|
LEVETIRACETAM ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$221.16
|
|
|
Service Code
|
NDC 68180011707
|
| Hospital Charge Code |
93834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.31 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna American Axle |
$143.75
|
| Rate for Payer: Aetna Commercial |
$187.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.75
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.93
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.99
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.75
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UMR Bronson Commercial |
$97.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.87
|
|
|
LEVOBUNOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
10394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
LEVOBUNOLOL 0.5 % EYE DROPS
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
10394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$448.40
|
|
|
Service Code
|
NDC 54482014801
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.30 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.46
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UMR Bronson Commercial |
$197.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$278.01
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: Aetna American Axle |
$180.71
|
| Rate for Payer: Aetna Commercial |
$236.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: Cash Price |
$222.41
|
| Rate for Payer: Cofinity Commercial |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$239.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.41
|
| Rate for Payer: Healthscope Commercial |
$250.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.31
|
| Rate for Payer: PHP Commercial |
$236.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.71
|
| Rate for Payer: Priority Health SBD |
$175.15
|
| Rate for Payer: UMR Bronson Commercial |
$122.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.51
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$448.40
|
|
|
Service Code
|
NDC 54482014801
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.91 |
| Max. Negotiated Rate |
$403.56 |
| Rate for Payer: Aetna American Axle |
$291.46
|
| Rate for Payer: Aetna Commercial |
$381.14
|
| Rate for Payer: Aetna Medicare |
$224.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: BCBS Complete |
$179.36
|
| Rate for Payer: Cash Price |
$358.72
|
| Rate for Payer: Cofinity Commercial |
$313.88
|
| Rate for Payer: Cofinity Commercial |
$385.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.72
|
| Rate for Payer: Healthscope Commercial |
$403.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.14
|
| Rate for Payer: PHP Commercial |
$381.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.46
|
| Rate for Payer: Priority Health SBD |
$282.49
|
| Rate for Payer: UMR Bronson Commercial |
$165.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.30
|
|
|
LEVOCARNITINE 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$278.01
|
|
|
Service Code
|
NDC 70954014010
|
| Hospital Charge Code |
108122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: Aetna American Axle |
$180.71
|
| Rate for Payer: Aetna Commercial |
$236.31
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: Cash Price |
$222.41
|
| Rate for Payer: Cofinity Commercial |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$239.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.41
|
| Rate for Payer: Healthscope Commercial |
$250.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.31
|
| Rate for Payer: PHP Commercial |
$236.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.71
|
| Rate for Payer: Priority Health SBD |
$175.15
|
| Rate for Payer: UMR Bronson Commercial |
$102.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.51
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$359.19
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.04 |
| Max. Negotiated Rate |
$323.27 |
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna American Axle |
$74.03
|
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$58.00
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: Aetna Commercial |
$96.81
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$70.11
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$62.46
|
| Rate for Payer: Cofinity Commercial |
$251.43
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$96.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health SBD |
$56.21
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: UMR Bronson Commercial |
$158.04
|
| Rate for Payer: UMR Bronson Commercial |
$39.26
|
| Rate for Payer: UMR Bronson Commercial |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$44.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
|
|
LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$113.90
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
20954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$102.51 |
| Rate for Payer: Aetna American Axle |
$74.03
|
| Rate for Payer: Aetna American Axle |
$58.00
|
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$233.47
|
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: Aetna Commercial |
$96.81
|
| Rate for Payer: Aetna Commercial |
$305.31
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$179.59
|
| Rate for Payer: Aetna Medicare |
$50.08
|
| Rate for Payer: Aetna Medicare |
$44.62
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS Complete |
$143.68
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: Cash Price |
$91.12
|
| Rate for Payer: Cash Price |
$287.35
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$97.95
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$70.11
|
| Rate for Payer: Cofinity Commercial |
$308.90
|
| Rate for Payer: Cofinity Commercial |
$251.43
|
| Rate for Payer: Cofinity Commercial |
$62.46
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$102.51
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$305.31
|
| Rate for Payer: PHP Commercial |
$96.81
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health SBD |
$226.29
|
| Rate for Payer: Priority Health SBD |
$56.21
|
| Rate for Payer: Priority Health SBD |
$71.76
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: UMR Bronson Commercial |
