|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,985.23 |
| Max. Negotiated Rate |
$4,592.66 |
| Rate for Payer: Aetna Commercial |
$4,133.39
|
| Rate for Payer: ASR ASR |
$4,454.88
|
| Rate for Payer: ASR Commercial |
$4,454.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,742.56
|
| Rate for Payer: BCN Commercial |
$3,560.69
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$4,317.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Healthscope Commercial |
$4,592.66
|
| Rate for Payer: Healthscope Whirlpool |
$4,454.88
|
| Rate for Payer: Mclaren Commercial |
$4,133.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: Nomi Health Commercial |
$3,765.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,041.54
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,401.21 |
| Max. Negotiated Rate |
$3,503.03 |
| Rate for Payer: Aetna Commercial |
$3,152.73
|
| Rate for Payer: Aetna Medicare |
$1,751.52
|
| Rate for Payer: ASR ASR |
$3,397.94
|
| Rate for Payer: ASR Commercial |
$3,397.94
|
| Rate for Payer: BCBS Complete |
$1,401.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,868.63
|
| Rate for Payer: BCN Commercial |
$2,715.90
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,292.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,503.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,397.94
|
| Rate for Payer: Mclaren Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,069.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,455.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,082.67
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,276.97 |
| Max. Negotiated Rate |
$3,503.03 |
| Rate for Payer: Aetna Commercial |
$3,152.73
|
| Rate for Payer: ASR ASR |
$3,397.94
|
| Rate for Payer: ASR Commercial |
$3,397.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,854.62
|
| Rate for Payer: BCN Commercial |
$2,715.90
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,292.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,503.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,397.94
|
| Rate for Payer: Mclaren Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,082.67
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,069.12 |
| Max. Negotiated Rate |
$2,672.79 |
| Rate for Payer: Aetna Commercial |
$2,405.51
|
| Rate for Payer: Aetna Medicare |
$1,336.39
|
| Rate for Payer: ASR ASR |
$2,592.61
|
| Rate for Payer: ASR Commercial |
$2,592.61
|
| Rate for Payer: BCBS Complete |
$1,069.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,188.75
|
| Rate for Payer: BCN Commercial |
$2,072.21
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,512.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,672.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,592.61
|
| Rate for Payer: Mclaren Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,341.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,873.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.06
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,737.31 |
| Max. Negotiated Rate |
$2,672.79 |
| Rate for Payer: Aetna Commercial |
$2,405.51
|
| Rate for Payer: ASR ASR |
$2,592.61
|
| Rate for Payer: ASR Commercial |
$2,592.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,178.06
|
| Rate for Payer: BCN Commercial |
$2,072.21
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,512.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,672.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,592.61
|
| Rate for Payer: Mclaren Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.06
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$729.86 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$919.51
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.85
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$787.12
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: Aetna Medicare |
$134.73
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Complete |
$107.78
|
| Rate for Payer: BCBS Trust/PPO |
$220.66
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.10
|
| Rate for Payer: Priority Health Narrow Network |
$188.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Trust/PPO |
$219.58
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$355.46 |
| Rate for Payer: Aetna Commercial |
$319.91
|
| Rate for Payer: Aetna Medicare |
$167.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: ASR ASR |
$344.80
|
| Rate for Payer: ASR Commercial |
$344.80
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: BCN Commercial |
$275.59
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$334.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$355.46
|
| Rate for Payer: Healthscope Whirlpool |
$344.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.12
|
| Rate for Payer: Mclaren Commercial |
$319.91
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$183.83
|
| Rate for Payer: PHP Medicaid |
$89.58
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.45
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health Narrow Network |
$249.18
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$259.04
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP DNSP |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$89.58
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.05 |
| Max. Negotiated Rate |
$355.46 |
| Rate for Payer: Aetna Commercial |
$319.91
|
| Rate for Payer: ASR ASR |
$344.80
|
| Rate for Payer: ASR Commercial |
