| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G2067 |
Med assist tx meth wk |
189,390 |
55,992 |
$43.44M |
| H0020 |
Alcohol and/or drug services |
989,059 |
105,151 |
$33.34M |
| 99214 |
|
186,326 |
158,191 |
$21.38M |
| 99213 |
|
136,927 |
120,503 |
$15.48M |
| G0396 |
Alcohol/subs interv 15-30mn |
118,700 |
66,747 |
$12.74M |
| 90791 |
|
10,389 |
8,753 |
$9.57M |
| J9271 |
Inj pembrolizumab |
914 |
740 |
$9.50M |
| 99283 |
|
47,880 |
43,034 |
$8.05M |
| 99284 |
|
31,366 |
29,087 |
$5.15M |
| H0040 |
Assert comm tx pgm per diem |
2,758 |
2,728 |
$5.08M |
| 99215 |
Prolong outpt/office vis |
30,109 |
27,572 |
$4.22M |
| 90834 |
|
24,097 |
9,545 |
$4.12M |
| 99285 |
|
27,220 |
25,566 |
$4.12M |
| 99212 |
|
30,347 |
25,094 |
$3.40M |
| 99204 |
|
21,542 |
21,090 |
$3.35M |
| G0378 |
Hospital observation per hr |
3,114 |
2,999 |
$3.03M |
| 36415 |
|
348,706 |
132,694 |
$2.82M |
| 97110 |
|
44,190 |
20,205 |
$2.64M |
| G0397 |
Alcohol/subs interv >30 min |
17,730 |
12,844 |
$2.52M |
| U0004 |
Cov-19 test non-cdc hgh thru |
39,944 |
37,489 |
$2.43M |
| 96361 |
|
12,135 |
10,786 |
$2.17M |
| 99203 |
|
14,755 |
14,501 |
$2.11M |
| J2426 |
Inj, invega sustenna, 1 mg |
987 |
882 |
$1.73M |
| J2505 |
Injection, pegfilgrastim 6mg |
491 |
370 |
$1.73M |
| 96413 |
|
9,428 |
6,310 |
$1.55M |
| H0004 |
Alcohol and/or drug services |
29,551 |
22,557 |
$1.53M |
| 93306 |
|
7,293 |
7,104 |
$1.52M |
| J0897 |
Denosumab injection |
1,051 |
994 |
$1.49M |
| 74177 |
|
7,042 |
6,959 |
$1.31M |
| G2078 |
Take-home meth |
27,274 |
12,341 |
$1.24M |
| 70450 |
|
6,940 |
6,672 |
$1.21M |
| H2001 |
Rehabilitation program 1/2 d |
8,254 |
1,225 |
$1.19M |
| 90853 |
|
15,048 |
5,060 |
$1.16M |
| 80053 |
|
80,186 |
59,753 |
$1.12M |
| 20611 |
|
7,137 |
4,285 |
$1.11M |
| 78815 |
|
1,518 |
1,502 |
$1.07M |
| 99396 |
|
7,737 |
7,663 |
$1.02M |
| 52000 |
|
1,196 |
1,183 |
$996K |
| 97162 |
|
7,685 |
7,639 |
$977K |
| 99282 |
|
5,681 |
4,318 |
$976K |
| H0005 |
Alcohol and/or drug services |
13,218 |
3,145 |
$921K |
| 96415 |
|
3,145 |
2,593 |
$896K |
| G0463 |
Hospital outpt clinic visit |
19,294 |
15,136 |
$859K |
| 77067 |
|
11,217 |
11,180 |
$857K |
| 97140 |
|
38,405 |
17,897 |
$811K |
| 90832 |
|
5,718 |
3,397 |
$796K |
| 99202 |
|
5,539 |
5,358 |
$775K |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
344 |
272 |
$774K |
| 80048 |
|
52,188 |
46,462 |
$764K |
| 96365 |
|
7,106 |
6,430 |
$750K |
| 99205 |
Prolong outpt/office vis |
4,119 |
4,064 |
$695K |
| J9144 |
Daratumumab, hyaluronidase |
179 |
117 |
$680K |
| 87536 |
|
8,636 |
8,530 |
$669K |
| 64615 |
|
1,098 |
1,082 |
$659K |
| 97112 |
|
23,594 |
11,526 |
$622K |
| 93970 |
|
2,350 |
2,322 |
$610K |
| 93458 |
|
361 |
357 |
$594K |
| 76856 |
|
3,096 |
3,065 |
$591K |
| C1713 |
Anchor/screw bn/bn,tis/bn |
953 |
942 |
$582K |
| 70553 |
|
2,282 |
2,272 |
$569K |
| 43239 |
|
850 |
847 |
$528K |
| J2350 |
Injection, ocrelizumab, 1 mg |
13 |
13 |
$519K |
| 78452 |
|
2,014 |
1,725 |
$518K |
| 31237 |
|
355 |
287 |
$510K |
| 87491 |
|
18,059 |
15,936 |
$490K |
| U0005 |
Infec agen detec ampli probe |
28,409 |
26,703 |
$474K |
| 77336 |
|
1,887 |
849 |
$452K |
| 77412 |
|
1,473 |
151 |
$437K |
| 95004 |
|
2,312 |
2,097 |
$437K |
| H0014 |
Alcohol and/or drug services |
2,352 |
1,488 |
$427K |
| J3380 |
Inj vedolizumab iv 1 mg |
85 |
82 |
$417K |
| 99395 |
|
3,128 |
3,106 |
$406K |
| J1745 |
Infliximab not biosimil 10mg |
221 |
126 |
$403K |
| 96360 |
|
4,123 |
3,882 |
$402K |
| J0585 |
Injection,onabotulinumtoxina |
2,679 |
1,724 |
$401K |
| J1950 |
Leuprolide acetate /3.75 mg |
237 |
228 |
$396K |
| 77386 |
|
1,069 |
88 |
$395K |
| 96366 |
|
3,481 |
2,790 |
$394K |
| 76700 |
|
2,571 |
2,545 |
$392K |
