|
HC ICD LEAD REMOVAL
|
Facility
|
IP
|
$2,664.59
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,865.21 |
| Max. Negotiated Rate |
$2,664.59 |
| Rate for Payer: Aetna Commercial |
$2,398.13
|
| Rate for Payer: ASR ASR |
$2,584.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,065.86
|
| Rate for Payer: BCN Commercial |
$2,065.86
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cofinity Commercial |
$2,504.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.67
|
| Rate for Payer: Healthscope Commercial |
$2,664.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,584.65
|
| Rate for Payer: Mclaren Commercial |
$2,398.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,264.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,865.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,344.84
|
|
|
HC ICD LEAD REMOVAL
|
Facility
|
OP
|
$2,664.59
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,865.21 |
| Max. Negotiated Rate |
$4,363.29 |
| Rate for Payer: Aetna Commercial |
$2,398.13
|
| Rate for Payer: Aetna Medicare |
$3,490.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,363.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,363.29
|
| Rate for Payer: ASR ASR |
$2,584.65
|
| Rate for Payer: BCBS Complete |
$2,005.02
|
| Rate for Payer: BCBS MAPPO |
$3,490.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,065.86
|
| Rate for Payer: BCN Commercial |
$2,065.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,490.63
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cofinity Commercial |
$2,504.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,490.63
|
| Rate for Payer: Healthscope Commercial |
$2,664.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,584.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,490.63
|
| Rate for Payer: Mclaren Commercial |
$2,398.13
|
| Rate for Payer: Mclaren Medicaid |
$1,909.37
|
| Rate for Payer: Mclaren Medicare |
$3,490.63
|
| Rate for Payer: Meridian Medicaid |
$2,005.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,665.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,014.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,264.90
|
| Rate for Payer: PACE Medicare |
$3,316.10
|
| Rate for Payer: PACE SWMI |
$3,490.63
|
| Rate for Payer: PHP Commercial |
$3,839.69
|
| Rate for Payer: PHP Medicaid |
$1,909.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,490.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,909.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,865.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,424.78
|
| Rate for Payer: Priority Health Medicare |
$3,490.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,891.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3,490.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,344.84
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.35
|
| Rate for Payer: VA VA |
$3,490.63
|
|
|
HC ICD POCKET REVISION
|
Facility
|
OP
|
$3,102.18
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$3,102.18 |
| Rate for Payer: Aetna Commercial |
$2,791.96
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$3,009.11
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.12
|
| Rate for Payer: BCN Commercial |
$2,405.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cofinity Commercial |
$2,916.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$3,102.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,009.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$2,791.96
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,636.85
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,822.98
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,202.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,729.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC ICD POCKET REVISION
|
Facility
|
IP
|
$3,102.18
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,171.53 |
| Max. Negotiated Rate |
$3,102.18 |
| Rate for Payer: Aetna Commercial |
$2,791.96
|
| Rate for Payer: ASR ASR |
$3,009.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.12
|
| Rate for Payer: BCN Commercial |
$2,405.12
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cofinity Commercial |
$2,916.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.74
|
| Rate for Payer: Healthscope Commercial |
$3,102.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,009.11
|
| Rate for Payer: Mclaren Commercial |
$2,791.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,636.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,729.92
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
IP
|
$17,340.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,138.00 |
| Max. Negotiated Rate |
$17,340.00 |
| Rate for Payer: Aetna Commercial |
$15,606.00
|
| Rate for Payer: ASR ASR |
$16,819.80
|
| Rate for Payer: BCBS Trust/PPO |
$13,443.70
|
| Rate for Payer: BCN Commercial |
$13,443.70
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cofinity Commercial |
$16,299.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,872.00
|
| Rate for Payer: Healthscope Commercial |
$17,340.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,819.80
|
| Rate for Payer: Mclaren Commercial |
$15,606.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,739.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,138.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,259.20
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
OP
|
$17,340.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,138.00 |
| Max. Negotiated Rate |
$36,554.11 |
| Rate for Payer: Aetna Commercial |
$15,606.00
|
| Rate for Payer: Aetna Medicare |
$29,243.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,554.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,554.11
|
| Rate for Payer: ASR ASR |
$16,819.80
|
| Rate for Payer: BCBS Complete |
$16,797.35
|
| Rate for Payer: BCBS MAPPO |
$29,243.29
|
| Rate for Payer: BCBS Trust/PPO |
$13,443.70
|
| Rate for Payer: BCN Commercial |
$13,443.70
|
| Rate for Payer: BCN Medicare Advantage |
$29,243.29
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cofinity Commercial |
$16,299.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,872.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,243.29
|
| Rate for Payer: Healthscope Commercial |
$17,340.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,819.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,243.29
