|
HC POC URINE PREG TEST
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna American Axle |
$18.93
|
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna American Axle |
$33.35
|
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: UMR Bronson Commercial |
$22.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna American Axle |
$33.35
|
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.28
|
| Rate for Payer: BCBS Complete |
$3.28
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Mclaren Medicaid |
$3.12
|
| Rate for Payer: Mclaren Medicare |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Meridian Medicaid |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PACE Medicare |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Exchange |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: UHCCP Medicaid |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.98
|
| Rate for Payer: VA VA |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna American Axle |
$178.21
|
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna Medicare |
$137.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: BCBS Complete |
$109.67
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health SBD |
$172.73
|
| Rate for Payer: UMR Bronson Commercial |
$101.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.63 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna American Axle |
$178.21
|
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health SBD |
$172.73
|
| Rate for Payer: UMR Bronson Commercial |
$120.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna American Axle |
$28.27
|
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health SBD |
$27.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna American Axle |
$28.27
|
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health SBD |
$27.40
|
| Rate for Payer: UMR Bronson Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.75 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna American Axle |
$347.41
|
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Aetna Medicare |
$267.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.41
|
| Rate for Payer: BCBS Complete |
$213.79
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$374.13
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health SBD |
$336.72
|
| Rate for Payer: UMR Bronson Commercial |
$197.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.85
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$235.17 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna American Axle |
$347.41
|
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.41
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$374.13
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health SBD |
$336.72
|
| Rate for Payer: UMR Bronson Commercial |
$235.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.85
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna American Axle |
$118.77
|
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: Aetna Medicare |
$91.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.77
|
| Rate for Payer: BCBS Complete |
$73.09
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health SBD |
$115.12
|
| Rate for Payer: UMR Bronson Commercial |
$67.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.05
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna American Axle |
$118.77
|
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.77
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health SBD |
$115.12
|
| Rate for Payer: UMR Bronson Commercial |
$80.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.05
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna American Axle |
$21.64
|
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
| Rate for Payer: UMR Bronson Commercial |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$41.41 |
| Rate for Payer: Aetna American Axle |
$21.64
|
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health SBD |
$20.97
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.71
|
| Rate for Payer: UHC Exchange |
$28.11
|
| Rate for Payer: UHC Medicare Advantage |
$14.71
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: VA VA |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Exchange |
$16.13
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: UMR Bronson Commercial |
$11.70
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: UMR Bronson Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$98.93 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna American Axle |
$359.77
|
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$387.44
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$498.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.12
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$470.47
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$348.70
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$682.30
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: UMR Bronson Commercial |
$204.79
|
| Rate for Payer: VA VA |
$357.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.12
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.54 |
| Max. Negotiated Rate |
$498.14 |
| Rate for Payer: Aetna American Axle |
$359.77
|
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.77
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$387.44
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Healthscope Commercial |
$498.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: PHP Commercial |
$470.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health SBD |
$348.70
|
| Rate for Payer: UMR Bronson Commercial |
$243.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.12
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,889.42 |
| Rate for Payer: Aetna American Axle |
$1,058.93
|
| Rate for Payer: Aetna Commercial |
$1,384.76
|
| Rate for Payer: Aetna Medicare |
$698.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$839.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$839.02
|
| Rate for Payer: BCBS Complete |
$377.76
|
| Rate for Payer: BCBS MAPPO |
$671.22
|
| Rate for Payer: BCN Medicare Advantage |
$671.22
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,401.05
|
| Rate for Payer: Cofinity Commercial |
$1,140.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,140.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.22
|
| Rate for Payer: Healthscope Commercial |
$1,466.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,140.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,221.85
|
| Rate for Payer: Mclaren Medicaid |
$359.77
|
| Rate for Payer: Mclaren Medicare |
$671.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.78
|
| Rate for Payer: Meridian Medicaid |
$377.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$771.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: PACE Medicare |
$637.66
|
| Rate for Payer: PACE SWMI |
$671.22
|
| Rate for Payer: PHP Commercial |
$1,384.76
|
| Rate for Payer: PHP Medicare Advantage |
$671.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health Medicare |
$671.22
|
| Rate for Payer: Priority Health SBD |
$1,026.35
|
| Rate for Payer: Railroad Medicare Medicare |
$671.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,889.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.22
|
| Rate for Payer: UHC Exchange |
$1,282.77
|
| Rate for Payer: UHC Medicare Advantage |
$671.22
|
| Rate for Payer: UHCCP Medicaid |
$359.77
|
| Rate for Payer: UMR Bronson Commercial |
$602.78
|
| Rate for Payer: VA VA |
$671.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,221.85
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$716.82 |
| Max. Negotiated Rate |
$1,466.22 |
| Rate for Payer: Aetna American Axle |
$1,058.93
|
| Rate for Payer: Aetna Commercial |
$1,384.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.93
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,140.39
|
| Rate for Payer: Cofinity Commercial |
$1,401.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,140.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Healthscope Commercial |
$1,466.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,140.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,221.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: PHP Commercial |
$1,384.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health SBD |
$1,026.35
|
| Rate for Payer: UMR Bronson Commercial |
$716.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,221.85
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