| 51798 |
|
2,744 |
2,188 |
$382K |
| 99393 |
|
3,775 |
3,761 |
$379K |
| 82306 |
|
17,671 |
17,468 |
$371K |
| 74176 |
|
2,129 |
2,105 |
$366K |
| 31231 |
|
4,229 |
3,983 |
$359K |
| 99394 |
|
3,419 |
3,407 |
$351K |
| J9355 |
Inj trastuzumab excl biosimi |
139 |
57 |
$344K |
| 99392 |
|
3,409 |
3,401 |
$342K |
| 80061 |
|
33,650 |
31,609 |
$321K |
| 71250 |
|
4,461 |
4,433 |
$320K |
| 90833 |
|
4,969 |
4,525 |
$320K |
| 76641 |
|
5,124 |
4,860 |
$315K |
| 45380 |
|
459 |
452 |
$314K |
| 99211 |
|
19,351 |
16,712 |
$307K |
| 71275 |
|
1,679 |
1,654 |
$307K |
| H0002 |
Alcohol and/or drug screenin |
1,441 |
1,422 |
$299K |
| 93320 |
|
2,488 |
2,479 |
$298K |
| 87591 |
|
18,001 |
15,901 |
$290K |
| 96367 |
|
3,704 |
2,513 |
$288K |
| 87428 |
|
10,932 |
10,616 |
$286K |
| 10005 |
|
865 |
838 |
$284K |
| 73721 |
|
1,265 |
1,209 |
$283K |
| 99386 |
|
1,947 |
1,940 |
$274K |
| 90792 |
|
1,293 |
1,189 |
$273K |
| 86361 |
|
9,215 |
8,744 |
$271K |
| 94375 |
|
2,103 |
1,838 |
$270K |
| 70486 |
|
2,925 |
2,894 |
$263K |
| 88305 |
|
8,806 |
6,959 |
$261K |
| 99391 |
|
2,359 |
2,296 |
$261K |
| 77063 |
|
10,884 |
10,850 |
$256K |
| 93976 |
|
839 |
829 |
$256K |
| 96372 |
|
19,377 |
16,059 |
$255K |
| 87633 |
|
2,505 |
2,464 |
$255K |
| 96375 |
|
14,560 |
11,821 |
$254K |
| 11900 |
|
1,144 |
1,108 |
$252K |
| 99385 |
|
1,651 |
1,643 |
$246K |
| 76536 |
|
3,231 |
3,213 |
$244K |
| 86850 |
|
9,813 |
8,770 |
$242K |
| 86480 |
|
4,165 |
4,110 |
$241K |
| 76830 |
|
3,956 |
3,900 |
$237K |
| 76770 |
|
1,330 |
1,324 |
$235K |
| 51741 |
|
1,402 |
1,375 |
$235K |
| 99281 |
|
1,372 |
1,253 |
$233K |
| 93880 |
|
1,277 |
1,251 |
$232K |
| 70551 |
|
1,395 |
1,389 |
$229K |
| 93303 |
|
853 |
850 |
$224K |
| 93975 |
|
668 |
655 |
$214K |
| 96910 |
|
2,275 |
526 |
$214K |
| 70491 |
|
1,346 |
1,340 |
$210K |
| 90460 |
|
10,891 |
9,724 |
$210K |
| 70543 |
|
678 |
676 |
$208K |
| 77066 |
Tomosynthesis, mammo |
2,431 |
2,422 |
$208K |
| 20610 |
|
738 |
662 |
$204K |
| J1453 |
Fosaprepitant injection |
1,966 |
1,363 |
$200K |
| C9803 |
Hopd covid-19 spec collect |
40,898 |
38,001 |
$199K |
| 74183 |
|
744 |
738 |
$195K |
| 46600 |
|
1,060 |
1,053 |
$194K |
| 31575 |
|
1,985 |
1,935 |
$192K |
| G0382 |
Lev 3 hosp type b ed visit |
1,181 |
1,153 |
$191K |
| 80076 |
|
22,678 |
21,234 |
$190K |
| S9485 |
Crisis intervention mental h |
163 |
160 |
$188K |
| 77065 |
Tomosynthesis, mammo |
2,942 |
2,774 |
$188K |
| 17110 |
|
810 |
794 |
$187K |
| 86901 |
|
10,026 |
8,778 |
$185K |
| 86900 |
|
10,093 |
8,784 |
$182K |
| 72148 |
|
1,148 |
1,141 |
$178K |
| 99291 |
|
1,182 |
1,143 |
$175K |
| A9552 |
F18 fdg |
1,487 |
1,467 |
$169K |
| 71046 |
|
20,174 |
19,420 |
$169K |
| 36000 |
|
9,449 |
9,144 |
$167K |
| 73221 |
|
750 |
725 |
$166K |
| 90677 |
|
1,363 |
1,359 |
$164K |
| 83970 |
|
5,805 |
5,672 |
$164K |
| 76998 |
|
1,056 |
1,034 |
$163K |
| 90686 |
|
9,969 |
9,936 |
$162K |
| 93005 |
|
50,128 |
44,250 |
$155K |
| 86703 |
|
13,134 |
12,936 |
$155K |
| J9202 |
Goserelin acetate implant |
231 |
223 |
$148K |
| 88307 |
|
1,056 |
858 |
$145K |
| 93017 |
|
2,416 |
2,401 |
$144K |
| 96374 |
|
14,230 |
13,000 |
$143K |
| 76642 |
|
2,939 |
2,900 |
$142K |
| 97165 |
|
1,310 |
1,292 |
$142K |
| 85025 |
|
87,222 |
76,711 |
$142K |
| 73564 |
|
6,886 |
5,225 |
$141K |
| 83880 |
|
7,680 |
7,100 |
$141K |
| 76705 |
|
2,767 |
2,715 |
$140K |
| 97161 |
|
1,365 |
1,355 |
$140K |
| 71260 |
|
1,685 |
1,677 |
$139K |
| 76816 |
|
2,647 |
2,246 |
$137K |
| Q5117 |
Inj., kanjinti, 10 mg |
142 |
88 |
$135K |
| 90750 |
|
1,134 |
1,110 |
$133K |
| 94060 |
|
901 |
808 |
$130K |
| 12011 |
|
372 |
370 |
$127K |
| 87624 |
|
4,469 |
4,426 |
$121K |
| 93971 |
|
1,911 |
1,831 |
$119K |
| 90836 |