|
| Rate for Payer: Mclaren Commercial |
$15,606.00
|
| Rate for Payer: Mclaren Medicaid |
$15,996.08
|
| Rate for Payer: Mclaren Medicare |
$29,243.29
|
| Rate for Payer: Meridian Medicaid |
$16,797.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,705.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,629.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,739.00
|
| Rate for Payer: PACE Medicare |
$27,781.13
|
| Rate for Payer: PACE SWMI |
$29,243.29
|
| Rate for Payer: PHP Commercial |
$32,167.62
|
| Rate for Payer: PHP Medicaid |
$15,996.08
|
| Rate for Payer: PHP Medicare Advantage |
$29,243.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,996.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,138.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,779.40
|
| Rate for Payer: Priority Health Medicare |
$29,243.29
|
| Rate for Payer: Priority Health Narrow Network |
$12,311.40
|
| Rate for Payer: Railroad Medicare Medicare |
$29,243.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,259.20
|
| Rate for Payer: UHC Medicare Advantage |
$30,120.59
|
| Rate for Payer: VA VA |
$29,243.29
|
|
|
HC ICP MONITOR
|
Facility
|
OP
|
$1,957.50
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$783.00 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,761.75
|
| Rate for Payer: ASR ASR |
$1,898.78
|
| Rate for Payer: BCBS Complete |
$783.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.65
|
| Rate for Payer: BCN Commercial |
$1,517.65
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cofinity Commercial |
$1,840.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,566.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,898.78
|
| Rate for Payer: Mclaren Commercial |
$1,761.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,663.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,781.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,389.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,722.60
|
|
|
HC ICP MONITOR
|
Facility
|
IP
|
$1,957.50
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,370.25 |
| Max. Negotiated Rate |
$1,957.50 |
| Rate for Payer: Aetna Commercial |
$1,761.75
|
| Rate for Payer: ASR ASR |
$1,898.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.65
|
| Rate for Payer: BCN Commercial |
$1,517.65
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cofinity Commercial |
$1,840.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,566.00
|
| Rate for Payer: Healthscope Commercial |
$1,957.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,898.78
|
| Rate for Payer: Mclaren Commercial |
$1,761.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,663.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,722.60
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$253.98
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
36100573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$253.98 |
| Rate for Payer: Aetna Commercial |
$228.58
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$246.36
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$196.91
|
| Rate for Payer: BCN Commercial |
$196.91
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$238.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$253.98
|
| Rate for Payer: Healthscope Whirlpool |
$246.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$228.58
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.88
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.50
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$253.98
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
36100573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.79 |
| Max. Negotiated Rate |
$253.98 |
| Rate for Payer: Aetna Commercial |
$228.58
|
| Rate for Payer: ASR ASR |
$246.36
|
| Rate for Payer: BCBS Trust/PPO |
$196.91
|
| Rate for Payer: BCN Commercial |
$196.91
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$238.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$253.98
|
| Rate for Payer: Healthscope Whirlpool |
$246.36
|
| Rate for Payer: Mclaren Commercial |
$228.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.50
|
|
|
HC IDENTIFICATION BY AGGLUTINATION
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
30600091
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$26.34
|
| Rate for Payer: ASR ASR |
$28.39
|
| Rate for Payer: BCBS Trust/PPO |
$22.69
|
| Rate for Payer: BCN Commercial |
$22.69
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$27.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Whirlpool |
$28.39
|
| Rate for Payer: Mclaren Commercial |
$26.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.76
|
|
|
HC IDENTIFICATION BY AGGLUTINATION
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
30600091
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$26.34
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$28.39
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$22.69
|
| Rate for Payer: BCN Commercial |
$22.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$27.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Whirlpool |
$28.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$26.34
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.88
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.64
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$20.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.76
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC I&D (OB SURGERY)
|
Facility
|
IP
|
$525.01
|
|
| Hospital Charge Code |
36000054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.51 |
| Max. Negotiated Rate |
$525.01 |
| Rate for Payer: Aetna Commercial |
$472.51
|
| Rate for Payer: ASR ASR |
$509.26
|
| Rate for Payer: BCBS Trust/PPO |
$407.04
|
| Rate for Payer: BCN Commercial |
$407.04
|
| Rate for Payer: Cash Price |
$420.01
|
| Rate for Payer: Cofinity Commercial |
$493.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.01
|
| Rate for Payer: Healthscope Commercial |
$525.01
|
| Rate for Payer: Healthscope Whirlpool |
$509.26
|
| Rate for Payer: Mclaren Commercial |
$472.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.01
|
|
|
HC I&D (OB SURGERY)
|
Facility
|
OP
|
$525.01
|
|
| Hospital Charge Code |
36000054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$525.01 |
| Rate for Payer: Aetna Commercial |
$472.51
|
| Rate for Payer: ASR ASR |
$509.26
|
