Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

MYMICHIGAN MEDICAL CENTER SAGINAW

NPI: 1871507509 · SAGINAW, MI 48601 · General Acute Care Hospital · NPI assigned 07/28/2006

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official JAMES, SARAH controls 20+ related entities in our dataset. Read more

$38.70M
Total Medicaid Paid
1,296,501
Total Claims
1,004,962
Beneficiaries
340
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialJAMES, SARAH (MANAGER PATIENT ACCOUNTING)
NPI Enumeration Date07/28/2006

Related Entities

Other providers sharing the same authorized official: JAMES, SARAH

ProviderCityStateTotal Paid
MYMICHIGAN MEDICAL CENTER MIDLAND MIDLAND MI $50.05M
MYMICHIGAN MEDICAL CENTER ALMA ALMA MI $25.31M
MYMICHIGAN MEDICAL CENTER MIDLAND MIDLAND MI $24.37M
MYMICHIGAN MEDICAL CENTER ALPENA ALPENA MI $21.24M
MYMICHIGAN MEDICAL CENTER CLARE CLARE MI $17.66M
MYMICHIGAN MEDICAL CENTER SAULT SAULT SAINTE MARIE MI $13.47M
MYMICHIGAN MEDICAL CENTER GLADWIN GLADWIN MI $10.43M
MYMICHIGAN MEDICAL CENTER TAWAS TAWAS CITY MI $9.11M
MYMICHIGAN MEDICAL GROUP MIDLAND MI $8.12M
MYMICHIGAN MEDICAL CENTER STANDISH STANDISH MI $7.15M
MYMICHIGAN MEDICAL GROUP MIDLAND MI $5.09M
MYMICHIGAN MEDICAL CENTER SAULT SAULT SAINTE MARIE MI $3.78M
MYMICHIGAN MEDICAL CENTER ALPENA ALPENA MI $2.89M
MYMICHIGAN MEDICAL CENTER MIDLAND MIDLAND MI $2.15M
MYMICHIGAN MEDICAL GROUP MIDLAND MI $2.08M
MYMICHIGAN MEDICAL GROUP MIDLAND MI $1.97M
MYMICHIGAN MEDICAL CENTER SAULT SAULT SAINTE MARIE MI $1.62M
MYMICHIGAN MEDICAL CENTER SAGINAW VASSAR MI $1.09M
MYMICHIGAN MEDICAL CENTER STANDISH STANDISH MI $967K
MYMICHIGAN MEDICAL CENTER SAGINAW SAGINAW MI $941K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 195,327 $5.66M
2019 200,552 $5.40M
2020 162,267 $4.34M
2021 189,463 $5.97M
2022 207,601 $6.21M
2023 199,085 $6.08M
2024 142,206 $5.04M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life 21,807 20,285 $7.12M
99284 Emergency department visit for the evaluation and management, high severity 40,014 37,348 $6.87M
99283 Emergency department visit for the evaluation and management, moderate severity 42,718 40,743 $5.11M
H2015 Comprehensive community support services, per 15 minutes 72,436 4,226 $4.22M
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 25,858 23,390 $2.16M
T1005 Respite care services, up to 15 minutes 67,938 2,318 $1.43M
74177 Computed tomography, abdomen and pelvis; with contrast material 5,617 5,438 $719K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 3,267 3,232 $558K
97112 Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination 18,360 4,903 $556K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 25,962 6,580 $549K
96361 Intravenous infusion, hydration; each additional hour 16,275 14,059 $528K
96375 Therapeutic injection; each additional sequential IV push 19,337 16,218 $486K
99282 Emergency department visit for the evaluation and management, low to moderate severity 6,399 6,242 $440K
71045 Radiologic examination, chest; single view 13,235 12,435 $439K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm 2,619 1,228 $424K
70450 Computed tomography, head or brain; without contrast material 5,733 5,441 $423K
G0378 Hospital observation service, per hour 5,484 4,326 $421K
