|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$134.02 |
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: ASR ASR |
$130.00
|
| Rate for Payer: ASR Commercial |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.21
|
| Rate for Payer: BCN Commercial |
$103.91
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$134.02
|
| Rate for Payer: Healthscope Whirlpool |
$130.00
|
| Rate for Payer: Mclaren Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.94
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$134.02 |
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: Aetna Medicare |
$67.01
|
| Rate for Payer: ASR ASR |
$130.00
|
| Rate for Payer: ASR Commercial |
$130.00
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: BCBS Trust/PPO |
$109.75
|
| Rate for Payer: BCN Commercial |
$103.91
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$134.02
|
| Rate for Payer: Healthscope Whirlpool |
$130.00
|
| Rate for Payer: Mclaren Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.43
|
| Rate for Payer: Priority Health Narrow Network |
$93.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.94
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: ASR Commercial |
$133.51
|
| Rate for Payer: BCBS Trust/PPO |
$112.16
|
| Rate for Payer: BCN Commercial |
$106.71
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Whirlpool |
$133.51
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: ASR Commercial |
$133.51
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.71
|
| Rate for Payer: BCN Commercial |
$106.71
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Whirlpool |
$133.51
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.43
|
| Rate for Payer: Priority Health Narrow Network |
$120.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$128.55
|
| Rate for Payer: Aetna Medicare |
$71.42
|
| Rate for Payer: ASR ASR |
$138.55
|
| Rate for Payer: ASR Commercial |
$138.55
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: BCBS Trust/PPO |
$116.96
|
| Rate for Payer: BCN Commercial |
$110.74
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$134.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$142.83
|
| Rate for Payer: Healthscope Whirlpool |
$138.55
|
| Rate for Payer: Mclaren Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.43
|
| Rate for Payer: Priority Health Narrow Network |
$120.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.69
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$142.83 |
| Rate for Payer: Aetna Commercial |
$128.55
|
| Rate for Payer: ASR ASR |
$138.55
|
| Rate for Payer: ASR Commercial |
$138.55
|
| Rate for Payer: BCBS Trust/PPO |
$116.39
|
| Rate for Payer: BCN Commercial |
$110.74
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$134.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$142.83
|
| Rate for Payer: Healthscope Whirlpool |
$138.55
|
| Rate for Payer: Mclaren Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.69
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$42.85
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: ASR ASR |
$46.18
|
| Rate for Payer: ASR Commercial |
$46.18
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| Rate for Payer: BCN Commercial |
$36.91
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$44.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$47.61
|
| Rate for Payer: Healthscope Whirlpool |
$46.18
|
| Rate for Payer: Mclaren Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.43
|
| Rate for Payer: Priority Health Narrow Network |
$120.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.90
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$47.61 |
| Rate for Payer: Aetna Commercial |
$42.85
|
| Rate for Payer: ASR ASR |
$46.18
|
| Rate for Payer: ASR Commercial |
$46.18
|
| Rate for Payer: BCBS Trust/PPO |
$38.80
|
| Rate for Payer: BCN Commercial |
$36.91
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$44.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$47.61
|
| Rate for Payer: Healthscope Whirlpool |
$46.18
|
| Rate for Payer: Mclaren Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.90
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$153.51 |
| Max. Negotiated Rate |
$236.17 |
| Rate for Payer: Aetna Commercial |
$212.55
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Trust/PPO |
$192.45
|
| Rate for Payer: BCN Commercial |
$183.10
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$222.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$236.17
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.83
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$236.17 |
| Rate for Payer: Aetna Commercial |
$212.55
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: BCBS Trust/PPO |
$193.40
|
| Rate for Payer: BCN Commercial |
$183.10
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$222.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$236.17
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.33
|
| Rate for Payer: Priority Health Narrow Network |
$52.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.83
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$250.29 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: ASR ASR |
$242.78
|
| Rate for Payer: ASR Commercial |
$242.78
|
| Rate for Payer: BCBS Trust/PPO |
$203.96
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$235.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$250.29
|
| Rate for Payer: Healthscope Whirlpool |
$242.78
|
| Rate for Payer: Mclaren Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.26
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$250.29 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: ASR ASR |
$242.78
|
| Rate for Payer: ASR Commercial |
$242.78
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: BCBS Trust/PPO |
$204.96
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$235.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$250.29
|
| Rate for Payer: Healthscope Whirlpool |
$242.78
|
| Rate for Payer: Mclaren Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.43
|
| Rate for Payer: Priority Health Narrow Network |
$120.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.26
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: ASR Commercial |
$34.63
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.28
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$25.03
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: ASR Commercial |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$29.09
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$118.61 |
| Rate for Payer: Aetna Commercial |
$106.75
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$115.05
|
| Rate for Payer: ASR Commercial |
$115.05
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$97.13
