|
PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 45382
|
| Hospital Charge Code |
45382
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$1,396.00 |
| Rate for Payer: Aetna Commercial |
$1,256.40
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,354.12
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.32
|
| Rate for Payer: BCN Commercial |
$1,082.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,116.80
|
| Rate for Payer: Cash Price |
$1,116.80
|
| Rate for Payer: Cofinity Commercial |
$1,312.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,116.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,396.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,354.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,256.40
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,186.60
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$977.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,270.36
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$991.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,228.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,396.00
|
|
|
Service Code
|
HCPCS 45382
|
| Hospital Charge Code |
45382
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$979.31 |
| Rate for Payer: Aetna Commercial |
$336.93
|
| Rate for Payer: Aetna Medicare |
$251.44
|
| Rate for Payer: BCBS Complete |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$251.44
|
| Rate for Payer: BCBS Trust/PPO |
$315.92
|
| Rate for Payer: BCN Commercial |
$979.31
|
| Rate for Payer: BCN Medicare Advantage |
$251.44
|
| Rate for Payer: Cash Price |
$1,116.80
|
| Rate for Payer: Cash Price |
$1,116.80
|
| Rate for Payer: Cofinity Commercial |
$362.07
|
| Rate for Payer: Cofinity Commercial |
$336.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.44
|
| Rate for Payer: Healthscope Commercial |
$301.73
|
| Rate for Payer: Healthscope Whirlpool |
$301.73
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$264.01
|
| Rate for Payer: PACE SWMI |
$251.44
|
| Rate for Payer: PHP Medicare Advantage |
$251.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$977.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.26
|
| Rate for Payer: Priority Health Medicare |
$251.44
|
| Rate for Payer: Priority Health Narrow Network |
$446.26
|
| Rate for Payer: UHC Medicare Advantage |
$258.98
|
|
|
PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 45386
|
| Min. Negotiated Rate |
$118.34 |
| Max. Negotiated Rate |
$905.80 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$205.71
|
| Rate for Payer: BCBS Complete |
$139.79
|
| Rate for Payer: BCBS MAPPO |
$205.71
|
| Rate for Payer: BCBS Trust/PPO |
$118.34
|
| Rate for Payer: BCN Commercial |
$898.67
|
| Rate for Payer: BCN Medicare Advantage |
$205.71
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cofinity Commercial |
$296.22
|
| Rate for Payer: Cofinity Commercial |
$275.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.71
|
| Rate for Payer: Healthscope Commercial |
$246.85
|
| Rate for Payer: Healthscope Whirlpool |
$246.85
|
| Rate for Payer: Meridian Medicaid |
$139.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.00
|
| Rate for Payer: PACE SWMI |
$205.71
|
| Rate for Payer: PHP Medicare Advantage |
$205.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$905.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.13
|
| Rate for Payer: Priority Health Medicare |
$205.71
|
| Rate for Payer: Priority Health Narrow Network |
$365.13
|
| Rate for Payer: UHC Medicare Advantage |
$211.88
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
45381
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna Commercial |
$260.84
|
| Rate for Payer: Aetna Medicare |
$194.66
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$194.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: BCN Commercial |
$650.43
|
| Rate for Payer: BCN Medicare Advantage |
$194.66
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$260.84
|
| Rate for Payer: Cofinity Commercial |
$280.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.66
|
| Rate for Payer: Healthscope Commercial |
$233.59
|
| Rate for Payer: Healthscope Whirlpool |
$233.59
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.39
|
| Rate for Payer: PACE SWMI |
$194.66
|
| Rate for Payer: PHP Medicare Advantage |
$194.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.73
|
| Rate for Payer: Priority Health Medicare |
$194.66
|
| Rate for Payer: Priority Health Narrow Network |
$345.73
|
| Rate for Payer: UHC Medicare Advantage |
$200.50
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$964.60 |
| Max. Negotiated Rate |
$1,378.00 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: ASR ASR |
$1,336.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.36
|
| Rate for Payer: BCN Commercial |
$1,068.36
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$1,295.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,102.40
|
| Rate for Payer: Healthscope Commercial |
$1,378.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.66
|
| Rate for Payer: Mclaren Commercial |
$1,240.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,171.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,212.64
