|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,229.93 |
| Max. Negotiated Rate |
$7,717.55 |
| Rate for Payer: Aetna Commercial |
$7,288.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,626.81
|
| Rate for Payer: BCN Commercial |
$6,626.81
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$7,374.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,860.05
|
| Rate for Payer: Healthscope Commercial |
$7,717.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,431.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: PHP Commercial |
$7,288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,460.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,229.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,546.05
|
| Rate for Payer: UHC Core |
$7,160.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,431.30
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,036.58 |
| Max. Negotiated Rate |
$7,717.55 |
| Rate for Payer: Aetna Commercial |
$7,288.80
|
| Rate for Payer: Aetna Medicare |
$2,229.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,679.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,679.71
|
| Rate for Payer: BCBS Complete |
$3,430.02
|
| Rate for Payer: BCBS MAPPO |
$2,143.76
|
| Rate for Payer: BCBS Trust/PPO |
$6,667.11
|
| Rate for Payer: BCN Commercial |
$6,667.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,143.76
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$7,374.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,860.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,143.76
|
| Rate for Payer: Healthscope Commercial |
$7,717.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,431.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,250.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,465.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: PACE Senior Care Partners |
$2,036.58
|
| Rate for Payer: PACE SWMI |
$2,143.76
|
| Rate for Payer: PHP Commercial |
$7,288.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,143.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,460.30
|
| Rate for Payer: Priority Health Medicare |
$2,143.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2,143.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,546.05
|
| Rate for Payer: UHC Core |
$7,160.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,143.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,208.08
|
| Rate for Payer: VA VA |
$2,143.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,431.30
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.35
|
| Rate for Payer: BCN Commercial |
$41.35
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$41.60
|
| Rate for Payer: BCN Commercial |
$41.60
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE SWMI |
$13.38
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.55
|
| Rate for Payer: Priority Health Medicare |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: BCN Commercial |
$69.01
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.91
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$69.43
|
| Rate for Payer: BCN Commercial |
$69.43
|
| Rate for Payer: BCN Medicare Advantage |
$22.32
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PACE Senior Care Partners |
$21.21
|
| Rate for Payer: PACE SWMI |
$22.32
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.69
|
| Rate for Payer: Priority Health Medicare |
$22.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.46
|
| Rate for Payer: Railroad Medicare Medicare |
$22.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.32
|
| Rate for Payer: UHC Medicare Advantage |
$22.99
|
| Rate for Payer: VA VA |
$22.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna Medicare |
$92.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.65
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$88.52
|
| Rate for Payer: BCBS Trust/PPO |
$275.29
|
| Rate for Payer: BCN Commercial |
$275.29
|
| Rate for Payer: BCN Medicare Advantage |
$88.52
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.55
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Senior Care Partners |
$84.09
|
| Rate for Payer: PACE SWMI |
$88.52
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: PHP Medicare Advantage |
$88.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.04
|
| Rate for Payer: Priority Health Medicare |
$88.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.95
|
| Rate for Payer: Railroad Medicare Medicare |
$88.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.58
|
| Rate for Payer: UHC Core |
$295.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.52
|
| Rate for Payer: UHC Medicare Advantage |
$91.17
|
| Rate for Payer: VA VA |
$88.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.55
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.95 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: BCBS Trust/PPO |
$273.63
|
| Rate for Payer: BCN Commercial |
$273.63
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.58
|
| Rate for Payer: UHC Core |
$295.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.55
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.05 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: BCBS Trust/PPO |
$206.60
|
| Rate for Payer: BCN Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.26
|
| Rate for Payer: UHC Core |
$223.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.50
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.49 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna Medicare |
$69.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.54
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$66.84
|
| Rate for Payer: BCBS Trust/PPO |
$207.86
|
| Rate for Payer: BCN Commercial |
$207.86
|
| Rate for Payer: BCN Medicare Advantage |
$66.84
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.50
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Senior Care Partners |
$63.49
|
| Rate for Payer: PACE SWMI |
$66.84
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: PHP Medicare Advantage |
