|
EXC LYMPH NODE(T
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
761T1594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$663.73 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,486.10
|
| Rate for Payer: Anthem Medicaid |
$663.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.40
|
| 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 |
$965.00
|
| Rate for Payer: Cash Price |
$965.00
|
| Rate for Payer: Cigna Commercial |
$1,601.90
|
| Rate for Payer: First Health Commercial |
$1,833.50
|
| Rate for Payer: Humana Commercial |
$1,640.50
|
| Rate for Payer: Humana KY Medicaid |
$663.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,582.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.70
|
| Rate for Payer: PHCS Commercial |
$1,852.80
|
| Rate for Payer: United Healthcare All Payer |
$1,698.40
|
|
|
EXC LYMPH NODE(T
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
761T1594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.00 |
| Max. Negotiated Rate |
$1,852.80 |
| Rate for Payer: Aetna Commercial |
$1,486.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.40
|
| Rate for Payer: Cash Price |
$965.00
|
| Rate for Payer: Cigna Commercial |
$1,601.90
|
| Rate for Payer: First Health Commercial |
$1,833.50
|
| Rate for Payer: Humana Commercial |
$1,640.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,582.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.70
|
| Rate for Payer: PHCS Commercial |
$1,852.80
|
| Rate for Payer: United Healthcare All Payer |
$1,698.40
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem Medicaid |
$799.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Humana KY Medicaid |
$799.57
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$807.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$223.95
|
| Rate for Payer: Ambetter Exchange |
$151.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.67
|
| Rate for Payer: Anthem Medicaid |
$112.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.24
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$305.34
|
| Rate for Payer: Healthspan PPO |
$262.95
|
| Rate for Payer: Humana Medicaid |
$112.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.81
|
| Rate for Payer: Molina Healthcare Passport |
$112.56
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.34
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.03
|
|
|
EXC MALIG LES 1.1-2.0 CM(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761P0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$305.34 |
| Rate for Payer: Aetna Commercial |
$223.95
|
| Rate for Payer: Ambetter Exchange |
$151.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.67
|
| Rate for Payer: Anthem Medicaid |
$112.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.24
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$305.34
|
| Rate for Payer: Healthspan PPO |
$262.95
|
| Rate for Payer: Humana Medicaid |
$112.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.81
|
| Rate for Payer: Molina Healthcare Passport |
$112.56
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.34
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.03
|
|
|
EXC MALIG LES 1.1-2.0 CM(T
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761T0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXC MALIG LES 1.1-2.0 CM(T
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761T0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
OP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,414.12 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem Medicaid |
$1,414.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| 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 |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Humana KY Medicaid |
$1,414.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,428.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,442.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,577.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.28
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
IP
|
$2,952.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.60 |
| Max. Negotiated Rate |
$2,833.92 |
| Rate for Payer: Aetna Commercial |
$2,273.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,302.56
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna Commercial |
$2,450.16
|
| Rate for Payer: First Health Commercial |
$2,804.40
|
| Rate for Payer: Humana Commercial |
$2,509.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,420.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,178.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,597.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,214.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.88
|
| Rate for Payer: PHCS Commercial |
$2,833.92
|
| Rate for Payer: United Healthcare All Payer |
$2,597.76
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$1,771.20 |
| Rate for Payer: Aetna Commercial |
$267.11
|
| Rate for Payer: Ambetter Exchange |
$180.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$106.14
|
| Rate for Payer: Anthem Medicaid |
$132.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.15
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna Commercial |
$347.67
|
| Rate for Payer: Healthspan PPO |
$300.03
|
| Rate for Payer: Humana Medicaid |
$132.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.60
|
| Rate for Payer: Molina Healthcare Passport |
$132.94
|
| Rate for Payer: Multiplan PHCS |
$1,771.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.25
|
| Rate for Payer: UHCCP Medicaid |
$111.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.96
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
OP
|
$2,952.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,833.92 |
| Rate for Payer: Aetna Commercial |
$2,273.04
|
| Rate for Payer: Anthem Medicaid |
$1,015.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,302.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna Commercial |
$2,450.16
|
| Rate for Payer: First Health Commercial |
$2,804.40
|
| Rate for Payer: Humana Commercial |
$2,509.20
|
| Rate for Payer: Humana KY Medicaid |
$1,015.19
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,025.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,420.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,178.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,035.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,597.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,214.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.88
|
| Rate for Payer: PHCS Commercial |
$2,833.92
|
| Rate for Payer: United Healthcare All Payer |
$2,597.76
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
IP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,233.60 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,577.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.28
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Professional
|
Both
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$2,467.20 |
| Rate for Payer: Aetna Commercial |
$294.20
|
| Rate for Payer: Ambetter Exchange |
$196.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$120.36
|
| Rate for Payer: Anthem Medicaid |
$159.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$196.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$196.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$235.42
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$368.35
|
| Rate for Payer: Healthspan PPO |
$321.68
|
| Rate for Payer: Humana Medicaid |
$159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$263.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$196.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.98
|
| Rate for Payer: Molina Healthcare Passport |
$159.78
|
| Rate for Payer: Multiplan PHCS |
$2,467.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.03
|
| Rate for Payer: UHCCP Medicaid |
$126.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$196.18
|
|
|
EXC MALIG LES 2.1-3.0 CM(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761P0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$347.67 |
| Rate for Payer: Aetna Commercial |
$267.11
|
