|
HC BANDING
|
Facility
|
OP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.26 |
| Max. Negotiated Rate |
$965.64 |
| Rate for Payer: Aetna Commercial |
$869.08
|
| Rate for Payer: Aetna Medicare |
$482.82
|
| Rate for Payer: ASR ASR |
$936.67
|
| Rate for Payer: ASR Commercial |
$936.67
|
| Rate for Payer: BCBS Complete |
$386.26
|
| Rate for Payer: BCBS Trust/PPO |
$790.76
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$907.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$965.64
|
| Rate for Payer: Healthscope Whirlpool |
$936.67
|
| Rate for Payer: Mclaren Commercial |
$869.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: Nomi Health Commercial |
$791.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.09
|
| Rate for Payer: Priority Health Narrow Network |
$676.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.76
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.84
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$589.96 |
| Rate for Payer: Aetna Commercial |
$530.96
|
| Rate for Payer: Aetna Medicare |
$294.98
|
| Rate for Payer: ASR ASR |
$572.26
|
| Rate for Payer: ASR Commercial |
$572.26
|
| Rate for Payer: BCBS Complete |
$235.98
|
| Rate for Payer: BCBS Trust/PPO |
$483.12
|
| Rate for Payer: BCN Commercial |
$457.40
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$554.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Healthscope Commercial |
$589.96
|
| Rate for Payer: Healthscope Whirlpool |
$572.26
|
| Rate for Payer: Mclaren Commercial |
$530.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: Nomi Health Commercial |
$483.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.92
|
| Rate for Payer: Priority Health Narrow Network |
$413.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.16
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$383.47 |
| Max. Negotiated Rate |
$589.96 |
| Rate for Payer: Aetna Commercial |
$530.96
|
| Rate for Payer: ASR ASR |
$572.26
|
| Rate for Payer: ASR Commercial |
$572.26
|
| Rate for Payer: BCBS Trust/PPO |
$480.76
|
| Rate for Payer: BCN Commercial |
$457.40
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$554.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Healthscope Commercial |
$589.96
|
| Rate for Payer: Healthscope Whirlpool |
$572.26
|
| Rate for Payer: Mclaren Commercial |
$530.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: Nomi Health Commercial |
$483.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.16
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
OP
|
$5,720.86
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,288.34 |
| Max. Negotiated Rate |
$5,720.86 |
| Rate for Payer: Aetna Commercial |
$5,148.77
|
| Rate for Payer: Aetna Medicare |
$2,860.43
|
| Rate for Payer: ASR ASR |
$5,549.23
|
| Rate for Payer: ASR Commercial |
$5,549.23
|
| Rate for Payer: BCBS Complete |
$2,288.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,684.81
|
| Rate for Payer: BCN Commercial |
$4,435.38
|
| Rate for Payer: Cash Price |
$4,576.69
|
| Rate for Payer: Cofinity Commercial |
$5,377.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,576.69
|
| Rate for Payer: Healthscope Commercial |
$5,720.86
|
| Rate for Payer: Healthscope Whirlpool |
$5,549.23
|
| Rate for Payer: Mclaren Commercial |
$5,148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,862.73
|
| Rate for Payer: Nomi Health Commercial |
$4,691.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,012.62
|
| Rate for Payer: Priority Health Narrow Network |
$4,010.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,034.36
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
IP
|
$5,720.86
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,718.56 |
| Max. Negotiated Rate |
$5,720.86 |
| Rate for Payer: Aetna Commercial |
$5,148.77
|
| Rate for Payer: ASR ASR |
$5,549.23
|
| Rate for Payer: ASR Commercial |
$5,549.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,661.93
|
| Rate for Payer: BCN Commercial |
$4,435.38
|
| Rate for Payer: Cash Price |
$4,576.69
|
| Rate for Payer: Cofinity Commercial |
$5,377.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,576.69
|
| Rate for Payer: Healthscope Commercial |
$5,720.86
|
| Rate for Payer: Healthscope Whirlpool |
$5,549.23
|
| Rate for Payer: Mclaren Commercial |
$5,148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,862.73
|
| Rate for Payer: Nomi Health Commercial |
$4,691.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,034.36
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,350.88
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,828.07 |
| Max. Negotiated Rate |
$4,350.88 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: ASR ASR |
$4,220.35
|
| Rate for Payer: ASR Commercial |
$4,220.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,545.53
|
| Rate for Payer: BCN Commercial |
$3,373.24
|
| Rate for Payer: Cash Price |
$3,480.70
|
| Rate for Payer: Cofinity Commercial |
$4,089.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.70
|
| Rate for Payer: Healthscope Commercial |
$4,350.88
|
| Rate for Payer: Healthscope Whirlpool |
$4,220.35
|
| Rate for Payer: Mclaren Commercial |
$3,915.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,698.25
|
| Rate for Payer: Nomi Health Commercial |
$3,567.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,828.77
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,350.88
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.35 |
| Max. Negotiated Rate |
$4,350.88 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna Medicare |
$2,175.44
|
| Rate for Payer: ASR ASR |
$4,220.35
|
| Rate for Payer: ASR Commercial |
$4,220.35
|
| Rate for Payer: BCBS Complete |
