|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
|
Facility
|
OP
|
$1,066.03
|
|
|
Service Code
|
CPT 31515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$1,066.03 |
| Rate for Payer: Aetna Medicare |
$393.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.39
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS MAPPO |
$378.71
|
| Rate for Payer: BCN Medicare Advantage |
$378.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.71
|
| Rate for Payer: Mclaren Medicaid |
$202.99
|
| Rate for Payer: Mclaren Medicare |
$378.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.65
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.52
|
| Rate for Payer: PACE Medicare |
$359.77
|
| Rate for Payer: PACE SWMI |
$378.71
|
| Rate for Payer: PHP Medicare Advantage |
$378.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Medicare |
$378.71
|
| Rate for Payer: Railroad Medicare Medicare |
$378.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.71
|
| Rate for Payer: UHC Exchange |
$723.75
|
| Rate for Payer: UHC Medicare Advantage |
$378.71
|
| Rate for Payer: UHCCP Medicaid |
$202.99
|
| Rate for Payer: VA VA |
$378.71
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31528
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, SUBSEQUENT
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31529
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
LARYNGOSCOPY, FLEXIBLE; DIAGNOSTIC
|
Facility
|
OP
|
$532.97
|
|
|
Service Code
|
CPT 31575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$361.85
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: VA VA |
$189.34
|
|
|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.95
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna Medicare |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.95
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 52647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 52649
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 52648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$861.95
|
|
|
Service Code
|
NDC 00013830304
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.26 |
| Max. Negotiated Rate |
$775.75 |
| Rate for Payer: Aetna American Axle |
$560.27
|
| Rate for Payer: Aetna Commercial |
$732.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.27
|
| Rate for Payer: Cash Price |
$689.56
|
| Rate for Payer: Cofinity Commercial |
$603.37
|
| Rate for Payer: Cofinity Commercial |
$741.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.56
|
| Rate for Payer: Healthscope Commercial |
$775.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.66
|
| Rate for Payer: PHP Commercial |
$732.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.27
|
| Rate for Payer: Priority Health SBD |
$543.03
|
| Rate for Payer: UMR Bronson Commercial |
$379.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.46
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$59.85
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$53.87 |
| Rate for Payer: Aetna American Axle |
$38.90
|
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna Medicare |
$29.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.88
|
| Rate for Payer: Healthscope Commercial |
$53.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.87
|
| Rate for Payer: PHP Commercial |
$50.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.90
|
| Rate for Payer: Priority Health SBD |
$37.71
|
| Rate for Payer: UMR Bronson Commercial |
$22.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.89
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna American Axle |
$17.20
|
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Aetna Medicare |
$13.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.20
|
| Rate for Payer: BCBS Complete |
$10.58
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health SBD |
$16.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$59.85
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$53.87 |
| Rate for Payer: Aetna American Axle |
$38.90
|
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.88
|
| Rate for Payer: Healthscope Commercial |
$53.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.87
|
| Rate for Payer: PHP Commercial |
$50.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.90
|
| Rate for Payer: Priority Health SBD |
$37.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.89
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna American Axle |
$17.20
|
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.20
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health SBD |
$16.67
|
| Rate for Payer: UMR Bronson Commercial |
$11.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$11.21
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna American Axle |
$7.29
|
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.29
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$50.75
|
|
|
Service Code
|
NDC 00517083001
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$11.21
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna American Axle |
$7.29
|
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.29
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