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress 998 979 $368K
71046 Radiologic examination, chest; 2 views 10,841 10,451 $328K
U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r 9,484 9,223 $321K
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 3,283 3,134 $286K
74176 Computed tomography, abdomen and pelvis; without contrast material 2,773 2,694 $257K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 3,802 3,151 $254K
80061 Lipid panel 7,848 7,619 $241K
94060 1,774 1,757 $216K
96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance 1,233 839 $188K
76705 Ultrasound, abdominal, real time with image documentation; limited 3,141 3,082 $169K
99281 Emergency department visit for the evaluation and management, self-limited or minor 3,758 3,658 $159K
97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) 11,935 4,606 $153K
97163 2,760 2,701 $148K
97530 Therapeutic activities, direct patient contact, each 15 minutes 5,393 2,338 $138K
G0463 Hospital outpatient clinic visit for assessment and management of a patient 2,392 1,834 $131K
72148 Magnetic resonance imaging, lumbar spine; without contrast material 1,369 1,354 $124K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 5,592 5,388 $119K
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences 596 586 $113K
77067 Screening mammography, bilateral, including computer-aided detection 2,394 2,389 $107K
71275 Computed tomographic angiography, chest, with contrast material 1,455 1,416 $105K
87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV 1,580 1,537 $105K
95810 Polysomnography; sleep staging with 4 or more additional parameters 221 219 $99K
G0384 Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) 170 163 $88K
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 151 146 $83K
95911 374 367 $83K
93971 1,712 1,673 $79K
88305 Level IV - Surgical pathology, gross and microscopic examination 5,029 4,756 $65K
76830 Ultrasound, transvaginal 1,161 1,152 $64K
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material 571 558 $64K
72131 1,866 1,833 $61K
80053 Comprehensive metabolic panel 49,135 43,256 $55K
93017 1,988 1,944 $53K
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe 6,809 6,593 $53K
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe 6,767 6,554 $52K
71260 Computed tomography, thorax, diagnostic; with contrast material 643 629 $51K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 987 979 $49K
72141 450 437 $49K
72125 Computed tomography, cervical spine; without contrast material 2,594 2,531 $40K
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed 3,804 3,681 $39K
85025 Blood count; complete (CBC), automated, and automated differential WBC count 58,648 47,395 $37K
84443 Thyroid stimulating hormone (TSH) 11,086 10,610 $37K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour 2,117 1,387 $33K
76881 583 527 $32K
73564 2,526 2,222 $31K
72110 1,141 1,132 $29K
97535 Self-care/home management training, each 15 minutes 1,584 960 $26K
70496 282 266 $26K
77063 Screening digital breast tomosynthesis, bilateral 2,158 2,155 $25K
72100 1,269 1,248 $25K
95910 201 201 $24K
74018 2,424 2,334 $24K
76000 590 552 $23K
95909 171 170 $22K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 1,841 1,787 $21K