$66.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.59
|
| Rate for Payer: Priority Health Medicare |
$66.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.05
|
| Rate for Payer: Railroad Medicare Medicare |
$66.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.26
|
| Rate for Payer: UHC Core |
$223.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.84
|
| Rate for Payer: UHC Medicare Advantage |
$68.84
|
| Rate for Payer: VA VA |
$66.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.50
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$137.89 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.07
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$36.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.14
|
| Rate for Payer: BCN Commercial |
$112.14
|
| Rate for Payer: BCN Medicare Advantage |
$36.06
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.17
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Senior Care Partners |
$34.25
|
| Rate for Payer: PACE SWMI |
$36.06
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: PHP Medicare Advantage |
$36.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.97
|
| Rate for Payer: Railroad Medicare Medicare |
$36.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.92
|
| Rate for Payer: UHC Core |
$120.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.06
|
| Rate for Payer: UHC Medicare Advantage |
$37.14
|
| Rate for Payer: VA VA |
$36.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.17
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.46
|
| Rate for Payer: BCN Commercial |
$111.46
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.92
|
| Rate for Payer: UHC Core |
$120.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.17
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.57 |
| Max. Negotiated Rate |
$491.01 |
| Rate for Payer: Aetna Commercial |
$463.73
|
| Rate for Payer: Aetna Medicare |
$141.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.49
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$136.39
|
| Rate for Payer: BCBS Trust/PPO |
$424.18
|
| Rate for Payer: BCN Commercial |
$424.18
|
| Rate for Payer: BCN Medicare Advantage |
$136.39
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$469.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.39
|
| Rate for Payer: Healthscope Commercial |
$491.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.18
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: PACE Senior Care Partners |
$129.57
|
| Rate for Payer: PACE SWMI |
$136.39
|
| Rate for Payer: PHP Commercial |
$463.73
|
| Rate for Payer: PHP Medicare Advantage |
$136.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.65
|
| Rate for Payer: Priority Health Medicare |
$136.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.74
|
| Rate for Payer: Railroad Medicare Medicare |
$136.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.10
|
| Rate for Payer: UHC Core |
$455.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.39
|
| Rate for Payer: UHC Medicare Advantage |
$140.48
|
| Rate for Payer: VA VA |
$136.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.18
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$491.01 |
| Rate for Payer: Aetna Commercial |
$463.73
|
| Rate for Payer: BCBS Trust/PPO |
$421.62
|
| Rate for Payer: BCN Commercial |
$421.62
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$469.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.46
|
| Rate for Payer: Healthscope Commercial |
$491.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: PHP Commercial |
$463.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.10
|
| Rate for Payer: UHC Core |
$455.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.18
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,145.90
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$908.96 |
| Max. Negotiated Rate |
$4,631.31 |
| Rate for Payer: Aetna Commercial |
$4,374.02
|
| Rate for Payer: Aetna Commercial |
$7,532.70
|
| Rate for Payer: Aetna Medicare |
$2,304.12
|
| Rate for Payer: Aetna Medicare |
$1,337.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,769.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,608.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,608.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,769.38
|
| Rate for Payer: BCBS Complete |
$954.41
|
| Rate for Payer: BCBS Complete |
$954.41
|
| Rate for Payer: BCBS MAPPO |
$1,286.48
|
| Rate for Payer: BCBS MAPPO |
$2,215.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,890.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,000.94
|
| Rate for Payer: BCN Commercial |
$6,890.20
|
| Rate for Payer: BCN Commercial |
$4,000.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,215.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,286.48
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cofinity Commercial |
$7,621.32
|
| Rate for Payer: Cofinity Commercial |
$4,425.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,116.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,089.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,286.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,215.50
|
| Rate for Payer: Healthscope Commercial |
$7,975.80
|
| Rate for Payer: Healthscope Commercial |
$4,631.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,859.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,646.50
|
| Rate for Payer: Mclaren Medicaid |
$908.96
|
| Rate for Payer: Mclaren Medicaid |
$908.96
|
| Rate for Payer: Meridian Medicaid |
$954.41
|
| Rate for Payer: Meridian Medicaid |
$954.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,326.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,350.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,547.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,479.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,374.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,532.70
|
| Rate for Payer: PACE Senior Care Partners |
$1,222.15
|
| Rate for Payer: PACE Senior Care Partners |
$2,104.72
|
