|
POST MODULAR 25MM AR-9582-25
|
Facility
|
IP
|
$7,415.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,633.35 |
| Max. Negotiated Rate |
$6,821.80 |
| Rate for Payer: Aetna Commercial |
$6,673.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,929.95
|
| Rate for Payer: Cash Price |
$2,224.50
|
| Rate for Payer: Cigna Commercial |
$6,821.80
|
| Rate for Payer: Health EOS Commercial |
$6,599.35
|
| Rate for Payer: HFN Commercial |
$6,821.80
|
| Rate for Payer: Multiplan Commercial |
$5,932.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,449.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.35
|
| Rate for Payer: Quartz Commercial |
$4,449.00
|
| Rate for Payer: WEA Trust Commercial |
$4,078.25
|
| Rate for Payer: WPS Commercial |
$5,492.29
|
|
|
POST MODULAR 30MM AR-9582-30
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.40 |
| Max. Negotiated Rate |
$28,520.00 |
| Rate for Payer: Aetna Commercial |
$6,417.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,131.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,996.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,634.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,565.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,422.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,778.90
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,559.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,989.95
|
| Rate for Payer: Health EOS Commercial |
$6,345.70
|
| Rate for Payer: HFN Commercial |
$6,559.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,347.50
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,278.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,559.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,493.70
|
| Rate for Payer: Quartz Commercial |
$4,634.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,278.00
|
| Rate for Payer: The Alliance Commercial |
$28,520.00
|
| Rate for Payer: WEA Trust Commercial |
$3,921.50
|
| Rate for Payer: WPS Commercial |
$5,281.19
|
|
|
POST MODULAR 30MM AR-9582-30
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,493.70 |
| Max. Negotiated Rate |
$6,559.60 |
| Rate for Payer: Aetna Commercial |
$6,417.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,131.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,778.90
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,559.60
|
| Rate for Payer: Health EOS Commercial |
$6,345.70
|
| Rate for Payer: HFN Commercial |
$6,559.60
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,278.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,559.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,493.70
|
| Rate for Payer: Quartz Commercial |
$4,278.00
|
| Rate for Payer: WEA Trust Commercial |
$3,921.50
|
| Rate for Payer: WPS Commercial |
$5,281.19
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$49,292.00
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$17,730.86 |
| Max. Negotiated Rate |
$49,292.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,730.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,603.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,589.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,111.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17,730.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,730.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,730.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,730.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,206.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,730.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,919.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,730.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,730.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,730.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,730.86
|
| Rate for Payer: NAPHCARE Commercial |
$26,596.29
|
| Rate for Payer: Quartz Medicare Advantage |
$17,730.86
|
| Rate for Payer: The Alliance Commercial |
$49,292.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,730.86
|
| Rate for Payer: United Healthcare PPO |
$27,963.40
|
| Rate for Payer: Wellcare Medicare |
$17,730.86
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$27,053.00
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$9,731.16 |
| Max. Negotiated Rate |
$27,053.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,731.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,241.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,430.78
|
| Rate for Payer: Anthem Medicare Advantage |
$9,731.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,731.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,731.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,731.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,129.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,731.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,607.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,731.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,731.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,731.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,731.16
|
| Rate for Payer: NAPHCARE Commercial |
$14,596.74
|
| Rate for Payer: Quartz Medicare Advantage |
$9,731.16
|
| Rate for Payer: The Alliance Commercial |
$27,053.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,731.16
|
| Rate for Payer: United Healthcare PPO |
$15,264.50
|
| Rate for Payer: Wellcare Medicare |
$9,731.16
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$57,100.00
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$20,539.59 |
| Max. Negotiated Rate |
$57,100.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,897.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,413.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,694.92
|
| Rate for Payer: Anthem Medicare Advantage |
$20,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,539.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,539.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,294.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,539.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,646.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,539.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,539.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,539.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,539.59
|
| Rate for Payer: NAPHCARE Commercial |
$30,809.38
|
| Rate for Payer: Quartz Medicare Advantage |
$20,539.59
|
| Rate for Payer: The Alliance Commercial |
$57,100.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,539.59
|
| Rate for Payer: United Healthcare PPO |
$32,422.06
|
| Rate for Payer: Wellcare Medicare |
$20,539.59
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$118,054.00
