|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$1,551.90 |
| Rate for Payer: Aetna Commercial |
$1,146.65
|
| Rate for Payer: Aetna Medicare |
$855.71
|
| Rate for Payer: BCBS Complete |
$578.36
|
| Rate for Payer: BCBS MAPPO |
$855.71
|
| Rate for Payer: BCBS Trust/PPO |
$210.79
|
| Rate for Payer: BCN Commercial |
$1,258.83
|
| Rate for Payer: BCN Medicare Advantage |
$855.71
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$1,232.22
|
| Rate for Payer: Cofinity Commercial |
$1,146.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.71
|
| Rate for Payer: Healthscope Commercial |
$1,026.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,026.85
|
| Rate for Payer: Meridian Medicaid |
$578.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$898.50
|
| Rate for Payer: PACE SWMI |
$855.71
|
| Rate for Payer: PHP Medicare Advantage |
$855.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$550.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,514.61
|
| Rate for Payer: Priority Health Medicare |
$855.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,514.61
|
| Rate for Payer: UHC Medicare Advantage |
$881.38
|
|
|
PR CLOSURE GASTROCOLIC FISTULA
|
Professional
|
Both
|
$3,817.00
|
|
|
Service Code
|
HCPCS 43880
|
| Min. Negotiated Rate |
$198.11 |
| Max. Negotiated Rate |
$2,781.10 |
| Rate for Payer: Aetna Commercial |
$2,113.21
|
| Rate for Payer: Aetna Medicare |
$1,577.02
|
| Rate for Payer: BCBS Complete |
$1,077.32
|
| Rate for Payer: BCBS MAPPO |
$1,577.02
|
| Rate for Payer: BCBS Trust/PPO |
$198.11
|
| Rate for Payer: BCN Commercial |
$2,311.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,577.02
|
| Rate for Payer: Cash Price |
$3,053.60
|
| Rate for Payer: Cash Price |
$3,053.60
|
| Rate for Payer: Cofinity Commercial |
$2,113.21
|
| Rate for Payer: Cofinity Commercial |
$2,270.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,577.02
|
| Rate for Payer: Healthscope Commercial |
$1,892.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,892.42
|
| Rate for Payer: Meridian Medicaid |
$1,077.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,655.87
|
| Rate for Payer: PACE SWMI |
$1,577.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,577.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,671.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,781.10
|
| Rate for Payer: Priority Health Medicare |
$1,577.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,781.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,624.33
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,917.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$1,341.90 |
| Rate for Payer: Aetna Commercial |
$945.70
|
| Rate for Payer: Aetna Medicare |
$705.75
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS MAPPO |
$705.75
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: BCN Commercial |
$1,038.93
|
| Rate for Payer: BCN Medicare Advantage |
$705.75
|
| Rate for Payer: Cash Price |
$1,533.60
|
| Rate for Payer: Cash Price |
$1,533.60
|
| Rate for Payer: Cofinity Commercial |
$945.70
|
| Rate for Payer: Cofinity Commercial |
$1,016.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.75
|
| Rate for Payer: Healthscope Commercial |
$846.90
|
| Rate for Payer: Healthscope Whirlpool |
$846.90
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$741.04
|
| Rate for Payer: PACE SWMI |
$705.75
|
| Rate for Payer: PHP Medicare Advantage |
$705.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,341.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,250.03
|
| Rate for Payer: Priority Health Medicare |
$705.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,250.03
|
| Rate for Payer: UHC Medicare Advantage |
$726.92
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,496.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$2,437.73 |
| Rate for Payer: Aetna Commercial |
$1,852.68
|
| Rate for Payer: Aetna Medicare |
$1,382.60
|
| Rate for Payer: BCBS Complete |
$931.51
|
| Rate for Payer: BCBS MAPPO |
$1,382.60
|
| Rate for Payer: BCBS Trust/PPO |
$175.40
|
| Rate for Payer: BCN Commercial |
$2,026.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,382.60
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cofinity Commercial |
$1,852.68
|
| Rate for Payer: Cofinity Commercial |
$1,990.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,382.60
|
| Rate for Payer: Healthscope Commercial |
$1,659.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,659.12
|
| Rate for Payer: Meridian Medicaid |
$931.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,451.73
|
| Rate for Payer: PACE SWMI |
$1,382.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,382.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,747.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,437.73
|
| Rate for Payer: Priority Health Medicare |
