|
J2327
|
HCPCS
|
Injection, Risankizumab-rzaa, Intravenous, 1 Mg
|
25
|
25
|
$24,894.48
|
$24,894.48
|
$20.27
|
$24,894.48
|
$21,284.78
|
2026-05-12
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
25
|
25
|
$13,990.41
|
$13,990.41
|
$8,771.99
|
$13,990.41
|
$13,290.89
|
2026-05-12
|
|
J9312
|
HCPCS
|
Injection, Rituximab, 10 Mg
|
25
|
25
|
$11,274.24
|
$11,274.24
|
$137.30
|
$11,274.24
|
$9,639.48
|
2026-05-12
|
|
J2353
|
HCPCS
|
Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg
|
25
|
25
|
$8,456.24
|
$8,456.24
|
$301.40
|
$8,456.24
|
$7,230.09
|
2026-05-12
|
|
9480836_5
|
CDM
|
Stravix 3cm X 6cm
|
23
|
23
|
$7,435.00
|
$7,435.00
|
$4,661.75
|
$7,435.00
|
$7,063.25
|
2026-05-12
|
|
J0401
|
HCPCS
|
Injection, Aripiprazole (abilify Maintena), 1 Mg
|
25
|
25
|
$6,526.16
|
$6,526.16
|
$14.57
|
$6,526.16
|
$5,579.87
|
2026-05-12
|
|
59410
|
HCPCS
|
Vaginal Delivery With Post Delivery Care
|
37
|
25
|
$7,223.00
|
$7,223.00
|
$70.00
|
$28,892.00
|
$5,196.23
|
2026-05-12
|
|
Q5130
|
HCPCS
|
Injection, Pegfilgrastim-pbbk (fylnetra), Biosimilar, 0.5 Mg
|
25
|
25
|
$6,000.00
|
$6,000.00
|
$213.26
|
$6,000.00
|
$5,130.00
|
2026-05-12
|
|
8098403_5
|
CDM
|
Room & Board - Semi-private (two Beds) - Medical/surgical/gyn
|
16
|
16
|
$5,191.83
|
$5,191.83
|
$3,200.76
|
$5,191.83
|
$4,932.24
|
2026-05-12
|
|
8098402_5
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
16
|
16
|
$4,621.00
|
$4,621.00
|
$2,848.85
|
$4,621.00
|
$4,389.95
|
2026-05-12
|
|
J3358
|
HCPCS
|
Ustekinumab, For Intravenous Injection, 1 Mg
|
25
|
25
|
$5,087.19
|
$5,087.19
|
$23.54
|
$5,087.19
|
$4,349.54
|
2026-05-12
|
|
8085548_5
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
16
|
16
|
$4,501.47
|
$4,501.47
|
$2,775.16
|
$4,501.47
|
$4,276.40
|
2026-05-12
|
|
J3240
|
HCPCS
|
Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial
|
25
|
25
|
$4,853.10
|
$4,853.10
|
$2,554.19
|
$4,853.10
|
$4,149.40
|
2026-05-12
|
|
90375
|
HCPCS
|
Rabies Immune Globulin For Injection
|
25
|
25
|
$4,827.16
|
$4,827.16
|
$395.65
|
$4,827.16
|
$4,127.22
|
2026-05-12
|
|
26952
|
HCPCS
|
Amputation Of Finger Or Thumb With Tissue Flap
|
37
|
25
|
$5,933.00
|
$5,933.00
|
$310.87
|
$5,933.00
|
$3,915.78
|
2026-05-12
|
|
J0875
|
HCPCS
|
Injection, Dalbavancin, 5 Mg
|
25
|
25
|
$4,024.80
|
$4,024.80
|
$28.47
|
$4,024.80
|
$3,441.20
|
2026-05-12
|
|
A0433
|
HCPCS
|
Advanced Life Support, Level 2 (als 2)
|
25
|
25
|
$3,553.00
|
$3,553.00
|
$2,227.73
|
$14,212.00
|
$3,375.35
|
2026-05-12
|
|
27550
|
HCPCS
|
Closed Treatment Of Dislocated Knee
|
37
|
25
|
$4,986.00
|
$4,986.00
|
$10.00
|
$4,986.00
|
$3,290.76
|
2026-05-12
|
|
J7307
|
HCPCS
|
Etonogestrel (contraceptive) Implant System, Including Implant And Supplies
|
25
|
25
|
$3,434.00
|
$3,434.00
|
$312.69
|
$3,434.00
|
$3,262.30
|
2026-05-12
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
25
|
25
|
$3,754.34
|
$3,754.34
|
$35.24
|
$3,754.34
|
$3,209.96
|
2026-05-12
|
|
A0434
|
HCPCS
|
Specialty Care Transport (sct)
|
25
|
25
|
$3,350.00
|
$3,350.00
|
$2,100.45
|
$13,400.00
|
$3,182.50
|
2026-05-12
|
|
27818
|
HCPCS
|
Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation
|
36
|
25
|
$4,562.00
|
$4,562.00
|
$373.29
|
$4,562.00
|
$3,025.98
|
2026-05-12
|
|
25565
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation
|
37
|
25
|
$4,527.00
|
$4,527.00
|
$10.00
|
$4,527.00
|
$2,987.82
|
2026-05-12
|
|
25605
|
HCPCS
|
Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit…
|
36
|
25
|
$4,502.00
|
$4,502.00
|
$271.41
|
$4,502.00
|
$2,986.18
|
2026-05-12
|
|
43236
|
HCPCS
|
Injection Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endos…
|
37
|
25
|
$4,300.00
|
$4,300.00
|
$35.00
|
$4,300.00
|
$2,838.00
|
2026-05-12
|
|
25505
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati…
|
37
|
25
|
$4,242.00
|
$4,242.00
|
$33.00
|
$4,242.00
|
$2,799.72
|
2026-05-12
|
|
J1569
|
HCPCS
|
Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…
|
48
|
25
|
$8,381.28
|
