|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,465.19 |
| Max. Negotiated Rate |
$2,254.14 |
| Rate for Payer: Aetna Commercial |
$2,028.73
|
| Rate for Payer: ASR ASR |
$2,186.52
|
| Rate for Payer: ASR Commercial |
$2,186.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.90
|
| Rate for Payer: BCN Commercial |
$1,747.63
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$2,118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,254.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.52
|
| Rate for Payer: Mclaren Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: Nomi Health Commercial |
$1,848.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.64
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.66 |
| Max. Negotiated Rate |
$2,254.14 |
| Rate for Payer: Aetna Commercial |
$2,028.73
|
| Rate for Payer: Aetna Medicare |
$1,127.07
|
| Rate for Payer: ASR ASR |
$2,186.52
|
| Rate for Payer: ASR Commercial |
$2,186.52
|
| Rate for Payer: BCBS Complete |
$901.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.92
|
| Rate for Payer: BCN Commercial |
$1,747.63
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$2,118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,254.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,186.52
|
| Rate for Payer: Mclaren Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: Nomi Health Commercial |
$1,848.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,975.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.64
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.32 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: ASR Commercial |
$251.19
|
| Rate for Payer: BCBS Trust/PPO |
$211.03
|
| Rate for Payer: BCN Commercial |
$200.77
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$258.96
|
| Rate for Payer: Healthscope Whirlpool |
$251.19
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$258.96 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$251.19
|
| Rate for Payer: ASR Commercial |
$251.19
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$212.06
|
| Rate for Payer: BCN Commercial |
$200.77
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$243.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$258.96
|
| Rate for Payer: Healthscope Whirlpool |
$251.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$233.06
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$212.35
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$181.53
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.22 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$472.46
|
| Rate for Payer: ASR ASR |
$509.20
|
| Rate for Payer: ASR Commercial |
$509.20
|
| Rate for Payer: BCBS Trust/PPO |
$427.78
|
| Rate for Payer: BCN Commercial |
$406.99
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$493.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Healthscope Whirlpool |
$509.20
|
| Rate for Payer: Mclaren Commercial |
$472.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: Nomi Health Commercial |
$430.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.96
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$472.46
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$509.20
|
| Rate for Payer: ASR Commercial |
$509.20
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$429.88
|
| Rate for Payer: BCN Commercial |
$406.99
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$493.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Healthscope Whirlpool |
$509.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$472.46
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: Nomi Health Commercial |
$430.46
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.06
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$197.65
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,155.64 |
| Max. Negotiated Rate |
$1,777.90 |
| Rate for Payer: Aetna Commercial |
$1,600.11
|
| Rate for Payer: ASR ASR |
$1,724.56
|
| Rate for Payer: ASR Commercial |
$1,724.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.81
|
| Rate for Payer: BCN Commercial |
$1,378.41
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,671.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,777.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,724.56
|
| Rate for Payer: Mclaren Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.22
|
| Rate for Payer: Nomi Health Commercial |
$1,457.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,564.55
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.16 |
| Max. Negotiated Rate |
$1,777.90 |
| Rate for Payer: Aetna Commercial |
$1,600.11
|
| Rate for Payer: Aetna Medicare |
$888.95
|
| Rate for Payer: ASR ASR |
$1,724.56
|
| Rate for Payer: ASR Commercial |
$1,724.56
|
| Rate for Payer: BCBS Complete |
$711.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.92
|
| Rate for Payer: BCN Commercial |
$1,378.41
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,671.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,777.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,724.56
|
| Rate for Payer: Mclaren Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.22
|
| Rate for Payer: Nomi Health Commercial |