| Rate for Payer: PACE SWMI |
$1,286.48
|
| Rate for Payer: PACE SWMI |
$2,215.50
|
| Rate for Payer: PHP Commercial |
$4,374.02
|
| Rate for Payer: PHP Commercial |
$7,532.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,286.48
|
| Rate for Payer: PHP Medicare Advantage |
$2,215.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,602.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,203.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,709.94
|
| Rate for Payer: Priority Health Medicare |
$2,215.50
|
| Rate for Payer: Priority Health Medicare |
$1,286.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,404.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,138.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,286.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,215.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,528.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,798.56
|
| Rate for Payer: UHC Core |
$4,296.83
|
| Rate for Payer: UHC Core |
$7,399.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,215.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,286.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,325.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,281.96
|
| Rate for Payer: VA VA |
$2,215.50
|
| Rate for Payer: VA VA |
$1,286.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,859.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,646.50
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$8,862.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,404.93 |
| Max. Negotiated Rate |
$7,975.80 |
| Rate for Payer: Aetna Commercial |
$7,532.70
|
| Rate for Payer: Aetna Commercial |
$4,374.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,848.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,976.75
|
| Rate for Payer: BCN Commercial |
$3,976.75
|
| Rate for Payer: BCN Commercial |
$6,848.55
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cofinity Commercial |
$4,425.47
|
| Rate for Payer: Cofinity Commercial |
$7,621.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,089.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,116.72
|
| Rate for Payer: Healthscope Commercial |
$7,975.80
|
| Rate for Payer: Healthscope Commercial |
$4,631.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,646.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,859.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,532.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,374.02
|
| Rate for Payer: PHP Commercial |
$7,532.70
|
| Rate for Payer: PHP Commercial |
$4,374.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,602.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,203.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,709.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,404.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,138.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,528.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,798.56
|
| Rate for Payer: UHC Core |
$4,296.83
|
| Rate for Payer: UHC Core |
$7,399.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,646.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,859.42
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,673.82
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,506.44 |
| Rate for Payer: Aetna Commercial |
$1,422.75
|
| Rate for Payer: Aetna Commercial |
$2,601.85
|
| Rate for Payer: Aetna Medicare |
$795.86
|
| Rate for Payer: Aetna Medicare |
$435.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$956.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$523.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$523.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$956.56
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS MAPPO |
$418.46
|
| Rate for Payer: BCBS MAPPO |
$765.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.93
|
| Rate for Payer: BCN Commercial |
$1,301.40
|
| Rate for Payer: BCN Commercial |
$2,379.93
|
| Rate for Payer: BCN Medicare Advantage |
$765.25
|
| Rate for Payer: BCN Medicare Advantage |
$418.46
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cofinity Commercial |
$1,439.49
|
| Rate for Payer: Cofinity Commercial |
$2,632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,339.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.46
|
| Rate for Payer: Healthscope Commercial |
$2,754.90
|
| Rate for Payer: Healthscope Commercial |
$1,506.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,255.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.75
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$439.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$803.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$481.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$880.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,422.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.85
|
| Rate for Payer: PACE Senior Care Partners |
$726.99
|
| Rate for Payer: PACE Senior Care Partners |
$397.53
|
| Rate for Payer: PACE SWMI |
$418.46
|
| Rate for Payer: PACE SWMI |
$765.25
|
| Rate for Payer: PHP Commercial |
$1,422.75
|
| Rate for Payer: PHP Commercial |
$2,601.85
|
| Rate for Payer: PHP Medicare Advantage |
$765.25
|
| Rate for Payer: PHP Medicare Advantage |
$418.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,663.07
|
| Rate for Payer: Priority Health Medicare |
$418.46
|
| Rate for Payer: Priority Health Medicare |
$765.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,866.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,020.86
|
| Rate for Payer: Railroad Medicare Medicare |
$765.25
|
| Rate for Payer: Railroad Medicare Medicare |
$418.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,472.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,693.68
|
| Rate for Payer: UHC Core |
$2,555.94
|
| Rate for Payer: UHC Core |
$1,397.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.25
|
| Rate for Payer: UHC Medicare Advantage |
$431.01
|
| Rate for Payer: UHC Medicare Advantage |
$788.21
|
| Rate for Payer: VA VA |