$8,381.28
|
$68.98
|
$8,381.28
|
$2,782.89
|
2026-05-12
|
|
20103
|
HCPCS
|
Exploration Of Wound Of Arm Or Leg
|
37
|
25
|
$4,157.00
|
$4,157.00
|
$14.00
|
$4,157.00
|
$2,743.62
|
2026-05-12
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
37
|
25
|
$4,026.50
|
$4,026.50
|
$79.89
|
$4,026.50
|
$2,684.06
|
2026-05-12
|
|
43249
|
HCPCS
|
Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl…
|
37
|
25
|
$4,054.00
|
$4,054.00
|
$40.00
|
$4,054.00
|
$2,675.64
|
2026-05-12
|
|
J1439
|
HCPCS
|
Injection, Ferric Carboxymaltose, 1 Mg
|
25
|
25
|
$3,078.50
|
$3,078.50
|
$8.02
|
$3,078.50
|
$2,632.12
|
2026-05-12
|
|
9480840_5
|
CDM
|
Grafix Pl Prime 1.5 X 2 Cm
|
23
|
23
|
$2,753.00
|
$2,753.00
|
$1,726.13
|
$2,753.00
|
$2,615.35
|
2026-05-12
|
|
45385
|
HCPCS
|
Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S…
|
37
|
25
|
$3,955.00
|
$3,955.00
|
$30.00
|
$3,955.00
|
$2,610.30
|
2026-05-12
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
37
|
25
|
$3,900.00
|
$3,900.00
|
$80.20
|
$3,900.00
|
$2,574.00
|
2026-05-12
|
|
45388
|
HCPCS
|
Destruction Of Polyp Or Growth Of Large Bowel Using A Flexible Endoscope
|
35
|
24
|
$3,777.78
|
$3,777.78
|
$30.00
|
$3,777.78
|
$2,518.27
|
2026-05-12
|
|
25690
|
HCPCS
|
Closed Treatment Of Dislocated Wrist (lunate) Bone With Manipulation
|
36
|
25
|
$3,749.00
|
$3,749.00
|
$231.94
|
$3,749.00
|
$2,486.71
|
2026-05-12
|
|
26765
|
HCPCS
|
Treatment Of Broken End Of Finger Or Thumb
|
36
|
25
|
$3,696.00
|
$3,696.00
|
$180.57
|
$3,696.00
|
$2,451.56
|
2026-05-12
|
|
99285
|
HCPCS
|
Emergency Department Visit With High Level Of Medical Decision Making
|
37
|
25
|
$3,705.00
|
$3,705.00
|
$108.08
|
$3,705.00
|
$2,445.30
|
2026-05-12
|
|
Q4133
|
HCPCS
|
Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter
|
25
|
25
|
$2,847.00
|
$2,847.00
|
$199.44
|
$2,847.00
|
$2,434.19
|
2026-05-12
|
|
27265
|
HCPCS
|
Closed Treatment Of Dislocated Hip Prosthesis
|
37
|
25
|
$3,688.00
|
$3,688.00
|
$6.00
|
$3,688.00
|
$2,434.08
|
2026-05-12
|
|
J1745
|
HCPCS
|
Injection, Infliximab, Excludes Biosimilar, 10 Mg
|
25
|
25
|
$2,802.76
|
$2,802.76
|
$91.61
|
$2,802.76
|
$2,396.36
|
2026-05-12
|
|
45384
|
HCPCS
|
Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec…
|
37
|
25
|
$3,618.00
|
$3,618.00
|
$15.00
|
$3,618.00
|
$2,387.88
|
2026-05-12
|
|
J3111
|
HCPCS
|
Injection, Romosozumab-aqqg, 1 Mg
|
25
|
25
|
$2,782.13
|
$2,782.13
|
$19.31
|
$2,782.13
|
$2,378.72
|
2026-05-12
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
60
|
25
|
$2,778.24
|
$2,778.24
|
$89.63
|
$3,338.17
|
$2,375.39
|
2026-05-12
|
|
43255
|
HCPCS
|
Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex…
|
36
|
25
|
$2,680.00
|
$2,680.00
|
$168.69
|
$2,680.00
|
$2,291.40
|
2026-05-12
|
|
Q5104
|
HCPCS
|
Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg
|
25
|
25
|
$2,603.72
|
$2,603.72
|
$68.84
|
$2,603.72
|
$2,226.18
|
2026-05-12
|
|
J7300
|
HCPCS
|
Intrauterine Copper Contraceptive
|
50
|
25
|
$2,819.50
|
$2,819.50
|
$1,428.31
|
$3,361.00
|
$2,218.26
|
2026-05-12
|
|
23575
|
HCPCS
|
Closed Treatment Of Broken Shoulder Blade With Manipulation
|
37
|
25
|
$3,316.00
|
$3,316.00
|
$35.00
|
$3,316.00
|
$2,188.56
|
2026-05-12
|
|
45380
|
HCPCS
|
Biopsy Of Large Bowel Using A Flexible Endoscope
|
37
|
25
|
$3,283.00
|
$3,283.00
|
$10.00
|
$3,283.00
|
$2,166.78
|
2026-05-12
|
|
13132
|
HCPCS
|
Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…
|
37
|
25
|
$3,262.00
|
$3,262.00
|
$129.20
|
$3,262.00
|
$2,152.92
|
2026-05-12
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
106
|
25
|
$2,521.79
|
$2,521.79
|
$80.55
|
$4,227.00
|
$2,147.29
|
2026-05-12
|
|
45381
|
HCPCS
|
Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope
|
37
|
25
|
$3,246.00
|
$3,246.00
|
$15.00
|
$3,246.00
|
$2,142.36
|
2026-05-12
|
|
46040
|
HCPCS
|
Drainage Of Deep Abscess In Rectum
|
37
|
25
|
$3,183.00
|
$3,183.00
|
$55.00
|
$3,183.00
|
$2,100.78
|
2026-05-12
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