$1,457.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,557.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,246.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,564.55
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$254.93 |
| Rate for Payer: Aetna Commercial |
$229.44
|
| Rate for Payer: Aetna Medicare |
$127.46
|
| Rate for Payer: ASR ASR |
$247.28
|
| Rate for Payer: ASR Commercial |
$247.28
|
| Rate for Payer: BCBS Complete |
$101.97
|
| Rate for Payer: BCBS Trust/PPO |
$208.76
|
| Rate for Payer: BCN Commercial |
$197.65
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$239.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$254.93
|
| Rate for Payer: Healthscope Whirlpool |
$247.28
|
| Rate for Payer: Mclaren Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: Nomi Health Commercial |
$209.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.37
|
| Rate for Payer: Priority Health Narrow Network |
$178.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.34
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.70 |
| Max. Negotiated Rate |
$254.93 |
| Rate for Payer: Aetna Commercial |
$229.44
|
| Rate for Payer: ASR ASR |
$247.28
|
| Rate for Payer: ASR Commercial |
$247.28
|
| Rate for Payer: BCBS Trust/PPO |
$207.74
|
| Rate for Payer: BCN Commercial |
$197.65
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$239.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$254.93
|
| Rate for Payer: Healthscope Whirlpool |
$247.28
|
| Rate for Payer: Mclaren Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: Nomi Health Commercial |
$209.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.34
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
IP
|
$745.52
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.59 |
| Max. Negotiated Rate |
$745.52 |
| Rate for Payer: Aetna Commercial |
$670.97
|
| Rate for Payer: ASR ASR |
$723.15
|
| Rate for Payer: ASR Commercial |
$723.15
|
| Rate for Payer: BCBS Trust/PPO |
$607.52
|
| Rate for Payer: BCN Commercial |
$578.00
|
| Rate for Payer: Cash Price |
$596.42
|
| Rate for Payer: Cofinity Commercial |
$700.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.42
|
| Rate for Payer: Healthscope Commercial |
$745.52
|
| Rate for Payer: Healthscope Whirlpool |
$723.15
|
| Rate for Payer: Mclaren Commercial |
$670.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.69
|
| Rate for Payer: Nomi Health Commercial |
$611.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.06
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
OP
|
$745.52
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.21 |
| Max. Negotiated Rate |
$745.52 |
| Rate for Payer: Aetna Commercial |
$670.97
|
| Rate for Payer: Aetna Medicare |
$372.76
|
| Rate for Payer: ASR ASR |
$723.15
|
| Rate for Payer: ASR Commercial |
$723.15
|
| Rate for Payer: BCBS Complete |
$298.21
|
| Rate for Payer: BCBS Trust/PPO |
$610.51
|
| Rate for Payer: BCN Commercial |
$578.00
|
| Rate for Payer: Cash Price |
$596.42
|
| Rate for Payer: Cofinity Commercial |
$700.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.42
|
| Rate for Payer: Healthscope Commercial |
$745.52
|
| Rate for Payer: Healthscope Whirlpool |
$723.15
|
| Rate for Payer: Mclaren Commercial |
$670.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.69
|
| Rate for Payer: Nomi Health Commercial |
$611.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.22
|
| Rate for Payer: Priority Health Narrow Network |
$522.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.06
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: ASR Commercial |
$59.99
|
| Rate for Payer: BCBS Trust/PPO |
$50.40
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: Nomi Health Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
OP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: ASR Commercial |
$59.99
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$50.65
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: Nomi Health Commercial |
$50.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
OP
|
$203.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$183.47
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$197.74
|
| Rate for Payer: ASR Commercial |
$197.74
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$158.05
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cofinity Commercial |
$191.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$203.86
|
| Rate for Payer: Healthscope Whirlpool |
$197.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$183.47
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.28
|
| Rate for Payer: Nomi Health Commercial |
$167.17
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
IP
|
$203.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$203.86 |
| Rate for Payer: Aetna Commercial |
$183.47
|
| Rate for Payer: ASR ASR |
$197.74
|
| Rate for Payer: ASR Commercial |
$197.74
|
| Rate for Payer: BCBS Trust/PPO |
$166.13
|
| Rate for Payer: BCN Commercial |
$158.05
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cofinity Commercial |
$191.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.09
|
| Rate for Payer: Healthscope Commercial |
$203.86
|
| Rate for Payer: Healthscope Whirlpool |