|
1,144 |
820 |
$116K |
| 87507 |
|
786 |
771 |
$114K |
| 99443 |
|
1,514 |
1,471 |
$113K |
| 92004 |
|
882 |
857 |
$113K |
| 12001 |
|
356 |
352 |
$111K |
| G0480 |
Drug test def 1-7 classes |
7,003 |
6,666 |
$110K |
| G0121 |
Colon ca scrn not hi rsk ind |
188 |
188 |
$109K |
| 93351 |
|
1,127 |
1,123 |
$109K |
| 88342 |
|
2,132 |
1,924 |
$105K |
| 93325 |
|
2,606 |
2,579 |
$104K |
| 80050 |
|
4,935 |
4,770 |
$102K |
| 95800 |
|
889 |
885 |
$98K |
| 96417 |
|
2,519 |
1,535 |
$98K |
| 87635 |
|
3,373 |
3,294 |
$96K |
| 10060 |
|
416 |
407 |
$95K |
| G0123 |
Screen cerv/vag thin layer |
4,282 |
4,263 |
$95K |
| 0002A |
|
2,662 |
2,653 |
$95K |
| H0039 |
Asser com tx face-face/15min |
57 |
57 |
$94K |
| 72197 |
|
365 |
364 |
$93K |
| 90461 |
|
3,545 |
3,535 |
$92K |
| H0033 |
Oral med adm direct observe |
2,678 |
318 |
$92K |
| 76815 |
|
1,191 |
1,075 |
$91K |
| A9500 |
Tc99m sestamibi |
1,273 |
1,264 |
$90K |
| 99051 |
|
8,755 |
8,538 |
$90K |
| 77080 |
|
2,492 |
2,483 |
$89K |
| J0592 |
Buprenorphine hydrochloride |
6,206 |
308 |
$89K |
| 83036 |
|
30,073 |
29,829 |
$87K |
| 77049 |
|
284 |
284 |
$87K |
| Q0138 |
Ferumoxytol, non-esrd |
268 |
205 |
$86K |
| 69210 |
|
2,648 |
2,216 |
$85K |
| C1769 |
Guide wire |
2,229 |
1,951 |
$84K |
| 72141 |
|
515 |
512 |
$82K |
| 90715 |
|
4,284 |
4,257 |
$80K |
| 88185 |
|
1,055 |
902 |
$79K |
| 90651 |
|
1,617 |
1,613 |
$79K |
| 19083 |
|
67 |
65 |
$78K |
| 0001A |
|
2,684 |
2,679 |
$78K |
| 97530 |
|
1,213 |
606 |
$76K |
| 88112 |
|
1,588 |
1,565 |
$76K |
| 95819 |
|
284 |
281 |
$75K |
| 97803 |
|
2,417 |
2,264 |
$75K |
| J2315 |
Naltrexone, depot form |
66 |
63 |
$75K |
| 90471 |
|
9,412 |
9,159 |
$72K |
| G2068 |
Med assist tx bupre oral |
246 |
101 |
$72K |
| C1725 |
Cath, translumin non-laser |
703 |
451 |
$71K |
| 45385 |
|
153 |
153 |
$71K |
| 70496 |
|
419 |
419 |
$71K |
| J9217 |
Leuprolide acetate suspnsion |
148 |
144 |
$71K |
| 87522 |
Neg quan hep c or qual rna |
2,560 |
2,483 |
$71K |
| 87631 |
|
1,686 |
1,653 |
$70K |
| 52356 |
|
46 |
44 |
$70K |
| 85610 |
|
24,203 |
22,849 |
$68K |
| 70480 |
|
605 |
605 |
$67K |
| J2785 |
Regadenoson injection |
1,194 |
1,186 |
$66K |
| 84443 |
|
20,401 |
19,800 |
$65K |
| 73130 |
|
4,932 |
4,296 |
$64K |
| 99442 |
|
1,127 |
1,097 |
$63K |
| 11102 |
|
169 |
167 |
$63K |
| 99201 |
|
514 |
467 |
$63K |
| 96402 |
|
1,859 |
1,603 |
$63K |
| Q5104 |
Injection, renflexis |
31 |
25 |
$61K |
| 83013 |
|
1,323 |
1,312 |
$60K |
| 88304 |
|
2,672 |
2,521 |
$59K |
| 77334 |
|
172 |
142 |
$59K |
| G0008 |
Admin influenza virus vac |
3,958 |
3,950 |
$58K |
| 93356 |
|
591 |
590 |
$58K |
| J0561 |
Penicillin g benzathine inj |
285 |
224 |
$57K |
| 95886 |
|
814 |
814 |
$56K |
| 90732 |
|
604 |
598 |
$55K |
| 90870 |
|
179 |
68 |
$55K |
| 91200 |
|
1,336 |
1,320 |
$55K |
| 90847 |
|
225 |
145 |
$55K |
| 73030 |
|
4,063 |
3,867 |
$55K |
| A9585 |
Gadobutrol injection |
4,150 |
3,841 |
$54K |
| 88184 |
|
1,001 |
984 |
$54K |
| 84439 |
|
13,111 |
12,758 |
$53K |
| 77300 |
|
162 |
153 |
$52K |
| 92557 |
|
1,393 |
1,312 |
$52K |
| 86803 |
|
15,902 |
15,672 |
$50K |
| 72125 |
|
2,014 |
1,940 |
$50K |
| U0002 |
Covid-19 lab test non-cdc |
1,577 |
1,409 |
$49K |
| 59820 |
|
62 |
61 |
$49K |
| 92551 |
|
1,123 |
1,123 |
$49K |
| J2469 |
Palonosetron hcl |
2,560 |
1,688 |
$49K |
| 94726 |
|
791 |
788 |
$49K |
| 90670 |
|
1,893 |
1,888 |
$48K |
| 73562 |
|
3,313 |
3,172 |
$48K |
| 76819 |
|
1,150 |
935 |
$46K |
| 74178 |
|
235 |
230 |
$46K |
| C1889 |
Implant/insert device, noc |
885 |
844 |
$46K |
| 76817 |
|
1,210 |
1,061 |
$46K |
| 73630 |
|
4,034 |
3,737 |
$45K |
| 86003 |
|
3,399 |
2,155 |
$44K |
| J1944 |
Aripiprazole lauroxil 1 mg |
24 |
24 |
$44K |
| 71271 |