60
|
25
|
$2,734.33
|
$2,734.33
|
$55.52
|
$2,791.67
|
$2,093.05
|
2026-05-12
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
37
|
25
|
$3,170.00
|
$3,170.00
|
$56.51
|
$3,170.00
|
$2,092.20
|
2026-05-12
|
|
J2354
|
HCPCS
|
Injection, Octreotide, Non-depot Form For Subcutaneous Or Intravenous Injection,…
|
25
|
25
|
$2,173.90
|
$2,173.90
|
$1,363.04
|
$2,173.90
|
$2,065.21
|
2026-05-12
|
|
27750
|
HCPCS
|
Closed Treatment Of Broken Middle Part Of Shin Bone
|
37
|
25
|
$3,107.00
|
$3,107.00
|
$184.99
|
$3,107.00
|
$2,050.62
|
2026-05-12
|
|
11606
|
HCPCS
|
Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm
|
37
|
25
|
$3,100.00
|
$3,100.00
|
$20.00
|
$3,100.00
|
$2,046.00
|
2026-05-12
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
37
|
25
|
$3,096.00
|
$3,096.00
|
$77.58
|
$3,096.00
|
$2,043.36
|
2026-05-12
|
|
11010
|
HCPCS
|
Removal Of Foreign Material From Skin And Tissue At Open Broken And/or Dislocate…
|
37
|
25
|
$3,019.00
|
$3,019.00
|
$225.24
|
$3,019.00
|
$1,992.54
|
2026-05-12
|
|
24530
|
HCPCS
|
Closed Treatment Of Upper Arm Bone Broken At Elbow
|
37
|
25
|
$2,969.00
|
$2,969.00
|
$10.00
|
$2,969.00
|
$1,959.54
|
2026-05-12
|
|
Q5103
|
HCPCS
|
Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg
|
25
|
25
|
$2,271.07
|
$2,271.07
|
$68.16
|
$2,271.07
|
$1,941.77
|
2026-05-12
|
|
43251
|
HCPCS
|
Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi…
|
35
|
24
|
$2,749.00
|
$2,749.00
|
$35.00
|
$2,749.00
|
$1,938.00
|
2026-05-12
|
|
J7301
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg
|
25
|
25
|
$2,022.76
|
$2,022.76
|
$1,268.27
|
$2,022.76
|
$1,921.62
|
2026-05-12
|
|
45378
|
HCPCS
|
Diagnostic Exam Of Large Bowel Using A Flexible Endoscope
|
37
|
25
|
$2,884.00
|
$2,884.00
|
$20.00
|
$2,884.00
|
$1,903.44
|
2026-05-12
|
|
99291
|
HCPCS
|
Critical Care, First 30-74 Minutes
|
37
|
25
|
$2,218.00
|
$2,218.00
|
$121.60
|
$2,218.00
|
$1,896.39
|
2026-05-12
|
|
26011
|
HCPCS
|
Complicated Drainage Of Abscess In Finger
|
37
|
25
|
$2,844.00
|
$2,844.00
|
$141.85
|
$2,844.00
|
$1,877.04
|
2026-05-12
|
|
70471
|
HCPCS
|
Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)…
|
62
|
23
|
$2,430.26
|
$2,430.26
|
$114.18
|
$2,553.98
|
$1,853.70
|
2026-05-12
|
|
13151
|
HCPCS
|
Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm
|
37
|
25
|
$2,258.00
|
$2,258.00
|
$45.00
|
$2,258.00
|
$1,849.65
|
2026-05-12
|
|
99284
|
HCPCS
|
Emergency Department Visit With Moderate Level Of Medical Decision Making
|
37
|
25
|
$2,785.00
|
$2,785.00
|
$68.35
|
$2,785.00
|
$1,838.10
|
2026-05-12
|
|
73706
|
HCPCS
|
CT Scan Of Blood Vessels Of Lower Leg With Contrast
|
83
|
25
|
$2,277.29
|
$2,277.29
|
$83.65
|
$2,421.13
|
$1,824.84
|
2026-05-12
|
|
70547
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Without Contrast
|
37
|
25
|
$2,736.50
|
$2,736.50
|
$53.21
|
$2,736.50
|
$1,824.15
|
2026-05-12
|
|
27560
|
HCPCS
|
Closed Treatment Of Dislocated Kneecap
|
37
|
25
|
$2,316.00
|
$2,316.00
|
$6.00
|
$2,316.00
|
$1,824.00
|
2026-05-12
|
|
5205755_1
|
CDM
|
Blood Administration Charges
|
23
|
23
|
$1,878.22
|
$1,878.22
|
$1,177.64
|
$1,878.22
|
$1,784.31
|
2026-05-12
|
|
J7297
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (liletta), 52 Mg
|
25
|
25
|
$1,863.46
|
$1,863.46
|
$1,168.39
|
$1,863.46
|
$1,770.29
|
2026-05-12
|
|
27047
|
HCPCS
|
Removal Of Growth Under Skin Of Pelvis And Hip, Less Than 3.0 Cm
|
25
|
25
|
$1,848.00
|
$1,848.00
|
$312.69
|
$1,848.00
|
$1,755.60
|
2026-05-12
|
|
J7165
|
HCPCS
|
Injection, Prothrombin Complex Concentrate, Human-lans, Per I.u. Of Factor Ix Ac…
|
25
|
25
|
$2,021.76
|
$2,021.76
|
$7.61
|
$2,021.76
|
$1,728.60
|
2026-05-12
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
37
|
25
|
$2,586.20
|
$2,586.20
|
$77.58
|
$2,586.20
|
$1,723.96
|
2026-05-12
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
37
|
25
|
$2,585.50
|
$2,585.50
|
$96.24
|
$2,585.50
|
$1,723.49
|
2026-05-12
|
|
24600
|
HCPCS
|
