|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$250.53
|
|
|
Service Code
|
NDC 49884015676
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$225.48 |
| Rate for Payer: Aetna American Axle |
$162.84
|
| Rate for Payer: Aetna Commercial |
$212.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.84
|
| Rate for Payer: Cash Price |
$200.42
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.42
|
| Rate for Payer: Healthscope Commercial |
$225.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.95
|
| Rate for Payer: PHP Commercial |
$212.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.84
|
| Rate for Payer: Priority Health SBD |
$157.83
|
| Rate for Payer: UMR Bronson Commercial |
$110.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.90
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$250.53
|
|
|
Service Code
|
NDC 49884015676
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$225.48 |
| Rate for Payer: Aetna American Axle |
$162.84
|
| Rate for Payer: Aetna Commercial |
$212.95
|
| Rate for Payer: Aetna Medicare |
$125.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.84
|
| Rate for Payer: BCBS Complete |
$100.21
|
| Rate for Payer: Cash Price |
$200.42
|
| Rate for Payer: Cofinity Commercial |
$175.37
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.42
|
| Rate for Payer: Healthscope Commercial |
$225.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.95
|
| Rate for Payer: PHP Commercial |
$212.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.84
|
| Rate for Payer: Priority Health SBD |
$157.83
|
| Rate for Payer: UMR Bronson Commercial |
$92.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.90
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$960.38
|
|
|
Service Code
|
NDC 70710161406
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$422.57 |
| Max. Negotiated Rate |
$864.34 |
| Rate for Payer: Aetna American Axle |
$624.25
|
| Rate for Payer: Aetna Commercial |
$816.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.25
|
| Rate for Payer: Cash Price |
$768.30
|
| Rate for Payer: Cofinity Commercial |
$672.27
|
| Rate for Payer: Cofinity Commercial |
$825.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$672.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.30
|
| Rate for Payer: Healthscope Commercial |
$864.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$672.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.32
|
| Rate for Payer: PHP Commercial |
$816.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.25
|
| Rate for Payer: Priority Health SBD |
$605.04
|
| Rate for Payer: UMR Bronson Commercial |
$422.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.28
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$960.38
|
|
|
Service Code
|
NDC 70710161406
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.34 |
| Max. Negotiated Rate |
$864.34 |
| Rate for Payer: Aetna American Axle |
$624.25
|
| Rate for Payer: Aetna Commercial |
$816.32
|
| Rate for Payer: Aetna Medicare |
$480.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.25
|
| Rate for Payer: BCBS Complete |
$384.15
|
| Rate for Payer: Cash Price |
$768.30
|
| Rate for Payer: Cofinity Commercial |
$672.27
|
| Rate for Payer: Cofinity Commercial |
$825.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$672.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.30
|
| Rate for Payer: Healthscope Commercial |
$864.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$672.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.32
|
| Rate for Payer: PHP Commercial |
$816.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.25
|
| Rate for Payer: Priority Health SBD |
$605.04
|
| Rate for Payer: UMR Bronson Commercial |
$355.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.28
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP
|
Facility
|
IP
|
$618.83
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
14757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.29 |
| Max. Negotiated Rate |
$556.95 |
| Rate for Payer: Aetna American Axle |
$402.24
|
| Rate for Payer: Aetna Commercial |
$526.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.24
|
| Rate for Payer: Cash Price |
$495.06
|
| Rate for Payer: Cofinity Commercial |
$433.18
|
| Rate for Payer: Cofinity Commercial |
$532.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$433.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$495.06
|
| Rate for Payer: Healthscope Commercial |
$556.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$433.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$464.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$526.01
|
| Rate for Payer: PHP Commercial |
$526.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.24
|
| Rate for Payer: Priority Health SBD |
$389.86
|
| Rate for Payer: UMR Bronson Commercial |
$272.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$464.12
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP
|
Facility
|
OP
|
$618.83
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
14757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.97 |
| Max. Negotiated Rate |
$556.95 |
| Rate for Payer: Aetna American Axle |
$402.24
|
| Rate for Payer: Aetna Commercial |
$526.01
|
| Rate for Payer: Aetna Medicare |
$309.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.24
|
| Rate for Payer: BCBS Complete |
$247.53
|
| Rate for Payer: Cash Price |
$495.06
|
| Rate for Payer: Cofinity Commercial |
$433.18
|
| Rate for Payer: Cofinity Commercial |
$532.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$433.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$495.06
|
| Rate for Payer: Healthscope Commercial |
$556.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$433.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$464.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$526.01
|
| Rate for Payer: PHP Commercial |
$526.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.24
|
| Rate for Payer: Priority Health SBD |
$389.86
|
| Rate for Payer: UMR Bronson Commercial |
$228.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$464.12
|
|
|
VARICELLA-ZOSTER IMMUNE GLOB-MALTOSE 125 UNIT/1.2 ML IM SOLUTION
|
Facility
|
IP
|
$5,674.69
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