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$118.61
|
| Rate for Payer: Healthscope Whirlpool |
$115.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$106.75
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.93
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$83.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$118.61 |
| Rate for Payer: Aetna Commercial |
$106.75
|
| Rate for Payer: ASR ASR |
$115.05
|
| Rate for Payer: ASR Commercial |
$115.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.66
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$111.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$118.61
|
| Rate for Payer: Healthscope Whirlpool |
$115.05
|
| Rate for Payer: Mclaren Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.38
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$86.05
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.07
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$73.66
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$94.57
|
| Rate for Payer: ASR ASR |
$101.93
|
| Rate for Payer: ASR Commercial |
$101.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.63
|
| Rate for Payer: BCN Commercial |
$81.47
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Healthscope Whirlpool |
$101.93
|
| Rate for Payer: Mclaren Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.47
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Trust/PPO |
$68.99
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$84.66 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: ASR ASR |
$82.12
|
| Rate for Payer: ASR Commercial |
$82.12
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$69.33
|
| Rate for Payer: BCN Commercial |
$65.64
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$79.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$84.66
|
| Rate for Payer: Healthscope Whirlpool |
$82.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.19
|
| Rate for Payer: Mclaren Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$56.31
|
| Rate for Payer: PHP Medicaid |
$27.44
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.18
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$59.35
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$79.34
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP DNSP |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$27.44
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$76.86 |
| Rate for Payer: Aetna Commercial |
$69.17
|
| Rate for Payer: ASR ASR |
$74.55
|
| Rate for Payer: ASR Commercial |
$74.55
|
| Rate for Payer: BCBS Trust/PPO |
$62.63
|
| Rate for Payer: BCN Commercial |
$59.59
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Healthscope Commercial |
$76.86
|
| Rate for Payer: Healthscope Whirlpool |
$74.55
|
| Rate for Payer: Mclaren Commercial |
$69.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: Nomi Health Commercial |
$63.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.64
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.18 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$69.17
|
| Rate for Payer: Aetna Medicare |
$46.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.72
|
| Rate for Payer: ASR ASR |
$74.55
|
| Rate for Payer: ASR Commercial |
$74.55
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$62.94
|
| Rate for Payer: BCN Commercial |
$59.59
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$76.86
|
| Rate for Payer: Healthscope Whirlpool |
$74.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.98
|
| Rate for Payer: Mclaren Commercial |
$69.17
|
| Rate for Payer: Mclaren Medicaid |
$25.18
|
| Rate for Payer: Mclaren Medicare |
$46.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.33
|
| Rate for Payer: Meridian Medicaid |
$26.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: Nomi Health Commercial |
$63.03
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$51.68
|
| Rate for Payer: PHP Medicaid |
$25.18
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.14
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health Narrow Network |
$252.11
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.98
|
| Rate for Payer: UHC Exchange |
$72.82
|
| Rate for Payer: UHC Medicare Advantage |
$46.98
|
| Rate for Payer: UHCCP DNSP |
$46.98
|
| Rate for Payer: UHCCP Medicaid |
$25.18
|
| Rate for Payer: VA VA |
$46.98
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$61.72 |
| Rate for Payer: Aetna Commercial |
$55.55
|
| Rate for Payer: ASR ASR |
$59.87
|
| Rate for Payer: ASR Commercial |
$59.87
|
| Rate for Payer: BCBS Trust/PPO |
$50.30
|
| Rate for Payer: BCN Commercial |
$47.85
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Healthscope Commercial |
$61.72
|
| Rate for Payer: Healthscope Whirlpool |
$59.87
|
| Rate for Payer: Mclaren Commercial |
$55.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: Nomi Health Commercial |
$50.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.31
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$55.55
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: ASR ASR |
$59.87
|
| Rate for Payer: ASR Commercial |
$59.87
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$47.85
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$61.72
|
| Rate for Payer: Healthscope Whirlpool |
$59.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.73
|
| Rate for Payer: Mclaren Commercial |
$55.55
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: Nomi Health Commercial |
$50.61
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicaid |
$20.22
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.14
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health Narrow Network |
$252.11
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$58.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP DNSP |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$20.22
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,570.54
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,320.85 |
| Max. Negotiated Rate |
$3,570.54 |
| Rate for Payer: Aetna Commercial |
$3,213.49
|
| Rate for Payer: ASR ASR |
$3,463.42
|
| Rate for Payer: ASR Commercial |
$3,463.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,909.63
|
| Rate for Payer: BCN Commercial |
$2,768.24
|
| Rate for Payer: Cash Price |
$2,856.43
|
| Rate for Payer: Cofinity Commercial |
$3,356.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.43
|
| Rate for Payer: Healthscope Commercial |
$3,570.54
|
| Rate for Payer: Healthscope Whirlpool |
$3,463.42
|
| Rate for Payer: Mclaren Commercial |
$3,213.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.96
|
| Rate for Payer: Nomi Health Commercial |
$2,927.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,142.08
|
|
