|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
IP
|
$34.95
|
|
|
Service Code
|
NDC 60687-744-11
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: Cash Price |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$30.06
|
| Rate for Payer: Healthscope Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.71
|
| Rate for Payer: PHP Commercial |
$29.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.46
|
| Rate for Payer: Priority Health SBD |
$22.02
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$306.71
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.23 |
| Max. Negotiated Rate |
$276.04 |
| Rate for Payer: Aetna Commercial |
$260.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.36
|
| Rate for Payer: Cash Price |
$245.37
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.77
|
| Rate for Payer: Healthscope Commercial |
$276.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.70
|
| Rate for Payer: PHP Commercial |
$260.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health SBD |
$193.23
|
|
|
DACARBAZINE 200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$306.71
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
2091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$276.04 |
| Rate for Payer: Aetna Commercial |
$260.70
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: BCBS Complete |
$76.30
|
| Rate for Payer: BCBS Complete |
$26.74
|
| Rate for Payer: BCBS Complete |
$122.68
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: Cash Price |
$245.37
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cash Price |
$245.37
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.77
|
| Rate for Payer: Cofinity Commercial |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$276.04
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.70
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Commercial |
$260.70
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: Priority Health SBD |
$42.12
|
|
|
DALBAVANCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
171111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,874.88 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,529.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,934.40
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cofinity Commercial |
$2,083.20
|
| Rate for Payer: Cofinity Commercial |
$2,559.36
|
| Rate for Payer: Healthscope Commercial |
$2,678.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,529.60
|
| Rate for Payer: PHP Commercial |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,083.20
|
| Rate for Payer: Priority Health SBD |
$1,874.88
|
|
|
DALFAMPRIDINE ER 10 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$9,960.03
|
|
|
Service Code
|
NDC 10144-427-60
|
| Hospital Charge Code |
100796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,274.82 |
| Max. Negotiated Rate |
$8,964.03 |
| Rate for Payer: Aetna Commercial |
$8,466.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,474.02
|
| Rate for Payer: Cash Price |
$7,968.02
|
| Rate for Payer: Cofinity Commercial |
$6,972.02
|
| Rate for Payer: Cofinity Commercial |
$8,565.63
|
| Rate for Payer: Healthscope Commercial |
$8,964.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,466.03
|
| Rate for Payer: PHP Commercial |
$8,466.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,972.02
|
| Rate for Payer: Priority Health SBD |
$6,274.82
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 78670-003-67
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.24
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505-003-67
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.24
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DANTROLENE IVPB
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505-003-67
|
| Hospital Charge Code |
400129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.30
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$153.24
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.08
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.24
|
| Rate for Payer: Priority Health SBD |
$137.92
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,359.42
|
|
|
Service Code
|
NDC 0310-6210-39
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$856.43 |
| Max. Negotiated Rate |
$1,223.48 |
| Rate for Payer: Aetna Commercial |
$1,155.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$883.62
|
| Rate for Payer: Cash Price |
$1,087.54
|
| Rate for Payer: Cofinity Commercial |
$1,169.10
|
| Rate for Payer: Cofinity Commercial |
$951.59
|
| Rate for Payer: Healthscope Commercial |
$1,223.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,155.51
|
| Rate for Payer: PHP Commercial |
$1,155.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$951.59
|
| Rate for Payer: Priority Health SBD |
$856.43
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$138.23
|
|
|
Service Code
|
NDC 70954-135-10
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.85
|
| Rate for Payer: Cash Price |
$110.58
|
