|
5% DEXTRSE IN .2 NS 500 CC
|
Facility
OP
|
$3.90
|
|
| Hospital Charge Code |
40502161
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna Government |
$1.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.95
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.95
|
|
|
5% DEXTRSE IN NRML SAL-1000CC
|
Facility
OP
|
$10.28
|
|
| Hospital Charge Code |
40502100
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.14
|
| Rate for Payer: Aetna Government |
$5.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.99
|
| Rate for Payer: Group Health Inc Commercial |
$5.14
|
| Rate for Payer: Group Health Inc Medicare |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.14
|
|
|
5% DXTRSE IN 33 NS 1000CC
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40509823
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
5% DXTRSE IN 45 NS 1000CC
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40502120
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
5% DXTRSE LACT. RINGERS 1L
|
Facility
OP
|
$5.67
|
|
| Hospital Charge Code |
40503510
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.86
|
| Rate for Payer: Group Health Inc Commercial |
$2.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.84
|
|
|
5-HIAA,QUANT.,24 HR URINE
|
Facility
OP
|
$32.25
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
40609085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.90
|
| Rate for Payer: Aetna Government |
$12.90
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.90
|
| Rate for Payer: EmblemHealth Commercial |
$12.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Group Health Inc Commercial |
$12.90
|
| Rate for Payer: Group Health Inc Medicare |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.90
|
| Rate for Payer: Healthfirst QHP |
$12.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.32
|
| Rate for Payer: Wellcare Medicare |
$11.61
|
|
|
5HLE L PLTE 2MM ADVMT100D LFT GSP
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE 2MM ADVMT100D LFT GSP
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE2MM ADVMT100D LFT MAL
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE2MM ADVMT100D LFT MAL
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE 2MM ADVMT100D LFT STD
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE 2MM ADVMT100D LFT STD
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE2MM ADVMT100D RGHT GSP
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE2MM ADVMT100D RGHT GSP
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE2MM ADVMT100D RGHT STD
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE2MM ADVMT100D RGHT STD
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE5MM ADVMT100D LFT STD
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE5MM ADVMT100D LFT STD
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE5MM ADVMT100D RGHT GSP
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE5MM ADVMT100D RGHT GSP
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5HLE L PLTE5MM SDVMT100D LFT GSP
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
5HLE L PLTE5MM SDVMT100D LFT GSP
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
5H L-PLATE LEFT W/8MM BAR
|
Facility
IP
|
$502.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
|
5H L-PLATE LEFT W/8MM BAR
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$527.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
| Rate for Payer: Group Health Inc Commercial |
$251.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
|
5H L-PLATE, RIGHT W/8MM BAR
|
Facility
IP
|
$502.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
