| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
Emergency room services |
69,258 |
54,636 |
$3.71M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
45,456 |
40,221 |
$2.58M |
| L8699 |
Prosthetic implant, not otherwise specified |
497 |
489 |
$2.14M |
| 0202U |
Oncology (prostate), multianalyte, gene expression profiling |
5,778 |
5,697 |
$1.98M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
26,386 |
23,328 |
$1.65M |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
7,129 |
6,694 |
$1.46M |
| 70450 |
Computed tomography, head or brain; without contrast material |
8,967 |
8,280 |
$1.40M |
| 99070 |
|
93,734 |
38,578 |
$1.31M |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
35,033 |
30,563 |
$1.02M |
| 93975 |
|
2,492 |
2,330 |
$896K |
| 80053 |
Comprehensive metabolic panel |
48,466 |
41,236 |
$887K |
| 0510 |
|
22,501 |
19,393 |
$837K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
65,090 |
53,853 |
$807K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
11,026 |
9,681 |
$639K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
4,802 |
4,647 |
$638K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
16,795 |
14,684 |
$582K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
3,935 |
3,664 |
$502K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
18,165 |
16,041 |
$467K |
| 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 |
7,197 |
6,166 |
$463K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
4,941 |
4,709 |
$445K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
2,997 |
2,707 |
$416K |
| 76830 |
Ultrasound, transvaginal |
5,441 |
4,920 |
$414K |
| 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 |
5,376 |
5,159 |
$411K |
| 84484 |
|
24,987 |
21,519 |
$393K |
| Z7502 |
|
10,143 |
9,986 |
$383K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
5,041 |
4,613 |
$383K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,338 |
3,138 |
$353K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
14,723 |
14,018 |
$352K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
5,617 |
5,062 |
$348K |
| 0762 |
|
4,589 |
2,848 |
$338K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
1,451 |
1,403 |
$332K |
| Q3014 |
Telehealth originating site facility fee |
12,951 |
11,310 |
$322K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
1,496 |
1,445 |
$312K |
| 71045 |
Radiologic examination, chest; single view |
20,787 |
19,046 |
$309K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
9,562 |
8,310 |
$289K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,517 |
1,483 |
$270K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
17,581 |
15,533 |
$241K |
| 71046 |
Radiologic examination, chest; 2 views |
8,792 |
7,701 |
$238K |
| 83690 |
|
22,375 |
19,635 |
$225K |
| 76801 |
|
3,476 |
2,796 |
$222K |
| 93971 |
|
2,285 |
2,091 |
$222K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
5,056 |
1,673 |
$219K |
| J3490 |
Unclassified drugs |
28,911 |
12,717 |
$207K |
| 0370 |
|
1,285 |
1,177 |
$199K |
| 99499 |
|
3,058 |
2,451 |
$185K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
2,748 |
2,217 |
$178K |
| G0378 |
Hospital observation service, per hour |
2,354 |
1,673 |
$160K |
| 81001 |
|
31,461 |
27,813 |
$154K |
| 99221 |
|
909 |
900 |
$154K |
| 87040 |
|
4,780 |
4,437 |
$145K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
2,378 |
1,810 |
$141K |
| 93970 |
|
810 |
750 |
$133K |
| 76642 |
|
1,498 |
1,373 |
$131K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
9,710 |
9,040 |
$130K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,341 |