$1,382.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,437.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,424.08
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 40830
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$805.66 |
| Rate for Payer: Aetna Commercial |
$189.37
|
| Rate for Payer: Aetna Medicare |
$141.32
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$141.32
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: BCN Medicare Advantage |
$141.32
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$189.37
|
| Rate for Payer: Cofinity Commercial |
$203.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.32
|
| Rate for Payer: Healthscope Commercial |
$169.58
|
| Rate for Payer: Healthscope Whirlpool |
$169.58
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.39
|
| Rate for Payer: PACE SWMI |
$141.32
|
| Rate for Payer: PHP Medicare Advantage |
$141.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.36
|
| Rate for Payer: Priority Health Medicare |
$141.32
|
| Rate for Payer: Priority Health Narrow Network |
$256.36
|
| Rate for Payer: UHC Medicare Advantage |
$145.56
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$949.88 |
| Rate for Payer: Aetna Commercial |
$261.59
|
| Rate for Payer: Aetna Medicare |
$195.22
|
| Rate for Payer: BCBS Complete |
$134.86
|
| Rate for Payer: BCBS MAPPO |
$195.22
|
| Rate for Payer: BCBS Trust/PPO |
$949.88
|
| Rate for Payer: BCN Commercial |
$436.39
|
| Rate for Payer: BCN Medicare Advantage |
$195.22
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$281.12
|
| Rate for Payer: Cofinity Commercial |
$261.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.22
|
| Rate for Payer: Healthscope Commercial |
$234.26
|
| Rate for Payer: Healthscope Whirlpool |
$234.26
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.98
|
| Rate for Payer: PACE SWMI |
$195.22
|
| Rate for Payer: PHP Medicare Advantage |
$195.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.96
|
| Rate for Payer: Priority Health Medicare |
$195.22
|
| Rate for Payer: Priority Health Narrow Network |
$353.96
|
| Rate for Payer: UHC Medicare Advantage |
$201.08
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA
|
Professional
|
Both
|
$3,219.00
|
|
|
Service Code
|
HCPCS 45820
|
| Min. Negotiated Rate |
$527.24 |
| Max. Negotiated Rate |
$2,253.30 |
| Rate for Payer: Aetna Commercial |
$1,697.12
|
| Rate for Payer: Aetna Medicare |
$1,266.51
|
| Rate for Payer: BCBS Complete |
$855.47
|
| Rate for Payer: BCBS MAPPO |
$1,266.51
|
| Rate for Payer: BCBS Trust/PPO |
$527.24
|
| Rate for Payer: BCN Commercial |
$1,862.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.51
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,697.12
|
| Rate for Payer: Cofinity Commercial |
$1,823.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.51
|
| Rate for Payer: Healthscope Commercial |
$1,519.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,519.81
|
| Rate for Payer: Meridian Medicaid |
$855.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,329.84
|
| Rate for Payer: PACE SWMI |
$1,266.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$814.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,253.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.76
|
| Rate for Payer: Priority Health Medicare |
$1,266.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,240.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,304.51
|
|
|
PR CLOSURE RECTOVESICAL FISTULA
|
Professional
|
Both
|
$2,803.00
|
|
|
Service Code
|
HCPCS 45800
|
| Min. Negotiated Rate |
$812.60 |
| Max. Negotiated Rate |
$2,234.88 |
| Rate for Payer: Aetna Commercial |
$1,692.67
|
| Rate for Payer: Aetna Medicare |
$1,263.19
|
| Rate for Payer: BCBS Complete |
$853.23
|
| Rate for Payer: BCBS MAPPO |
$1,263.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.43
|
| Rate for Payer: BCN Commercial |
$1,857.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.19
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cofinity Commercial |
$1,692.67
|
| Rate for Payer: Cofinity Commercial |
$1,818.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.19
|
| Rate for Payer: Healthscope Commercial |
$1,515.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,515.83
|
| Rate for Payer: Meridian Medicaid |
$853.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,326.35
|
| Rate for Payer: PACE SWMI |
$1,263.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,263.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,962.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,234.88
|
| Rate for Payer: Priority Health Medicare |
$1,263.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,234.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.09
|
|
|
PR CLOSURE SALIVARY FISTULA
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 42600