76642 516 511 $20K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 17,310 14,975 $19K
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 20,515 18,463 $19K
95806 230 230 $18K
10060 254 248 $18K
76536 379 375 $18K
73030 2,520 2,331 $17K
36415 Collection of venous blood by venipuncture 27,066 22,099 $17K
73630 2,828 2,604 $17K
97167 388 380 $17K
73130 2,558 2,331 $16K
93458 19 13 $16K
83036 Hemoglobin; glycosylated (A1C) 5,234 5,085 $15K
80048 Basic metabolic panel (calcium, ionized) 12,729 10,173 $15K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 45 44 $15K
93351 88 88 $15K
93225 382 380 $14K
95819 134 127 $14K
71271 276 276 $13K
71250 245 243 $12K
86900 3,634 3,414 $12K
97162 285 272 $12K
99406 1,184 1,096 $11K
76775 432 426 $11K
82607 2,294 2,216 $10K
88304 1,325 1,260 $10K
97161 252 244 $10K
86780 212 203 $9K
97116 1,227 714 $9K
84439 6,303 6,063 $9K
73610 2,386 2,267 $9K
70486 433 428 $8K
82728 1,490 1,440 $7K
97803 993 987 $6K
96367 278 194 $6K
82746 1,453 1,396 $6K
93970 76 76 $6K
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed 4,977 4,517 $6K
73502 979 912 $6K
72050 142 140 $6K
73110 1,336 1,266 $5K
76700 Ultrasound, abdominal, real time with image documentation; complete 102 97 $5K
U0005 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 417 415 $5K
88342 244 233 $5K
93226 494 491 $5K
70551 Magnetic resonance imaging, brain; without contrast material 53 51 $5K
29540 91 88 $5K
83970 275 266 $5K
83550 1,413 1,385 $5K
93880 59 55 $5K
87086 Culture, bacterial; quantitative colony count, urine 14,285 13,635 $4K
95811 12 12 $4K
73221 37 37 $4K
72128 310 301 $4K
94726 1,738 1,722 $4K
74022 4,242 4,126 $4K
76801 78 77 $4K
83735 19,291 16,392 $4K
83540 1,550 1,515 $4K
86140 9,757 8,982 $4K
85610 11,986 10,235 $3K
97597 42 33 $3K
88307 70 67 $3K
96415 68 49 $3K
97602 34 24 $3K
83880 3,277 3,084 $3K
80306 5,899 5,560 $2K
86850 3,167 2,963 $2K
87070 3,136 3,005 $2K
29515 32 32 $2K
87077 1,316 1,263 $2K
77065 Tomosynthesis, mammo 45 43 $2K
85027 1,793 1,591 $2K
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets 4,517 4,433 $2K
82043 715 692 $2K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 4,754 3,553 $1K
73080 392 378 $1K
87186 2,944 2,843 $1K
84702 1,580 1,421 $1K
84153 194 188 $1K
72040 45 45 $1K
82550 10,845 9,825 $1K
64400 13 12 $1K
85652 3,547 3,307 $1K
73590 423 391 $1K
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) 106 105 $1K
83690 17,881 16,101 $1K
83013 40 40 $1K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 7,972 5,841 $1K
72170 910 892 $1K
70498 307 293 $1K
84100 6,525 5,612 $1K
86480 55 55 $1K
74019 165 161 $1K
94618 189 186 $1K
85730 8,367 7,597 $1K
81003 22,790 21,567 $1K
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies 115 115 $1K
87420 636 620 $1K
80076 783 646 $1K
97760 29 25 $986.20
82570 496 482 $954.75
87205 1,528 1,426 $951.40
73140 328 319 $934.55
86039 231 225 $933.36
87088 2,592 2,518 $930.11
86901 3,628 3,403 $929.00
73700 16 16 $910.70
93308 12 12 $844.94
85007 1,688 1,490 $837.66
84703 6,747 6,413 $814.47
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 33 33 $808.36
73562 165 149 $777.51
81001 8,611 8,324 $771.24
80074 38 36 $753.69
72072 38 38 $739.14