169165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,496.86 |
| Max. Negotiated Rate |
$5,107.22 |
| Rate for Payer: Aetna American Axle |
$3,688.55
|
| Rate for Payer: Aetna Commercial |
$4,823.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,688.55
|
| Rate for Payer: Cash Price |
$4,539.75
|
| Rate for Payer: Cofinity Commercial |
$3,972.28
|
| Rate for Payer: Cofinity Commercial |
$4,880.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,972.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,539.75
|
| Rate for Payer: Healthscope Commercial |
$5,107.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,972.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,256.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,823.49
|
| Rate for Payer: PHP Commercial |
$4,823.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,688.55
|
| Rate for Payer: Priority Health SBD |
$3,575.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,496.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,256.02
|
|
|
VARICELLA-ZOSTER IMMUNE GLOB-MALTOSE 125 UNIT/1.2 ML IM SOLUTION
|
Facility
|
OP
|
$5,674.69
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
169165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.94 |
| Max. Negotiated Rate |
$6,648.29 |
| Rate for Payer: Aetna American Axle |
$3,688.55
|
| Rate for Payer: Aetna Commercial |
$4,823.49
|
| Rate for Payer: Aetna Medicare |
$2,456.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,688.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,952.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,952.28
|
| Rate for Payer: BCBS Complete |
$1,329.23
|
| Rate for Payer: BCBS MAPPO |
$2,361.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,361.82
|
| Rate for Payer: Cash Price |
$4,539.75
|
| Rate for Payer: Cash Price |
$4,539.75
|
| Rate for Payer: Cofinity Commercial |
$4,880.23
|
| Rate for Payer: Cofinity Commercial |
$3,972.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,972.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,539.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,361.82
|
| Rate for Payer: Healthscope Commercial |
$5,107.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,972.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,256.02
|
| Rate for Payer: Mclaren Medicaid |
$1,265.94
|
| Rate for Payer: Mclaren Medicare |
$2,361.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,479.91
|
| Rate for Payer: Meridian Medicaid |
$1,329.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,716.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,823.49
|
| Rate for Payer: PACE Medicare |
$2,243.73
|
| Rate for Payer: PACE SWMI |
$2,361.82
|
| Rate for Payer: PHP Commercial |
$4,823.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,361.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,265.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,688.55
|
| Rate for Payer: Priority Health Medicare |
$2,361.82
|
| Rate for Payer: Priority Health SBD |
$3,575.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,361.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,648.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,361.82
|
| Rate for Payer: UHC Exchange |
$4,513.67
|
| Rate for Payer: UHC Medicare Advantage |
$2,361.82
|
| Rate for Payer: UHCCP Medicaid |
$1,265.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,099.64
|
| Rate for Payer: VA VA |
$2,361.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,256.02
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; ARTERIAL, OTHER THAN HEMORRHAGE OR TUMOR (EG, CONGENITAL OR ACQUIRED ARTERIAL MALFORMATIONS, ARTERIOVENOUS MALFORMATIONS, ARTERIOVENOUS FISTULAS, ANEURYSMS, PSEUDOANEURYSMS)
|
Facility
|
OP
|
$49,296.87
|
|
|
Service Code
|
CPT 37242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Exchange |
$33,468.77
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,386.88
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; FOR ARTERIAL OR VENOUS HEMORRHAGE OR LYMPHATIC EXTRAVASATION
|
Facility
|
OP
|
$31,133.44
|
|
|
Service Code
|
CPT 37244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$21,137.21
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; VENOUS, OTHER THAN HEMORRHAGE (EG, CONGENITAL OR ACQUIRED VENOUS MALFORMATIONS, VENOUS AND CAPILLARY HEMANGIOMAS, VARICES, VARICOCELES)
|
Facility
|
OP
|
$31,133.44
|
|
|
Service Code
|
CPT 37241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$21,137.21
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna American Axle |
$60.64
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Medicare |
$46.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: UMR Bronson Commercial |
$34.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
IP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna American Axle |
$60.64
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: UMR Bronson Commercial |
$41.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.73
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$48.36 |
| Rate for Payer: Aetna American Axle |
$34.92
|
| Rate for Payer: Aetna American Axle |
$78.11
|
| Rate for Payer: Aetna American Axle |
$100.66
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna American Axle |
$65.97
|
| Rate for Payer: Aetna American Axle |
$60.64
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna American Axle |
$41.62
|
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: Aetna Commercial |
$86.27
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna Medicare |
$77.43
|
| Rate for Payer: Aetna Medicare |
$50.74
|
| Rate for Payer: Aetna Medicare |
$26.86
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Aetna Medicare |
$32.02
|
| Rate for Payer: Aetna Medicare |
$46.65
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.62
|
| Rate for Payer: BCBS Complete |
$25.61
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Complete |
$61.94
|
| Rate for Payer: BCBS Complete |
$22.48
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$21.49
|
| Rate for Payer: BCBS Complete |
$40.60
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$81.19
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Cofinity Commercial |
$44.82
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$87.28