|
574 |
574 |
$42K |
| 87517 |
|
1,228 |
1,197 |
$41K |
| 97016 |
|
2,473 |
1,434 |
$41K |
| G0279 |
Tomosynthesis, mammo |
1,394 |
1,390 |
$39K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
15,839 |
12,789 |
$39K |
| 92550 |
|
653 |
640 |
$38K |
| 76801 |
|
707 |
636 |
$37K |
| 87652 |
|
1,736 |
1,707 |
$35K |
| 93225 |
|
290 |
285 |
$35K |
| 90837 |
|
219 |
127 |
$34K |
| 86769 |
|
1,133 |
1,118 |
$34K |
| 87086 |
|
13,038 |
12,177 |
$33K |
| 76818 |
|
694 |
348 |
$33K |
| 82607 |
|
5,705 |
5,639 |
$32K |
| J9045 |
Carboplatin injection |
1,317 |
908 |
$32K |
| G0009 |
Admin pneumococcal vaccine |
2,112 |
2,107 |
$32K |
| 92060 |
|
504 |
503 |
$32K |
| J9267 |
Paclitaxel injection |
1,223 |
669 |
$32K |
| J2001 |
Lidocaine injection |
6,917 |
6,623 |
$31K |
| 81001 |
|
27,633 |
24,789 |
$31K |
| 90734 |
|
1,560 |
1,553 |
$30K |
| 72100 |
|
1,731 |
1,720 |
$30K |
| Q9957 |
Inj perflutren lip micros,ml |
642 |
633 |
$30K |
| 94729 |
|
813 |
809 |
$30K |
| 82784 |
|
5,323 |
3,346 |
$29K |
| 46607 |
|
49 |
49 |
$29K |
| 82670 |
|
1,979 |
1,918 |
$29K |
| 82728 |
|
5,956 |
5,830 |
$29K |
| 76857 |
|
709 |
698 |
$28K |
| 73610 |
|
2,763 |
2,579 |
$28K |
| J3490 |
Drugs unclassified injection |
1,731 |
1,571 |
$28K |
| 77062 |
|
689 |
687 |
$28K |
| 84153 |
|
4,003 |
3,743 |
$28K |
| 96401 |
|
604 |
297 |
$27K |
| 76805 |
|
470 |
446 |
$27K |
| G2211 |
Complex e/m visit add on |
2,649 |
2,583 |
$26K |
| 95117 |
|
975 |
361 |
$26K |
| 97163 |
|
174 |
174 |
$26K |
| 96920 |
|
118 |
37 |
$26K |
| 93925 |
|
174 |
169 |
$25K |
| 93978 |
|
169 |
168 |
$25K |
| 76937 |
|
195 |
189 |
$25K |
| 73502 |
|
1,827 |
1,789 |
$25K |
| 0004A |
|
684 |
666 |
$25K |
| 85730 |
|
17,311 |
16,516 |
$25K |
| 87902 |
|
115 |
111 |
$25K |
| 86780 |
|
8,938 |
8,822 |
$24K |
| 99244 |
|
147 |
147 |
$24K |
| 85027 |
|
12,246 |
11,831 |
$24K |
| 91320 |
|
318 |
318 |
$24K |
| 88341 |
|
408 |
395 |
$24K |
| 88172 |
|
542 |
479 |
$23K |
| 0124A |
|
628 |
617 |
$23K |
| 87340 |
|
7,762 |
7,353 |
$22K |
| 97116 |
|
785 |
409 |
$22K |
| 77290 |
|
54 |
54 |
$22K |
| 76775 |
|
488 |
483 |
$22K |
| 96376 |
|
2,623 |
2,260 |
$22K |
| 76813 |
|
459 |
435 |
$21K |
| 86706 |
|
5,279 |
5,234 |
$21K |
| 64483 |
|
39 |
38 |
$21K |
| 95911 |
|
255 |
254 |
$21K |
| 92567 |
|
485 |
480 |
$21K |
| 83001 |
|
2,178 |
2,138 |
$21K |
| 73110 |
|
1,997 |
1,830 |
$21K |
| 84403 |
|
1,650 |
1,587 |
$21K |
| 99243 |
|
143 |
143 |
$21K |
| T2022 |
Case management, per month |
185 |
185 |
$20K |
| 90648 |
|
1,750 |
1,746 |
$20K |
| J2704 |
Inj, propofol, 10 mg |
8,945 |
8,008 |
$20K |
| 83655 |
|
1,654 |
1,648 |
$20K |
| 54161 |
|
19 |
19 |
$20K |
| 74174 |
|
90 |
90 |
$19K |
| 88173 |
|
694 |
611 |
$19K |
| 86140 |
|
11,321 |
11,000 |
$19K |
| 92014 |
|
164 |
158 |
$19K |
| 94010 |
|
682 |
602 |
$19K |
| J1631 |
Haloperidol decanoate inj |
1,030 |
959 |
$18K |
| 20550 |
|
102 |
102 |
$18K |
| 86160 |
|
3,684 |
1,943 |
$18K |
| H0001 |
Alcohol and/or drug assess |
100 |
99 |
$17K |
| 82043 |
|
7,606 |
7,313 |
$17K |
| 86704 |
|
4,266 |
4,237 |
$17K |
| C1894 |
Intro/sheath, non-laser |
1,613 |
1,559 |
$17K |
| C9600 |
Perc drug-el cor stent sing |
14 |
12 |
$17K |
| 77061 |
|
466 |
464 |
$17K |
| C1887 |
Catheter, guiding |
581 |
562 |
$16K |
| 11721 |
|
649 |
508 |
$16K |
| 83002 |
|
1,666 |
1,634 |
$16K |
| 84484 |
|
18,374 |
14,457 |
$16K |
| 92134 |
|
255 |
242 |
$16K |
| 0241U |
|
261 |
255 |
$16K |
| 81003 |
|
11,680 |
11,240 |
$15K |
| 76870 |
|
406 |
403 |
$15K |
| 83735 |
|
10,562 |
8,845 |
$14K |
| 82962 |
|
10,648 |
7,569 |
$14K |
| 90723 |
|
1,360 |
1,358 |
$14K |
| 90661 |
|
604 |
604 |
$14K |
| 71045 |
|
4,706 |
4,461 |
$14K |
| 84550 |
|
8,201 |
7,684 |
$14K |
| 82977 |