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$808.27 |
| Rate for Payer: Aetna Commercial |
$469.16
|
| Rate for Payer: Aetna Medicare |
$350.12
|
| Rate for Payer: BCBS Complete |
$241.99
|
| Rate for Payer: BCBS MAPPO |
$350.12
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$808.27
|
| Rate for Payer: BCN Medicare Advantage |
$350.12
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cofinity Commercial |
$469.16
|
| Rate for Payer: Cofinity Commercial |
$504.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.12
|
| Rate for Payer: Healthscope Commercial |
$420.14
|
| Rate for Payer: Healthscope Whirlpool |
$420.14
|
| Rate for Payer: Meridian Medicaid |
$241.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.63
|
| Rate for Payer: PACE SWMI |
$350.12
|
| Rate for Payer: PHP Medicare Advantage |
$350.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$630.90
|
| Rate for Payer: Priority Health Medicare |
$350.12
|
| Rate for Payer: Priority Health Narrow Network |
$630.90
|
| Rate for Payer: UHC Medicare Advantage |
$360.62
|
|
|
PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 57320
|
| Min. Negotiated Rate |
$364.02 |
| Max. Negotiated Rate |
$1,656.75 |
| Rate for Payer: Aetna Commercial |
$751.06
|
| Rate for Payer: Aetna Medicare |
$560.49
|
| Rate for Payer: BCBS Complete |
$382.22
|
| Rate for Payer: BCBS MAPPO |
$560.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.75
|
| Rate for Payer: BCN Commercial |
$831.73
|
| Rate for Payer: BCN Medicare Advantage |
$560.49
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$751.06
|
| Rate for Payer: Cofinity Commercial |
$807.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.49
|
| Rate for Payer: Healthscope Commercial |
$672.59
|
| Rate for Payer: Healthscope Whirlpool |
$672.59
|
| Rate for Payer: Meridian Medicaid |
$382.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$588.51
|
| Rate for Payer: PACE SWMI |
$560.49
|
| Rate for Payer: PHP Medicare Advantage |
$560.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.77
|
| Rate for Payer: Priority Health Medicare |
$560.49
|
| Rate for Payer: Priority Health Narrow Network |
$805.77
|
| Rate for Payer: UHC Medicare Advantage |
$577.30
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$158.26 |
| Max. Negotiated Rate |
$410.20 |
| Rate for Payer: Aetna Commercial |
$314.97
|
| Rate for Payer: Aetna Medicare |
$235.05
|
| Rate for Payer: BCBS Complete |
$166.17
|
| Rate for Payer: BCBS MAPPO |
$235.05
|
| Rate for Payer: BCBS Trust/PPO |
$393.06
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: BCN Medicare Advantage |
$235.05
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cofinity Commercial |
$338.47
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.05
|
| Rate for Payer: Healthscope Commercial |
$282.06
|
| Rate for Payer: Healthscope Whirlpool |
$282.06
|
| Rate for Payer: Meridian Medicaid |
$166.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.80
|
| Rate for Payer: PACE SWMI |
$235.05
|
| Rate for Payer: PHP Medicare Advantage |
$235.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.78
|
| Rate for Payer: Priority Health Medicare |
$235.05
|
| Rate for Payer: Priority Health Narrow Network |
$372.78
|
| Rate for Payer: UHC Medicare Advantage |
$242.10
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$303.87
|
| Rate for Payer: Aetna Medicare |
$226.77
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCBS MAPPO |
$226.77
|
| Rate for Payer: BCBS Trust/PPO |
$226.26
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: BCN Medicare Advantage |
$226.77
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$326.55
|
| Rate for Payer: Cofinity Commercial |
$303.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.77
|
| Rate for Payer: Healthscope Commercial |
$272.12
|
| Rate for Payer: Healthscope Whirlpool |
$272.12
|
| Rate for Payer: Meridian Medicaid |
$160.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$238.11
|
| Rate for Payer: PACE SWMI |
$226.77
|
| Rate for Payer: PHP Medicare Advantage |
$226.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.00
|
| Rate for Payer: Priority Health Medicare |
$226.77
|
| Rate for Payer: Priority Health Narrow Network |
$360.00
|
| Rate for Payer: UHC Medicare Advantage |
$233.57
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$578.90 |
| Rate for Payer: Aetna Commercial |
$443.98
|
| Rate for Payer: Aetna Medicare |
$331.33
|
| Rate for Payer: BCBS Complete |
$234.38
|
| Rate for Payer: BCBS MAPPO |
$331.33
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$544.87
|
| Rate for Payer: BCN Medicare Advantage |
$331.33
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$443.98
|
| Rate for Payer: Cofinity Commercial |
$477.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.33
|
| Rate for Payer: Healthscope Commercial |
$397.60
|
