|
HC MOG FACS, S
|
Facility
|
IP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$344.11 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.04
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Advantage |
$382.35
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: Priority Health SBD |
$344.11
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Advantage |
$382.35
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$344.11
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$693.96 |
| Rate for Payer: Aetna Commercial |
$655.41
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$434.91
|
| Rate for Payer: BCN Commercial |
$434.91
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Advantage |
$539.75
|
| Rate for Payer: Cofinity Commercial |
$663.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$693.96
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$655.41
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$485.77
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.20
|
| Rate for Payer: UHC Core |
$401.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$303.03
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$485.77 |
| Max. Negotiated Rate |
$693.96 |
| Rate for Payer: Aetna Commercial |
$655.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.20
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Advantage |
$539.75
|
| Rate for Payer: Cofinity Commercial |
$663.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Healthscope Commercial |
$693.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: PHP Commercial |
$655.41
|
| Rate for Payer: Priority Health SBD |
$485.77
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$415.38 |
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna Medicare |
$133.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.55
|
| Rate for Payer: BCBS Complete |
$70.54
|
| Rate for Payer: BCBS MAPPO |
$128.44
|
| Rate for Payer: BCBS Trust/PPO |
$68.10
|
| Rate for Payer: BCN Commercial |
$68.10
|
| Rate for Payer: BCN Medicare Advantage |
$128.44
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.44
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Mclaren Medicaid |
$67.17
|
| Rate for Payer: Mclaren Medicare |
$128.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$385.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Medicare |
$122.02
|
| Rate for Payer: PACE SWMI |
$128.44
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: PHP Medicare Advantage |
$128.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$415.38
|
| Rate for Payer: Priority Health Medicare |
$128.44
|
| Rate for Payer: Priority Health SBD |
$157.39
|
| Rate for Payer: Priority Health Tiered Network |
$332.30
|
| Rate for Payer: Railroad Medicare Medicare |
$128.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.39
|
| Rate for Payer: UHC Core |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.44
|
| Rate for Payer: UHC Exchange |
$98.18
|
| Rate for Payer: UHC Medicaid |
$67.17
|
| Rate for Payer: UHCCP Medicaid |
$67.17
|
| Rate for Payer: VA VA |
$128.44
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$157.39 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: Priority Health SBD |
$157.39
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna Medicare |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: BCBS Complete |
$178.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.06
|
| Rate for Payer: UHC Core |
$232.50
|
| Rate for Payer: UHC Exchange |
$175.38
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
IP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.14 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Advantage |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$60.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: BCBS Complete |
$48.69
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Advantage |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC MOUSE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC MOUSE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
OP
|
$174.20
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$148.07
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.88
|
| Rate for Payer: BCN Commercial |
$132.88
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$139.36
|
| Rate for Payer: Cash Price |
$139.36
|
| Rate for Payer: Cofinity Advantage |
$121.94
|
| Rate for Payer: Cofinity Commercial |
$149.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$156.78
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.07
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.65
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$148.07
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$109.75
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
IP
|
$174.20
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$156.78 |
| Rate for Payer: Aetna Commercial |
$148.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.23
|
| Rate for Payer: Cash Price |
$139.36
|
| Rate for Payer: Cofinity Advantage |
$121.94
|
| Rate for Payer: Cofinity Commercial |
$149.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.36
|
| Rate for Payer: Healthscope Commercial |
$156.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.65
|
| Rate for Payer: PHP Commercial |
$148.07
|
| Rate for Payer: Priority Health SBD |
$109.75
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
IP
|
$54.86
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
OP
|
$54.86
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: BCBS Complete |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
IP
|
$387.35
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$244.03 |
| Max. Negotiated Rate |
$348.62 |
| Rate for Payer: Aetna Commercial |
$329.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.78
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Cofinity Advantage |
$271.14
|
| Rate for Payer: Cofinity Commercial |
$333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.88
|
| Rate for Payer: Healthscope Commercial |
$348.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.51
|
| Rate for Payer: PHP Commercial |
$329.25
|
| Rate for Payer: Priority Health SBD |
$244.03
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
OP
|
$387.35
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$555.60 |
| Rate for Payer: Aetna Commercial |
$329.25
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: BCBS Complete |
$101.71
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$197.46
|
| Rate for Payer: BCN Commercial |
$197.46
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Cofinity Advantage |
$271.14
|
| Rate for Payer: Cofinity Commercial |
$333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$348.62
|
| Rate for Payer: Mclaren Medicaid |
$96.86
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: Meridian Medicaid |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.25
|
| Rate for Payer: Nomi Health Commercial |
$555.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.51
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$329.25
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$185.20
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health SBD |
$244.03
|
| Rate for Payer: Priority Health Tiered Network |
$148.16
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.80
|
| Rate for Payer: UHC Core |
$277.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.20
|
| Rate for Payer: UHC Exchange |
$277.80
|
| Rate for Payer: UHC Medicaid |
$96.86
|
| Rate for Payer: UHCCP Medicaid |
$96.86
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
IP
|
$612.32
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$385.76 |
| Max. Negotiated Rate |
$551.09 |
| Rate for Payer: Aetna Commercial |
$520.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.01
|
| Rate for Payer: Cash Price |
$489.86
|
| Rate for Payer: Cofinity Advantage |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.86
|
| Rate for Payer: Healthscope Commercial |
$551.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$459.24
|
| Rate for Payer: PHP Commercial |
$520.47
|
| Rate for Payer: Priority Health SBD |
$385.76
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
OP
|
$612.32
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.90 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$520.47
|
| Rate for Payer: Aetna Medicare |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.00
|
| Rate for Payer: BCBS Complete |
$164.76
|
| Rate for Payer: BCBS MAPPO |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$319.86
|
| Rate for Payer: BCN Commercial |
$319.86
|
| Rate for Payer: BCN Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$489.86
|
| Rate for Payer: Cash Price |
$489.86
|
| Rate for Payer: Cofinity Advantage |
$428.62
|
| Rate for Payer: Cofinity Commercial |
$526.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$551.09
|
| Rate for Payer: Mclaren Medicaid |
$156.90
|
| Rate for Payer: Mclaren Medicare |
$300.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.00
|
| Rate for Payer: Meridian Medicaid |
$315.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$330.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.47
|
| Rate for Payer: Nomi Health Commercial |
$900.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$459.24
|
| Rate for Payer: PACE Medicare |
$285.00
|
| Rate for Payer: PACE SWMI |
$300.00
|
| Rate for Payer: PHP Commercial |
$520.47
|
| Rate for Payer: PHP Medicare Advantage |
$300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$300.00
|
| Rate for Payer: Priority Health Medicare |
$300.00
|
| Rate for Payer: Priority Health SBD |
$385.76
|
| Rate for Payer: Priority Health Tiered Network |
$240.00
|
| Rate for Payer: Railroad Medicare Medicare |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.00
|
| Rate for Payer: UHC Core |
$450.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$300.00
|
| Rate for Payer: UHC Exchange |
$450.00
|
| Rate for Payer: UHC Medicaid |
$156.90
|
| Rate for Payer: UHCCP Medicaid |
$156.90
|
| Rate for Payer: VA VA |
$300.00
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$661.13
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.51 |
| Max. Negotiated Rate |
$595.02 |
| Rate for Payer: Aetna Commercial |
$561.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.73
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cofinity Advantage |
$462.79
|
| Rate for Payer: Cofinity Commercial |
$568.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.90
|
| Rate for Payer: Healthscope Commercial |
$595.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.85
|
| Rate for Payer: PHP Commercial |
$561.96
|
| Rate for Payer: Priority Health SBD |
$416.51
|
|