| Rate for Payer: BCBS Complete |
$210.00
|
| Rate for Payer: BCBS Trust/PPO |
$407.04
|
| Rate for Payer: BCN Commercial |
$407.04
|
| Rate for Payer: Cash Price |
$420.01
|
| Rate for Payer: Cofinity Commercial |
$493.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.01
|
| Rate for Payer: Healthscope Commercial |
$525.01
|
| Rate for Payer: Healthscope Whirlpool |
$509.26
|
| Rate for Payer: Mclaren Commercial |
$472.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.76
|
| Rate for Payer: Priority Health Narrow Network |
$372.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.01
|
|
|
HC I&D PILONIDAL CYST
|
Facility
|
IP
|
$913.63
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.54 |
| Max. Negotiated Rate |
$913.63 |
| Rate for Payer: Aetna Commercial |
$822.27
|
| Rate for Payer: ASR ASR |
$886.22
|
| Rate for Payer: BCBS Trust/PPO |
$708.34
|
| Rate for Payer: BCN Commercial |
$708.34
|
| Rate for Payer: Cash Price |
$730.90
|
| Rate for Payer: Cofinity Commercial |
$858.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.90
|
| Rate for Payer: Healthscope Commercial |
$913.63
|
| Rate for Payer: Healthscope Whirlpool |
$886.22
|
| Rate for Payer: Mclaren Commercial |
$822.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$776.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.99
|
|
|
HC I&D PILONIDAL CYST
|
Facility
|
OP
|
$913.63
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.29 |
| Max. Negotiated Rate |
$913.63 |
| Rate for Payer: Aetna Commercial |
$822.27
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$886.22
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$708.34
|
| Rate for Payer: BCN Commercial |
$708.34
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$730.90
|
| Rate for Payer: Cash Price |
$730.90
|
| Rate for Payer: Cofinity Commercial |
$858.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$913.63
|
| Rate for Payer: Healthscope Whirlpool |
$886.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$822.27
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$776.59
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.86
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$174.29
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.99
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC I&D PROCEDURE
|
Facility
|
IP
|
$480.54
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.38 |
| Max. Negotiated Rate |
$480.54 |
| Rate for Payer: Aetna Commercial |
$432.49
|
| Rate for Payer: ASR ASR |
$466.12
|
| Rate for Payer: BCBS Trust/PPO |
$372.56
|
| Rate for Payer: BCN Commercial |
$372.56
|
| Rate for Payer: Cash Price |
$384.43
|
| Rate for Payer: Cofinity Commercial |
$451.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.43
|
| Rate for Payer: Healthscope Commercial |
$480.54
|
| Rate for Payer: Healthscope Whirlpool |
$466.12
|
| Rate for Payer: Mclaren Commercial |
$432.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.88
|
|
|
HC I&D PROCEDURE
|
Facility
|
OP
|
$480.54
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$480.54 |
| Rate for Payer: Aetna Commercial |
$432.49
|
| Rate for Payer: ASR ASR |
$466.12
|
| Rate for Payer: BCBS Complete |
$192.22
|
| Rate for Payer: BCBS Trust/PPO |
$372.56
|
| Rate for Payer: BCN Commercial |
$372.56
|
| Rate for Payer: Cash Price |
$384.43
|
| Rate for Payer: Cofinity Commercial |
$451.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.43
|
| Rate for Payer: Healthscope Commercial |
$480.54
|
| Rate for Payer: Healthscope Whirlpool |
$466.12
|
| Rate for Payer: Mclaren Commercial |
$432.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.29
|
| Rate for Payer: Priority Health Narrow Network |
$341.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.88
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$832.62
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.98 |
| Max. Negotiated Rate |
$832.62 |
| Rate for Payer: Aetna Commercial |
$749.36
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: ASR ASR |
$807.64
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$645.53
|
| Rate for Payer: BCN Commercial |
$645.53
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$666.10
|
| Rate for Payer: Cash Price |
$666.10
|
| Rate for Payer: Cofinity Commercial |
$782.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$832.62
|
| Rate for Payer: Healthscope Whirlpool |
$807.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$285.16
|
| Rate for Payer: Mclaren Commercial |
$749.36
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$707.73
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$313.68
|
| Rate for Payer: PHP Medicaid |
$155.98
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.51
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$350.81
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.71
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$832.62
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.83 |
| Max. Negotiated Rate |
$832.62 |
| Rate for Payer: Aetna Commercial |
$749.36
|
| Rate for Payer: ASR ASR |
$807.64
|
| Rate for Payer: BCBS Trust/PPO |
$645.53
|
| Rate for Payer: BCN Commercial |
$645.53
|
| Rate for Payer: Cash Price |
$666.10
|
| Rate for Payer: Cofinity Commercial |
$782.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.10
|
| Rate for Payer: Healthscope Commercial |
$832.62
|
| Rate for Payer: Healthscope Whirlpool |
$807.64
|
| Rate for Payer: Mclaren Commercial |
$749.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$707.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.71
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.23
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.02
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.22
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$9.37
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: ASR ASR |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$10.23
|
| Rate for Payer: BCN Commercial |
$10.23
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$12.80
|
| Rate for Payer: Mclaren Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.62
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$49.25 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$5.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$16.32
|
| Rate for Payer: Healthscope Whirlpool |
$15.83
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