|
7,123 |
6,287 |
$14K |
| 95165 |
|
1,007 |
364 |
$14K |
| 72110 |
|
557 |
552 |
$14K |
| 76811 |
|
231 |
221 |
$14K |
| 83690 |
|
13,204 |
12,365 |
$14K |
| 99381 |
|
131 |
131 |
$14K |
| 82024 |
|
402 |
386 |
$14K |
| A9577 |
Inj multihance |
1,160 |
1,067 |
$14K |
| 19081 |
|
13 |
13 |
$14K |
| 92507 |
|
147 |
62 |
$14K |
| 58100 |
|
39 |
39 |
$13K |
| 90680 |
|
1,135 |
1,132 |
$13K |
| 84146 |
|
1,219 |
1,206 |
$13K |
| 94640 |
|
6,185 |
5,108 |
$13K |
| 95012 |
|
1,214 |
1,202 |
$13K |
| 72170 |
|
915 |
910 |
$13K |
| 95885 |
|
129 |
127 |
$13K |
| 83516 |
|
2,761 |
2,176 |
$13K |
| 51729 |
|
29 |
25 |
$13K |
| 96377 |
|
645 |
494 |
$13K |
| 84100 |
|
8,830 |
7,952 |
$12K |
| 87480 |
|
1,776 |
1,742 |
$12K |
| 96411 |
|
172 |
110 |
$12K |
| 88300 |
|
904 |
765 |
$12K |
| 97802 |
|
177 |
177 |
$12K |
| 87510 |
|
1,771 |
1,737 |
$12K |
| 82378 |
|
1,433 |
1,160 |
$12K |
| C1874 |
Stent, coated/cov w/del sys |
14 |
13 |
$12K |
| 87660 |
|
1,777 |
1,743 |
$12K |
| 86360 |
|
347 |
341 |
$12K |
| 93922 |
|
295 |
287 |
$12K |
| 99441 |
|
322 |
295 |
$12K |
| A4648 |
Implantable tissue marker |
872 |
828 |
$12K |
| 90674 |
|
622 |
622 |
$12K |
| 59841 |
|
14 |
14 |
$11K |
| 72131 |
|
130 |
130 |
$11K |
| 99417 |
Prolong home eval add 15m |
742 |
730 |
$11K |
| 82550 |
|
6,357 |
6,149 |
$11K |
| 84445 |
|
277 |
273 |
$11K |
| 73080 |
|
696 |
659 |
$11K |
| 86376 |
|
1,450 |
1,442 |
$11K |
| 73560 |
|
1,180 |
1,101 |
$11K |
| 84702 |
|
4,774 |
4,365 |
$11K |
| 76882 |
|
232 |
223 |
$11K |
| G0383 |
Lev 4 hosp type b ed visit |
66 |
66 |
$11K |
| 83615 |
|
5,137 |
4,304 |
$10K |
| 85651 |
|
11,670 |
11,375 |
$10K |
| 84480 |
|
2,745 |
2,703 |
$10K |
| 29580 |
|
56 |
24 |
$10K |
| 86334 |
|
1,227 |
1,121 |
$10K |
| 86431 |
|
4,805 |
4,761 |
$10K |
| 1036F |
|
36,705 |
33,423 |
$10K |
| 29125 |
|
71 |
67 |
$10K |
| 99397 |
|
126 |
76 |
$10K |
| 29540 |
|
64 |
63 |
$10K |
| 86300 |
|
920 |
712 |
$10K |
| 70498 |
|
323 |
323 |
$9K |
| 82533 |
|
1,115 |
987 |
$9K |
| 90846 |
|
70 |
55 |
$9K |
| 86235 |
|
2,784 |
1,638 |
$9K |
| 19281 |
|
13 |
12 |
$9K |
| H2010 |
Comprehensive med svc 15 min |
153 |
139 |
$9K |
| 0003A |
|
232 |
230 |
$9K |
| 90633 |
|
1,195 |
1,194 |
$9K |
| 90472 |
|
831 |
815 |
$9K |
| 93308 |
|
55 |
54 |
$9K |
| 81025 |
|
3,873 |
3,626 |
$9K |
| 92015 |
|
655 |
655 |
$9K |
| 92610 |
|
103 |
98 |
$9K |
| H0050 |
Alcohol/drug service 15 min |
177 |
160 |
$9K |
| M0243 |
Casirivi and imdevi inj |
20 |
20 |
$8K |
| J3301 |
Triamcinolone acet inj nos |
3,079 |
2,978 |
$8K |
| 72050 |
|
277 |
275 |
$8K |
| 74018 |
|
732 |
709 |
$8K |
| 83520 |
|
1,144 |
1,111 |
$8K |
| 90739 |
|
115 |
114 |
$8K |
| 86147 |
|
447 |
442 |
$8K |
| 90694 |
|
629 |
628 |
$8K |
| 86800 |
|
1,215 |
1,052 |
$7K |
| 82785 |
|
1,243 |
1,216 |
$7K |
| 72040 |
|
404 |
403 |
$7K |
| 95249 |
|
217 |
213 |
$7K |
| 90480 |
|
322 |
322 |
$7K |
| 64616 |
|
12 |
12 |
$7K |
| 86592 |
|
4,835 |
4,764 |
$7K |
| 82172 |
|
942 |
932 |
$7K |
| 81374 |
|
109 |
109 |
$7K |
| 86141 |
|
1,388 |
1,370 |
$7K |
| 87040 |
|
4,056 |
2,372 |
$7K |
| 82105 |
|
2,096 |
2,011 |
$7K |
| 90662 |
|
537 |
536 |
$7K |
| 96110 |
|
175 |
173 |
$7K |
| 0071A |
|
166 |
164 |
$7K |
| 90620 |
|
561 |
561 |
$7K |
| 51797 |
|
29 |
25 |
$6K |
| 36416 |
|
469 |
448 |
$6K |
| 92558 |
|
195 |
195 |
$6K |
| 87070 |
|
2,279 |
2,178 |
$6K |
| 73590 |
|
847 |
802 |
$6K |
| 84156 |
|
4,003 |
3,672 |
$6K |
| 0072A |
|
157 |
154 |
$6K |
| 87186 |
|
3,057 |
2,777 |
$6K |
| 83010 |
|
1,131 |
1,117 |
$6K |
| 76942 |
|
53 |
53 |
$6K |
| 96368 |
|
387 |
327 |
$6K |
| 73523 |
|
262 |
257 |
$6K |
| 82570 |
|
2,829 |
2,668 |
$6K |
| 95912 |
|
50 |
50 |
$6K |
| 86200 |
|
1,053 |
1,045 |
$6K |
| 83883 |
|