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,378.00
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna Commercial |
$260.84
|
| Rate for Payer: Aetna Medicare |
$194.66
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$194.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: BCN Commercial |
$650.43
|
| Rate for Payer: BCN Medicare Advantage |
$194.66
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$260.84
|
| Rate for Payer: Cofinity Commercial |
$280.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.66
|
| Rate for Payer: Healthscope Commercial |
$233.59
|
| Rate for Payer: Healthscope Whirlpool |
$233.59
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.39
|
| Rate for Payer: PACE SWMI |
$194.66
|
| Rate for Payer: PHP Medicare Advantage |
$194.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.73
|
| Rate for Payer: Priority Health Medicare |
$194.66
|
| Rate for Payer: Priority Health Narrow Network |
$345.73
|
| Rate for Payer: UHC Medicare Advantage |
$200.50
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
45381
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$1,378.00 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,336.66
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.36
|
| Rate for Payer: BCN Commercial |
$1,068.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cofinity Commercial |
$1,295.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,102.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,378.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,240.20
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,171.30
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.98
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$978.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,212.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
|
Professional
|
Both
|
$533.00
|
|
|
Service Code
|
HCPCS 45391
|
| Min. Negotiated Rate |
$161.67 |
| Max. Negotiated Rate |
$444.51 |
| Rate for Payer: Aetna Commercial |
$335.54
|
| Rate for Payer: Aetna Medicare |
$250.40
|
| Rate for Payer: BCBS Complete |
$169.75
|
| Rate for Payer: BCBS MAPPO |
$250.40
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$250.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cofinity Commercial |
$360.58
|
| Rate for Payer: Cofinity Commercial |
$335.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.40
|
| Rate for Payer: Healthscope Commercial |
$300.48
|
| Rate for Payer: Healthscope Whirlpool |
$300.48
|
| Rate for Payer: Meridian Medicaid |
$169.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.92
|
| Rate for Payer: PACE SWMI |
$250.40
|
| Rate for Payer: PHP Medicare Advantage |
$250.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.51
|
| Rate for Payer: Priority Health Medicare |
$250.40
|
| Rate for Payer: Priority Health Narrow Network |
$444.51
|
| Rate for Payer: UHC Medicare Advantage |
$257.91
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$297.61
|
| Rate for Payer: Aetna Medicare |
$222.10
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS MAPPO |
$222.10
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$717.86
|
| Rate for Payer: BCN Medicare Advantage |
$222.10
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$319.82
|
| Rate for Payer: Cofinity Commercial |
$297.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.10
|
| Rate for Payer: Healthscope Commercial |
$266.52
|
| Rate for Payer: Healthscope Whirlpool |
$266.52
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.20
|
| Rate for Payer: PACE SWMI |
$222.10
|
| Rate for Payer: PHP Medicare Advantage |
$222.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.36
|
| Rate for Payer: Priority Health Medicare |
$222.10
|
| Rate for Payer: Priority Health Narrow Network |
$393.36
|
| Rate for Payer: UHC Medicare Advantage |
$228.76
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$1,278.00
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,377.40
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.93
|
| Rate for Payer: BCN Commercial |
$1,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,278.00
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.20
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,008.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$994.00 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$1,278.00
|
| Rate for Payer: ASR ASR |
$1,377.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.93
|
| Rate for Payer: BCN Commercial |
$1,100.93
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Healthscope Commercial |
$1,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.40
|
| Rate for Payer: Mclaren Commercial |
$1,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.60
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
45384
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$297.61
|
| Rate for Payer: Aetna Medicare |
$222.10
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS MAPPO |
$222.10
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$717.86
|
| Rate for Payer: BCN Medicare Advantage |
$222.10
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$319.82
|
| Rate for Payer: Cofinity Commercial |
$297.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.10