| Rate for Payer: Cofinity Commercial |
$118.88
|
| Rate for Payer: Cofinity Commercial |
$96.76
|
| Rate for Payer: Healthscope Commercial |
$124.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.50
|
| Rate for Payer: PHP Commercial |
$117.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.76
|
| Rate for Payer: Priority Health SBD |
$87.08
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$235.55
|
|
|
Service Code
|
NDC 49938-102-30
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.22
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.88
|
| Rate for Payer: Priority Health SBD |
$148.40
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.15
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.18
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$33.64
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,325.80
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$835.25 |
| Max. Negotiated Rate |
$1,193.22 |
| Rate for Payer: Aetna Commercial |
$1,126.93
|
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$1,060.64
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cofinity Commercial |
$928.06
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$101.24
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$35.11
|
| Rate for Payer: Cofinity Commercial |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$1,140.19
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$45.64
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$45.14
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Healthscope Commercial |
$1,193.22
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,126.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.12
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: PHP Commercial |
$1,126.93
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.59
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$31.60
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$91.12
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$835.25
|
| Rate for Payer: Priority Health SBD |
$41.08
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,329.35
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1,196.42 |
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Healthscope Commercial |
$1,196.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.54
|
| Rate for Payer: Priority Health SBD |
$837.49
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$40,737.80
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$36,664.02 |
| Rate for Payer: Aetna Commercial |
$34,627.13
|
| Rate for Payer: Aetna Medicare |
$51.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,479.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.31
|
| Rate for Payer: BCBS Complete |
$28.17
|
| Rate for Payer: BCBS MAPPO |
$49.05
|
| Rate for Payer: BCBS Trust/PPO |
$145.20
|
| Rate for Payer: BCN Medicare Advantage |
$49.05
|
| Rate for Payer: Cash Price |
$32,590.24
|
| Rate for Payer: Cash Price |
$32,590.24
|
| Rate for Payer: Cofinity Commercial |
$35,034.51
|
| Rate for Payer: Cofinity Commercial |
$28,516.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.05
|
| Rate for Payer: Healthscope Commercial |
$36,664.02
|
| Rate for Payer: Mclaren Medicaid |
$26.83
|
| Rate for Payer: Mclaren Medicare |
$49.05
|
| Rate for Payer: Meridian Medicaid |
$28.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,627.13
|
| Rate for Payer: PACE Medicare |
$46.60
|
| Rate for Payer: PACE SWMI |
$49.05
|
| Rate for Payer: PHP Commercial |
$34,627.13
|
| Rate for Payer: PHP Medicare Advantage |
$49.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,516.46
|
| Rate for Payer: Priority Health Medicare |
$49.05
|
| Rate for Payer: Priority Health SBD |
$25,664.81
|
| Rate for Payer: Railroad Medicare Medicare |
$49.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.05
|
| Rate for Payer: UHC Medicare Advantage |
$50.52
|
| Rate for Payer: VA VA |
$49.05
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,922.82
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,361.38 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna Commercial |
$5,884.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,499.83
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cofinity Commercial |
$4,845.97
|
| Rate for Payer: Cofinity Commercial |
$5,953.63
|
| Rate for Payer: Healthscope Commercial |
$6,230.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,884.40
|
| Rate for Payer: PHP Commercial |
$5,884.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.97
|
| Rate for Payer: Priority Health SBD |
$4,361.38
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,130.12
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$1,917.11 |
| Rate for Payer: Aetna Commercial |
$1,810.60
|
| Rate for Payer: Aetna Commercial |
$5,884.40
|
| Rate for Payer: Aetna Medicare |
$64.17
|
| Rate for Payer: Aetna Medicare |
$64.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,499.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.13
|
| Rate for Payer: BCBS Complete |