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$42,465.36 |
| Max. Negotiated Rate |
$118,054.00 |
| Rate for Payer: Aetna Managed Medicare |
$42,465.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92,941.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71,238.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67,681.54
|
| Rate for Payer: Anthem Medicare Advantage |
$42,465.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,465.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,465.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,465.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75,132.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,465.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,353.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,465.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,465.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,465.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,465.36
|
| Rate for Payer: NAPHCARE Commercial |
$63,698.04
|
| Rate for Payer: Quartz Medicare Advantage |
$42,465.36
|
| Rate for Payer: The Alliance Commercial |
$118,054.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,465.36
|
| Rate for Payer: United Healthcare PPO |
$67,227.54
|
| Rate for Payer: Wellcare Medicare |
$42,465.36
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,441.00
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$12,388.80 |
| Max. Negotiated Rate |
$34,441.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,388.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,388.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,388.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,388.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,388.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,388.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,026.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,388.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,388.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,388.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$18,583.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12,388.80
|
| Rate for Payer: The Alliance Commercial |
$34,441.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,388.80
|
| Rate for Payer: United Healthcare PPO |
$19,483.30
|
| Rate for Payer: Wellcare Medicare |
$12,388.80
|
|
|
Post Op Ostomy Follow Up
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$128.40
|
| Rate for Payer: The Alliance Commercial |
$856.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Post Op Ostomy Follow Up
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Post op shoe applied - Treatments Done
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
3149555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Post op shoe applied - Treatments Done
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
3149555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
POST OUTRIGGER 30 DEG 11MM 390.012
|
Facility
|
OP
|
$2,219.00
|
|
| Hospital Charge Code |
2966383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$8,876.00 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,908.34
|
| Rate for Payer: Aetna Managed Medicare |
$621.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,442.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,109.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.07
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,041.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,241.75
|
| Rate for Payer: Health EOS Commercial |
$1,974.91
|
| Rate for Payer: HFN Commercial |
$2,041.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,664.25
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,331.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,041.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,087.31
|
| Rate for Payer: Quartz Commercial |
$1,442.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,331.40
|
| Rate for Payer: The Alliance Commercial |
$8,876.00
|
| Rate for Payer: WEA Trust Commercial |
$1,220.45
|
| Rate for Payer: WPS Commercial |
$1,643.61
|
|
|
POST OUTRIGGER 30 DEG 11MM 390.012
|
Facility
|
IP
|
$2,219.00
|
|
| Hospital Charge Code |
2966383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.31 |
| Max. Negotiated Rate |
$2,041.48 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,908.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.07
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,041.48
|
| Rate for Payer: Health EOS Commercial |
$1,974.91
|
| Rate for Payer: HFN Commercial |
$2,041.48
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,331.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,041.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,087.31
|
| Rate for Payer: Quartz Commercial |
$1,331.40
|
| Rate for Payer: WEA Trust Commercial |
$1,220.45
|
| Rate for Payer: WPS Commercial |
$1,643.61
|
|
|
POST OUTRIGGER 90 DEG 11MM 390.013
|
Facility
|
OP
|
$1,494.00
|
|
| Hospital Charge Code |
4632638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.32 |
| Max. Negotiated Rate |
$5,976.00 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Aetna Managed Medicare |
$418.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$971.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$836.04
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.50
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$971.10
|
| Rate for Payer: Quartz Medicare Advantage |
$896.40
|
| Rate for Payer: The Alliance Commercial |
$5,976.00
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
POST OUTRIGGER 90 DEG 11MM 390.013
|
Facility
|
IP
|
$1,494.00
|
|
| Hospital Charge Code |
4632638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.06 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$896.40
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
POST OUTRIGGER STRAIGHT 11MM 390.011
|
Facility
|
IP
|
$1,821.00
|
|
| Hospital Charge Code |
3133479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.29 |
| Max. Negotiated Rate |
$1,675.32 |
| Rate for Payer: Aetna Commercial |
$1,638.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.13
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,675.32
|
| Rate for Payer: Health EOS Commercial |
$1,620.69
|
| Rate for Payer: HFN Commercial |
$1,675.32
|
| Rate for Payer: Multiplan Commercial |
$1,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.32
|
| Rate for Payer: Quartz Beloit One Network |
$892.29
|
| Rate for Payer: Quartz Commercial |
$1,092.60
|
| Rate for Payer: WEA Trust Commercial |
$1,001.55
|
| Rate for Payer: WPS Commercial |
$1,348.81
|
|
|
POST OUTRIGGER STRAIGHT 11MM 390.011
|
Facility
|
OP
|
$1,821.00
|
|
| Hospital Charge Code |