2,761 |
$124K |
| 84443 |
Thyroid stimulating hormone (TSH) |
5,247 |
4,876 |
$121K |
| 84703 |
|
10,635 |
9,559 |
$119K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
5,033 |
4,238 |
$118K |
| 83605 |
|
7,180 |
6,458 |
$114K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
764 |
756 |
$110K |
| 84702 |
|
5,936 |
4,889 |
$103K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
6,172 |
6,010 |
$102K |
| 81025 |
|
12,769 |
10,676 |
$99K |
| 73564 |
|
2,382 |
2,156 |
$96K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
1,451 |
1,436 |
$96K |
| 85730 |
|
12,438 |
11,403 |
$95K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,708 |
1,559 |
$94K |
| 72110 |
|
1,897 |
1,715 |
$90K |
| 83880 |
|
4,429 |
4,076 |
$88K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,544 |
1,455 |
$85K |
| 76770 |
|
1,115 |
1,022 |
$84K |
| 83735 |
|
9,575 |
8,037 |
$81K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
9,475 |
8,546 |
$80K |
| J1815 |
Injection, insulin, per 5 units |
1,021 |
800 |
$71K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,174 |
1,146 |
$69K |
| Z9725 |
|
2,350 |
2,326 |
$68K |
| 0720 |
|
1,721 |
1,340 |
$65K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
430 |
379 |
$64K |
| 85610 |
|
13,104 |
11,951 |
$64K |
| 73630 |
|
2,484 |
2,285 |
$62K |
| 97803 |
|
800 |
469 |
$61K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,232 |
1,154 |
$60K |
| 74022 |
|
1,417 |
1,341 |
$58K |
| 70486 |
|
225 |
223 |
$57K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
837 |
821 |
$56K |
| 87186 |
|
3,725 |
3,227 |
$54K |
| 73610 |
|
2,080 |
1,920 |
$54K |
| 82550 |
|
6,166 |
5,378 |
$52K |
| 73030 |
|
1,953 |
1,796 |
$51K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
3,886 |
3,499 |
$51K |
| 73130 |
|
1,727 |
1,547 |
$48K |
| 0710 |
|
1,409 |
1,297 |
$46K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
1,271 |
965 |
$46K |
| 90715 |
|
1,490 |
1,397 |
$44K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
9,898 |
8,771 |
$44K |
| 84439 |
|
3,532 |
3,315 |
$43K |
| 86920 |
|
177 |
163 |
$40K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
458 |
394 |
$40K |
| 84145 |
|
2,077 |
1,999 |
$39K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
1,668 |
696 |
$38K |
| 86901 |
|
6,192 |
5,483 |
$36K |
| 86850 |
|
3,344 |
3,048 |
$36K |
| 72050 |
|
829 |
721 |
$35K |
| 85379 |
|
2,308 |
2,208 |
$34K |
| 72131 |
|
216 |
215 |
$33K |
| 73110 |
|
1,273 |
1,129 |
$33K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
559 |
523 |
$32K |
| 87070 |
|
2,461 |
2,168 |
$32K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
1,019 |
987 |
$31K |
| 71250 |
|
194 |
192 |
$31K |
| 74018 |
|
1,393 |
1,275 |
$31K |
| 77066 |
Tomosynthesis, mammo |
247 |
247 |
$31K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
1,368 |
936 |
$29K |
| 85027 |
|
2,804 |
2,474 |
$29K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
233 |
152 |
$28K |
| 87088 |
|
3,741 |
3,435 |
$27K |
| 82553 |
|
1,528 |
1,052 |
$27K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
362 |
321 |
$26K |
| 0760 |
|
719 |
481 |
$26K |
| 80143 |
|
1,681 |
1,594 |
$25K |
| 84481 |
|
1,114 |
1,087 |
$25K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
301 |
279 |
$24K |
| 80179 |
|
1,638 |
1,558 |
$24K |
| 70496 |
|
100 |
97 |
$24K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
60 |
59 |
$24K |
| 73502 |
|
724 |
697 |
$23K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
5,616 |
4,715 |
$23K |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
1,300 |
1,241 |
$22K |
| P9016 |
