|
BX ANORECTAL ANAL APROACH
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
76101876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.11 |
| Max. Negotiated Rate |
$406.58 |
| Rate for Payer: Aetna Commercial |
$406.58
|
| Rate for Payer: Ambetter Exchange |
$286.83
|
| Rate for Payer: Anthem Medicaid |
$158.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$344.20
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$371.87
|
| Rate for Payer: Healthspan PPO |
$342.87
|
| Rate for Payer: Humana Medicaid |
$158.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.27
|
| Rate for Payer: Molina Healthcare Passport |
$158.11
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.88
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.83
|
|
|
BX ANORECTAL ANAL APROACH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
761P1876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.11 |
| Max. Negotiated Rate |
$406.58 |
| Rate for Payer: Aetna Commercial |
$406.58
|
| Rate for Payer: Ambetter Exchange |
$286.83
|
| Rate for Payer: Anthem Medicaid |
$158.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$344.20
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$371.87
|
| Rate for Payer: Healthspan PPO |
$342.87
|
| Rate for Payer: Humana Medicaid |
$158.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.27
|
| Rate for Payer: Molina Healthcare Passport |
$158.11
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.88
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.83
|
|
|
BX BONE SUPRFCL OPEN
|
Professional
|
Both
|
$4,784.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
76100330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.42 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$336.16
|
| Rate for Payer: Ambetter Exchange |
$132.42
|
| Rate for Payer: Anthem Medicaid |
$144.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.90
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$375.17
|
| Rate for Payer: Healthspan PPO |
$304.49
|
| Rate for Payer: Humana Medicaid |
$144.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.78
|
| Rate for Payer: Molina Healthcare Passport |
$144.88
|
| Rate for Payer: Multiplan PHCS |
$2,870.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.15
|
| Rate for Payer: UHCCP Medicaid |
$1,674.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.42
|
|
|
BX BONE SUPRFCL OPEN
|
Facility
|
OP
|
$4,784.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
76100330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.22 |
| Max. Negotiated Rate |
$4,592.64 |
| Rate for Payer: Aetna Commercial |
$3,683.68
|
| Rate for Payer: Anthem Medicaid |
$1,645.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$3,970.72
|
| Rate for Payer: First Health Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial |
$4,066.40
|
| Rate for Payer: Humana KY Medicaid |
$1,645.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,678.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,162.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.96
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
|
BX BONE SUPRFCL OPEN
|
Facility
|
IP
|
$4,784.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
76100330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.20 |
| Max. Negotiated Rate |
$4,592.64 |
| Rate for Payer: Aetna Commercial |
$3,683.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.52
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$3,970.72
|
| Rate for Payer: First Health Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial |
$4,066.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,162.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.96
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
|
BX BONE SUPRFCL OPEN(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
761P0330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.42 |
| Max. Negotiated Rate |
$375.17 |
| Rate for Payer: Aetna Commercial |
$336.16
|
| Rate for Payer: Ambetter Exchange |
$132.42
|
| Rate for Payer: Anthem Medicaid |
$144.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.90
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$375.17
|
| Rate for Payer: Healthspan PPO |
$304.49
|
| Rate for Payer: Humana Medicaid |
$144.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.78
|
| Rate for Payer: Molina Healthcare Passport |
$144.88
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.15
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.42
|
|
|
BX BONE SUPRFCL OPEN(T
|
Facility
|
OP
|
$4,234.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
761T0330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,456.07 |
| Max. Negotiated Rate |
$4,064.64 |
| Rate for Payer: Aetna Commercial |
$3,260.18
|
| Rate for Payer: Anthem Medicaid |
$1,456.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,302.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,117.00
|
| Rate for Payer: Cash Price |
$2,117.00
|
| Rate for Payer: Cigna Commercial |
$3,514.22
|
| Rate for Payer: First Health Commercial |
$4,022.30
|
| Rate for Payer: Humana Commercial |
$3,598.90
|
| Rate for Payer: Humana KY Medicaid |
$1,456.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,470.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,471.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,124.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,485.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,725.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,683.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,921.46
|
| Rate for Payer: PHCS Commercial |