Repair Of Dislocated Elbow
|
37
|
25
|
$2,605.00
|
$2,605.00
|
$13.00
|
$2,605.00
|
$1,719.30
|
2026-05-12
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
37
|
25
|
$2,573.00
|
$2,573.00
|
$101.99
|
$2,573.00
|
$1,715.16
|
2026-05-12
|
|
A0427
|
HCPCS
|
Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - …
|
25
|
25
|
$1,802.00
|
$1,802.00
|
$1,129.85
|
$7,208.00
|
$1,711.90
|
2026-05-12
|
|
87483
|
HCPCS
|
Test For Detecting Nucleic Acid Of Organism Causing Infection Of Central Nervous…
|
25
|
25
|
$1,963.00
|
$1,963.00
|
$478.26
|
$1,963.00
|
$1,678.37
|
2026-05-12
|
|
23650
|
HCPCS
|
Closed Treatment Of Dislocated Shoulder With Manipulation
|
37
|
25
|
$2,496.00
|
$2,496.00
|
$6.00
|
$2,496.00
|
$1,647.36
|
2026-05-12
|
|
13121
|
HCPCS
|
Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm
|
36
|
25
|
$2,476.00
|
$2,476.00
|
$168.65
|
$2,476.00
|
$1,642.33
|
2026-05-12
|
|
43239
|
HCPCS
|
Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop…
|
37
|
25
|
$2,464.00
|
$2,464.00
|
$35.00
|
$2,464.00
|
$1,626.24
|
2026-05-12
|
|
26770
|
HCPCS
|
Closed Treatment Of Dislocated Finger Joint With Manipulation
|
36
|
25
|
$1,894.00
|
$1,894.00
|
$124.72
|
$1,894.00
|
$1,619.37
|
2026-05-12
|
|
12016
|
HCPCS
|
Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.…
|
36
|
25
|
$2,424.00
|
$2,424.00
|
$109.91
|
$2,424.00
|
$1,607.84
|
2026-05-12
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
37
|
25
|
$2,412.00
|
$2,412.00
|
$101.99
|
$2,412.00
|
$1,607.84
|
2026-05-12
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
37
|
25
|
$2,417.50
|
$2,417.50
|
$62.09
|
$2,417.50
|
$1,595.55
|
2026-05-12
|
|
27786
|
HCPCS
|
Closed Treatment Of Broken Outside Lower Leg Bone At Ankle
|
37
|
25
|
$2,411.00
|
$2,411.00
|
$173.92
|
$2,411.00
|
$1,591.26
|
2026-05-12
|
|
43244
|
HCPCS
|
Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope
|
36
|
25
|
$1,854.00
|
$1,854.00
|
$205.21
|
$2,781.60
|
$1,585.17
|
2026-05-12
|
|
12054
|
HCPCS
|
Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1…
|
36
|
25
|
$2,378.00
|
$2,378.00
|
$155.99
|
$2,378.00
|
$1,577.33
|
2026-05-12
|
|
25600
|
HCPCS
|
Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb …
|
36
|
25
|
$2,371.00
|
$2,371.00
|
$157.38
|
$2,371.00
|
$1,572.68
|
2026-05-12
|
|
J0248
|
HCPCS
|
Injection, Remdesivir, 1 Mg
|
25
|
25
|
$1,797.12
|
$1,797.12
|
$10.52
|
$1,797.12
|
$1,536.54
|
2026-05-12
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
37
|
25
|
$2,290.50
|
$2,290.50
|
$79.24
|
$2,290.50
|
$1,526.85
|
2026-05-12
|
|
11406
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm
|
36
|
25
|
$2,283.00
|
$2,283.00
|
$193.22
|
$2,283.00
|
$1,514.32
|
2026-05-12
|
|
73701
|
HCPCS
|
CT Scan Of Leg With Contrast Material
|
60
|
25
|
$1,922.20
|
$1,922.20
|
$51.57
|
$2,055.67
|
$1,506.12
|
2026-05-12
|
|
72196
|
HCPCS
|
MRI Scan Of Pelvis With Contrast
|
37
|
25
|
$2,238.00
|
$2,238.00
|
$76.93
|
$2,238.00
|
$1,491.85
|
2026-05-12
|
|
25560
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Both Forearm Bones
|
36
|
25
|
$2,230.00
|
$2,230.00
|
$148.97
|
$2,230.00
|
$1,479.16
|
2026-05-12
|
|
70470
|
HCPCS
|
CT Scan Of Head Or Brain Before And After Contrast
|
37
|
25
|
$2,221.00
|
$2,221.00
|
$56.51
|
$2,221.00
|
$1,465.86
|
2026-05-12
|
|
71260
|
HCPCS
|
CT Scan Of Chest With Contrast
|
60
|
25
|
$1,890.95
|
$1,890.95
|
$51.92
|
$1,920.87
|
$1,443.84
|
2026-05-12
|
|
9440982_5
|
CDM
|
Snare, Rotatable 20mm
|
23
|
23
|
$1,518.00
|
$1,518.00
|
$951.79
|
$1,518.00
|
$1,442.10
|
2026-05-12
|
|
30905
|
HCPCS
|
Initial Control Of Nose Bleed And Insertion Of Packing
|
37
|
25
|
$1,669.00
|
$1,669.00
|
$28.00
|
$1,799.30
|
$1,427.00
|
2026-05-12
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
37
|
25
|
$2,139.70
|
$2,139.70
|
$80.90
|
$2,139.70
|
$1,426.33
|
2026-05-12
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
37
|
25
|
$2,124.50
|
$2,124.50
|
$79.59
|
$2,124.50
|
$1,416.19
|
2026-05-12
|
|
70487
