|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$214.38
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: PHP Commercial |
$260.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.94
|
| Rate for Payer: UMR Bronson Commercial |
$134.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.69
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 46672005310
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.31 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$153.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: BCBS Complete |
$122.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$214.38
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: PHP Commercial |
$260.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.69
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.92
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$133.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$151.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.92
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY
|
Facility
|
OP
|
$434.49
|
|
|
Service Code
|
NDC 10223020103
|
| Hospital Charge Code |
9328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.76 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna American Axle |
$282.42
|
| Rate for Payer: Aetna Commercial |
$369.32
|
| Rate for Payer: Aetna Medicare |
$217.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.42
|
| Rate for Payer: BCBS Complete |
$173.80
|
| Rate for Payer: Cash Price |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$304.14
|
| Rate for Payer: Cofinity Commercial |
$373.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.59
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.32
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.42
|
| Rate for Payer: Priority Health SBD |
$273.73
|
| Rate for Payer: UMR Bronson Commercial |
$160.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.87
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY
|
Facility
|
IP
|
$434.49
|
|
|
Service Code
|
NDC 10223020103
|
| Hospital Charge Code |
9328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna American Axle |
$282.42
|
| Rate for Payer: Aetna Commercial |
$369.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.42
|
| Rate for Payer: Cash Price |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$304.14
|
| Rate for Payer: Cofinity Commercial |
$373.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.59
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.32
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.42
|
| Rate for Payer: Priority Health SBD |
$273.73
|
| Rate for Payer: UMR Bronson Commercial |
$191.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.87
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna American Axle |
$9.59
|
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Medicare |
$7.38
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Complete |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.93
|
| Rate for Payer: BCBS Trust/PPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$10.93
|
| Rate for Payer: BCN Commercial |
$10.93
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.46
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna American Axle |
$9.59
|
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
OP
|
$11,394.31
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$10,254.88 |
| Rate for Payer: Aetna American Axle |
$7,406.30
|
| Rate for Payer: Aetna Commercial |
$9,685.16
|
| Rate for Payer: Aetna Medicare |
$75.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,406.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.58
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS MAPPO |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$195.36
|
| Rate for Payer: BCN Commercial |
$195.36
|
| Rate for Payer: BCN Medicare Advantage |
$72.46
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cofinity Commercial |
$9,799.11
|
| Rate for Payer: Cofinity Commercial |
$7,976.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,976.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,115.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.46
|
| Rate for Payer: Healthscope Commercial |
$10,254.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,545.73
|
| Rate for Payer: Mclaren Medicaid |
$38.84
|
| Rate for Payer: Mclaren Medicare |
$72.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.08
|
| Rate for Payer: Meridian Medicaid |
$40.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,685.16
|
| Rate for Payer: Nomi Health Commercial |
$217.38
|
| Rate for Payer: PACE Medicare |
$68.84
|
| Rate for Payer: PACE SWMI |
$72.46
|
| Rate for Payer: PHP Commercial |
$9,685.16
|
| Rate for Payer: PHP Medicare Advantage |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,406.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.76
|
| Rate for Payer: Priority Health Medicare |
$72.46
|
| Rate for Payer: Priority Health Narrow Network |
$157.41
|
| Rate for Payer: Priority Health SBD |
$7,178.42
|
| Rate for Payer: Railroad Medicare Medicare |
$72.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.46
|
| Rate for Payer: UHC Exchange |
$138.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.46
|
| Rate for Payer: UHCCP Medicaid |
$38.84
|
| Rate for Payer: UMR Bronson Commercial |
$4,215.89
|
| Rate for Payer: VA VA |
$72.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,545.73
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
IP
|
$11,394.31
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,013.50 |
| Max. Negotiated Rate |
$10,254.88 |
| Rate for Payer: Aetna American Axle |
$7,406.30
|
| Rate for Payer: Aetna Commercial |
$9,685.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,406.30
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cofinity Commercial |
$7,976.02
|
| Rate for Payer: Cofinity Commercial |