3133479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.88 |
| Max. Negotiated Rate |
$7,284.00 |
| Rate for Payer: Aetna Commercial |
$1,638.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.06
|
| Rate for Payer: Aetna Managed Medicare |
$509.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.13
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,675.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.03
|
| Rate for Payer: Health EOS Commercial |
$1,620.69
|
| Rate for Payer: HFN Commercial |
$1,675.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.75
|
| Rate for Payer: Multiplan Commercial |
$1,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.32
|
| Rate for Payer: Quartz Beloit One Network |
$892.29
|
| Rate for Payer: Quartz Commercial |
$1,183.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.60
|
| Rate for Payer: The Alliance Commercial |
$7,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.55
|
| Rate for Payer: WPS Commercial |
$1,348.81
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$41,367.00
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$14,880.04 |
| Max. Negotiated Rate |
$41,367.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,880.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,309.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,764.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,528.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,880.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,880.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,880.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,880.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,118.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,880.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,106.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,880.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,880.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,880.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,880.04
|
| Rate for Payer: NAPHCARE Commercial |
$22,320.06
|
| Rate for Payer: Quartz Medicare Advantage |
$14,880.04
|
| Rate for Payer: The Alliance Commercial |
$41,367.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,880.04
|
| Rate for Payer: United Healthcare PPO |
$23,437.95
|
| Rate for Payer: Wellcare Medicare |
$14,880.04
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$19,375.00
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,969.28 |
| Max. Negotiated Rate |
$19,375.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,969.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,105.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,578.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,000.16
|
| Rate for Payer: Anthem Medicare Advantage |
$6,969.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,969.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,969.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,969.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,211.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,969.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,975.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,969.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,969.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,969.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,969.28
|
| Rate for Payer: NAPHCARE Commercial |
$10,453.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,969.28
|
| Rate for Payer: The Alliance Commercial |
$19,375.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,969.28
|
| Rate for Payer: United Healthcare PPO |
$10,880.22
|
| Rate for Payer: Wellcare Medicare |
$6,969.28
|
|
|
Post pelvic ring fx w/man closed 27198
|
Professional
|
Both
|
$1,834.00
|
|
|
Service Code
|
CPT 27198
|
| Hospital Charge Code |
5184673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.80 |
| Max. Negotiated Rate |
$1,742.30 |
| Rate for Payer: Aetna Commercial |
$1,742.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,577.24
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,742.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,100.40
|
| Rate for Payer: Health EOS Commercial |
$1,668.94
|
| Rate for Payer: HFN Commercial |
$1,742.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,050.39
|
| Rate for Payer: Multiplan Commercial |
$1,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,742.30
|
| Rate for Payer: Quartz Beloit One Network |
$806.96
|
| Rate for Payer: Quartz Commercial |
$1,045.38
|
| Rate for Payer: The Alliance Commercial |
$917.00
|
| Rate for Payer: United Healthcare Medicaid |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$1,008.70
|
| Rate for Payer: WPS Commercial |
$1,358.44
|
|
|
Post pelvic ring fx w/o man closed 27197
|
Professional
|
Both
|
$721.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
5184674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.87 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Aetna Commercial |
$684.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$684.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.60
|
| Rate for Payer: Health EOS Commercial |
$656.11
|
| Rate for Payer: HFN Commercial |
$684.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.56
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: Preferred Network Access Commercial |
$684.95
|
| Rate for Payer: Quartz Beloit One Network |
$317.24
|
| Rate for Payer: Quartz Commercial |
$410.97
|
| Rate for Payer: The Alliance Commercial |
$360.50
|
| Rate for Payer: United Healthcare Medicaid |
$90.87
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
Post-TR ABO/Rh
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.59
|
| Rate for Payer: Anthem Medicaid |
$3.09
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$3.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicaid |
$3.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.09
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WMAP Medicaid |
$3.09
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Post-TR ABO/Rh
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Post-Transfusion Reaction ABSC
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
973774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$214.24 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicaid |
$5.38
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Dean Health Medicaid |
$5.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.38
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Medicaid |
$5.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$143.25
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WMAP Medicaid |
$5.38
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