1,131 |
1,071 |
$6K |
| 99493 |
|
82 |
64 |
$6K |
| 90882 |
|
322 |
266 |
$6K |
| 73140 |
|
581 |
551 |
$6K |
| 82652 |
|
330 |
328 |
$5K |
| H0038 |
Self-help/peer svc per 15min |
222 |
206 |
$5K |
| 84165 |
|
1,486 |
1,377 |
$5K |
| 36430 |
|
15 |
13 |
$5K |
| 51600 |
|
16 |
12 |
$5K |
| 99383 |
|
37 |
37 |
$5K |
| 90707 |
|
325 |
323 |
$5K |
| 93226 |
|
74 |
73 |
$5K |
| 57454 |
|
12 |
12 |
$5K |
| 88313 |
|
363 |
306 |
$5K |
| 51702 |
|
27 |
26 |
$4K |
| 99401 |
|
53 |
52 |
$4K |
| J0690 |
Cefazolin sodium injection |
4,950 |
4,765 |
$4K |
| 82627 |
|
320 |
317 |
$4K |
| 92504 |
|
513 |
452 |
$4K |
| 86039 |
|
1,394 |
1,381 |
$4K |
| 46601 |
|
13 |
13 |
$4K |
| 87661 |
|
232 |
229 |
$4K |
| 86225 |
|
1,466 |
1,428 |
$4K |
| C1753 |
Cath, intravas ultrasound |
25 |
25 |
$3K |
| 82565 |
|
1,477 |
1,434 |
$3K |
| 86038 |
|
1,163 |
1,151 |
$3K |
| 88177 |
|
73 |
66 |
$3K |
| 84432 |
|
295 |
289 |
$3K |
| 85378 |
|
3,191 |
3,083 |
$3K |
| 90656 |
|
346 |
346 |
$3K |
| 84481 |
|
769 |
758 |
$3K |
| 82746 |
|
642 |
633 |
$3K |
| Q0091 |
Obtaining screen pap smear |
1,991 |
1,984 |
$3K |
| 86593 |
|
2,599 |
2,548 |
$3K |
| 80164 |
|
598 |
567 |
$3K |
| 92526 |
|
21 |
12 |
$3K |
| 71100 |
|
284 |
276 |
$3K |
| 73700 |
|
16 |
14 |
$3K |
| A9502 |
Tc99m tetrofosmin |
67 |
66 |
$3K |
| G0010 |
Admin hepatitis b vaccine |
182 |
176 |
$3K |
| J0330 |
Succinycholine chloride inj |
1,568 |
1,143 |
$3K |
| 86762 |
|
422 |
419 |
$3K |
| 80307 |
|
90 |
82 |
$3K |
| 74455 |
|
24 |
24 |
$3K |
| T1013 |
Sign lang/oral interpreter |
148 |
119 |
$3K |
| 95250 |
|
16 |
15 |
$3K |
| 73090 |
|
482 |
455 |
$3K |
| 86765 |
|
433 |
428 |
$3K |
| J2930 |
Methylprednisolone injection |
1,100 |
962 |
$2K |
| 99358 |
Prolong nursin fac eval 15m |
27 |
27 |
$2K |
| 88311 |
|
382 |
355 |
$2K |
| 83521 |
|
688 |
360 |
$2K |
| 11042 |
|
14 |
13 |
$2K |
| 77417 |
|
51 |
26 |
$2K |
| J1100 |
Dexamethasone sodium phos |
8,948 |
7,455 |
$2K |
| 92020 |
|
43 |
43 |
$2K |
| 82247 |
|
1,109 |
1,086 |
$2K |
| 86682 |
|
1,014 |
870 |
$2K |
| 90746 |
|
66 |
61 |
$2K |
| 90716 |
|
197 |
197 |
$2K |
| 87389 |
|
218 |
218 |
$2K |
| 86618 |
|
261 |
253 |
$2K |
| T1023 |
Program intake assessment |
37 |
37 |
$2K |
| 83921 |
|
259 |
257 |
$2K |
| 97010 |
|
148 |
70 |
$2K |
| 86256 |
|
218 |
113 |
$2K |
| 93926 |
|
25 |
25 |
$2K |
| 82248 |
|
1,285 |
1,219 |
$2K |
| 84460 |
|
1,050 |
1,038 |
$2K |
| 93270 |
|
29 |
29 |
$2K |
| 82947 |
|
4,656 |
3,725 |
$2K |
| 87075 |
|
654 |
622 |
$2K |
| 72114 |
|
65 |
65 |
$2K |
| 90710 |
|
266 |
266 |
$2K |
| 87205 |
|
1,671 |
1,569 |
$2K |
| J3370 |
Vancomycin hcl injection |
1,070 |
807 |
$2K |
| 81479 |
|
35 |
19 |
$2K |
| 99384 |
|
12 |
12 |
$2K |
| 83090 |
|
196 |
193 |
$2K |
| 90700 |
|
182 |
182 |
$2K |
| 86335 |
|
78 |
62 |
$2K |
| J8540 |
Oral dexamethasone |
938 |
628 |
$2K |
| 83550 |
|
600 |
596 |
$2K |
| J2710 |
Neostigmine methylslfte inj |
661 |
657 |
$1K |
| 83695 |
|
189 |
188 |
$1K |
| 93280 |
|
82 |
66 |
$1K |
| S0028 |
Injection, famotidine, 20 mg |
3,594 |
3,108 |
$1K |
| J1642 |
Inj heparin sodium per 10 u |
4,396 |
2,676 |
$1K |
| 84681 |
|
151 |
148 |
$1K |
| J3010 |
Fentanyl citrate injection |
8,717 |
8,453 |
$1K |
| 90653 |
|
158 |
158 |
$1K |
| 90696 |
|
184 |
184 |
$1K |
| 73600 |
|
163 |
153 |
$1K |
| 87880 |
|
527 |
517 |
$1K |
| J1885 |
Ketorolac tromethamine inj |
13,662 |
12,376 |
$1K |
| 81002 |
|
1,160 |
1,110 |
$1K |
| 51784 |
|
31 |
25 |
$1K |
| 82107 |
|
37 |
37 |
$1K |
| 99496 |
|
24 |
24 |
$1K |
| 83930 |
|
706 |
699 |
$1K |
| 73070 |
|
338 |
322 |
$1K |
| 84703 |
|
3,549 |
3,434 |
$1K |
| J1200 |
Diphenhydramine hcl injectio |
3,659 |
2,982 |
$1K |
| 74160 |
|
12 |
12 |
$1K |
| 96523 |
|
42 |
41 |
