|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BILAT CONT
|
Facility
|
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 64489
|
| Hospital Charge Code |
37000032
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,260.63 |
| Max. Negotiated Rate |
$1,800.90 |
| Rate for Payer: Aetna Commercial |
$1,700.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.65
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cofinity Advantage |
$1,400.70
|
| Rate for Payer: Cofinity Commercial |
$1,720.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,600.80
|
| Rate for Payer: Healthscope Commercial |
$1,800.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,700.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,500.75
|
| Rate for Payer: PHP Commercial |
$1,700.85
|
| Rate for Payer: Priority Health SBD |
$1,260.63
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BILAT CONT
|
Facility
|
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 64489
|
| Hospital Charge Code |
37000032
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$469.96 |
| Max. Negotiated Rate |
$1,800.90 |
| Rate for Payer: Aetna Commercial |
$1,700.85
|
| Rate for Payer: Aetna Medicare |
$1,000.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.65
|
| Rate for Payer: BCBS Complete |
$800.40
|
| Rate for Payer: BCBS Trust/PPO |
$469.96
|
| Rate for Payer: BCN Commercial |
$469.96
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cofinity Advantage |
$1,400.70
|
| Rate for Payer: Cofinity Commercial |
$1,720.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,600.80
|
| Rate for Payer: Healthscope Commercial |
$1,800.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,700.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,500.75
|
| Rate for Payer: PHP Commercial |
$1,700.85
|
| Rate for Payer: Priority Health SBD |
$1,260.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,300.65
|
| Rate for Payer: UHC Core |
$1,042.52
|
| Rate for Payer: UHC Exchange |
$786.39
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
OP
|
$1,218.27
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$1,096.44 |
| Rate for Payer: Aetna Commercial |
$1,035.53
|
| Rate for Payer: Aetna Medicare |
$609.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.88
|
| Rate for Payer: BCBS Complete |
$487.31
|
| Rate for Payer: BCBS Trust/PPO |
$320.44
|
| Rate for Payer: BCN Commercial |
$320.44
|
| Rate for Payer: Cash Price |
$974.62
|
| Rate for Payer: Cash Price |
$974.62
|
| Rate for Payer: Cofinity Advantage |
$852.79
|
| Rate for Payer: Cofinity Commercial |
$1,047.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.62
|
| Rate for Payer: Healthscope Commercial |
$1,096.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$974.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.70
|
| Rate for Payer: PHP Commercial |
$1,035.53
|
| Rate for Payer: Priority Health SBD |
$767.51
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
IP
|
$1,218.27
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$767.51 |
| Max. Negotiated Rate |
$1,096.44 |
| Rate for Payer: Aetna Commercial |
$1,035.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.88
|
| Rate for Payer: Cash Price |
$974.62
|
| Rate for Payer: Cofinity Advantage |
$852.79
|
| Rate for Payer: Cofinity Commercial |
$1,047.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.62
|
| Rate for Payer: Healthscope Commercial |
$1,096.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.70
|
| Rate for Payer: PHP Commercial |
$1,035.53
|
| Rate for Payer: Priority Health SBD |
$767.51
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNILAT CONT
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 64487
|
| Hospital Charge Code |
37000031
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$840.42 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna Commercial |
$1,133.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.10
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Cofinity Advantage |
$933.80
|
| Rate for Payer: Cofinity Commercial |
$1,147.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.20
|
| Rate for Payer: Healthscope Commercial |
$1,200.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.50
|
| Rate for Payer: PHP Commercial |
$1,133.90
|
| Rate for Payer: Priority Health SBD |
$840.42
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNILAT CONT
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 64487
|
| Hospital Charge Code |
37000031
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna Commercial |
$1,133.90
|
| Rate for Payer: Aetna Medicare |
$667.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.10
|
| Rate for Payer: BCBS Complete |
$533.60
|
| Rate for Payer: BCBS Trust/PPO |
$354.80
|
| Rate for Payer: BCN Commercial |
$354.80
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Cash Price |
$1,067.20
|
| Rate for Payer: Cofinity Advantage |
$933.80
|
| Rate for Payer: Cofinity Commercial |
$1,147.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.20
|
| Rate for Payer: Healthscope Commercial |
$1,200.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,067.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,000.50
|
| Rate for Payer: PHP Commercial |
$1,133.90
|
| Rate for Payer: Priority Health SBD |
$840.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.10
|
| Rate for Payer: UHC Core |
$695.01
|
| Rate for Payer: UHC Exchange |
$524.26
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
OP
|
$5,001.20
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$999.34 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$999.34
|
| Rate for Payer: BCN Commercial |
$999.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$4,000.96
|
| Rate for Payer: Cash Price |
$4,000.96
|
| Rate for Payer: Cash Price |
$4,000.96
|
| Rate for Payer: Cofinity Advantage |
$3,500.84
|
| Rate for Payer: Cofinity Commercial |
$4,301.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$4,501.08
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,251.02
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,750.90
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$4,251.02
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health SBD |
$3,150.76
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,250.78
|
| Rate for Payer: UHC Core |
$2,605.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$1,965.47
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
IP
|
$5,001.20
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,150.76 |
| Max. Negotiated Rate |
$4,501.08 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.78
|
| Rate for Payer: Cash Price |
$4,000.96
|
| Rate for Payer: Cofinity Advantage |
$3,500.84
|
| Rate for Payer: Cofinity Commercial |
$4,301.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.96
|
| Rate for Payer: Healthscope Commercial |
$4,501.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,251.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,750.90
|
| Rate for Payer: PHP Commercial |
$4,251.02
|
| Rate for Payer: Priority Health SBD |
$3,150.76
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
IP
|
$4,328.18
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,726.75 |
| Max. Negotiated Rate |
$3,895.36 |
| Rate for Payer: Aetna Commercial |
$3,678.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,813.32
|
| Rate for Payer: Cash Price |
$3,462.54
|
| Rate for Payer: Cofinity Advantage |
$3,029.73
|
| Rate for Payer: Cofinity Commercial |