Red blood cells, leukocytes reduced, each unit |
124 |
114 |
$22K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
5,013 |
3,985 |
$22K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
255 |
254 |
$21K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
19,092 |
16,711 |
$20K |
| Z7500 |
|
575 |
525 |
$19K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
246 |
80 |
$19K |
| 84100 |
|
3,723 |
2,929 |
$19K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
317 |
299 |
$19K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
621 |
600 |
$18K |
| 76870 |
|
310 |
297 |
$18K |
| 36415 |
Collection of venous blood by venipuncture |
10,028 |
7,957 |
$18K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,035 |
883 |
$17K |
| 0011A |
|
480 |
480 |
$17K |
| 70498 |
|
74 |
73 |
$16K |
| 0942 |
|
455 |
201 |
$16K |
| 80192 |
|
656 |
639 |
$16K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
457 |
291 |
$16K |
| 99218 |
|
95 |
95 |
$16K |
| 86140 |
|
2,378 |
2,140 |
$16K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
604 |
308 |
$14K |
| 87077 |
|
1,748 |
1,551 |
$14K |
| 80076 |
|
1,252 |
1,235 |
$14K |
| 27447 |
|
14 |
14 |
$13K |
| 86900 |
|
3,680 |
3,345 |
$13K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
382 |
320 |
$13K |
| 87400 |
|
2,562 |
2,121 |
$13K |
| 82805 |
|
328 |
287 |
$13K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,401 |
2,028 |
$12K |
| 0012A |
|
318 |
318 |
$12K |
| 82948 |
|
2,143 |
1,966 |
$12K |
| 94799 |
|
76 |
64 |
$12K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,850 |
4,359 |
$11K |
| 73590 |
|
581 |
555 |
$11K |
| 10060 |
|
390 |
348 |
$11K |
| 73080 |
|
439 |
406 |
$11K |
| 93350 |
|
158 |
131 |
$11K |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
2,967 |
2,846 |
$11K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
11,190 |
9,911 |
$10K |
| 12001 |
|
372 |
355 |
$10K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
2,319 |
2,053 |
$10K |
| J1644 |
Injection, heparin sodium, per 1000 units |
860 |
511 |
$10K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
5,887 |
5,347 |
$10K |
| 85007 |
|
2,368 |
2,088 |
$10K |
| 81003 |
|
2,957 |
2,808 |
$10K |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,682 |
1,491 |
$9K |
| 86403 |
|
523 |
480 |
$9K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
13 |
13 |
$8K |
| 87205 |
|
1,406 |
1,242 |
$8K |
| 87641 |
|
309 |
300 |
$8K |
| 70491 |
|
28 |
26 |
$8K |
| 96376 |
|
338 |
257 |
$8K |
| 81002 |
|
1,441 |
977 |
$8K |
| 73560 |
|
381 |
372 |
$8K |
| 85651 |
|
1,783 |
1,612 |
$8K |
| 82010 |
|
440 |
387 |
$8K |
| 72072 |
|
226 |
202 |
$7K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
4,191 |
3,448 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,591 |
1,492 |
$7K |
| 51701 |
|
245 |
241 |
$7K |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
4,854 |
4,347 |
$7K |
| A4217 |
Sterile water/saline, 500 ml |
858 |
839 |
$6K |
| 0270 |
|
984 |
513 |
$6K |
| Z6400 |
|
210 |
209 |
$6K |
| 87075 |
|
336 |
286 |
$5K |
| 87210 |
|
825 |
781 |
$5K |
| 97802 |
|
38 |
38 |
$5K |
| 0250 |
|
3,111 |
2,192 |
$5K |
| 97039 |
|
317 |
173 |
$5K |
| 82533 |
|
217 |
202 |
$5K |
| 73140 |
|
288 |
271 |
$5K |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
1,139 |
1,015 |
$5K |
| J2704 |
Injection, propofol, 10 mg |
1,182 |
1,105 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
154 |
144 |
$4K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
252 |
183 |
$4K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
81 |
81 |
$4K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
272 |