$1,740.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,562.94
|
| Rate for Payer: BCN Commercial |
$3,373.24
|
| Rate for Payer: Cash Price |
$3,480.70
|
| Rate for Payer: Cofinity Commercial |
$4,089.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.70
|
| Rate for Payer: Healthscope Commercial |
$4,350.88
|
| Rate for Payer: Healthscope Whirlpool |
$4,220.35
|
| Rate for Payer: Mclaren Commercial |
$3,915.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,698.25
|
| Rate for Payer: Nomi Health Commercial |
$3,567.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,812.24
|
| Rate for Payer: Priority Health Narrow Network |
$3,049.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,828.77
|
|
|
HC BARRX RFA
|
Facility
|
IP
|
$2,044.39
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,328.85 |
| Max. Negotiated Rate |
$2,044.39 |
| Rate for Payer: Aetna Commercial |
$1,839.95
|
| Rate for Payer: ASR ASR |
$1,983.06
|
| Rate for Payer: ASR Commercial |
$1,983.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,665.97
|
| Rate for Payer: BCN Commercial |
$1,585.02
|
| Rate for Payer: Cash Price |
$1,635.51
|
| Rate for Payer: Cofinity Commercial |
$1,921.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.51
|
| Rate for Payer: Healthscope Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,983.06
|
| Rate for Payer: Mclaren Commercial |
$1,839.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.73
|
| Rate for Payer: Nomi Health Commercial |
$1,676.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,799.06
|
|
|
HC BARRX RFA
|
Facility
|
OP
|
$2,044.39
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$817.76 |
| Max. Negotiated Rate |
$2,044.39 |
| Rate for Payer: Aetna Commercial |
$1,839.95
|
| Rate for Payer: Aetna Medicare |
$1,022.20
|
| Rate for Payer: ASR ASR |
$1,983.06
|
| Rate for Payer: ASR Commercial |
$1,983.06
|
| Rate for Payer: BCBS Complete |
$817.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.15
|
| Rate for Payer: BCN Commercial |
$1,585.02
|
| Rate for Payer: Cash Price |
$1,635.51
|
| Rate for Payer: Cofinity Commercial |
$1,921.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.51
|
| Rate for Payer: Healthscope Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,983.06
|
| Rate for Payer: Mclaren Commercial |
$1,839.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.73
|
| Rate for Payer: Nomi Health Commercial |
$1,676.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,791.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,799.06
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,420.13
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,873.08 |
| Max. Negotiated Rate |
$4,420.13 |
| Rate for Payer: Aetna Commercial |
$3,978.12
|
| Rate for Payer: ASR ASR |
$4,287.53
|
| Rate for Payer: ASR Commercial |
$4,287.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,601.96
|
| Rate for Payer: BCN Commercial |
$3,426.93
|
| Rate for Payer: Cash Price |
$3,536.10
|
| Rate for Payer: Cofinity Commercial |
$4,154.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,536.10
|
| Rate for Payer: Healthscope Commercial |
$4,420.13
|
| Rate for Payer: Healthscope Whirlpool |
$4,287.53
|
| Rate for Payer: Mclaren Commercial |
$3,978.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,757.11
|
| Rate for Payer: Nomi Health Commercial |
$3,624.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,873.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,889.71
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,420.13
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,768.05 |
| Max. Negotiated Rate |
$4,420.13 |
| Rate for Payer: Aetna Commercial |
$3,978.12
|
| Rate for Payer: Aetna Medicare |
$2,210.06
|
| Rate for Payer: ASR ASR |
$4,287.53
|
| Rate for Payer: ASR Commercial |
$4,287.53
|
| Rate for Payer: BCBS Complete |
$1,768.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,619.64
|
| Rate for Payer: BCN Commercial |
$3,426.93
|
| Rate for Payer: Cash Price |
$3,536.10
|
| Rate for Payer: Cofinity Commercial |
$4,154.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,536.10
|
| Rate for Payer: Healthscope Commercial |
$4,420.13
|
| Rate for Payer: Healthscope Whirlpool |
$4,287.53
|
| Rate for Payer: Mclaren Commercial |
$3,978.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,757.11
|
| Rate for Payer: Nomi Health Commercial |
$3,624.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,873.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,872.92
|
| Rate for Payer: Priority Health Narrow Network |
$3,098.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,889.71
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
OP
|
$16.66
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$16.66 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$16.16
|
| Rate for Payer: ASR Commercial |
$16.16
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.64
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$16.66
|
| Rate for Payer: Healthscope Whirlpool |
$16.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$14.99
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$13.66
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.60
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$11.68
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.46
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
IP
|
$16.66
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$16.66 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: ASR ASR |
$16.16
|
| Rate for Payer: ASR Commercial |
$16.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.58
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$16.66
|