$3,722.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.54
|
| Rate for Payer: Healthscope Commercial |
$3,895.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,246.14
|
| Rate for Payer: PHP Commercial |
$3,678.95
|
| Rate for Payer: Priority Health SBD |
$2,726.75
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
OP
|
$4,328.18
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$3,678.95
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,813.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$726.80
|
| Rate for Payer: BCN Commercial |
$726.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,462.54
|
| Rate for Payer: Cash Price |
$3,462.54
|
| Rate for Payer: Cash Price |
$3,462.54
|
| Rate for Payer: Cofinity Advantage |
$3,029.73
|
| Rate for Payer: Cofinity Commercial |
$3,722.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$3,895.36
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.95
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,246.14
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$3,678.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,726.75
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,813.32
|
| Rate for Payer: UHC Core |
$2,254.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$1,700.97
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Advantage |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.16
|
| Rate for Payer: BCBS Complete |
$17.21
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCBS Trust/PPO |
$33.41
|
| Rate for Payer: BCN Commercial |
$33.41
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Advantage |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$16.39
|
| Rate for Payer: Mclaren Medicare |
$31.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Meridian Medicaid |
$32.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PACE Medicare |
$29.76
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.33
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Priority Health Tiered Network |
$25.06
|
| Rate for Payer: Railroad Medicare Medicare |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.00
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.33
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$16.39
|
| Rate for Payer: UHCCP Medicaid |
$16.39
|
| Rate for Payer: VA VA |
$31.33
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$39.72 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Mclaren Medicaid |
$6.92
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$39.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.24
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: Priority Health Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.86
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$19.86
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY FT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Mclaren Medicaid |
$6.92
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$39.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.24
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$45.23
|
| Rate for Payer: Priority Health Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.86
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$19.86
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY FT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.23 |
| Max. Negotiated Rate |
$64.61 |
| Rate for Payer: Aetna Commercial |
$61.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Advantage |
$50.25
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.84
|
| Rate for Payer: PHP Commercial |
$61.02
|
| Rate for Payer: Priority Health SBD |
$45.23
|
|
|
HC TRIAD CREAM
|
Facility
|
OP
|
$28.25
|
|
| Hospital Charge Code |
27000605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$14.72
|
| Rate for Payer: UHC Exchange |
$11.10
|
|
|
HC TRIAD CREAM
|
Facility
|
IP
|
$28.25
|
|
| Hospital Charge Code |
27000605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
30600222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Advantage |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$43.46
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$68.98
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30600206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Advantage |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$43.46
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
30600222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Advantage |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health SBD |
$43.46
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$68.98
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30600206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$58.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.84
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cofinity Advantage |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.73
|
| Rate for Payer: PHP Commercial |
$58.63
|
| Rate for Payer: Priority Health SBD |
$43.46
|
|
|
HC TRIGGER POINT INJ
|
Facility
|
OP
|
$456.30
|
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$410.67 |
| Rate for Payer: Aetna Commercial |
$387.86
|
| Rate for Payer: Aetna Medicare |
$228.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.60
|
| Rate for Payer: BCBS Complete |
$182.52
|
| Rate for Payer: Cash Price |
$365.04
|
| Rate for Payer: Cash Price |
$365.04
|
| Rate for Payer: Cofinity Advantage |
$319.41
|
| Rate for Payer: Cofinity Commercial |
$392.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.04
|
| Rate for Payer: Healthscope Commercial |
$410.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.23
|
| Rate for Payer: PHP Commercial |
$387.86
|
| Rate for Payer: Priority Health SBD |
$287.47
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC TRIGGER POINT INJ
|
Facility
|
IP
|
$456.30
|
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.47 |
| Max. Negotiated Rate |
$410.67 |
| Rate for Payer: Aetna Commercial |
$387.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.60
|
| Rate for Payer: Cash Price |
$365.04
|
| Rate for Payer: Cofinity Advantage |
$319.41
|
| Rate for Payer: Cofinity Commercial |
$392.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.04
|
| Rate for Payer: Healthscope Commercial |
$410.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.23
|
| Rate for Payer: PHP Commercial |
$387.86
|
| Rate for Payer: Priority Health SBD |
$287.47
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$22.09
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$19.88 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.17
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$17.67
|
| Rate for Payer: Cash Price |
$17.67
|
| Rate for Payer: Cofinity Advantage |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$19.88
|
| Rate for Payer: Mclaren Medicaid |
$3.00
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.78
|
| Rate for Payer: Nomi Health Commercial |
$17.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.57
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$18.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.74
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: Priority Health Tiered Network |
$4.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.61
|
| Rate for Payer: UHC Core |
$8.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.74
|
| Rate for Payer: UHC Exchange |
$8.61
|
| Rate for Payer: UHC Medicaid |
$3.00
|
| Rate for Payer: UHCCP Medicaid |
$3.00
|
| Rate for Payer: VA VA |
$5.74
|
|