$344.80
|
| Rate for Payer: BCBS Trust/PPO |
$289.66
|
| Rate for Payer: BCN Commercial |
$275.59
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$334.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Healthscope Commercial |
$355.46
|
| Rate for Payer: Healthscope Whirlpool |
$344.80
|
| Rate for Payer: Mclaren Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.80
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Trust/PPO |
$219.58
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$543.79 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: Aetna Medicare |
$350.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.54
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Complete |
$197.45
|
| Rate for Payer: BCBS MAPPO |
$350.83
|
| Rate for Payer: BCBS Trust/PPO |
$220.66
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: BCN Medicare Advantage |
$350.83
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.83
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$350.83
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Mclaren Medicaid |
$188.04
|
| Rate for Payer: Mclaren Medicare |
$350.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.37
|
| Rate for Payer: Meridian Medicaid |
$197.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PACE Medicare |
$333.29
|
| Rate for Payer: PACE SWMI |
$350.83
|
| Rate for Payer: PHP Commercial |
$385.91
|
| Rate for Payer: PHP Medicaid |
$188.04
|
| Rate for Payer: PHP Medicare Advantage |
$350.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.10
|
| Rate for Payer: Priority Health Medicare |
$350.83
|
| Rate for Payer: Priority Health Narrow Network |
$188.89
|
| Rate for Payer: Railroad Medicare Medicare |
$350.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.83
|
| Rate for Payer: UHC Exchange |
$543.79
|
| Rate for Payer: UHC Medicare Advantage |
$350.83
|
| Rate for Payer: UHCCP DNSP |
$350.83
|
| Rate for Payer: UHCCP Medicaid |
$188.04
|
| Rate for Payer: VA VA |
$350.83
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.04 |
| Max. Negotiated Rate |
$1,470.09 |
| Rate for Payer: Aetna Commercial |
$1,323.08
|
| Rate for Payer: Aetna Medicare |
$735.04
|
| Rate for Payer: ASR ASR |
$1,425.99
|
| Rate for Payer: ASR Commercial |
$1,425.99
|
| Rate for Payer: BCBS Complete |
$588.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.86
|
| Rate for Payer: BCN Commercial |
$1,139.76
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,381.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Healthscope Commercial |
$1,470.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.99
|
| Rate for Payer: Mclaren Commercial |
$1,323.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,288.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.68
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.56 |
| Max. Negotiated Rate |
$1,470.09 |
| Rate for Payer: Aetna Commercial |
$1,323.08
|
| Rate for Payer: ASR ASR |
$1,425.99
|
| Rate for Payer: ASR Commercial |
$1,425.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.98
|
| Rate for Payer: BCN Commercial |
$1,139.76
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,381.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Healthscope Commercial |
$1,470.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.99
|
| Rate for Payer: Mclaren Commercial |
$1,323.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.68
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.22 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,197.99
|
| Rate for Payer: ASR ASR |
$1,291.17
|
| Rate for Payer: ASR Commercial |
$1,291.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.71
|
| Rate for Payer: BCN Commercial |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,251.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.17
|
| Rate for Payer: Mclaren Commercial |
$1,197.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.43
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.37
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.44 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,197.99
|
| Rate for Payer: Aetna Medicare |
$665.55
|
| Rate for Payer: ASR ASR |
$1,291.17
|
| Rate for Payer: ASR Commercial |
$1,291.17
|
| Rate for Payer: BCBS Complete |
$532.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.04
|
| Rate for Payer: BCN Commercial |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,251.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.17
|
| Rate for Payer: Mclaren Commercial |
$1,197.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.43
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,166.31
|
| Rate for Payer: Priority Health Narrow Network |
$933.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.37
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$41.81
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.02
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.88
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: PHP Medicaid |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.96
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Narrow Network |
$35.97
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$9.11
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP DNSP |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$40.04
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Trust/PPO |
$46.55
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
|