$1K |
| S0020 |
Injection, bupivicaine hydro |
1,977 |
1,941 |
$1K |
| A9581 |
Gadoxetate disodium inj |
15 |
15 |
$1K |
| 73620 |
|
255 |
235 |
$1K |
| 99153 |
Mod sedat endo service >5yrs |
620 |
595 |
$1K |
| J1644 |
Inj heparin sodium per 1000u |
2,935 |
1,958 |
$1K |
| 97804 |
|
39 |
38 |
$1K |
| 87430 |
|
934 |
922 |
$1K |
| 84300 |
|
526 |
512 |
$1K |
| J1050 |
Medroxyprogesterone acetate |
25 |
25 |
$980.51 |
| 80178 |
|
269 |
252 |
$966.91 |
| 99152 |
|
771 |
742 |
$962.82 |
| 87651 |
|
29 |
28 |
$950.07 |
| J2250 |
Inj midazolam hydrochloride |
7,035 |
6,757 |
$945.29 |
| 84145 |
|
228 |
225 |
$928.28 |
| 92133 |
|
12 |
12 |
$922.98 |
| 84270 |
|
58 |
58 |
$911.62 |
| S0077 |
Injection, clindamycin phosp |
220 |
207 |
$899.29 |
| 90698 |
|
146 |
146 |
$876.79 |
| J1030 |
Methylprednisolone 40 mg inj |
305 |
293 |
$874.21 |
| A9699 |
Radiopharm rx agent noc |
37 |
36 |
$862.56 |
| J1170 |
Hydromorphone injection |
1,149 |
934 |
$861.44 |
| 84425 |
|
132 |
130 |
$830.74 |
| J1815 |
Insulin injection |
829 |
515 |
$803.88 |
| 82088 |
|
27 |
24 |
$800.17 |
| 90714 |
|
40 |
40 |
$796.94 |
| J0696 |
Ceftriaxone sodium injection |
3,010 |
2,737 |
$786.15 |
| 84402 |
|
50 |
50 |
$785.67 |
| 86606 |
|
195 |
194 |
$781.13 |
| J2405 |
Ondansetron hcl injection |
11,402 |
10,215 |
$769.89 |
| 83993 |
|
143 |
141 |
$733.19 |
| 86304 |
|
77 |
71 |
$723.99 |
| 83540 |
|
296 |
292 |
$719.98 |
| J0131 |
Inj, acetaminophen (nos) |
211 |
205 |
$700.00 |
| 85612 |
|
200 |
198 |
$673.90 |
| 84436 |
|
248 |
248 |
$648.68 |
| 86735 |
|
156 |
153 |
$643.77 |
| C1781 |
Mesh (implantable) |
26 |
25 |
$619.34 |
| 80346 |
|
25 |
25 |
$617.69 |
| S0109 |
Methadone oral 5mg |
59 |
39 |
$614.95 |
| J9171 |
Docetaxel injection |
13 |
12 |
$607.76 |
| 70220 |
|
32 |
32 |
$593.11 |
| 93793 |
|
95 |
39 |
$590.32 |
| C1819 |
Tissue localization-excision |
43 |
41 |
$570.24 |
| 72070 |
|
61 |
61 |
$536.09 |
| 0042T |
|
12 |
12 |
$522.87 |
| J2270 |
Morphine sulfate injection |
2,448 |
2,024 |
$503.45 |
| 88360 |
|
16 |
12 |
$503.28 |
| 90744 |
|
86 |
86 |
$499.80 |
| J3420 |
Vitamin b12 injection |
516 |
473 |
$493.06 |
| G0447 |
Behavior counsel obesity 15m |
13 |
13 |
$483.04 |
| J3475 |
Inj magnesium sulfate |
864 |
602 |
$462.27 |
| 87338 |
|
97 |
97 |
$448.92 |
| 86580 |
|
29 |
27 |
$447.29 |
| J2919 |
Inj, methylpred sod succ 5mg |
106 |
91 |
$447.10 |
| 74430 |
|
13 |
13 |
$439.02 |
| 4004F |
|
8,453 |
7,777 |
$436.63 |
| 80069 |
|
68 |
67 |
$385.39 |
| 73503 |
|
17 |
16 |
$380.03 |
| 87109 |
|
94 |
94 |
$375.09 |
| G0108 |
Diab manage trn per indiv |
12 |
12 |
$372.43 |
| 86709 |
|
120 |
118 |
$367.21 |
| 83498 |
|
39 |
38 |
$351.40 |
| 86705 |
|
132 |
132 |
$346.88 |
| 73060 |
|
100 |
96 |
$340.20 |
| 82390 |
|
94 |
94 |
$336.98 |
| 90681 |
|
51 |
51 |
$323.44 |
| 84144 |
|
24 |
24 |
$309.88 |
| 82040 |
|
575 |
558 |
$306.71 |
| 82157 |
|
31 |
30 |
$292.80 |
| 91308 |
|
86 |
84 |
$275.28 |
| 36591 |
|
13 |
13 |
$271.49 |
| J3480 |
Inj potassium chloride |
334 |
179 |
$271.46 |
| 82330 |
|
95 |
84 |
$259.28 |
| J1630 |
Haloperidol injection |
1,950 |
1,777 |
$255.43 |
| C2617 |
Stent, non-cor, tem w/o del |
64 |
60 |
$251.57 |
| C1758 |
Catheter, ureteral |
100 |
95 |
$241.24 |
| 86787 |
|
54 |
53 |
$230.73 |
| 86316 |
|
28 |
25 |
$226.85 |
| 87116 |
|
43 |
41 |
$226.80 |
| 82010 |
|
212 |
194 |
$223.85 |
| 84154 |
|
31 |
31 |
$218.84 |
| G2077 |
Periodic assessment |
96 |
79 |
$212.64 |
| 84105 |
|
73 |
70 |
$209.61 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
1,107 |
1,070 |
$206.27 |
| 73522 |
|
13 |
13 |
$200.63 |
| 87101 |
|
67 |
66 |
$199.85 |
| 88302 |
|
13 |
12 |
$189.48 |
| J2765 |
Metoclopramide hcl injection |
3,483 |
3,364 |