$4,064.64
|
| Rate for Payer: United Healthcare All Payer |
$3,725.92
|
|
|
BX BONE SUPRFCL OPEN(T
|
Facility
|
IP
|
$4,234.00
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
761T0330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,270.20 |
| Max. Negotiated Rate |
$4,064.64 |
| Rate for Payer: Aetna Commercial |
$3,260.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,302.52
|
| Rate for Payer: Cash Price |
$2,117.00
|
| Rate for Payer: Cigna Commercial |
$3,514.22
|
| Rate for Payer: First Health Commercial |
$4,022.30
|
| Rate for Payer: Humana Commercial |
$3,598.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,471.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,124.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,270.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,725.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,683.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,921.46
|
| Rate for Payer: PHCS Commercial |
$4,064.64
|
| Rate for Payer: United Healthcare All Payer |
$3,725.92
|
|
|
BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$2,685.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$923.37 |
| Max. Negotiated Rate |
$2,577.60 |
| Rate for Payer: Aetna Commercial |
$2,067.45
|
| Rate for Payer: Anthem Medicaid |
$923.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,094.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$2,228.55
|
| Rate for Payer: First Health Commercial |
$2,550.75
|
| Rate for Payer: Humana Commercial |
$2,282.25
|
| Rate for Payer: Humana KY Medicaid |
$923.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$932.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,201.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,981.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$941.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,362.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,335.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.65
|
| Rate for Payer: PHCS Commercial |
$2,577.60
|
| Rate for Payer: United Healthcare All Payer |
$2,362.80
|
|
|
BX BREAST 1ST LESION MR IMAG
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.19 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Ambetter Exchange |
$167.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.19
|
| Rate for Payer: Anthem Medicaid |
$752.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$167.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$167.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$201.55
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$1,589.20
|
| Rate for Payer: Healthspan PPO |
$1,230.80
|
| Rate for Payer: Humana Medicaid |
$752.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$260.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$167.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$767.15
|
| Rate for Payer: Molina Healthcare Passport |
$752.11
|
| Rate for Payer: Multiplan PHCS |
$1,611.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.35
|
| Rate for Payer: UHCCP Medicaid |
$162.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$759.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$167.96
|
|
|
BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$2,685.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.50 |
| Max. Negotiated Rate |
$2,577.60 |
| Rate for Payer: Aetna Commercial |
$2,067.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,094.30
|
| Rate for Payer: Cash Price |
$1,342.50
|
| Rate for Payer: Cigna Commercial |
$2,228.55
|
| Rate for Payer: First Health Commercial |
$2,550.75
|
| Rate for Payer: Humana Commercial |
$2,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,201.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,981.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,362.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,335.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.65
|
| Rate for Payer: PHCS Commercial |
$2,577.60
|
| Rate for Payer: United Healthcare All Payer |
$2,362.80
|
|
|
BX BREAST 1ST LESION MR IMA(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
761P0282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.19 |
| Max. Negotiated Rate |
$1,589.20 |
| Rate for Payer: Ambetter Exchange |
$167.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.19
|
| Rate for Payer: Anthem Medicaid |
$752.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$167.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$167.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$201.55
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$1,589.20
|
| Rate for Payer: Healthspan PPO |
$1,230.80
|
| Rate for Payer: Humana Medicaid |
$752.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$260.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$167.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$767.15
|
| Rate for Payer: Molina Healthcare Passport |
$752.11
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.35
|
| Rate for Payer: UHCCP Medicaid |
$162.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$759.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$167.96
|
|
|
BX BREAST 1ST LESION MR IMA(T
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
761T0282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$678.00 |
| Max. Negotiated Rate |
$2,169.60 |
| Rate for Payer: Aetna Commercial |
$1,740.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,762.80
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cigna Commercial |
$1,875.80
|
| Rate for Payer: First Health Commercial |