| Rate for Payer: Healthscope Whirlpool |
$397.60
|
| Rate for Payer: Meridian Medicaid |
$234.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$347.90
|
| Rate for Payer: PACE SWMI |
$331.33
|
| Rate for Payer: PHP Medicare Advantage |
$331.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.95
|
| Rate for Payer: Priority Health Medicare |
$331.33
|
| Rate for Payer: Priority Health Narrow Network |
$524.95
|
| Rate for Payer: UHC Medicare Advantage |
$341.27
|
|
|
PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 27198
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$2,080.97 |
| Rate for Payer: Aetna Commercial |
$415.92
|
| Rate for Payer: Aetna Medicare |
$310.39
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$310.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,080.97
|
| Rate for Payer: BCN Commercial |
$461.32
|
| Rate for Payer: BCN Medicare Advantage |
$310.39
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$446.96
|
| Rate for Payer: Cofinity Commercial |
$415.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.39
|
| Rate for Payer: Healthscope Commercial |
$372.47
|
| Rate for Payer: Healthscope Whirlpool |
$372.47
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$325.91
|
| Rate for Payer: PACE SWMI |
$310.39
|
| Rate for Payer: PHP Medicare Advantage |
$310.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.06
|
| Rate for Payer: Priority Health Medicare |
$310.39
|
| Rate for Payer: Priority Health Narrow Network |
$482.06
|
| Rate for Payer: UHC Medicare Advantage |
$319.70
|
|
|
PR CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 27197
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$1,831.62 |
| Rate for Payer: Aetna Commercial |
$174.72
|
| Rate for Payer: Aetna Medicare |
$130.39
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$130.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,831.62
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: BCN Medicare Advantage |
$130.39
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$187.76
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.39
|
| Rate for Payer: Healthscope Commercial |
$156.47
|
| Rate for Payer: Healthscope Whirlpool |
$156.47
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.91
|
| Rate for Payer: PACE SWMI |
$130.39
|
| Rate for Payer: PHP Medicare Advantage |
$130.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.29
|
| Rate for Payer: Priority Health Medicare |
$130.39
|
| Rate for Payer: Priority Health Narrow Network |
$205.29
|
| Rate for Payer: UHC Medicare Advantage |
$134.30
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$268.38 |
| Max. Negotiated Rate |
$707.70 |
| Rate for Payer: Aetna Commercial |
$540.33
|
| Rate for Payer: Aetna Medicare |
$403.23
|
| Rate for Payer: BCBS Complete |
$281.80
|
| Rate for Payer: BCBS MAPPO |
$403.23
|
| Rate for Payer: BCBS Trust/PPO |
$372.98
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$403.23
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cofinity Commercial |
$540.33
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.23
|
| Rate for Payer: Healthscope Commercial |
$483.88
|
| Rate for Payer: Healthscope Whirlpool |
$483.88
|
| Rate for Payer: Meridian Medicaid |
$281.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$423.39
|
| Rate for Payer: PACE SWMI |
$403.23
|
| Rate for Payer: PHP Medicare Advantage |
$403.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.74
|
| Rate for Payer: Priority Health Medicare |
$403.23
|
| Rate for Payer: Priority Health Narrow Network |
$634.74
|
| Rate for Payer: UHC Medicare Advantage |
$415.33
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$200.22 |
| Max. Negotiated Rate |
$498.94 |
| Rate for Payer: Aetna Commercial |
$400.66
|
| Rate for Payer: Aetna Medicare |
$299.00
|
| Rate for Payer: BCBS Complete |
$210.23
|
| Rate for Payer: BCBS MAPPO |
$299.00
|
| Rate for Payer: BCBS Trust/PPO |
$328.60
|
| Rate for Payer: BCN Commercial |
$498.94
|
| Rate for Payer: BCN Medicare Advantage |
$299.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$430.56
|
| Rate for Payer: Cofinity Commercial |
$400.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.00
|
| Rate for Payer: Healthscope Commercial |
$358.80
|
| Rate for Payer: Healthscope Whirlpool |
$358.80
|
| Rate for Payer: Meridian Medicaid |
$210.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$313.95
|
| Rate for Payer: PACE SWMI |
$299.00
|
| Rate for Payer: PHP Medicare Advantage |
$299.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$470.31
|
| Rate for Payer: Priority Health Medicare |
$299.00
|
| Rate for Payer: Priority Health Narrow Network |
$470.31
|
| Rate for Payer: UHC Medicare Advantage |
$307.97
|
|
|
PR CLSR ANAL FSTL W/RCT ADVMNT FLAP
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 46288