|
HCPCS
|
CT Scan Of Face With Contrast
|
37
|
25
|
$2,100.86
|
$2,100.86
|
$50.26
|
$2,100.86
|
$1,386.57
|
2026-05-12
|
|
43235
|
HCPCS
|
Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible…
|
37
|
25
|
$2,099.00
|
$2,099.00
|
$15.00
|
$2,099.00
|
$1,385.34
|
2026-05-12
|
|
40831
|
HCPCS
|
Repair Of Lacerated Mouth, More Than 2.5 Cm
|
37
|
25
|
$2,043.00
|
$2,043.00
|
$30.53
|
$2,043.00
|
$1,348.38
|
2026-05-12
|
|
41800
|
HCPCS
|
Drainage Of Abscess, Cyst, Or Blood Accumulation Of Dental Bone
|
37
|
25
|
$1,537.00
|
$1,537.00
|
$18.00
|
$2,499.45
|
$1,314.14
|
2026-05-12
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
83
|
25
|
$1,552.19
|
$1,552.19
|
$77.25
|
$1,608.19
|
$1,301.75
|
2026-05-12
|
|
P9034
|
HCPCS
|
Platelets, Pheresis, Each Unit
|
48
|
25
|
$1,435.00
|
$1,435.00
|
$632.61
|
$1,449.00
|
$1,301.08
|
2026-05-12
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
37
|
25
|
$1,951.50
|
$1,951.50
|
$101.99
|
$1,951.50
|
$1,300.87
|
2026-05-12
|
|
Q5101
|
HCPCS
|
Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram
|
25
|
25
|
$1,517.11
|
$1,517.11
|
$6.99
|
$1,517.11
|
$1,297.13
|
2026-05-12
|
|
54700
|
HCPCS
|
Incision And Drainage Of Sperm Reservoir, Testis, And/or Scrotal Area
|
37
|
25
|
$1,950.00
|
$1,950.00
|
$25.00
|
$1,950.00
|
$1,287.00
|
2026-05-12
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
40
|
25
|
$1,811.50
|
$1,811.50
|
$101.65
|
$1,811.50
|
$1,255.37
|
2026-05-12
|
|
A0429
|
HCPCS
|
Ambulance Service, Basic Life Support, Emergency Transport (bls-emergency)
|
25
|
25
|
$1,319.00
|
$1,319.00
|
$827.01
|
$5,276.00
|
$1,253.05
|
2026-05-12
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
37
|
25
|
$1,863.50
|
$1,863.50
|
$56.16
|
$1,863.50
|
$1,242.21
|
2026-05-12
|
|
26600
|
HCPCS
|
Closed Treatment Of Broken Hand Bone
|
36
|
25
|
$1,870.00
|
$1,870.00
|
$138.83
|
$1,870.00
|
$1,240.37
|
2026-05-12
|
|
28190
|
HCPCS
|
Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin
|
37
|
25
|
$1,450.00
|
$1,450.00
|
$65.00
|
$1,896.20
|
$1,239.75
|
2026-05-12
|
|
32551
|
HCPCS
|
Removal Of Fluid From Between Lung And Chest Cavity
|
36
|
25
|
$1,859.00
|
$1,859.00
|
$131.42
|
$1,859.00
|
$1,233.08
|
2026-05-12
|
|
90675
|
HCPCS
|
Rabies Vaccine For Injection Into Muscle
|
97
|
25
|
$1,430.47
|
$1,430.47
|
$462.62
|
$1,559.21
|
$1,228.46
|
2026-05-12
|
|
76942
|
HCPCS
|
Ultrasonic Guidance For Needle Placement
|
25
|
25
|
$1,433.00
|
$1,433.00
|
$76.77
|
$1,433.00
|
$1,225.22
|
2026-05-12
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
37
|
25
|
$1,853.19
|
$1,853.19
|
$61.45
|
$1,853.19
|
$1,223.10
|
2026-05-12
|
|
73200
|
HCPCS
|
CT Scan Of Arm Without Contrast
|
60
|
25
|
$1,467.31
|
$1,467.31
|
$44.82
|
$1,663.43
|
$1,218.63
|
2026-05-12
|
|
A0426
|
HCPCS
|
Ambulance Service, Advanced Life Support, Non-emergency Transport, Level 1 (als …
|
25
|
25
|
$1,280.00
|
$1,280.00
|
$802.56
|
$5,120.00
|
$1,216.00
|
2026-05-12
|
|
23075
|
HCPCS
|
Removal Of Growth Under Skin Of Shoulder Area, Less Than 3.0 Cm
|
25
|
25
|
$1,406.00
|
$1,406.00
|
$121.00
|
$1,406.00
|
$1,202.13
|
2026-05-12
|
|
57460
|
HCPCS
|
Biopsy Of Cervix Using An Endoscope With Loop Electrode
|
25
|
25
|
$1,405.00
|
$1,405.00
|
$186.97
|
$1,405.00
|
$1,201.28
|
2026-05-12
|
|
A0428
|
HCPCS
|
Ambulance Service, Basic Life Support, Non-emergency Transport, (bls)
|
25
|
25
|
$1,258.00
|
$1,258.00
|
$788.77
|
$5,032.00
|
$1,195.10
|
2026-05-12
|
|
72126
|
HCPCS
|
CT Scan Of Upper Spine With Contrast
|
37
|
25
|
$1,798.00
|
$1,798.00
|
$54.20
|
$1,798.00
|
$1,190.32
|
2026-05-12
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
37
|
25
|
$1,783.50
|
$1,783.50
|
$105.54
|
$1,783.50
|
$1,188.88
|
2026-05-12
|
|
72193
|
HCPCS
|
CT Scan Of Pelvis With Contrast
|
37
|
25
|
$1,801.09
|
$1,801.09
|
$51.57
|
$1,801.09
|
$1,188.72
|
2026-05-12
|
|
71250
|
HCPCS
|
CT Scan Of Chest Without Contrast
|
60
|
25
|
$1,529.13
|
$1,529.13
|
$47.78
|
$1,592.09
|
$1,182.02
|