U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc 49 43 $728.97
84484 15,726 13,358 $716.77
76870 40 38 $709.92
81025 15,889 15,168 $680.52
82962 8,619 5,440 $654.89
86038 168 163 $652.90
76882 17 15 $623.45
82565 362 334 $620.52
86235 61 60 $612.19
87631 501 489 $571.16
82553 4,356 3,718 $566.73
83516 109 85 $534.74
83605 13,273 11,868 $525.09
73090 312 287 $392.37
84436 138 134 $391.60
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 4,257 4,180 $383.03
82330 827 615 $381.03
82150 1,404 1,330 $355.52
73560 153 122 $338.76
73120 23 14 $338.58
84460 204 200 $323.45
83615 408 338 $319.89
84450 203 198 $314.88
84425 53 53 $311.49
86803 51 51 $311.01
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe 3,754 3,657 $297.22
85379 3,132 3,044 $287.82
87040 2,170 2,000 $260.10
86431 139 136 $253.10
84520 168 160 $241.14
87634 1,323 1,310 $203.57
71101 13 13 $195.15
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal 190 184 $190.46
84550 153 152 $187.44
Q9957 Injection, perflutren lipid microspheres, per ml 334 326 $168.74
86200 40 40 $162.32
84146 61 57 $156.76
87210 4,376 4,241 $149.54
G0103 Prostate cancer screening; prostate specific antigen test (psa) 24 24 $114.46
97804 28 28 $112.00
82274 103 102 $110.72
86160 25 25 $99.85
87340 24 24 $97.13
J1885 Injection, ketorolac tromethamine, per 15 mg 18,343 16,935 $96.17
A9270 Non-covered item or service 46,137 39,653 $91.66
J7030 Infusion, normal saline solution , 1000 cc 26,771 23,710 $88.17
99407 13 12 $67.68
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe 19 19 $66.47
93320 148 147 $66.11
J1100 Injection, dexamethasone sodium phosphate, 1 mg 7,588 6,949 $60.00
82800 794 767 $57.79
29125 61 55 $54.30
86308 334 332 $53.21
93325 149 147 $49.13
73600 16 12 $48.33
73620 36 29 $48.33
86256 12 12 $46.01
84132 54 50 $45.87
82378 14 12 $45.74
87801 Infectious agent detection by nucleic acid; amplified probe, multiple organisms 18 18 $39.60
87481 18 18 $39.60
84480 13 12 $30.46
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 9,805 9,385 $25.79
85018 174 157 $24.97
85014 188 170 $24.97
82010 876 821 $19.26
J1170 Injection, hydromorphone, up to 4 mg 5,971 4,937 $18.00
85044 13 13 $15.35
82248 15 14 $12.30
J2405 Injection, ondansetron hydrochloride, per 1 mg 17,042 14,748 $10.20
J3475 Injection, magnesium sulfate, per 500 mg 1,509 1,322 $9.73
J1644 Injection, heparin sodium, per 1000 units 3,624 2,816 $8.93
J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) 58 52 $1.04
J8597 Antiemetic drug, oral, not otherwise specified 13 12 $0.29
J0360 Injection, hydralazine hcl, up to 20 mg 66 55 $0.00
J7512 Prednisone, immediate release or delayed release, oral, 1 mg 2,281 2,187 $0.00
J0690 Injection, cefazolin sodium, 500 mg 3,071 2,744 $0.00
J7050 Infusion, normal saline solution, 250 cc 1,830 1,508 $0.00
J2250 Injection, midazolam hydrochloride, per 1 mg 4,539 4,267 $0.00
J0696 Injection, ceftriaxone sodium, per 250 mg 6,186 5,736 $0.00
J2765 Injection, metoclopramide hcl, up to 10 mg 2,090 1,993 $0.00
J8540 Dexamethasone, oral, 0.25 mg 436 426 $0.00
96376 6,788 4,472 $0.00
A4648 Tissue marker, implantable, any type, each 13 12 $0.00
97010 5,238 1,708 $0.00
A9585 Injection, gadobutrol, 0.1 ml 777 752 $0.00
95886 2,313 2,300 $0.00