$132.90
|
| Rate for Payer: UMR Bronson Commercial |
$42.14
|
| Rate for Payer: UMR Bronson Commercial |
$33.02
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.42
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$332.64
|
|
|
Service Code
|
NDC 70954049210
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$299.38 |
| Rate for Payer: Aetna American Axle |
$216.22
|
| Rate for Payer: Aetna Commercial |
$282.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.22
|
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Cofinity Commercial |
$232.85
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.11
|
| Rate for Payer: Healthscope Commercial |
$299.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.74
|
| Rate for Payer: PHP Commercial |
$282.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.22
|
| Rate for Payer: Priority Health SBD |
$209.56
|
| Rate for Payer: UMR Bronson Commercial |
$146.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.48
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$332.64
|
|
|
Service Code
|
NDC 70954049210
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$299.38 |
| Rate for Payer: Aetna American Axle |
$216.22
|
| Rate for Payer: Aetna Commercial |
$282.74
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.22
|
| Rate for Payer: BCBS Complete |
$133.06
|
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Cofinity Commercial |
$232.85
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.11
|
| Rate for Payer: Healthscope Commercial |
$299.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.74
|
| Rate for Payer: PHP Commercial |
$282.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.22
|
| Rate for Payer: Priority Health SBD |
$209.56
|
| Rate for Payer: UMR Bronson Commercial |
$123.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.48
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 09900000879
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$342.58
|
|
|
Service Code
|
NDC 50383017290
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.74 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna American Axle |
$222.68
|
| Rate for Payer: Aetna Commercial |
$291.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.68
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cofinity Commercial |
$239.81
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.06
|
| Rate for Payer: Healthscope Commercial |
$308.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.19
|
| Rate for Payer: PHP Commercial |
$291.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.68
|
| Rate for Payer: Priority Health SBD |
$215.83
|
| Rate for Payer: UMR Bronson Commercial |
$150.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.94
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$503.72
|
|
|
Service Code
|
NDC 54482014407
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$453.35 |
| Rate for Payer: Aetna American Axle |
$327.42
|
| Rate for Payer: Aetna Commercial |
$428.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.42
|
| Rate for Payer: Cash Price |
$402.98
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Commercial |
$433.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.98
|
| Rate for Payer: Healthscope Commercial |
$453.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.16
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.42
|
| Rate for Payer: Priority Health SBD |
$317.34
|
| Rate for Payer: UMR Bronson Commercial |
$221.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.79
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 09900000879
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Aetna American Axle |
$2.27
|
| Rate for Payer: Aetna Commercial |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.98
|
| Rate for Payer: PHP Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.62
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$342.58
|
|
|
Service Code
|
NDC 50383017290
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna American Axle |
$222.68
|
| Rate for Payer: Aetna Commercial |
$291.19
|
| Rate for Payer: Aetna Medicare |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.68
|
| Rate for Payer: BCBS Complete |
$137.03
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cofinity Commercial |
$239.81
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.06
|
| Rate for Payer: Healthscope Commercial |
$308.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.19
|
| Rate for Payer: PHP Commercial |
$291.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.68
|
| Rate for Payer: Priority Health SBD |
$215.83
|
| Rate for Payer: UMR Bronson Commercial |
$126.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.94
|
|
|
LEVOCARNITINE 330 MG TABLET
|
Facility
|
OP
|
$503.72
|
|
|
Service Code
|
NDC 54482014407
|
| Hospital Charge Code |
20952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.38 |
| Max. Negotiated Rate |
$453.35 |
| Rate for Payer: Aetna American Axle |
$327.42
|
| Rate for Payer: Aetna Commercial |
$428.16
|
| Rate for Payer: Aetna Medicare |
$251.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.42
|
| Rate for Payer: BCBS Complete |
$201.49
|
| Rate for Payer: Cash Price |
$402.98
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Commercial |
$433.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.98
|
| Rate for Payer: Healthscope Commercial |
$453.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.16
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.42
|
| Rate for Payer: Priority Health SBD |
$317.34
|
| Rate for Payer: UMR Bronson Commercial |
$186.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.79
|
|
|
LEVOCARNITINE SD 20 MG/ML IV
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
157117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.05 |
| 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 |
$32.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$24.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
LEVOCARNITINE SD 20 MG/ML IV
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J1955
|
| Hospital Charge Code |
157117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$760.72
|
|
|
Service Code
|
NDC 00527194866
