|
BUR 2.0X54 ROUND 1608-006-087
|
Facility
|
OP
|
$375.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: AlohaCare Medicaid |
$187.50
|
| Rate for Payer: AlohaCare Medicare |
$116.25
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Devoted Health Medicare |
$127.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.25
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Humana Medicare |
$116.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.25
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.25
|
| Rate for Payer: University Health Alliance Commercial |
$273.34
|
|
|
BUR 3.0MM ROUND 1608-006-091
|
Facility
|
IP
|
$356.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$345.32 |
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$320.40
|
| Rate for Payer: MDX Hawaii PPO |
$345.32
|
|
|
BUR 3.0MM ROUND 1608-006-091
|
Facility
|
OP
|
$356.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$345.32 |
| Rate for Payer: AlohaCare Medicaid |
$178.00
|
| Rate for Payer: AlohaCare Medicare |
$110.36
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Devoted Health Medicare |
$121.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$338.20
|
| Rate for Payer: Health Management Network Commercial |
$302.60
|
| Rate for Payer: Humana Medicare |
$110.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$320.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.36
|
| Rate for Payer: MDX Hawaii PPO |
$345.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.36
|
| Rate for Payer: University Health Alliance Commercial |
$259.49
|
|
|
BUR DIAMOND 4MM 15 DEG
|
Facility
|
IP
|
$998.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.30 |
| Max. Negotiated Rate |
$968.06 |
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
|
|
BUR DIAMOND 4MM 15 DEG
|
Facility
|
OP
|
$998.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$968.06 |
| Rate for Payer: AlohaCare Medicaid |
$499.00
|
| Rate for Payer: AlohaCare Medicare |
$309.38
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Devoted Health Medicare |
$339.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$309.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.10
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Humana Medicare |
$309.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$508.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.38
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$309.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$309.38
|
| Rate for Payer: University Health Alliance Commercial |
$727.44
|
|
|
BUR DIAMOND 4MM 70 DEG
|
Facility
|
OP
|
$998.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.38 |
| Max. Negotiated Rate |
$968.06 |
| Rate for Payer: AlohaCare Medicaid |
$499.00
|
| Rate for Payer: AlohaCare Medicare |
$309.38
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Devoted Health Medicare |
$339.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$309.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.10
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Humana Medicare |
$309.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$508.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.38
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$309.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$309.38
|
| Rate for Payer: University Health Alliance Commercial |
$727.44
|
|
|
BUR DIAMOND 4MM 70 DEG
|
Facility
|
IP
|
$998.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.30 |
| Max. Negotiated Rate |
$968.06 |
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
|
|
BUR OVAL CUTTING 14-S0903
|
Facility
|
IP
|
$91.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
BUR OVAL CUTTING 14-S0903
|
Facility
|
OP
|
$91.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$28.21
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$30.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$28.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.21
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.21
|
| Rate for Payer: University Health Alliance Commercial |
$66.33
|
|
|
BURR 12 FLUTE OVAL AR-8550OBT
|
Facility
|
OP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$104.00
|
| Rate for Payer: AlohaCare Medicare |
$64.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$70.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$64.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.48
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.48
|
| Rate for Payer: University Health Alliance Commercial |
$151.61
|
|
|
BURR 12 FLUTE OVAL AR-8550OBT
|
Facility
|
IP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
BURR 2.2 X 16MM NEURO 7021-815
|
Facility
|
OP
|
$246.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.26 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: AlohaCare Medicaid |
$123.00
|
| Rate for Payer: AlohaCare Medicare |
$76.26
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$83.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.70
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$76.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.26
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.26
|
| Rate for Payer: University Health Alliance Commercial |
$179.31
|
|
|
BURR 2.2 X 16MM NEURO 7021-815
|
Facility
|
IP
|
$246.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
|
|
BURR 3MM 15 DEG
|
Facility
|
OP
|
$2,430.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.30 |
| Max. Negotiated Rate |
$2,357.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,215.00
|
| Rate for Payer: AlohaCare Medicare |
$753.30
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Devoted Health Medicare |
$826.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$753.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,308.50
|
| Rate for Payer: Health Management Network Commercial |
$2,065.50
|
| Rate for Payer: Humana Medicare |
$753.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,187.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,239.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$753.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,357.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$753.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$753.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$753.30
|
| Rate for Payer: University Health Alliance Commercial |
$1,771.23
|
|
|
BURR 3MM 15 DEG
|
Facility
|
IP
|
$2,430.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,065.50 |
| Max. Negotiated Rate |
$2,357.10 |
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Health Management Network Commercial |
$2,065.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,187.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,357.10
|
|
|
BURR 3MM X 25MM NEURO 7021-917
|
Facility
|
OP
|
$216.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: AlohaCare Medicaid |
$108.00
|
| Rate for Payer: AlohaCare Medicare |
$66.96
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Devoted Health Medicare |
$73.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Humana Medicare |
$66.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.96
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.96
|
| Rate for Payer: University Health Alliance Commercial |
$157.44
|
|
|
BURR 3MM X 25MM NEURO 7021-917
|
Facility
|
IP
|
$216.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
|
|
BURR 4.0MM FLAT 180MM LG HIGH
|
Facility
|
OP
|
$444.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.64 |
| Max. Negotiated Rate |
$430.68 |
| Rate for Payer: AlohaCare Medicaid |
$222.00
|
| Rate for Payer: AlohaCare Medicare |
$137.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Devoted Health Medicare |
$150.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Humana Medicare |
$137.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$399.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$226.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.64
|
| Rate for Payer: MDX Hawaii PPO |
$430.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.64
|
| Rate for Payer: University Health Alliance Commercial |
$323.63
|
|
|
BURR 4.0MM FLAT 180MM LG HIGH
|
Facility
|
IP
|
$444.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$430.68 |
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Management Network Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$399.60
|
| Rate for Payer: MDX Hawaii PPO |
$430.68
|
|
|
BURR 4MM 15 DEG
|
Facility
|
OP
|
$2,160.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.60 |
| Max. Negotiated Rate |
$2,095.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,080.00
|
| Rate for Payer: AlohaCare Medicare |
$669.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Devoted Health Medicare |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$669.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,052.00
|
| Rate for Payer: Health Management Network Commercial |
$1,836.00
|
| Rate for Payer: Humana Medicare |
$669.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,944.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,101.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$669.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,095.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$669.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$669.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$669.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,574.42
|
|
|
BURR 4MM 15 DEG
|
Facility
|
IP
|
$2,160.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,095.20 |
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Health Management Network Commercial |
$1,836.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,944.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,095.20
|
|
|
BURR 5.5MMX13CM AR-8550RBE
|
Facility
|
OP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$104.00
|
| Rate for Payer: AlohaCare Medicare |
$64.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$70.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$64.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.48
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.48
|
| Rate for Payer: University Health Alliance Commercial |
$151.61
|
|
|
BURR 5.5MMX13CM AR-8550RBE
|
Facility
|
IP
|
$208.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.20
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
BUR RND CUTTING 17.5MM 3.1MM
|
Facility
|
IP
|
$275.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
BUR RND CUTTING 17.5MM 3.1MM
|
Facility
|
OP
|
$275.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: AlohaCare Medicaid |
$137.50
|
| Rate for Payer: AlohaCare Medicare |
$85.25
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Devoted Health Medicare |
$93.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$85.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.25
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.25
|
| Rate for Payer: University Health Alliance Commercial |
$200.45
|
|