$35.44
|
| Rate for Payer: BCBS Complete |
$35.44
|
| Rate for Payer: BCBS MAPPO |
$61.70
|
| Rate for Payer: BCBS MAPPO |
$61.70
|
| Rate for Payer: BCBS Trust/PPO |
$182.65
|
| Rate for Payer: BCBS Trust/PPO |
$182.65
|
| Rate for Payer: BCN Medicare Advantage |
$61.70
|
| Rate for Payer: BCN Medicare Advantage |
$61.70
|
| Rate for Payer: Cash Price |
$1,704.10
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cash Price |
$1,704.10
|
| Rate for Payer: Cash Price |
$5,538.26
|
| Rate for Payer: Cofinity Commercial |
$1,491.08
|
| Rate for Payer: Cofinity Commercial |
$1,831.90
|
| Rate for Payer: Cofinity Commercial |
$4,845.97
|
| Rate for Payer: Cofinity Commercial |
$5,953.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.70
|
| Rate for Payer: Healthscope Commercial |
$6,230.54
|
| Rate for Payer: Healthscope Commercial |
$1,917.11
|
| Rate for Payer: Mclaren Medicaid |
$33.75
|
| Rate for Payer: Mclaren Medicaid |
$33.75
|
| Rate for Payer: Mclaren Medicare |
$61.70
|
| Rate for Payer: Mclaren Medicare |
$61.70
|
| Rate for Payer: Meridian Medicaid |
$35.44
|
| Rate for Payer: Meridian Medicaid |
$35.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,810.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,884.40
|
| Rate for Payer: PACE Medicare |
$58.62
|
| Rate for Payer: PACE Medicare |
$58.62
|
| Rate for Payer: PACE SWMI |
$61.70
|
| Rate for Payer: PACE SWMI |
$61.70
|
| Rate for Payer: PHP Commercial |
$5,884.40
|
| Rate for Payer: PHP Commercial |
$1,810.60
|
| Rate for Payer: PHP Medicare Advantage |
$61.70
|
| Rate for Payer: PHP Medicare Advantage |
$61.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.97
|
| Rate for Payer: Priority Health Medicare |
$61.70
|
| Rate for Payer: Priority Health Medicare |
$61.70
|
| Rate for Payer: Priority Health SBD |
$4,361.38
|
| Rate for Payer: Priority Health SBD |
$1,341.98
|
| Rate for Payer: Railroad Medicare Medicare |
$61.70
|
| Rate for Payer: Railroad Medicare Medicare |
$61.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.70
|
| Rate for Payer: UHC Medicare Advantage |
$63.56
|
| Rate for Payer: UHC Medicare Advantage |
$63.56
|
| Rate for Payer: VA VA |
$61.70
|
| Rate for Payer: VA VA |
$61.70
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,519.86 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Cofinity Commercial |
$1,688.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,050.60
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.73
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,039.71 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$3,377.45
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,101.19
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,377.45
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$4,824.93
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$4,342.44 |
| Rate for Payer: Aetna Commercial |
$4,101.19
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cash Price |
$3,859.94
|
| Rate for Payer: Cofinity Commercial |
$4,149.44
|
| Rate for Payer: Cofinity Commercial |
$3,377.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$4,342.44
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,101.19
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$4,101.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,377.45
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$3,039.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$421.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$669.09
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$602.18 |
| Rate for Payer: Aetna Commercial |
$568.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.91
|
| Rate for Payer: Cash Price |
$535.27
|
| Rate for Payer: Cofinity Commercial |
$468.36
|
| Rate for Payer: Cofinity Commercial |
$575.42
|
| Rate for Payer: Healthscope Commercial |
$602.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.73
|
| Rate for Payer: PHP Commercial |
$568.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.36
|
| Rate for Payer: Priority Health SBD |
$421.53
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Cofinity Commercial |
$4,116.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,998.34
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,116.28
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: VA VA |
$2.93
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$5,880.40
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,704.65 |
| Max. Negotiated Rate |
$5,292.36 |
| Rate for Payer: Aetna Commercial |
$4,998.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,822.26
|
| Rate for Payer: Cash Price |
$4,704.32
|
| Rate for Payer: Cofinity Commercial |
$4,116.28
|
| Rate for Payer: Cofinity Commercial |
$5,057.14
|
| Rate for Payer: Healthscope Commercial |
$5,292.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,998.34
|
| Rate for Payer: PHP Commercial |
$4,998.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,116.28
|
| Rate for Payer: Priority Health SBD |
$3,704.65
|
|