2026-05-12
|
|
30300
|
HCPCS
|
Removal Of Foreign Body In Nose
|
37
|
25
|
$1,372.00
|
$1,372.00
|
$5.00
|
$4,281.65
|
$1,173.06
|
2026-05-12
|
|
12020
|
HCPCS
|
Simple Closure Of Surface Wound Reopening
|
36
|
25
|
$1,757.00
|
$1,757.00
|
$171.26
|
$1,757.00
|
$1,165.42
|
2026-05-12
|
|
11043
|
HCPCS
|
Removal Of Muscle And/or Tissue, 20.0 Sq Cm Or Less
|
65
|
25
|
$1,560.00
|
$1,560.00
|
$25.00
|
$1,634.00
|
$1,163.45
|
2026-05-12
|
|
10061
|
HCPCS
|
Complicated Or Multiple Drainage Of Skin Abscess
|
41
|
25
|
$1,236.00
|
$1,236.00
|
$75.76
|
$1,668.20
|
$1,157.10
|
2026-05-12
|
|
12034
|
HCPCS
|
Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5…
|
36
|
25
|
$1,716.00
|
$1,716.00
|
$103.87
|
$1,716.00
|
$1,138.22
|
2026-05-12
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
37
|
25
|
$1,700.50
|
$1,700.50
|
$98.02
|
$1,700.50
|
$1,133.55
|
2026-05-12
|
|
73700
|
HCPCS
|
CT Scan Of Leg Without Contrast
|
60
|
25
|
$1,473.18
|
$1,473.18
|
$44.82
|
$1,497.41
|
$1,125.19
|
2026-05-12
|
|
99283
|
HCPCS
|
Emergency Department Visit With Low Level Of Medical Decision Making
|
37
|
25
|
$1,703.00
|
$1,703.00
|
$44.60
|
$1,703.00
|
$1,123.98
|
2026-05-12
|
|
23500
|
HCPCS
|
Closed Treatment Of Broken Collar Bone
|
36
|
25
|
$1,694.00
|
$1,694.00
|
$92.93
|
$1,694.00
|
$1,123.63
|
2026-05-12
|
|
92950
|
HCPCS
|
Manual Attempt To Restore Blood Circulation And Breathing
|
42
|
25
|
$1,740.00
|
$1,740.00
|
$115.00
|
$1,740.00
|
$1,119.69
|
2026-05-12
|
|
70486
|
HCPCS
|
CT Scan Of Face Without Contrast
|
60
|
25
|
$1,431.71
|
$1,431.71
|
$38.42
|
$1,524.11
|
$1,119.19
|
2026-05-12
|
|
67938
|
HCPCS
|
Removal Of Embedded Foreign Body In Eyelid
|
37
|
25
|
$1,305.00
|
$1,305.00
|
$99.88
|
$3,207.20
|
$1,115.78
|
2026-05-12
|
|
12032
|
HCPCS
|
Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 …
|
37
|
25
|
$1,672.00
|
$1,672.00
|
$40.00
|
$1,672.00
|
$1,103.52
|
2026-05-12
|
|
59414
|
HCPCS
|
Delivery Of Placenta
|
37
|
25
|
$1,275.00
|
$1,275.00
|
$60.00
|
$2,406.35
|
$1,090.13
|
2026-05-12
|
|
46221
|
HCPCS
|
Removal Of External Hemorrhoids By Rubber Banding
|
36
|
25
|
$1,615.00
|
$1,615.00
|
$77.07
|
$1,615.00
|
$1,071.23
|
2026-05-12
|
|
11983
|
HCPCS
|
Removal With Reinsertion Of Drug Delivery Implant Into Tissue
|
25
|
25
|
$1,235.00
|
$1,235.00
|
$260.07
|
$1,235.00
|
$1,055.93
|
2026-05-12
|
|
73201
|
HCPCS
|
CT Scan Of Arm With Contrast
|
37
|
25
|
$1,580.00
|
$1,580.00
|
$51.57
|
$1,580.00
|
$1,053.23
|
2026-05-12
|
|
72128
|
HCPCS
|
CT Scan Of Middle Spine Without Contrast
|
37
|
25
|
$1,579.22
|
$1,579.22
|
$44.82
|
$1,579.22
|
$1,042.28
|
2026-05-12
|
|
12042
|
HCPCS
|
Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm
|
37
|
25
|
$1,578.00
|
$1,578.00
|
$22.00
|
$1,578.00
|
$1,041.48
|
2026-05-12
|
|
11760
|
HCPCS
|
Repair Of Fingernail Or Toenail Bed
|
37
|
25
|
$1,570.00
|
$1,570.00
|
$65.00
|
$1,570.00
|
$1,036.20
|
2026-05-12
|
|
99292
|
HCPCS
|
Critical Care, Each Additional 30 Minutes
|
37
|
25
|
$1,209.00
|
$1,209.00
|
$58.90
|
$1,209.00
|
$1,033.70
|
2026-05-12
|
|
74150
|
HCPCS
|
CT Scan Of Abdomen Without Contrast
|
37
|
25
|
$1,564.88
|
$1,564.88
|
$52.89
|
$1,564.88
|
$1,032.82
|
2026-05-12
|
|
99245
|
HCPCS
|
Office Or Other Outpatient Consultation With High Level Of Medical Decision Maki…
|
7
|
7
|
$1,083.00
|
$1,083.00
|
$758.10
|
$1,083.00
|
$1,028.85
|
2026-05-12
|
|
12002
|
HCPCS
|
Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, …
|
60
|
25
|
$1,199.00
|
$1,199.00
|
$37.00
|
$1,497.00
|
$1,025.15
|
2026-05-12
|
|
36556
|
HCPCS
|
Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older)
|
37
|
25
|
$1,548.00
|
$1,548.00
|
$72.30
|
$1,548.00
|
$1,021.68
|
2026-05-12
|
|
26720
|
HCPCS
|
Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand
|
37
|
25
|
$1,455.00
|
$1,455.00
|
$11.00
|
$1,455.00
|
$1,017.45
|
2026-05-12
|
|
70488
|
HCPCS
|
CT Scan Of Face Before And After Contrast
|
37
|
25
|
$1,506.00
|
$1,506.00
|
$56.51
|
$1,506.00