|
| Rate for Payer: Healthscope Commercial |
$266.52
|
| Rate for Payer: Healthscope Whirlpool |
$266.52
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.20
|
| Rate for Payer: PACE SWMI |
$222.10
|
| Rate for Payer: PHP Medicare Advantage |
$222.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.36
|
| Rate for Payer: Priority Health Medicare |
$222.10
|
| Rate for Payer: Priority Health Narrow Network |
$393.36
|
| Rate for Payer: UHC Medicare Advantage |
$228.76
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$994.00 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$1,278.00
|
| Rate for Payer: ASR ASR |
$1,377.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.93
|
| Rate for Payer: BCN Commercial |
$1,100.93
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Healthscope Commercial |
$1,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.40
|
| Rate for Payer: Mclaren Commercial |
$1,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.60
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$330.78
|
| Rate for Payer: Aetna Medicare |
$246.85
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS MAPPO |
$246.85
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: BCN Medicare Advantage |
$246.85
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$355.46
|
| Rate for Payer: Cofinity Commercial |
$330.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.85
|
| Rate for Payer: Healthscope Commercial |
$296.22
|
| Rate for Payer: Healthscope Whirlpool |
$296.22
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$259.19
|
| Rate for Payer: PACE SWMI |
$246.85
|
| Rate for Payer: PHP Medicare Advantage |
$246.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.04
|
| Rate for Payer: Priority Health Medicare |
$246.85
|
| Rate for Payer: Priority Health Narrow Network |
$438.04
|
| Rate for Payer: UHC Medicare Advantage |
$254.26
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$994.00 |
| Rate for Payer: Aetna Commercial |
$330.78
|
| Rate for Payer: Aetna Medicare |
$246.85
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS MAPPO |
$246.85
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: BCN Medicare Advantage |
$246.85
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$355.46
|
| Rate for Payer: Cofinity Commercial |
$330.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.85
|
| Rate for Payer: Healthscope Commercial |
$296.22
|
| Rate for Payer: Healthscope Whirlpool |
$296.22
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$259.19
|
| Rate for Payer: PACE SWMI |
$246.85
|
| Rate for Payer: PHP Medicare Advantage |
$246.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.04
|
| Rate for Payer: Priority Health Medicare |
$246.85
|
| Rate for Payer: Priority Health Narrow Network |
$438.04
|
| Rate for Payer: UHC Medicare Advantage |
$254.26
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$1,278.00
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,377.40
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.93
|
| Rate for Payer: BCN Commercial |
$1,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,334.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,420.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,278.00
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.00
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.20
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,008.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$396.09
|
| Rate for Payer: Aetna Medicare |
$295.59
|
| Rate for Payer: BCBS Complete |
$200.39
|
| Rate for Payer: BCBS MAPPO |
$295.59
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$435.90
|
| Rate for Payer: BCN Medicare Advantage |
$295.59
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$425.65
|
| Rate for Payer: Cofinity Commercial |
$396.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.59
|
| Rate for Payer: Healthscope Commercial |
$354.71
|
| Rate for Payer: Healthscope Whirlpool |
$354.71
|
| Rate for Payer: Meridian Medicaid |
$200.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$310.37
|
| Rate for Payer: PACE SWMI |
$295.59
|
| Rate for Payer: PHP Medicare Advantage |
$295.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.47
|
| Rate for Payer: Priority Health Medicare |
$295.59
|
| Rate for Payer: Priority Health Narrow Network |
$524.47
|
| Rate for Payer: UHC Medicare Advantage |
$304.46
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$1,575.92 |
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.92
|
| Rate for Payer: BCN Commercial |
$34.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.44
|
| Rate for Payer: Priority Health Narrow Network |
$31.44
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$480.86 |
| Rate for Payer: Aetna Commercial |
$76.90
|
| Rate for Payer: Aetna Medicare |
$57.39
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$57.39
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: BCN Medicare Advantage |
$57.39
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$76.90
|
| Rate for Payer: Cofinity Commercial |
$82.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$68.87
|
| Rate for Payer: Healthscope Whirlpool |
$68.87