| Rate for Payer: Healthscope Whirlpool |
$16.16
|
| Rate for Payer: Mclaren Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.66
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
OP
|
$17.69
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$17.16
|
| Rate for Payer: ASR Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$17.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.50
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$12.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.46
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
IP
|
$17.69
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: ASR ASR |
$17.16
|
| Rate for Payer: ASR Commercial |
$17.16
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$16.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$17.69
|
| Rate for Payer: Healthscope Whirlpool |
$17.16
|
| Rate for Payer: Mclaren Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.57
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$62.04 |
| Rate for Payer: Aetna Commercial |
$28.66
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.58
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: ASR Commercial |
$30.88
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS MAPPO |
$8.46
|
| Rate for Payer: BCBS Trust/PPO |
$26.07
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Medicare Advantage |
$8.46
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.46
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.46
|
| Rate for Payer: Mclaren Commercial |
$28.66
|
| Rate for Payer: Mclaren Medicaid |
$4.53
|
| Rate for Payer: Mclaren Medicare |
$8.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.88
|
| Rate for Payer: Meridian Medicaid |
$4.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: PACE Medicare |
$8.04
|
| Rate for Payer: PACE SWMI |
$8.46
|
| Rate for Payer: PHP Commercial |
$9.31
|
| Rate for Payer: PHP Medicaid |
$4.53
|
| Rate for Payer: PHP Medicare Advantage |
$8.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.04
|
| Rate for Payer: Priority Health Medicare |
$8.46
|
| Rate for Payer: Priority Health Narrow Network |
$49.63
|
| Rate for Payer: Railroad Medicare Medicare |
$8.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.46
|
| Rate for Payer: UHC Exchange |
$13.11
|
| Rate for Payer: UHC Medicare Advantage |
$8.46
|
| Rate for Payer: UHCCP DNSP |
$8.46
|
| Rate for Payer: UHCCP Medicaid |
$4.53
|
| Rate for Payer: VA VA |
$8.46
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$31.84
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$28.66
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: ASR Commercial |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.95
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Mclaren Commercial |
$28.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.02
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
OP
|
$94.78
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$94.78 |
| Rate for Payer: Aetna Commercial |
$85.30
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$91.94
|
| Rate for Payer: ASR Commercial |
$91.94
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$77.62
|
| Rate for Payer: BCN Commercial |
$73.48
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cofinity Commercial |
$89.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$94.78
|
| Rate for Payer: Healthscope Whirlpool |
$91.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$85.30
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.56
|
| Rate for Payer: Nomi Health Commercial |
$77.72
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.05
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$66.44
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
IP
|
$94.78
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$94.78 |
| Rate for Payer: Aetna Commercial |
$85.30
|
| Rate for Payer: ASR ASR |
$91.94
|
| Rate for Payer: ASR Commercial |
$91.94
|
| Rate for Payer: BCBS Trust/PPO |
$77.24
|
| Rate for Payer: BCN Commercial |
$73.48
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cofinity Commercial |
$89.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.82
|
| Rate for Payer: Healthscope Commercial |
$94.78
|
| Rate for Payer: Healthscope Whirlpool |
$91.94
|
| Rate for Payer: Mclaren Commercial |
$85.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.56
|
| Rate for Payer: Nomi Health Commercial |
$77.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.41
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
OP
|
$431.77
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna Commercial |
$388.59
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$418.82
|
| Rate for Payer: ASR Commercial |
$418.82
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$353.58
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$405.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Healthscope Whirlpool |
$418.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$388.59
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.32
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$302.67
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
IP
|
$431.77
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$280.65 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna Commercial |
$388.59
|
| Rate for Payer: ASR ASR |
$418.82
|
| Rate for Payer: ASR Commercial |
$418.82
|
| Rate for Payer: BCBS Trust/PPO |
$351.85
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$405.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Healthscope Whirlpool |
$418.82
|
| Rate for Payer: Mclaren Commercial |
$388.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.96
|
|