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$2,458.18 |
| Rate for Payer: Aetna Commercial |
$734.28
|
| Rate for Payer: Aetna Medicare |
$547.97
|
| Rate for Payer: BCBS Complete |
$377.52
|
| Rate for Payer: BCBS MAPPO |
$547.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,458.18
|
| Rate for Payer: BCN Commercial |
$818.53
|
| Rate for Payer: BCN Medicare Advantage |
$547.97
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$734.28
|
| Rate for Payer: Cofinity Commercial |
$789.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.97
|
| Rate for Payer: Healthscope Commercial |
$657.56
|
| Rate for Payer: Healthscope Whirlpool |
$657.56
|
| Rate for Payer: Meridian Medicaid |
$377.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$575.37
|
| Rate for Payer: PACE SWMI |
$547.97
|
| Rate for Payer: PHP Medicare Advantage |
$547.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,151.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$984.85
|
| Rate for Payer: Priority Health Medicare |
$547.97
|
| Rate for Payer: Priority Health Narrow Network |
$984.85
|
| Rate for Payer: UHC Medicare Advantage |
$564.41
|
|
|
PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA
|
Professional
|
Both
|
$1,835.00
|
|
|
Service Code
|
HCPCS 32810
|
| Min. Negotiated Rate |
$570.84 |
| Max. Negotiated Rate |
$1,299.88 |
| Rate for Payer: Aetna Commercial |
$1,187.70
|
| Rate for Payer: Aetna Medicare |
$886.34
|
| Rate for Payer: BCBS Complete |
$599.38
|
| Rate for Payer: BCBS MAPPO |
$886.34
|
| Rate for Payer: BCBS Trust/PPO |
$807.77
|
| Rate for Payer: BCN Commercial |
$1,299.88
|
| Rate for Payer: BCN Medicare Advantage |
$886.34
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cofinity Commercial |
$1,276.33
|
| Rate for Payer: Cofinity Commercial |
$1,187.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.34
|
| Rate for Payer: Healthscope Commercial |
$1,063.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,063.61
|
| Rate for Payer: Meridian Medicaid |
$599.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$930.66
|
| Rate for Payer: PACE SWMI |
$886.34
|
| Rate for Payer: PHP Medicare Advantage |
$886.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.70
|
| Rate for Payer: Priority Health Medicare |
$886.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.70
|
| Rate for Payer: UHC Medicare Advantage |
$912.93
|
|
|
PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL
|
Professional
|
Both
|
$2,528.00
|
|
|
Service Code
|
HCPCS 44650
|
| Min. Negotiated Rate |
$245.13 |
| Max. Negotiated Rate |
$2,514.18 |
| Rate for Payer: Aetna Commercial |
$1,910.63
|
| Rate for Payer: Aetna Medicare |
$1,425.84
|
| Rate for Payer: BCBS Complete |
$960.35
|
| Rate for Payer: BCBS MAPPO |
$1,425.84
|
| Rate for Payer: BCBS Trust/PPO |
$245.13
|
| Rate for Payer: BCN Commercial |
$2,089.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.84
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cash Price |
$2,022.40
|
| Rate for Payer: Cofinity Commercial |
$2,053.21
|
| Rate for Payer: Cofinity Commercial |
$1,910.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.84
|
| Rate for Payer: Healthscope Commercial |
$1,711.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,711.01
|
| Rate for Payer: Meridian Medicaid |
$960.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,497.13
|
| Rate for Payer: PACE SWMI |
$1,425.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$914.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.18
|
| Rate for Payer: Priority Health Medicare |
$1,425.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,514.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,468.62
|
|
|
PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ
|
Professional
|
Both
|
$3,506.00
|
|
|
Service Code
|
HCPCS 44661
|
| Min. Negotiated Rate |
$246.19 |
| Max. Negotiated Rate |
$2,694.09 |
| Rate for Payer: Aetna Commercial |
$2,048.02
|
| Rate for Payer: Aetna Medicare |
$1,528.37
|
| Rate for Payer: BCBS Complete |
$1,027.00
|
| Rate for Payer: BCBS MAPPO |
$1,528.37
|
| Rate for Payer: BCBS Trust/PPO |
$246.19
|
| Rate for Payer: BCN Commercial |
$2,239.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.37
|
| Rate for Payer: Cash Price |
$2,804.80
|
| Rate for Payer: Cash Price |
$2,804.80
|
| Rate for Payer: Cofinity Commercial |
$2,200.85
|
| Rate for Payer: Cofinity Commercial |
$2,048.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.37
|
| Rate for Payer: Healthscope Commercial |
$1,834.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.04
|
| Rate for Payer: Meridian Medicaid |
$1,027.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,604.79
|
| Rate for Payer: PACE SWMI |
$1,528.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$978.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,694.09
|
| Rate for Payer: Priority Health Medicare |