$2,147.00
|
| Rate for Payer: Humana Commercial |
$1,921.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,853.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,667.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,988.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,559.40
|
| Rate for Payer: PHCS Commercial |
$2,169.60
|
| Rate for Payer: United Healthcare All Payer |
$1,988.80
|
|
|
BX BREAST 1ST LESION MR IMA(T
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 19085
|
| Hospital Charge Code |
761T0282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.21 |
| Max. Negotiated Rate |
$2,169.60 |
| Rate for Payer: Aetna Commercial |
$1,740.20
|
| Rate for Payer: Anthem Medicaid |
$777.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,762.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cigna Commercial |
$1,875.80
|
| Rate for Payer: First Health Commercial |
$2,147.00
|
| Rate for Payer: Humana Commercial |
$1,921.00
|
| Rate for Payer: Humana KY Medicaid |
$777.21
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$785.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,853.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,667.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$792.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,988.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,559.40
|
| Rate for Payer: PHCS Commercial |
$2,169.60
|
| Rate for Payer: United Healthcare All Payer |
$1,988.80
|
|
|
BX BREAST 1ST LESION STRTCTC
|
Professional
|
Both
|
$5,351.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
76100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.05 |
| Max. Negotiated Rate |
$3,210.60 |
| Rate for Payer: Ambetter Exchange |
$152.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$142.05
|
| Rate for Payer: Anthem Medicaid |
$502.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.37
|
| Rate for Payer: Cash Price |
$2,675.50
|
| Rate for Payer: Cash Price |
$2,675.50
|
| Rate for Payer: Cigna Commercial |
$1,060.97
|
| Rate for Payer: Healthspan PPO |
$823.94
|
| Rate for Payer: Humana Medicaid |
$502.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.04
|
| Rate for Payer: Molina Healthcare Passport |
$502.98
|
| Rate for Payer: Multiplan PHCS |
$3,210.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.65
|
| Rate for Payer: UHCCP Medicaid |
$149.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.81
|
|
|
BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$5,351.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
76100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,605.30 |
| Max. Negotiated Rate |
$5,136.96 |
| Rate for Payer: Aetna Commercial |
$4,120.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.78
|
| Rate for Payer: Cash Price |
$2,675.50
|
| Rate for Payer: Cigna Commercial |
$4,441.33
|
| Rate for Payer: First Health Commercial |
$5,083.45
|
| Rate for Payer: Humana Commercial |
$4,548.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,949.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,655.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,692.19
|
| Rate for Payer: PHCS Commercial |
$5,136.96
|
| Rate for Payer: United Healthcare All Payer |
$4,708.88
|
|
|
BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$5,351.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
76100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,136.96 |
| Rate for Payer: Aetna Commercial |
$4,120.27
|
| Rate for Payer: Anthem Medicaid |
$1,840.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,675.50
|
| Rate for Payer: Cash Price |
$2,675.50
|
| Rate for Payer: Cigna Commercial |
$4,441.33
|
| Rate for Payer: First Health Commercial |
$5,083.45
|
| Rate for Payer: Humana Commercial |
$4,548.35
|
| Rate for Payer: Humana KY Medicaid |
$1,840.21
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,949.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,877.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,655.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,692.19
|
| Rate for Payer: PHCS Commercial |
$5,136.96
|
| Rate for Payer: United Healthcare All Payer |
$4,708.88
|
|
|
BX BREAST 1ST LESION STRTCT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
761P0278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.05 |
| Max. Negotiated Rate |
$1,060.97 |
| Rate for Payer: Ambetter Exchange |
$152.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$142.05
|
| Rate for Payer: Anthem Medicaid |
$502.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.37
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,060.97
|
| Rate for Payer: Healthspan PPO |
$823.94
|
| Rate for Payer: Humana Medicaid |
$502.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.04
|
| Rate for Payer: Molina Healthcare Passport |
$502.98
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.65
|
| Rate for Payer: UHCCP Medicaid |
$149.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.81
|
|
|
BX BREAST 1ST LESION STRTCT(T
|
Facility
|
IP
|
$4,351.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
761T0278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,305.30 |
| Max. Negotiated Rate |
$4,176.96 |
| Rate for Payer: Aetna Commercial |
$3,350.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.78
|
| Rate for Payer: Cash Price |
$2,175.50
|
| Rate for Payer: Cigna Commercial |
$3,611.33
|
| Rate for Payer: First Health Commercial |
$4,133.45
|
| Rate for Payer: Humana Commercial |
$3,698.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.19
|
| Rate for Payer: PHCS Commercial |
