|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$436.23 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna American Axle |
$766.34
|
| Rate for Payer: Aetna Commercial |
$1,002.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.34
|
| Rate for Payer: BCBS Complete |
$471.60
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,013.93
|
| Rate for Payer: Cofinity Commercial |
$825.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Healthscope Commercial |
$1,061.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$825.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$884.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: PHP Commercial |
$1,002.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: Priority Health SBD |
$742.76
|
| Rate for Payer: UMR Bronson Commercial |
$436.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$884.24
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna American Axle |
$766.34
|
| Rate for Payer: Aetna Commercial |
$1,002.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.34
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,013.93
|
| Rate for Payer: Cofinity Commercial |
$825.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Healthscope Commercial |
$1,061.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$825.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$884.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: PHP Commercial |
$1,002.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: Priority Health SBD |
$742.76
|
| Rate for Payer: UMR Bronson Commercial |
$518.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$884.24
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,603.84 |
| Max. Negotiated Rate |
$3,280.57 |
| Rate for Payer: Aetna American Axle |
$2,369.30
|
| Rate for Payer: Aetna Commercial |
$3,098.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,369.30
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$2,551.56
|
| Rate for Payer: Cofinity Commercial |
$3,134.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Healthscope Commercial |
$3,280.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,551.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,733.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: PHP Commercial |
$3,098.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: Priority Health SBD |
$2,296.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,603.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,733.81
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,348.68 |
| Max. Negotiated Rate |
$3,280.57 |
| Rate for Payer: Aetna American Axle |
$2,369.30
|
| Rate for Payer: Aetna Commercial |
$3,098.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,369.30
|
| Rate for Payer: BCBS Complete |
$1,458.03
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$2,551.56
|
| Rate for Payer: Cofinity Commercial |
$3,134.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Healthscope Commercial |
$3,280.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,551.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,733.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: PHP Commercial |
$3,098.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: Priority Health SBD |
$2,296.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,348.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,733.81
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.50 |
| Max. Negotiated Rate |
$1,275.34 |
| Rate for Payer: Aetna American Axle |
$921.08
|
| Rate for Payer: Aetna Commercial |
$1,204.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.08
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,218.65
|
| Rate for Payer: Cofinity Commercial |
$991.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Healthscope Commercial |
$1,275.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$991.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: PHP Commercial |
$1,204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: Priority Health SBD |
$892.74
|
| Rate for Payer: UMR Bronson Commercial |
$623.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.78
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$1,275.34 |
| Rate for Payer: Aetna American Axle |
$921.08
|
| Rate for Payer: Aetna Commercial |
$1,204.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.08
|
| Rate for Payer: BCBS Complete |
$566.82
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,218.65
|
| Rate for Payer: Cofinity Commercial |
$991.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Healthscope Commercial |
$1,275.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$991.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: PHP Commercial |
$1,204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: Priority Health SBD |
$892.74
|
| Rate for Payer: UMR Bronson Commercial |
$524.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.78
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.62 |
| Max. Negotiated Rate |
$3,905.57 |
| Rate for Payer: Aetna American Axle |
$2,820.69
|
| Rate for Payer: Aetna Commercial |
$3,688.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.69
|
| Rate for Payer: BCBS Complete |
$1,735.81
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$3,037.66
|
| Rate for Payer: Cofinity Commercial |
$3,731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Healthscope Commercial |
$3,905.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: PHP Commercial |
$3,688.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: Priority Health SBD |
$2,733.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,605.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.64
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,909.39 |
| Max. Negotiated Rate |
$3,905.57 |
| Rate for Payer: Aetna American Axle |
$2,820.69
|
| Rate for Payer: Aetna Commercial |
$3,688.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.69
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$3,037.66
|
| Rate for Payer: Cofinity Commercial |
$3,731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Healthscope Commercial |
$3,905.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: PHP Commercial |
$3,688.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: Priority Health SBD |
$2,733.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,909.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.64
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.27 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna American Axle |
$1,026.42
|
| Rate for Payer: Aetna Commercial |
$1,342.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.42
|
| Rate for Payer: BCBS Complete |
$631.64
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,105.38
|
| Rate for Payer: Cofinity Commercial |
$1,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Healthscope Commercial |
$1,421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,105.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: PHP Commercial |
$1,342.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: Priority Health SBD |
$994.84
|
| Rate for Payer: UMR Bronson Commercial |
$584.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.33
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.81 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna American Axle |
$1,026.42
|
| Rate for Payer: Aetna Commercial |
$1,342.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.42
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,105.38
|
| Rate for Payer: Cofinity Commercial |
$1,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Healthscope Commercial |
$1,421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,105.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: PHP Commercial |
$1,342.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: Priority Health SBD |
$994.84
|
| Rate for Payer: UMR Bronson Commercial |
$694.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.33