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.22
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$91.34
|
| Rate for Payer: Healthscope Commercial |
$57.63
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$86.27
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$54.43
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health SBD |
$40.34
|
| Rate for Payer: Priority Health SBD |
$35.41
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$61.53
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$63.94
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: UMR Bronson Commercial |
$23.69
|
| Rate for Payer: UMR Bronson Commercial |
$37.55
|
| Rate for Payer: UMR Bronson Commercial |
$44.46
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: UMR Bronson Commercial |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$34.52
|
| Rate for Payer: UMR Bronson Commercial |
$19.88
|
| Rate for Payer: UMR Bronson Commercial |
$57.30
|
| Rate for Payer: UMR Bronson Commercial |
$36.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$56.21
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna American Axle |
$65.97
|
| Rate for Payer: Aetna American Axle |
$100.66
|
| Rate for Payer: Aetna American Axle |
$78.11
|
| Rate for Payer: Aetna American Axle |
$41.62
|
| Rate for Payer: Aetna American Axle |
$63.49
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$34.92
|
| Rate for Payer: Aetna American Axle |
$60.64
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Aetna Commercial |
$54.43
|
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$86.27
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$44.97
|
| Rate for Payer: Cash Price |
$51.22
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$81.19
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.34
|
| Rate for Payer: Cofinity Commercial |
$87.28
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$55.07
|
| Rate for Payer: Cofinity Commercial |
$44.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.97
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$91.34
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Healthscope Commercial |
$57.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$47.78
|
| Rate for Payer: PHP Commercial |
$86.27
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$54.43
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health SBD |
$35.41
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$61.53
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$40.34
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$63.94
|
| Rate for Payer: UMR Bronson Commercial |
$68.14
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: UMR Bronson Commercial |
$52.87
|
| Rate for Payer: UMR Bronson Commercial |
$44.66
|
| Rate for Payer: UMR Bronson Commercial |
$41.05
|
| Rate for Payer: UMR Bronson Commercial |
$28.17
|
| Rate for Payer: UMR Bronson Commercial |
$23.64
|
| Rate for Payer: UMR Bronson Commercial |
$24.73
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna American Axle |
$249.73
|
| Rate for Payer: Aetna American Axle |
$290.53
|
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Priority Health SBD |
$281.59
|
| Rate for Payer: UMR Bronson Commercial |
$169.05
|
| Rate for Payer: UMR Bronson Commercial |
$196.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.23
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$446.97
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$402.27 |
| Rate for Payer: Aetna American Axle |
$290.53
|
| Rate for Payer: Aetna American Axle |
$249.73
|
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.23
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Mclaren Medicare |
$2.01
|
| Rate for Payer: Mclaren Medicare |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: PACE Medicare |
$1.91
|
| Rate for Payer: PACE Medicare |
$1.91
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health Medicare |
$2.01
|
| Rate for Payer: Priority Health Medicare |
$2.01
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Priority Health SBD |
$281.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: UHCCP Medicaid |
$1.08
|
| Rate for Payer: UHCCP Medicaid |
$1.08
|
| Rate for Payer: UMR Bronson Commercial |
$142.15
|
| Rate for Payer: UMR Bronson Commercial |
$165.38
|
| Rate for Payer: VA VA |
$2.01
|
| Rate for Payer: VA VA |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.15
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
NDC 55150023510
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna American Axle |
$10.85
|
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.85
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$11.68
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.19
|
| Rate for Payer: PHP Commercial |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.85
|
| Rate for Payer: Priority Health SBD |
$10.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.52
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.63
|
|
|
Service Code
|
NDC 47335093144
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Aetna American Axle |
$14.71
|
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.71
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$19.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.71
|
| Rate for Payer: Priority Health SBD |
$14.26
|
| Rate for Payer: UMR Bronson Commercial |
$8.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.97
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.63
|
|
|
Service Code
|
NDC 47335093144
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Aetna American Axle |
$14.71
|
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.71
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$19.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.71
|
| Rate for Payer: Priority Health SBD |
$14.26
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.97
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 67457043810
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 67457043810
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 67457043800
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 67457043800
|
| Hospital Charge Code |
11634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