$197.74
|
| Rate for Payer: Mclaren Commercial |
$183.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.28
|
| Rate for Payer: Nomi Health Commercial |
$167.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.40
|
|
|
HC FLUID CREATININE
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC FLUID CREATININE
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| 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 |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| 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 |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.25
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$109.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
IP
|
$108.20
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$108.20 |
| Rate for Payer: Aetna Commercial |
$97.38
|
| Rate for Payer: ASR ASR |
$104.95
|
| Rate for Payer: ASR Commercial |
$104.95
|
| Rate for Payer: BCBS Trust/PPO |
$88.17
|
| Rate for Payer: BCN Commercial |
$83.89
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$101.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Healthscope Commercial |
$108.20
|
| Rate for Payer: Healthscope Whirlpool |
$104.95
|
| Rate for Payer: Mclaren Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: Nomi Health Commercial |
$88.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.22
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
OP
|
$108.20
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$108.20 |
| Rate for Payer: Aetna Commercial |
$97.38
|
| Rate for Payer: Aetna Medicare |
$54.10
|
| Rate for Payer: ASR ASR |
$104.95
|
| Rate for Payer: ASR Commercial |
$104.95
|
| Rate for Payer: BCBS Complete |
$43.28
|
| Rate for Payer: BCBS Trust/PPO |
$88.60
|
| Rate for Payer: BCN Commercial |
$83.89
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$101.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Healthscope Commercial |
$108.20
|
| Rate for Payer: Healthscope Whirlpool |
$104.95
|
| Rate for Payer: Mclaren Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: Nomi Health Commercial |
$88.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.51
|
| Rate for Payer: Priority Health Narrow Network |
$40.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.22
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$72.77 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.76
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: ASR Commercial |
$108.59
|
| Rate for Payer: BCBS Trust/PPO |
$91.23
|
| Rate for Payer: BCN Commercial |
$86.79
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$111.95
|
| Rate for Payer: Healthscope Whirlpool |
$108.59
|
| Rate for Payer: Mclaren Commercial |
$100.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.76
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: ASR Commercial |
$108.59
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$91.68
|
| Rate for Payer: BCN Commercial |
$86.79
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$111.95
|
| Rate for Payer: Healthscope Whirlpool |
$108.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$100.76
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.09
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$78.48
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.76
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: ASR Commercial |
$108.59
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$91.68
|
| Rate for Payer: BCN Commercial |
$86.79
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$111.95
|
| Rate for Payer: Healthscope Whirlpool |
$108.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$100.76
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.09
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$78.48
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$72.77 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.76
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: ASR Commercial |
$108.59
|
| Rate for Payer: BCBS Trust/PPO |
$91.23
|
| Rate for Payer: BCN Commercial |
$86.79
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$111.95
|
| Rate for Payer: Healthscope Whirlpool |
$108.59
|
| Rate for Payer: Mclaren Commercial |
$100.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
|
|
HC FLUTTER VALVE SUPPLY
|
Facility
|
OP
|
$118.69
|
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$106.82
|
| Rate for Payer: Aetna Medicare |
$59.34
|
| Rate for Payer: ASR ASR |
$115.13
|
| Rate for Payer: ASR Commercial |
$115.13
|
| Rate for Payer: BCBS Complete |
$47.48
|
| Rate for Payer: BCBS Trust/PPO |
$97.20
|
| Rate for Payer: BCN Commercial |
$92.02
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cofinity Commercial |
$111.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.95
|
| Rate for Payer: Healthscope Commercial |
$118.69
|
| Rate for Payer: Healthscope Whirlpool |
$115.13
|
| Rate for Payer: Mclaren Commercial |
$106.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.89
|
| Rate for Payer: Nomi Health Commercial |
$97.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.00
|
| Rate for Payer: Priority Health Narrow Network |
$83.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.45
|
|