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.62 |
| Max. Negotiated Rate |
$4,358.08 |
| Rate for Payer: Aetna American Axle |
$3,147.50
|
| Rate for Payer: Aetna Commercial |
$4,115.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.50
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$3,389.62
|
| Rate for Payer: Cofinity Commercial |
$4,164.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Healthscope Commercial |
$4,358.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,389.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,631.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: PHP Commercial |
$4,115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: Priority Health SBD |
$3,050.66
|
| Rate for Payer: UMR Bronson Commercial |
$2,130.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,631.73
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,791.65 |
| Max. Negotiated Rate |
$4,358.08 |
| Rate for Payer: Aetna American Axle |
$3,147.50
|
| Rate for Payer: Aetna Commercial |
$4,115.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.50
|
| Rate for Payer: BCBS Complete |
$1,936.92
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$3,389.62
|
| Rate for Payer: Cofinity Commercial |
$4,164.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Healthscope Commercial |
$4,358.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,389.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,631.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: PHP Commercial |
$4,115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: Priority Health SBD |
$3,050.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,791.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,631.73
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$732.43 |
| Max. Negotiated Rate |
$1,781.59 |
| Rate for Payer: Aetna American Axle |
$1,286.70
|
| Rate for Payer: Aetna Commercial |
$1,682.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.70
|
| Rate for Payer: BCBS Complete |
$791.82
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,385.68
|
| Rate for Payer: Cofinity Commercial |
$1,702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Healthscope Commercial |
$1,781.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,385.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: PHP Commercial |
$1,682.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: Priority Health SBD |
$1,247.11
|
| Rate for Payer: UMR Bronson Commercial |
$732.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.66
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$871.00 |
| Max. Negotiated Rate |
$1,781.59 |
| Rate for Payer: Aetna American Axle |
$1,286.70
|
| Rate for Payer: Aetna Commercial |
$1,682.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.70
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,385.68
|
| Rate for Payer: Cofinity Commercial |
$1,702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Healthscope Commercial |
$1,781.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,385.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: PHP Commercial |
$1,682.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: Priority Health SBD |
$1,247.11
|
| Rate for Payer: UMR Bronson Commercial |
$871.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.66
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Aetna American Axle |
$48.93
|
| Rate for Payer: Aetna Commercial |
$63.99
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$52.70
|
| Rate for Payer: Cofinity Commercial |
$64.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$67.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.46
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$63.99
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.18
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$14.54
|
| Rate for Payer: Priority Health SBD |
$47.43
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$27.85
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.46
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Aetna American Axle |
$48.93
|
| Rate for Payer: Aetna Commercial |
$63.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.93
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$52.70
|
| Rate for Payer: Cofinity Commercial |
$64.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Healthscope Commercial |
$67.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: PHP Commercial |
$63.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health SBD |
$47.43
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.46
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,659.37 |
| Max. Negotiated Rate |
$3,394.16 |
| Rate for Payer: Aetna American Axle |
$2,451.34
|
| Rate for Payer: Aetna Commercial |
$3,205.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,451.34
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$2,639.90
|
| Rate for Payer: Cofinity Commercial |
$3,243.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Healthscope Commercial |
$3,394.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,639.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,828.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: PHP Commercial |
$3,205.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: Priority Health SBD |
$2,375.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,659.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,828.47
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$934.24 |
| Max. Negotiated Rate |
$3,501.24 |
| Rate for Payer: Aetna American Axle |
$2,451.34
|
| Rate for Payer: Aetna Commercial |
$3,205.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,451.34
|
| Rate for Payer: BCBS Complete |
$1,508.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,501.24
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$2,639.90
|
| Rate for Payer: Cofinity Commercial |
$3,243.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Healthscope Commercial |
$3,394.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,639.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,828.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: PHP Commercial |
$3,205.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.80
|
| Rate for Payer: Priority Health Narrow Network |
$934.24
|
| Rate for Payer: Priority Health SBD |
$2,375.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,395.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,828.47
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| 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 |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| 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 |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.40
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$20.32
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.22
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.40
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$20.32
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.22
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna American Axle |
$50.39
|
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.40
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$20.32
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.22
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna American Axle |
$50.39
|
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: UMR Bronson Commercial |
$34.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Mclaren Medicare |
$14.69
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health Narrow Network |
$16.12
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$24.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Exchange |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$15.13
|
| Rate for Payer: UMR Bronson Commercial |
$24.05
|
| Rate for Payer: VA VA |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