$418.46
|
| Rate for Payer: VA VA |
$765.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,255.36
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,673.82
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,020.86 |
| Max. Negotiated Rate |
$1,506.44 |
| Rate for Payer: Aetna Commercial |
$1,422.75
|
| Rate for Payer: Aetna Commercial |
$2,601.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,365.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.53
|
| Rate for Payer: BCN Commercial |
$2,365.54
|
| Rate for Payer: BCN Commercial |
$1,293.53
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,439.49
|
| Rate for Payer: Cofinity Commercial |
$2,632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,339.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.80
|
| Rate for Payer: Healthscope Commercial |
$2,754.90
|
| Rate for Payer: Healthscope Commercial |
$1,506.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,255.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,422.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.85
|
| Rate for Payer: PHP Commercial |
$1,422.75
|
| Rate for Payer: PHP Commercial |
$2,601.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,663.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,020.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,866.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,472.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,693.68
|
| Rate for Payer: UHC Core |
$1,397.64
|
| Rate for Payer: UHC Core |
$2,555.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,255.36
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,611.36 |
| Max. Negotiated Rate |
$2,377.80 |
| Rate for Payer: Aetna Commercial |
$2,245.70
|
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,041.74
|
| Rate for Payer: BCBS Trust/PPO |
$904.18
|
| Rate for Payer: BCN Commercial |
$2,041.74
|
| Rate for Payer: BCN Commercial |
$904.18
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$2,272.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.60
|
| Rate for Payer: Healthscope Commercial |
$2,377.80
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,245.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: PHP Commercial |
$2,245.70
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,298.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,611.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,324.96
|
| Rate for Payer: UHC Core |
$976.95
|
| Rate for Payer: UHC Core |
$2,206.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.50
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna Commercial |
$2,245.70
|
| Rate for Payer: Aetna Medicare |
$304.20
|
| Rate for Payer: Aetna Medicare |
$686.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$825.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$825.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.62
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS MAPPO |
$660.50
|
| Rate for Payer: BCBS MAPPO |
$292.50
|
| Rate for Payer: BCBS Trust/PPO |
$909.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.16
|
| Rate for Payer: BCN Commercial |
$2,054.16
|
| Rate for Payer: BCN Commercial |
$909.68
|
| Rate for Payer: BCN Medicare Advantage |
$660.50
|
| Rate for Payer: BCN Medicare Advantage |
$292.50
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$2,272.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.50
|
| Rate for Payer: Healthscope Commercial |
$2,377.80
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.50
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$307.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$693.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$759.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,245.70
|
| Rate for Payer: PACE Senior Care Partners |
$627.48
|
| Rate for Payer: PACE Senior Care Partners |
$277.88
|
| Rate for Payer: PACE SWMI |
$292.50
|
| Rate for Payer: PACE SWMI |
$660.50
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: PHP Commercial |
$2,245.70
|
| Rate for Payer: PHP Medicare Advantage |
$660.50
|
| Rate for Payer: PHP Medicare Advantage |
$292.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,298.54
|
| Rate for Payer: Priority Health Medicare |
$292.50
|
| Rate for Payer: Priority Health Medicare |
$660.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,611.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.58
|
| Rate for Payer: Railroad Medicare Medicare |
$660.50
|
| Rate for Payer: Railroad Medicare Medicare |
$292.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,324.96
|
| Rate for Payer: UHC Core |
$976.95
|
| Rate for Payer: UHC Core |
$2,206.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$660.50
|
| Rate for Payer: UHC Medicare Advantage |
$680.32
|
| Rate for Payer: UHC Medicare Advantage |
$301.28
|
| Rate for Payer: VA VA |
$292.50
|
| Rate for Payer: VA VA |
$660.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.50
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$1,431.90 |
| Rate for Payer: Aetna Commercial |
$1,352.35
|
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna Medicare |
$185.64
|
| Rate for Payer: Aetna Medicare |
$413.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.12
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS MAPPO |
$178.50
|
| Rate for Payer: BCBS MAPPO |
$397.75
|
| Rate for Payer: BCBS Trust/PPO |
$555.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.00
|
| Rate for Payer: BCN Commercial |
$555.14
|
| Rate for Payer: BCN Commercial |
$1,237.00
|
| Rate for Payer: BCN Medicare Advantage |
$397.75
|
| Rate for Payer: BCN Medicare Advantage |
$178.50
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Commercial |
$1,368.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$1,431.90
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.25
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$417.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$457.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.35
|
| Rate for Payer: PACE Senior Care Partners |