$9,799.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,976.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,115.45
|
| Rate for Payer: Healthscope Commercial |
$10,254.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,545.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,685.16
|
| Rate for Payer: PHP Commercial |
$9,685.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,406.30
|
| Rate for Payer: Priority Health SBD |
$7,178.42
|
| Rate for Payer: UMR Bronson Commercial |
$5,013.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,545.73
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$64,470.71
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.11 |
| Max. Negotiated Rate |
$58,023.64 |
| Rate for Payer: Aetna American Axle |
$41,905.96
|
| Rate for Payer: Aetna Commercial |
$54,800.10
|
| Rate for Payer: Aetna Medicare |
$233.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,905.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$280.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$280.11
|
| Rate for Payer: BCBS Complete |
$126.12
|
| Rate for Payer: BCBS MAPPO |
$224.09
|
| Rate for Payer: BCBS Trust/PPO |
$604.20
|
| Rate for Payer: BCN Commercial |
$604.20
|
| Rate for Payer: BCN Medicare Advantage |
$224.09
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cofinity Commercial |
$55,444.81
|
| Rate for Payer: Cofinity Commercial |
$45,129.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$45,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51,576.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.09
|
| Rate for Payer: Healthscope Commercial |
$58,023.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45,129.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48,353.03
|
| Rate for Payer: Mclaren Medicaid |
$120.11
|
| Rate for Payer: Mclaren Medicare |
$224.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.29
|
| Rate for Payer: Meridian Medicaid |
$126.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,800.10
|
| Rate for Payer: Nomi Health Commercial |
$672.27
|
| Rate for Payer: PACE Medicare |
$212.89
|
| Rate for Payer: PACE SWMI |
$224.09
|
| Rate for Payer: PHP Commercial |
$54,800.10
|
| Rate for Payer: PHP Medicare Advantage |
$224.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41,905.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.97
|
| Rate for Payer: Priority Health Medicare |
$224.09
|
| Rate for Payer: Priority Health Narrow Network |
$498.38
|
| Rate for Payer: Priority Health SBD |
$40,616.55
|
| Rate for Payer: Railroad Medicare Medicare |
$224.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.09
|
| Rate for Payer: UHC Exchange |
$428.26
|
| Rate for Payer: UHC Medicare Advantage |
$224.09
|
| Rate for Payer: UHCCP Medicaid |
$120.11
|
| Rate for Payer: UMR Bronson Commercial |
$23,854.16
|
| Rate for Payer: VA VA |
$224.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48,353.03
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$64,470.71
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28,367.11 |
| Max. Negotiated Rate |
$58,023.64 |
| Rate for Payer: Aetna American Axle |
$41,905.96
|
| Rate for Payer: Aetna Commercial |
$54,800.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,905.96
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cofinity Commercial |
$45,129.50
|
| Rate for Payer: Cofinity Commercial |
$55,444.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$45,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51,576.57
|
| Rate for Payer: Healthscope Commercial |
$58,023.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45,129.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48,353.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,800.10
|
| Rate for Payer: PHP Commercial |
$54,800.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41,905.96
|
| Rate for Payer: Priority Health SBD |
$40,616.55
|
| Rate for Payer: UMR Bronson Commercial |
$28,367.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48,353.03
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$84.75
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$76.28 |
| Rate for Payer: Aetna American Axle |
$55.09
|
| Rate for Payer: Aetna Commercial |
$72.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.09
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.80
|
| Rate for Payer: Healthscope Commercial |
$76.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.04
|
| Rate for Payer: PHP Commercial |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.09
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$37.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$447.35
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.52 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna Medicare |
$223.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: BCBS Complete |
$178.94
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
| Rate for Payer: UMR Bronson Commercial |
$165.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.51
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$447.35
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.83 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
| Rate for Payer: UMR Bronson Commercial |
$196.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.51
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$84.75
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$76.28 |
| Rate for Payer: Aetna American Axle |
$55.09
|
| Rate for Payer: Aetna Commercial |
$72.04
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.09
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.80
|
| Rate for Payer: Healthscope Commercial |
$76.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.04
|
| Rate for Payer: PHP Commercial |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.09
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