$1,528.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,694.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,574.22
|
|
|
PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS 44660
|
| Min. Negotiated Rate |
$250.41 |
| Max. Negotiated Rate |
$2,327.78 |
| Rate for Payer: Aetna Commercial |
$1,766.44
|
| Rate for Payer: Aetna Medicare |
$1,318.24
|
| Rate for Payer: BCBS Complete |
$895.05
|
| Rate for Payer: BCBS MAPPO |
$1,318.24
|
| Rate for Payer: BCBS Trust/PPO |
$250.41
|
| Rate for Payer: BCN Commercial |
$1,934.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,318.24
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cofinity Commercial |
$1,898.27
|
| Rate for Payer: Cofinity Commercial |
$1,766.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,318.24
|
| Rate for Payer: Healthscope Commercial |
$1,581.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,581.89
|
| Rate for Payer: Meridian Medicaid |
$895.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,384.15
|
| Rate for Payer: PACE SWMI |
$1,318.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,318.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,327.78
|
| Rate for Payer: Priority Health Medicare |
$1,318.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,327.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,357.79
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 43420
|
| Min. Negotiated Rate |
$652.21 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna Commercial |
$1,347.92
|
| Rate for Payer: Aetna Medicare |
$1,005.91
|
| Rate for Payer: BCBS Complete |
$684.82
|
| Rate for Payer: BCBS MAPPO |
$1,005.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: BCN Commercial |
$1,490.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.91
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.51
|
| Rate for Payer: Cofinity Commercial |
$1,347.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.91
|
| Rate for Payer: Healthscope Commercial |
$1,207.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.09
|
| Rate for Payer: Meridian Medicaid |
$684.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,056.21
|
| Rate for Payer: PACE SWMI |
$1,005.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,848.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,793.91
|
| Rate for Payer: Priority Health Medicare |
$1,005.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,793.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.09
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 43425
|
| Min. Negotiated Rate |
$911.43 |
| Max. Negotiated Rate |
$2,866.50 |
| Rate for Payer: Aetna Commercial |
$1,907.38
|
| Rate for Payer: Aetna Medicare |
$1,423.42
|
| Rate for Payer: BCBS Complete |
$957.00
|
| Rate for Payer: BCBS MAPPO |
$1,423.42
|
| Rate for Payer: BCBS Trust/PPO |
$986.34
|
| Rate for Payer: BCN Commercial |
$2,080.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.42
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cofinity Commercial |
$2,049.72
|
| Rate for Payer: Cofinity Commercial |
$1,907.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.42
|
| Rate for Payer: Healthscope Commercial |
$1,708.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,708.10
|
| Rate for Payer: Meridian Medicaid |
$957.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.59
|
| Rate for Payer: PACE SWMI |
$1,423.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$911.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,866.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,503.00
|
| Rate for Payer: Priority Health Medicare |
$1,423.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,503.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.12
|
|
|
PR CLSR LACRIMAL PUNCTUM PLUG EACH
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 68761
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,031.77 |
| Rate for Payer: Aetna Commercial |
$149.42
|
| Rate for Payer: Aetna Medicare |
$111.51
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$111.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.77
|
| Rate for Payer: BCN Commercial |
$170.81
|
| Rate for Payer: BCN Medicare Advantage |
$111.51
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$149.42
|
| Rate for Payer: Cofinity Commercial |
$160.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.51
|
| Rate for Payer: Healthscope Commercial |
$133.81
|
| Rate for Payer: Healthscope Whirlpool |
$133.81
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.09
|
| Rate for Payer: PACE SWMI |
$111.51
|
| Rate for Payer: PHP Medicare Advantage |
$111.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.56
|
| Rate for Payer: Priority Health Medicare |
$111.51
|
| Rate for Payer: Priority Health Narrow Network |
$202.56
|
| Rate for Payer: UHC Medicare Advantage |
$114.86
|
|