$169.58
|
| Rate for Payer: PACE Senior Care Partners |
$377.86
|
| Rate for Payer: PACE SWMI |
$397.75
|
| Rate for Payer: PACE SWMI |
$178.50
|
| Rate for Payer: PHP Commercial |
$1,352.35
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: PHP Medicare Advantage |
$397.75
|
| Rate for Payer: PHP Medicare Advantage |
$178.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$621.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.17
|
| Rate for Payer: Priority Health Medicare |
$397.75
|
| Rate for Payer: Priority Health Medicare |
$178.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$435.47
|
| Rate for Payer: Railroad Medicare Medicare |
$397.75
|
| Rate for Payer: Railroad Medicare Medicare |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.08
|
| Rate for Payer: UHC Core |
$1,328.48
|
| Rate for Payer: UHC Core |
$596.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.50
|
| Rate for Payer: UHC Medicare Advantage |
$183.86
|
| Rate for Payer: UHC Medicare Advantage |
$409.68
|
| Rate for Payer: VA VA |
$397.75
|
| Rate for Payer: VA VA |
$178.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.25
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$970.35 |
| Max. Negotiated Rate |
$1,431.90 |
| Rate for Payer: Aetna Commercial |
$1,352.35
|
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: BCBS Trust/PPO |
$551.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.52
|
| Rate for Payer: BCN Commercial |
$551.78
|
| Rate for Payer: BCN Commercial |
$1,229.52
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$1,368.26
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$1,431.90
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,193.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: PHP Commercial |
$1,352.35
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$621.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$435.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.32
|
| Rate for Payer: UHC Core |
$596.19
|
| Rate for Payer: UHC Core |
$1,328.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,193.25
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,595.58 |
| Max. Negotiated Rate |
$3,830.18 |
| Rate for Payer: Aetna Commercial |
$3,617.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,288.84
|
| Rate for Payer: BCN Commercial |
$3,288.84
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$3,659.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,404.60
|
| Rate for Payer: Healthscope Commercial |
$3,830.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,191.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: PHP Commercial |
$3,617.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,702.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,595.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,745.06
|
| Rate for Payer: UHC Core |
$3,553.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,191.81
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,010.74 |
| Max. Negotiated Rate |
$5,851.75 |
| Rate for Payer: Aetna Commercial |
$3,617.39
|
| Rate for Payer: Aetna Medicare |
$1,106.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,329.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,329.92
|
| Rate for Payer: BCBS Complete |
$5,851.75
|
| Rate for Payer: BCBS MAPPO |
$1,063.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,308.85
|
| Rate for Payer: BCN Commercial |
$3,308.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.94
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$3,659.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,404.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.94
|
| Rate for Payer: Healthscope Commercial |
$3,830.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,191.81
|
| Rate for Payer: Mclaren Medicaid |
$5,573.10
|
| Rate for Payer: Meridian Medicaid |
$5,851.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,117.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,223.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: PACE Senior Care Partners |
$1,010.74
|
| Rate for Payer: PACE SWMI |
$1,063.94
|
| Rate for Payer: PHP Commercial |
$3,617.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,573.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,702.50
|
| Rate for Payer: Priority Health Medicare |
$1,063.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,595.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,063.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,745.06
|
| Rate for Payer: UHC Core |
$3,553.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,095.86
|
| Rate for Payer: VA VA |
$1,063.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,191.81
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$398.84 |
| Rate for Payer: Aetna Commercial |
$376.68
|
| Rate for Payer: Aetna Medicare |
$115.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.48
|
| Rate for Payer: BCBS Complete |
$177.26
|
| Rate for Payer: BCBS MAPPO |
$110.79
|
| Rate for Payer: BCBS Trust/PPO |
$344.55
|
| Rate for Payer: BCN Commercial |
$344.55
|
| Rate for Payer: BCN Medicare Advantage |
$110.79
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$381.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.79
|
| Rate for Payer: Healthscope Commercial |
$398.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: PACE Senior Care Partners |
$105.25
|
| Rate for Payer: PACE SWMI |
$110.79
|
| Rate for Payer: PHP Commercial |
$376.68
|
| Rate for Payer: PHP Medicare Advantage |
$110.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.54
|
| Rate for Payer: Priority Health Medicare |
$110.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.28
|
| Rate for Payer: Railroad Medicare Medicare |
$110.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.97
|
| Rate for Payer: UHC Core |
$370.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.79
|
| Rate for Payer: UHC Medicare Advantage |
$114.11
|
| Rate for Payer: VA VA |
$110.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.36
|
|