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.72 |
| Max. Negotiated Rate |
$684.65 |
| Rate for Payer: Aetna American Axle |
$494.47
|
| Rate for Payer: Aetna Commercial |
$646.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.47
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cofinity Commercial |
$532.50
|
| Rate for Payer: Cofinity Commercial |
$654.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$532.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.58
|
| Rate for Payer: Healthscope Commercial |
$684.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.61
|
| Rate for Payer: PHP Commercial |
$646.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.47
|
| Rate for Payer: Priority Health SBD |
$479.25
|
| Rate for Payer: UMR Bronson Commercial |
$334.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.54
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$760.72
|
|
|
Service Code
|
NDC 00527194866
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.47 |
| Max. Negotiated Rate |
$684.65 |
| Rate for Payer: Aetna American Axle |
$494.47
|
| Rate for Payer: Aetna Commercial |
$646.61
|
| Rate for Payer: Aetna Medicare |
$380.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.47
|
| Rate for Payer: BCBS Complete |
$304.29
|
| Rate for Payer: Cash Price |
$608.58
|
| Rate for Payer: Cofinity Commercial |
$532.50
|
| Rate for Payer: Cofinity Commercial |
$654.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$532.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.58
|
| Rate for Payer: Healthscope Commercial |
$684.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.61
|
| Rate for Payer: PHP Commercial |
$646.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.47
|
| Rate for Payer: Priority Health SBD |
$479.25
|
| Rate for Payer: UMR Bronson Commercial |
$281.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.54
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,639.68
|
|
|
Service Code
|
NDC 00527194868
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$606.68 |
| Max. Negotiated Rate |
$1,475.71 |
| Rate for Payer: Aetna American Axle |
$1,065.79
|
| Rate for Payer: Aetna Commercial |
$1,393.73
|
| Rate for Payer: Aetna Medicare |
$819.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.79
|
| Rate for Payer: BCBS Complete |
$655.87
|
| Rate for Payer: Cash Price |
$1,311.74
|
| Rate for Payer: Cofinity Commercial |
$1,147.78
|
| Rate for Payer: Cofinity Commercial |
$1,410.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.74
|
| Rate for Payer: Healthscope Commercial |
$1,475.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,147.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,229.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.73
|
| Rate for Payer: PHP Commercial |
$1,393.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.79
|
| Rate for Payer: Priority Health SBD |
$1,033.00
|
| Rate for Payer: UMR Bronson Commercial |
$606.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,229.76
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$996.48
|
|
|
Service Code
|
NDC 50383028608
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$438.45 |
| Max. Negotiated Rate |
$896.83 |
| Rate for Payer: Aetna American Axle |
$647.71
|
| Rate for Payer: Aetna Commercial |
$847.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.71
|
| Rate for Payer: Cash Price |
$797.18
|
| Rate for Payer: Cofinity Commercial |
$697.54
|
| Rate for Payer: Cofinity Commercial |
$856.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$697.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.18
|
| Rate for Payer: Healthscope Commercial |
$896.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$697.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.01
|
| Rate for Payer: PHP Commercial |
$847.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.71
|
| Rate for Payer: Priority Health SBD |
$627.78
|
| Rate for Payer: UMR Bronson Commercial |
$438.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.36
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
OP
|
$2,154.24
|
|
|
Service Code
|
NDC 50383028616
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$797.07 |
| Max. Negotiated Rate |
$1,938.82 |
| Rate for Payer: Aetna American Axle |
$1,400.26
|
| Rate for Payer: Aetna Commercial |
$1,831.10
|
| Rate for Payer: Aetna Medicare |
$1,077.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.26
|
| Rate for Payer: BCBS Complete |
$861.70
|
| Rate for Payer: Cash Price |
$1,723.39
|
| Rate for Payer: Cofinity Commercial |
$1,507.97
|
| Rate for Payer: Cofinity Commercial |
$1,852.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,723.39
|
| Rate for Payer: Healthscope Commercial |
$1,938.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,507.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,615.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,831.10
|
| Rate for Payer: PHP Commercial |
$1,831.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.26
|
| Rate for Payer: Priority Health SBD |
$1,357.17
|
| Rate for Payer: UMR Bronson Commercial |
$797.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,615.68
|
|
|
LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,639.68
|
|
|
Service Code
|
NDC 00527194868
|
| Hospital Charge Code |
39970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$721.46 |
| Max. Negotiated Rate |
$1,475.71 |
| Rate for Payer: Aetna American Axle |
$1,065.79
|
| Rate for Payer: Aetna Commercial |
$1,393.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.79
|
| Rate for Payer: Cash Price |
$1,311.74
|
| Rate for Payer: Cofinity Commercial |
$1,147.78
|
| Rate for Payer: Cofinity Commercial |
$1,410.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.74
|
| Rate for Payer: Healthscope Commercial |
$1,475.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,147.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,229.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.73
|
| Rate for Payer: PHP Commercial |
$1,393.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.79
|
| Rate for Payer: Priority Health SBD |
$1,033.00
|
| Rate for Payer: UMR Bronson Commercial |
$721.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,229.76
|
|
