|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$502.02
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna American Axle |
$326.31
|
| Rate for Payer: Aetna Commercial |
$426.72
|
| Rate for Payer: Aetna Medicare |
$151.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.72
|
| Rate for Payer: BCBS Complete |
$83.51
|
| Rate for Payer: BCBS MAPPO |
$145.38
|
| Rate for Payer: BCBS Trust/PPO |
$272.90
|
| Rate for Payer: BCN Medicare Advantage |
$145.38
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$351.41
|
| Rate for Payer: Cofinity Commercial |
$431.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.38
|
| Rate for Payer: Healthscope Commercial |
$451.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Mclaren Medicaid |
$79.52
|
| Rate for Payer: Mclaren Medicare |
$145.38
|
| Rate for Payer: Meridian Medicaid |
$83.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.72
|
| Rate for Payer: PACE Medicare |
$138.11
|
| Rate for Payer: PACE SWMI |
$145.38
|
| Rate for Payer: PHP Commercial |
$426.72
|
| Rate for Payer: PHP Medicare Advantage |
$145.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.65
|
| Rate for Payer: Priority Health Medicare |
$145.38
|
| Rate for Payer: Priority Health Narrow Network |
$366.12
|
| Rate for Payer: Priority Health SBD |
$316.27
|
| Rate for Payer: Railroad Medicare Medicare |
$145.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.66
|
| Rate for Payer: UHC Core |
$1,004.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.38
|
| Rate for Payer: UHC Exchange |
$40.60
|
| Rate for Payer: UHC Medicare Advantage |
$149.74
|
| Rate for Payer: UMR Bronson Commercial |
$185.75
|
| Rate for Payer: VA VA |
$145.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$87.31
|
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.88
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna American Axle |
$87.31
|
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
| Rate for Payer: UMR Bronson Commercial |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,448.05 |
| Max. Negotiated Rate |
$2,961.92 |
| Rate for Payer: Aetna American Axle |
$2,139.16
|
| Rate for Payer: Aetna Commercial |
$2,797.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.16
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$2,303.71
|
| Rate for Payer: Cofinity Commercial |
$2,830.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Healthscope Commercial |
$2,961.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,303.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,468.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: PHP Commercial |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: Priority Health SBD |
$2,073.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,448.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,468.26
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$255.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.87 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$303.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.87 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$303.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$255.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.49
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$10.28
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Medicaid |
$10.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$17.85
|
| Rate for Payer: PACE SWMI |
$18.79
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.78
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health Narrow Network |
$20.62
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.55
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.79
|
| Rate for Payer: UHC Exchange |
$18.79
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: VA VA |
$18.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
OP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$526.50 |
| Max. Negotiated Rate |
$1,280.66 |
| Rate for Payer: Aetna American Axle |
$924.92
|
| Rate for Payer: Aetna Commercial |
$1,209.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.92
|
| Rate for Payer: BCBS Complete |
$569.18
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,223.75
|
| Rate for Payer: Cofinity Commercial |
$996.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Healthscope Commercial |
$1,280.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: PHP Commercial |
$1,209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: Priority Health SBD |
$896.46
|
| Rate for Payer: UMR Bronson Commercial |
$526.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.22
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
IP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$626.10 |
| Max. Negotiated Rate |
$1,280.66 |
| Rate for Payer: Aetna American Axle |
$924.92
|
| Rate for Payer: Aetna Commercial |
$1,209.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.92
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,223.75
|
| Rate for Payer: Cofinity Commercial |
$996.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Healthscope Commercial |
$1,280.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: PHP Commercial |
$1,209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: Priority Health SBD |
$896.46
|
| Rate for Payer: UMR Bronson Commercial |
$626.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.22
|
|
|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
OP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna American Axle |
$917.03
|
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.03
|
| Rate for Payer: BCBS Complete |
$564.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Cofinity Commercial |
$987.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$987.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: Priority Health SBD |
$888.81
|
| Rate for Payer: UMR Bronson Commercial |
$522.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
IP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.76 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna American Axle |
$917.03
|
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.03
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Cofinity Commercial |
$987.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$987.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: Priority Health SBD |
$888.81
|
| Rate for Payer: UMR Bronson Commercial |
$620.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.10 |
| Max. Negotiated Rate |
$1,215.21 |
| Rate for Payer: Aetna American Axle |
$877.65
|
| Rate for Payer: Aetna Commercial |
$1,147.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.65
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,161.20
|
| Rate for Payer: Cofinity Commercial |
$945.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Healthscope Commercial |
$1,215.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$945.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: PHP Commercial |
$1,147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: Priority Health SBD |
$850.64
|
| Rate for Payer: UMR Bronson Commercial |
$594.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.67
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$499.59 |
| Max. Negotiated Rate |
$1,215.21 |
| Rate for Payer: Aetna American Axle |
$877.65
|
| Rate for Payer: Aetna Commercial |
$1,147.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.65
|
| Rate for Payer: BCBS Complete |
$540.09
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,161.20
|
| Rate for Payer: Cofinity Commercial |
$945.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Healthscope Commercial |
$1,215.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$945.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: PHP Commercial |
$1,147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: Priority Health SBD |
$850.64
|
| Rate for Payer: UMR Bronson Commercial |
$499.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.67
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.22 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna American Axle |
$785.66
|
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.66
|
| Rate for Payer: BCBS Complete |
$483.48
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Cofinity Commercial |
$846.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$846.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health SBD |
$761.48
|
| Rate for Payer: UMR Bronson Commercial |
$447.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.83 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna American Axle |
$785.66
|
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.66
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Cofinity Commercial |
$846.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$846.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health SBD |
$761.48
|
| Rate for Payer: UMR Bronson Commercial |
$531.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.00
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.49
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$45.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna American Axle |
$35.10
|
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Cofinity Commercial |
$37.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health SBD |
$34.02
|
| Rate for Payer: UMR Bronson Commercial |
$23.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna American Axle |
$35.10
|
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$16.05
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Mclaren Medicaid |
$15.28
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.32
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$30.66
|
| Rate for Payer: Priority Health SBD |
$34.02
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$46.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$27.94
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: UMR Bronson Commercial |
$19.98
|
| Rate for Payer: VA VA |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$16.05
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$15.28
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.32
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health Narrow Network |
$30.66
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$46.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$27.94
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