|
$1,003.90
|
2026-05-12
|
|
49083
|
HCPCS
|
Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance
|
42
|
25
|
$1,360.00
|
$1,360.00
|
$65.00
|
$4,443.15
|
$997.82
|
2026-05-12
|
|
72192
|
HCPCS
|
CT Scan Of Pelvis Without Contrast
|
37
|
25
|
$1,508.66
|
$1,508.66
|
$48.10
|
$1,508.66
|
$995.72
|
2026-05-12
|
|
30903
|
HCPCS
|
Complex Control Of Nose Bleed
|
37
|
25
|
$1,162.00
|
$1,162.00
|
$13.00
|
$1,331.90
|
$993.51
|
2026-05-12
|
|
16030
|
HCPCS
|
Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface
|
17
|
12
|
$1,045.00
|
$1,045.00
|
$81.53
|
$1,358.50
|
$992.75
|
2026-05-12
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
37
|
25
|
$1,482.50
|
$1,482.50
|
$97.33
|
$1,482.50
|
$988.23
|
2026-05-12
|
|
49082
|
HCPCS
|
Drainage Of Fluid From Abdominal Cavity
|
42
|
25
|
$1,374.00
|
$1,374.00
|
$30.00
|
$1,374.00
|
$985.15
|
2026-05-12
|
|
94002
|
HCPCS
|
Initial Hospital Inpatient Or Observation Ventilation Assistance And Management
|
25
|
25
|
$1,149.00
|
$1,149.00
|
$64.26
|
$1,149.00
|
$982.40
|
2026-05-12
|
|
72131
|
HCPCS
|
CT Scan Of Lower Spine Without Contrast
|
37
|
25
|
$1,471.25
|
$1,471.25
|
$44.82
|
$1,471.25
|
$971.03
|
2026-05-12
|
|
92960
|
HCPCS
|
External Shock To Heart To Regulate Heart Beat
|
37
|
25
|
$1,467.00
|
$1,467.00
|
$91.21
|
$1,467.00
|
$968.22
|
2026-05-12
|
|
72125
|
HCPCS
|
CT Scan Of Upper Spine Without Contrast
|
37
|
25
|
$1,462.86
|
$1,462.86
|
$44.82
|
$1,462.86
|
$965.48
|
2026-05-12
|
|
C9046
|
HCPCS
|
Cocaine Hydrochloride Nasal Solution (goprelto), 1 Mg
|
25
|
25
|
$1,016.06
|
$1,016.06
|
$637.07
|
$4,064.24
|
$965.26
|
2026-05-12
|
|
J7298
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg
|
25
|
25
|
$1,010.00
|
$1,010.00
|
$633.27
|
$1,010.00
|
$959.50
|
2026-05-12
|
|
12004
|
HCPCS
|
Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, …
|
37
|
25
|
$1,434.00
|
$1,434.00
|
$65.75
|
$1,434.00
|
$946.44
|
2026-05-12
|
|
73221
|
HCPCS
|
MRI Scan Of Arm Joint Without Contrast
|
37
|
25
|
$1,415.00
|
$1,415.00
|
$61.18
|
$1,415.00
|
$943.24
|
2026-05-12
|
|
70480
|
HCPCS
|
CT Scan Of Cranial Cavity Without Contrast
|
37
|
25
|
$1,413.50
|
$1,413.50
|
$57.18
|
$1,413.50
|
$942.24
|
2026-05-12
|
|
70490
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Without Contrast
|
37
|
25
|
$1,413.18
|
$1,413.18
|
$57.18
|
$1,413.18
|
$942.02
|
2026-05-12
|
|
70544
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Without Contrast
|
37
|
25
|
$1,410.00
|
$1,410.00
|
$53.21
|
$1,410.00
|
$939.91
|
2026-05-12
|
|
G0121
|
HCPCS
|
Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For …
|
12
|
12
|
$1,780.00
|
$1,780.00
|
$156.36
|
$1,780.00
|
$938.50
|
2026-05-12
|
|
62270
|
HCPCS
|
Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap For Diagnostic Test
|
17
|
12
|
$977.00
|
$977.00
|
$18.00
|
$4,004.25
|
$928.15
|
2026-05-12
|
|
70460
|
HCPCS
|
CT Scan Head Or Brain With Contrast
|
37
|
25
|
$1,398.94
|
$1,398.94
|
$50.26
|
$1,398.94
|
$923.30
|
2026-05-12
|
|
12013
|
HCPCS
|
Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6…
|
36
|
25
|
$1,370.00
|
$1,370.00
|
$50.29
|
$1,370.00
|
$908.72
|
2026-05-12
|
|
70492
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Before And After Contrast
|
37
|
25
|
$1,357.50
|
$1,357.50
|
$71.48
|
$1,357.50
|
$904.91
|
2026-05-12
|
|
28630
|
HCPCS
|
Closed Treatment Of Dislocated Joint Between Toe And Foot
|
37
|
25
|
$1,058.00
|
$1,058.00
|
$61.06
|
$2,530.80
|
$904.59
|
2026-05-12
|
|
54150
|
HCPCS
|
Removal Of Foreskin Using Clamp Or Device
|
25
|
25
|
$941.00
|
$941.00
|
$590.01
|
$3,764.00
|
$893.95
|
2026-05-12
|
|
51703
|
HCPCS
|
Complicated Insertion Of Bladder Tube
|
37
|
25
|
$1,037.00
|
$1,037.00
|
$63.29
|
$2,129.90
|
$886.64
|
2026-05-12
|
|
9294429_5
|
CDM
|
Maye Omni 350 100 Ml
|
23
|
23
|
$924.00
|
$924.00
|
$579.35
|
$924.00
|
$877.80
|
2026-05-12
|
|
9449849_5
|
CDM
|
Dressing Kit With Foam 10x10 Snap
|
23
|
23
|
$920.89
|
$920.89
|
$577.40
|
$920.89
