.79
|
| Rate for Payer: BCN Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Healthscope Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health SBD |
$16.64
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.35
|
| Rate for Payer: UMR Bronson Commercial |
$9.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna American Axle |
$17.17
|
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.17
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.46
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Priority Health SBD |
$16.64
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: UMR Bronson Commercial |
$11.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.82
|
|
|
PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$1,057.50
|
|
|
Service Code
|
NDC 00054372763
|
| Hospital Charge Code |
6654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.28 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna American Axle |
$687.38
|
| Rate for Payer: Aetna Commercial |
$898.88
|
| Rate for Payer: Aetna Medicare |
$528.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.38
|
| Rate for Payer: BCBS Complete |
$423.00
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cofinity Commercial |
$740.25
|
| Rate for Payer: Cofinity Commercial |
$909.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$740.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.00
|
| Rate for Payer: Healthscope Commercial |
$951.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$740.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$793.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.88
|
| Rate for Payer: PHP Commercial |
$898.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.38
|
| Rate for Payer: Priority Health SBD |
$666.22
|
| Rate for Payer: UMR Bronson Commercial |
$391.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$793.12
|
|
|
PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$1,057.50
|
|
|
Service Code
|
NDC 00054372763
|
| Hospital Charge Code |
6654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.30 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna American Axle |
$687.38
|
| Rate for Payer: Aetna Commercial |
$898.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.38
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cofinity Commercial |
$740.25
|
| Rate for Payer: Cofinity Commercial |
$909.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$740.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.00
|
| Rate for Payer: Healthscope Commercial |
$951.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$740.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$793.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.88
|
| Rate for Payer: PHP Commercial |
$898.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.38
|
| Rate for Payer: Priority Health SBD |
$666.22
|
| Rate for Payer: UMR Bronson Commercial |
$465.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$793.12
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$14.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$132.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