J1642 Injection, heparin sodium, (heparin lock flush), per 10 units 2,218 1,190 $0.00
94200 90 84 $0.00
J3010 Injection, fentanyl citrate, 0.1 mg 6,692 6,218 $0.00
J2060 Injection, lorazepam, 2 mg 1,979 1,763 $0.00
C1769 Guide wire 1,639 1,504 $0.00
J2360 Injection, orphenadrine citrate, up to 60 mg 881 850 $0.00
J7060 5% dextrose/water (500 ml = 1 unit) 824 668 $0.00
J2704 Injection, propofol, 10 mg 5,384 5,087 $0.00
94760 1,376 1,360 $0.00
J2175 Injection, meperidine hydrochloride, per 100 mg 113 95 $0.00
J1630 Injection, haloperidol, up to 5 mg 318 287 $0.00
J2785 Injection, regadenoson, 0.1 mg 99 92 $0.00
J1815 Injection, insulin, per 5 units 320 236 $0.00
Q0162 Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen 163 160 $0.00
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose 351 344 $0.00
J3490 Unclassified drugs 2,118 1,953 $0.00
J0330 Injection, succinylcholine chloride, up to 20 mg 163 161 $0.00
12001 192 191 $0.00
J2370 Injection, phenylephrine hcl, up to 1 ml 339 289 $0.00
81015 77 77 $0.00
J3480 Injection, potassium chloride, per 2 meq 281 208 $0.00
82803 25 25 $0.00
J0500 Injection, dicyclomine hcl, up to 20 mg 12 12 $0.00
J1790 Injection, droperidol, up to 5 mg 67 60 $0.00
0399T 13 13 $0.00
J0280 Injection, aminophyllin, up to 250 mg 53 52 $0.00
J1940 Injection, furosemide, up to 20 mg 17 13 $0.00
J0456 Injection, azithromycin, 500 mg 27 24 $0.00
J2371 Injection, phenylephrine hydrochloride, 20 micrograms 88 85 $0.00
12002 40 40 $0.00
76377 12 12 $0.00
96368 15 12 $0.00
J3360 Injection, diazepam, up to 5 mg 31 29 $0.00
29130 14 14 $0.00
84145 307 292 $0.00
J7120 Ringers lactate infusion, up to 1000 cc 3,884 3,515 $0.00
C9113 Injection, pantoprazole sodium, per vial 555 460 $0.00
J2270 Injection, morphine sulfate, up to 10 mg 5,443 4,720 $0.00
J2550 Injection, promethazine hcl, up to 50 mg 1,783 1,552 $0.00
J1200 Injection, diphenhydramine hcl, up to 50 mg 3,856 3,292 $0.00
J1245 Injection, dipyridamole, per 10 mg 347 337 $0.00
J0780 Injection, prochlorperazine, up to 10 mg 1,231 1,127 $0.00
94729 1,839 1,823 $0.00
A9502 Technetium tc-99m tetrofosmin, diagnostic, per study dose 41 37 $0.00
C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser 252 229 $0.00
93356 1,169 1,160 $0.00
A9575 Injection, gadoterate meglumine, 0.1 ml 671 656 $0.00
J2930 Injection, methylprednisolone sodium succinate, up to 125 mg 2,688 2,507 $0.00
90715 1,703 1,691 $0.00
J1650 Injection, enoxaparin sodium, 10 mg 917 664 $0.00
J2710 Injection, neostigmine methylsulfate, up to 0.5 mg 1,266 1,166 $0.00
J3370 Injection, vancomycin hcl, 500 mg 131 99 $0.00
29530 77 74 $0.00
C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 535 500 $0.00
J7510 Prednisolone oral, per 5 mg 169 168 $0.00
J1580 Injection, garamycin, gentamicin, up to 80 mg 27 25 $0.00
S0028 Injection, famotidine, 20 mg 161 149 $0.00
C1887 Catheter, guiding (may include infusion/perfusion capability) 174 164 $0.00
J2919 Injection, methylprednisolone sodium succinate, 5 mg 106 100 $0.00
29260 35 35 $0.00
J1171 Injection, hydromorphone, 0.1 mg 20 20 $0.00
85384 25 25 $0.00
12011 14 14 $0.00
G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program 71 71 $0.00
J0171 Injection, adrenalin, epinephrine, 0.1 mg 21 19 $0.00
84207 15 14 $0.00