$186.77 |
| 83605 |
|
225 |
195 |
$186.18 |
| 87077 |
|
76 |
67 |
$185.86 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
866 |
848 |
$178.53 |
| 86301 |
|
40 |
36 |
$177.45 |
| J1650 |
Inj enoxaparin sodium |
255 |
128 |
$173.34 |
| 86328 |
|
18 |
17 |
$172.01 |
| 81381 |
|
13 |
13 |
$169.90 |
| 77072 |
|
14 |
14 |
$163.96 |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
28 |
28 |
$156.39 |
| J2060 |
Lorazepam injection |
1,281 |
1,170 |
$154.84 |
| 84133 |
|
75 |
70 |
$144.41 |
| J0171 |
Adrenalin epinephrine inject |
342 |
334 |
$139.74 |
| 82175 |
|
62 |
37 |
$132.79 |
| 82397 |
|
14 |
14 |
$125.67 |
| 82436 |
|
60 |
55 |
$121.21 |
| 86701 |
|
12 |
12 |
$118.90 |
| 85007 |
|
155 |
139 |
$116.29 |
| 86708 |
|
14 |
14 |
$111.10 |
| J7620 |
Albuterol ipratrop non-comp |
2,325 |
1,859 |
$96.93 |
| 73100 |
|
14 |
12 |
$95.90 |
| 82610 |
|
15 |
15 |
$88.46 |
| J1580 |
Garamycin gentamicin inj |
125 |
123 |
$85.76 |
| Q0162 |
Ondansetron oral |
3,476 |
3,140 |
$82.11 |
| 84132 |
|
80 |
72 |
$81.94 |
| 86162 |
|
15 |
15 |
$81.32 |
| 82955 |
|
13 |
13 |
$79.70 |
| J7613 |
Albuterol non-comp unit |
2,207 |
1,827 |
$77.10 |
| 74019 |
|
14 |
14 |
$73.04 |
| OP250 |
|
66 |
41 |
$69.60 |
| J7512 |
Prednisone ir or dr oral 1mg |
2,057 |
1,691 |
$68.75 |
| 85045 |
|
45 |
44 |
$67.59 |
| 73552 |
|
13 |
12 |
$62.63 |
| 82365 |
|
37 |
33 |
$62.19 |
| 85384 |
|
78 |
70 |
$59.60 |
| 90611 |
|
109 |
109 |
$55.99 |
| 86255 |
|
13 |
13 |
$52.00 |
| 91312 |
|
513 |
510 |
$51.10 |
| J2272 |
Inj, morphine (fresenius) |
67 |
62 |
$48.00 |
| 83935 |
|
14 |
14 |
$47.50 |
| J1940 |
Furosemide injection |
164 |
100 |
$43.63 |
| 80177 |
|
15 |
15 |
$42.73 |
| 82140 |
|
15 |
13 |
$37.12 |
| 82150 |
|
14 |
12 |
$30.18 |
| 91307 |
|
314 |
279 |
$28.74 |
| 85347 |
|
86 |
70 |
$24.34 |
| J7120 |
Ringers lactate infusion |
43 |
28 |
$22.69 |
| 84520 |
|
14 |
14 |
$22.39 |
| 84075 |
|
76 |
74 |
$20.61 |
| J7050 |
Normal saline solution infus |
236 |
165 |
$19.83 |
| Q0163 |
Diphenhydramine hcl 50mg |
2,551 |
1,896 |
$17.84 |
| G9902 |
Pt scrn tbco and id as user |
7,972 |
7,252 |
$17.01 |
| 82270 |
|
55 |
54 |
$15.93 |
| 91300 |
|
4,140 |
3,753 |
$14.15 |
| J0295 |
Ampicillin sulbactam 1.5 gm |
56 |
53 |
$13.14 |
| 84155 |
|
54 |
53 |
$12.91 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
124 |
123 |
$12.80 |
| J2795 |
Ropivacaine hcl injection |
93 |
92 |
$10.36 |
| J0692 |
Cefepime hcl for injection |
14 |
14 |
$8.89 |
| J2550 |
Promethazine hcl injection |
163 |
157 |
$7.60 |
| J7644 |
Ipratropium bromide non-comp |
557 |
502 |
$7.48 |
| 84450 |
|
56 |
55 |
$6.78 |
| J2370 |
Phenylephrine hcl injection |
68 |
66 |
$6.17 |
| J1598 |
Inj glycopyrrolate fres kabi |
54 |
53 |
$5.82 |
| J0688 |
Inj cefazolin sodium, hikma |
103 |
102 |
$5.18 |
| J3411 |
Thiamine hcl 100 mg |
33 |
25 |
$3.53 |
| 87449 |
|
15 |
15 |
$3.30 |
| J2004 |
Inj, lidocaine w epinephrine |
39 |
38 |
$0.46 |
| G9687 |
Hospice anytime msmt per |
92 |
86 |
$0.23 |
| 3077F |
|
247 |
228 |
$0.21 |
| 3079F |
|
308 |
288 |
$0.18 |
| 3078F |
|
328 |
300 |
$0.18 |
| 3074F |
|
298 |
281 |
$0.13 |
| 3080F |
|
141 |
132 |
$0.13 |
| G9903 |
Pt scrn tbco id as non user |
15 |
15 |
$0.13 |
| 3075F |
|
212 |
200 |
$0.12 |
| 1123F |
|
126 |
103 |
$0.01 |
| 83050 |
|
84 |
76 |
$0.00 |
| G2074 |
Med assist tx no drug |
39 |
22 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
71 |
66 |
$0.00 |
| 3044F |
|
13 |
13 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
13 |
12 |
$0.00 |
| 99080 |
|
3,041 |
680 |
$0.00 |
| J1953 |
Levetiracetam injection |
28 |
28 |
$0.00 |
| 99499 |
|
1,527 |
836 |
$0.00 |
| J2210 |
Methylergonovin maleate inj |
29 |
29 |
$0.00 |
| 82375 |
|
84 |
76 |
$0.00 |