| Rate for Payer: Ambetter Exchange |
$180.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$106.14
|
| Rate for Payer: Anthem Medicaid |
$132.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.15
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$347.67
|
| Rate for Payer: Healthspan PPO |
$300.03
|
| Rate for Payer: Humana Medicaid |
$132.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.60
|
| Rate for Payer: Molina Healthcare Passport |
$132.94
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.25
|
| Rate for Payer: UHCCP Medicaid |
$111.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.96
|
|
|
EXC MALIG LES 2.1-3.0 CM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761P0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$368.35 |
| Rate for Payer: Aetna Commercial |
$294.20
|
| Rate for Payer: Ambetter Exchange |
$196.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$120.36
|
| Rate for Payer: Anthem Medicaid |
$159.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$196.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$196.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$235.42
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$368.35
|
| Rate for Payer: Healthspan PPO |
$321.68
|
| Rate for Payer: Humana Medicaid |
$159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$263.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$196.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.98
|
| Rate for Payer: Molina Healthcare Passport |
$159.78
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.03
|
| Rate for Payer: UHCCP Medicaid |
$126.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$196.18
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
IP
|
$3,512.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761T0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,053.60 |
| Max. Negotiated Rate |
$3,371.52 |
| Rate for Payer: Aetna Commercial |
$2,704.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.36
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cigna Commercial |
$2,914.96
|
| Rate for Payer: First Health Commercial |
$3,336.40
|
| Rate for Payer: Humana Commercial |
$2,985.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,090.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.28
|
| Rate for Payer: PHCS Commercial |
$3,371.52
|
| Rate for Payer: United Healthcare All Payer |
$3,090.56
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
OP
|
$2,602.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761T0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,497.92 |
| Rate for Payer: Aetna Commercial |
$2,003.54
|
| Rate for Payer: Anthem Medicaid |
$894.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,029.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,301.00
|
| Rate for Payer: Cash Price |
$1,301.00
|
| Rate for Payer: Cigna Commercial |
$2,159.66
|
| Rate for Payer: First Health Commercial |
$2,471.90
|
| Rate for Payer: Humana Commercial |
$2,211.70
|
| Rate for Payer: Humana KY Medicaid |
$894.83
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$903.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,133.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,920.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,289.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,951.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,795.38
|
| Rate for Payer: PHCS Commercial |
$2,497.92
|
| Rate for Payer: United Healthcare All Payer |
$2,289.76
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761T0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.60 |
| Max. Negotiated Rate |
$2,497.92 |
| Rate for Payer: Aetna Commercial |
$2,003.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,029.56
|
| Rate for Payer: Cash Price |
$1,301.00
|
| Rate for Payer: Cigna Commercial |
$2,159.66
|
| Rate for Payer: First Health Commercial |
$2,471.90
|
| Rate for Payer: Humana Commercial |
$2,211.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,133.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,920.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,289.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,951.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,263.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,795.38
|
| Rate for Payer: PHCS Commercial |
$2,497.92
|
| Rate for Payer: United Healthcare All Payer |
$2,289.76
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
OP
|
$3,512.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761T0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,207.78 |
| Max. Negotiated Rate |
$3,371.52 |
| Rate for Payer: Aetna Commercial |
$2,704.24
|
| Rate for Payer: Anthem Medicaid |
$1,207.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.36
|
| 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cigna Commercial |
$2,914.96
|
| Rate for Payer: First Health Commercial |
$3,336.40
|
| Rate for Payer: Humana Commercial |
$2,985.20
|
| Rate for Payer: Humana KY Medicaid |
$1,207.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,090.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,055.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.28
|
| Rate for Payer: PHCS Commercial |
$3,371.52
|
| Rate for Payer: United Healthcare All Payer |
$3,090.56
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Professional
|
Both
|
$3,142.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$1,885.20 |
| Rate for Payer: Aetna Commercial |
$294.45
|
| Rate for Payer: Ambetter Exchange |
$199.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.75
|
| Rate for Payer: Anthem Medicaid |
$150.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$199.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$199.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$239.65
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$376.86
|
| Rate for Payer: Healthspan PPO |
$332.16
|
| Rate for Payer: Humana Medicaid |
$150.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$265.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$199.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.03
|
| Rate for Payer: Molina Healthcare Passport |
$150.03
|
| Rate for Payer: Multiplan PHCS |
$1,885.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.62
|
| Rate for Payer: UHCCP Medicaid |
$116.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$199.71
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Professional
|
Both
|
$4,580.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$2,748.00 |
| Rate for Payer: Aetna Commercial |
$336.11
|
| Rate for Payer: Ambetter Exchange |
$223.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.88
|
| Rate for Payer: Anthem Medicaid |
$193.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.76
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$307.39
|
| Rate for Payer: Healthspan PPO |
$363.33
|
| Rate for Payer: Humana Medicaid |
$193.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$299.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.91
|
| Rate for Payer: Molina Healthcare Passport |
$193.05
|
| Rate for Payer: Multiplan PHCS |
$2,748.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.07
|
| Rate for Payer: UHCCP Medicaid |
$140.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.13
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
IP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.60 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,733.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,167.98
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,374.00 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,984.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,160.20
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
OP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem Medicaid |
$1,080.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Humana KY Medicaid |
$1,080.53
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,091.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,733.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,167.98
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