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.26
|
| Rate for Payer: PACE SWMI |
$57.39
|
| Rate for Payer: PHP Medicare Advantage |
$57.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.50
|
| Rate for Payer: Priority Health Medicare |
$57.39
|
| Rate for Payer: Priority Health Narrow Network |
$91.50
|
| Rate for Payer: UHC Medicare Advantage |
$59.11
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$1,712.22 |
| Rate for Payer: Aetna Commercial |
$278.47
|
| Rate for Payer: Aetna Medicare |
$207.81
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$207.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.22
|
| Rate for Payer: BCN Commercial |
$322.04
|
| Rate for Payer: BCN Medicare Advantage |
$207.81
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$299.25
|
| Rate for Payer: Cofinity Commercial |
$278.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.81
|
| Rate for Payer: Healthscope Commercial |
$249.37
|
| Rate for Payer: Healthscope Whirlpool |
$249.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.20
|
| Rate for Payer: PACE SWMI |
$207.81
|
| Rate for Payer: PHP Medicare Advantage |
$207.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.62
|
| Rate for Payer: Priority Health Medicare |
$207.81
|
| Rate for Payer: Priority Health Narrow Network |
$311.62
|
| Rate for Payer: UHC Medicare Advantage |
$214.04
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$2,901.95 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$88.86
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,901.95
|
| Rate for Payer: BCN Commercial |
$140.79
|
| Rate for Payer: BCN Medicare Advantage |
$88.86
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$127.96
|
| Rate for Payer: Cofinity Commercial |
$119.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.86
|
| Rate for Payer: Healthscope Commercial |
$97.75
|
| Rate for Payer: Healthscope Whirlpool |
$97.75
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.30
|
| Rate for Payer: PACE SWMI |
$88.86
|
| Rate for Payer: PHP Medicare Advantage |
$88.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.79
|
| Rate for Payer: Priority Health Medicare |
$88.86
|
| Rate for Payer: Priority Health Narrow Network |
$114.79
|
| Rate for Payer: UHC Medicare Advantage |
$91.53
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$3,367.38 |
| Rate for Payer: Aetna Commercial |
$464.12
|
| Rate for Payer: Aetna Medicare |
$346.36
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS MAPPO |
$346.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,367.38
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$346.36
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$498.76
|
| Rate for Payer: Cofinity Commercial |
$464.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.36
|
| Rate for Payer: Healthscope Commercial |
$415.63
|
| Rate for Payer: Healthscope Whirlpool |
$415.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.68
|
| Rate for Payer: PACE SWMI |
$346.36
|
| Rate for Payer: PHP Medicare Advantage |
$346.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.77
|
| Rate for Payer: Priority Health Medicare |
$346.36
|
| Rate for Payer: Priority Health Narrow Network |
$592.77
|
| Rate for Payer: UHC Medicare Advantage |
$356.75
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$2,796.82 |
| Rate for Payer: Aetna Commercial |
$462.66
|
| Rate for Payer: Aetna Medicare |
$345.27
|
| Rate for Payer: BCBS Complete |
$258.80
|
| Rate for Payer: BCBS MAPPO |
$345.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,796.82
|
| Rate for Payer: BCN Commercial |
$534.61
|
| Rate for Payer: BCN Medicare Advantage |
$345.27
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cofinity Commercial |
$497.19
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.27
|
| Rate for Payer: Healthscope Commercial |
$414.32
|
| Rate for Payer: Healthscope Whirlpool |
$414.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$362.53
|
| Rate for Payer: PACE SWMI |
$345.27
|
| Rate for Payer: PHP Medicare Advantage |
$345.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.16
|
| Rate for Payer: Priority Health Medicare |
$345.27
|
| Rate for Payer: Priority Health Narrow Network |
$591.16
|
| Rate for Payer: UHC Medicare Advantage |
$355.63
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,220.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,688.00 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: BCBS Complete |
$1,688.00
|
| Rate for Payer: Cash Price |
$3,376.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,954.00
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$2,933.12 |
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Medicare |
$13.65
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,933.12
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$13.65
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.65
|
| Rate for Payer: Healthscope Commercial |
$16.38
|
| Rate for Payer: Healthscope Whirlpool |
$16.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.33
|
| Rate for Payer: PACE SWMI |
$13.65
|
| Rate for Payer: PHP Medicare Advantage |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow Network |
$22.69
|
| Rate for Payer: UHC Medicare Advantage |
$14.06
|
|