243 |
$4K |
| 72128 |
|
27 |
27 |
$3K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
13 |
12 |
$3K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
14 |
13 |
$3K |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
4,788 |
4,221 |
$3K |
| 76536 |
|
58 |
57 |
$3K |
| 99217 |
|
106 |
106 |
$3K |
| 77065 |
Tomosynthesis, mammo |
25 |
25 |
$3K |
| 72100 |
|
114 |
113 |
$3K |
| 82570 |
|
391 |
374 |
$3K |
| Z7610 |
|
1,448 |
921 |
$3K |
| 82140 |
|
187 |
177 |
$3K |
| 93017 |
|
38 |
25 |
$3K |
| 0002A |
|
70 |
70 |
$3K |
| S0197 |
Prenatal vitamins, 30-day supply |
1,527 |
987 |
$2K |
| 73090 |
|
116 |
99 |
$2K |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
319 |
311 |
$2K |
| 97116 |
|
100 |
67 |
$2K |
| J2060 |
Injection, lorazepam, 2 mg |
1,872 |
1,626 |
$2K |
| 36600 |
|
193 |
176 |
$2K |
| 0001A |
|
69 |
69 |
$2K |
| 90632 |
|
30 |
29 |
$2K |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
174 |
160 |
$2K |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
69 |
67 |
$2K |
| S0077 |
Injection, clindamycin phosphate, 300 mg |
158 |
129 |
$1K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
433 |
331 |
$1K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
185 |
176 |
$1K |
| 0258 |
|
388 |
296 |
$1K |
| 94760 |
|
180 |
166 |
$1K |
| 99401 |
|
99 |
57 |
$1K |
| 99402 |
|
50 |
40 |
$1K |
| 0272 |
|
188 |
113 |
$1K |
| 82803 |
|
44 |
37 |
$1K |
| 80061 |
Lipid panel |
75 |
68 |
$939.43 |
| 88300 |
|
263 |
261 |
$904.34 |
| 87420 |
|
63 |
31 |
$894.45 |
| 71101 |
|
26 |
26 |
$883.91 |
| 87581 |
|
14 |
13 |
$775.83 |
| 87486 |
|
14 |
13 |
$775.83 |
| 86592 |
|
133 |
131 |
$715.24 |
| 85018 |
|
160 |
160 |
$695.13 |
| 86703 |
|
45 |
43 |
$693.08 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$677.76 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
16 |
12 |
$661.05 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
400 |
378 |
$637.20 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
34 |
34 |
$618.24 |
| 82607 |
|
51 |
50 |
$608.39 |
| 87807 |
|
65 |
65 |
$564.94 |
| 99201 |
|
12 |
12 |
$529.16 |
| J3360 |
Injection, diazepam, up to 5 mg |
40 |
35 |
$508.88 |
| J0688 |
Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg |
146 |
119 |
$507.04 |
| 88342 |
|
12 |
12 |
$500.31 |
| S9452 |
Nutrition classes, non-physician provider, per session |
17 |
13 |
$344.40 |
| 84550 |
|
57 |
51 |
$344.37 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
216 |
190 |
$287.34 |
| J0456 |
Injection, azithromycin, 500 mg |
61 |
54 |
$263.68 |
| H2000 |
Comprehensive multidisciplinary evaluation |
15 |
14 |
$246.00 |
| 82150 |
|
27 |
25 |
$245.35 |
| 82728 |
|
16 |
12 |
$236.90 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
103 |
96 |
$207.50 |
| 80164 |
|
12 |
12 |
$205.61 |
| 73660 |
|
13 |
13 |
$192.83 |
| 31720 |
|
15 |
15 |
$153.00 |
| 70360 |
|
12 |
12 |
$151.57 |
| J7050 |
Infusion, normal saline solution, 250 cc |
92 |
80 |
$139.58 |
| 72170 |
|
12 |
12 |
$138.05 |
| J0736 |
Injection, clindamycin phosphate, 300 mg |
31 |
26 |
$132.62 |
| J1953 |
Injection, levetiracetam, 10 mg |
14 |
13 |
$95.00 |
| 83615 |
|
13 |
12 |
$81.60 |
| 82746 |
|
12 |
12 |
$81.08 |
| J1630 |
Injection, haloperidol, up to 5 mg |
92 |
84 |
$74.07 |
| Q9966 |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
15 |
14 |
$64.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
45 |
42 |
$44.50 |
| 0637 |
|
187 |
178 |
$39.18 |
| J1940 |
Injection, furosemide, up to 20 mg |
14 |
12 |
$6.40 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
485 |
64 |
$0.00 |
| 0100U |
|
22 |
22 |
$0.00 |