$4,176.96
|
| Rate for Payer: United Healthcare All Payer |
$3,828.88
|
|
|
BX BREAST 1ST LESION STRTCT(T
|
Facility
|
OP
|
$4,351.00
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
761T0278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.31 |
| Max. Negotiated Rate |
$4,176.96 |
| Rate for Payer: Aetna Commercial |
$3,350.27
|
| Rate for Payer: Anthem Medicaid |
$1,496.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,175.50
|
| Rate for Payer: Cash Price |
$2,175.50
|
| Rate for Payer: Cigna Commercial |
$3,611.33
|
| Rate for Payer: First Health Commercial |
$4,133.45
|
| Rate for Payer: Humana Commercial |
$3,698.35
|
| Rate for Payer: Humana KY Medicaid |
$1,496.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.19
|
| Rate for Payer: PHCS Commercial |
$4,176.96
|
| Rate for Payer: United Healthcare All Payer |
$3,828.88
|
|
|
BX BREAST 1ST LESION US IMAG
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
76100280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,209.00 |
| Max. Negotiated Rate |
$3,868.80 |
| Rate for Payer: Aetna Commercial |
$3,103.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.40
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$3,344.90
|
| Rate for Payer: First Health Commercial |
$3,828.50
|
| Rate for Payer: Humana Commercial |
$3,425.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,304.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,209.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,546.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,022.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,506.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.70
|
| Rate for Payer: PHCS Commercial |
$3,868.80
|
| Rate for Payer: United Healthcare All Payer |
$3,546.40
|
|
|
BX BREAST 1ST LESION US IMAG
|
Professional
|
Both
|
$4,030.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
76100280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Ambetter Exchange |
$143.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.00
|
| Rate for Payer: Anthem Medicaid |
$499.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.32
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$1,052.98
|
| Rate for Payer: Healthspan PPO |
$817.14
|
| Rate for Payer: Humana Medicaid |
$499.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.08
|
| Rate for Payer: Molina Healthcare Passport |
$499.10
|
| Rate for Payer: Multiplan PHCS |
$2,418.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.68
|
| Rate for Payer: UHCCP Medicaid |
$139.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.60
|
|
|
BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
76100280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,385.92 |
| Max. Negotiated Rate |
$3,868.80 |
| Rate for Payer: Aetna Commercial |
$3,103.10
|
| Rate for Payer: Anthem Medicaid |
$1,385.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cigna Commercial |
$3,344.90
|
| Rate for Payer: First Health Commercial |
$3,828.50
|
| Rate for Payer: Humana Commercial |
$3,425.50
|
| Rate for Payer: Humana KY Medicaid |
$1,385.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,400.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,304.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,413.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,546.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,022.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,506.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.70
|
| Rate for Payer: PHCS Commercial |
$3,868.80
|
| Rate for Payer: United Healthcare All Payer |
$3,546.40
|
|
|
BX BREAST 1ST LESION US IMA(P
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
761P0280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$1,052.98 |
| Rate for Payer: Ambetter Exchange |
$143.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.00
|
| Rate for Payer: Anthem Medicaid |
$499.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.32
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,052.98
|
| Rate for Payer: Healthspan PPO |
$817.14
|
| Rate for Payer: Humana Medicaid |
$499.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.08
|
| Rate for Payer: Molina Healthcare Passport |
$499.10
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.68
|
| Rate for Payer: UHCCP Medicaid |
$139.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.60
|
|
|
BX BREAST 1ST LESION US IMA(T
|
Facility
|
OP
|
$2,755.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
761T0280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$947.44 |
| Max. Negotiated Rate |
$2,644.80 |
| Rate for Payer: Aetna Commercial |
$2,121.35
|
| Rate for Payer: Anthem Medicaid |
$947.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,148.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,377.50
|
| Rate for Payer: Cash Price |
$1,377.50
|
| Rate for Payer: Cigna Commercial |
$2,286.65
|
| Rate for Payer: First Health Commercial |
$2,617.25
|
| Rate for Payer: Humana Commercial |
$2,341.75
|
| Rate for Payer: Humana KY Medicaid |
$947.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$957.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,259.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,033.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$966.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,424.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,396.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,900.95
|
| Rate for Payer: PHCS Commercial |
$2,644.80
|
| Rate for Payer: United Healthcare All Payer |
$2,424.40
|
|