|
$874.85
|
2026-05-12
|
|
J1610
|
HCPCS
|
Injection, Glucagon Hydrochloride, Per 1 Mg
|
48
|
25
|
$970.44
|
$970.44
|
$285.27
|
$970.44
|
$874.51
|
2026-05-12
|
|
26750
|
HCPCS
|
Closed Treatment Of Broken End Of Finger Or Thumb
|
37
|
25
|
$1,316.00
|
$1,316.00
|
$37.00
|
$1,316.00
|
$868.56
|
2026-05-12
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
37
|
25
|
$1,301.00
|
$1,301.00
|
$65.91
|
$1,301.00
|
$867.25
|
2026-05-12
|
|
G0105
|
HCPCS
|
Colorectal Cancer Screening; Colonoscopy On Individual At High Risk
|
12
|
12
|
$1,614.00
|
$1,614.00
|
$156.19
|
$1,614.00
|
$859.54
|
2026-05-12
|
|
12041
|
HCPCS
|
Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.5 Cm Or Less
|
37
|
25
|
$1,290.00
|
$1,290.00
|
$22.00
|
$1,290.00
|
$851.40
|
2026-05-12
|
|
93306
|
HCPCS
|
Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…
|
37
|
25
|
$1,264.50
|
$1,264.50
|
$65.80
|
$1,264.50
|
$842.92
|
2026-05-12
|
|
20520
|
HCPCS
|
Removal Of Foreign Body In Muscle Or Tendon
|
37
|
25
|
$1,271.00
|
$1,271.00
|
$18.00
|
$1,271.00
|
$838.86
|
2026-05-12
|
|
93320
|
HCPCS
|
Ultrasound Of Heart Blood Flow, Valves And Chambers
|
37
|
25
|
$1,264.50
|
$1,264.50
|
$16.98
|
$1,264.50
|
$834.57
|
2026-05-12
|
|
62322
|
HCPCS
|
Injection Of Substance Into Lower Spine Canal
|
25
|
25
|
$974.00
|
$974.00
|
$138.50
|
$974.00
|
$832.77
|
2026-05-12
|
|
70450
|
HCPCS
|
CT Scan Head Or Brain Without Contrast
|
37
|
25
|
$1,242.56
|
$1,242.56
|
$38.07
|
$1,242.56
|
$820.09
|
2026-05-12
|
|
99244
|
HCPCS
|
Office Or Other Outpatient Consultation With Moderate Level Of Medical Decision …
|
7
|
7
|
$863.00
|
$863.00
|
$604.10
|
$863.00
|
$819.85
|
2026-05-12
|
|
13160
|
HCPCS
|
Extensive Or Complicated Repair Of Surface Wound Reopening
|
12
|
12
|
$1,075.00
|
$1,075.00
|
$548.40
|
$1,021.25
|
$808.44
|
2026-05-12
|
|
90679
|
HCPCS
|
Respiratory Syncytial Virus Vaccine, preF, Recombinant, Subunit, Adjuvanted, For…
|
25
|
25
|
$848.00
|
$848.00
|
$531.70
|
$3,392.00
|
$805.60
|
2026-05-12
|
|
31500
|
HCPCS
|
Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope
|
42
|
25
|
$1,236.00
|
$1,236.00
|
$30.00
|
$1,236.00
|
$795.37
|
2026-05-12
|
|
12011
|
HCPCS
|
Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5…
|
36
|
25
|
$1,191.00
|
$1,191.00
|
$49.99
|
$1,191.00
|
$789.99
|
2026-05-12
|
|
73718
|
HCPCS
|
MRI Scan Of Leg Without Contrast
|
37
|
25
|
$1,180.00
|
$1,180.00
|
$60.14
|
$1,180.00
|
$786.59
|
2026-05-12
|
|
11042
|
HCPCS
|
Removal Of Skin And Tissue, 20.0 Sq Cm Or Less
|
65
|
25
|
$826.00
|
$826.00
|
$53.31
|
$1,547.00
|
$784.70
|
2026-05-12
|
|
35226
|
HCPCS
|
Repair Of Blood Vessel Of Leg
|
12
|
12
|
$2,522.00
|
$2,522.00
|
$106.48
|
$2,395.90
|
$784.41
|
2026-05-12
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
37
|
25
|
$1,174.50
|
$1,174.50
|
$66.26
|
$1,174.50
|
$782.92
|
2026-05-12
|
|
90677
|
HCPCS
|
Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), For Intramuscular Use
|
25
|
25
|
$824.00
|
$824.00
|
$516.65
|
$3,296.00
|
$782.80
|
2026-05-12
|
|
24341
|
HCPCS
|
Repair Of Tendon Or Muscle Of Upper Arm Or Elbow
|
12
|
12
|
$1,725.00
|
$1,725.00
|
$449.74
|
$1,638.75
|
$782.01
|
2026-05-12
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
37
|
25
|
$1,172.00
|
$1,172.00
|
$64.40
|
$1,172.00
|
$781.26
|
2026-05-12
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
37
|
25
|
$1,171.00
|
$1,171.00
|
$65.91
|
$1,171.00
|
$780.59
|
2026-05-12
|
|
70551
|
HCPCS
|
MRI Scan Of Brain Without Contrast
|
37
|
25
|
$1,170.50
|
$1,170.50
|
$65.57
|
$1,170.50
|
$780.26
|
2026-05-12
|
|
10080
|
HCPCS
|
Simple Drainage Of Cyst Of Tailbone
|
37
|
25
|
$1,078.00
|
$1,078.00
|
$18.00
|
$1,078.00
|
$776.15
|
2026-05-12
|
|
10021
|
HCPCS
|
Fine Needle Aspiration Biopsy, First Growth
|
37
|
25
|
$905.00
|
$905.00
|
$37.00
|
$1,501.95
|
$773.78
|
2026-05-12
|
|
28510
|
HCPCS
|
Closed Treatment Of Broken Toe
|
36
|
25
|
$905.00
|
$905.00
|
$75.26
|
$1,446.85
|
$773.78
|
2026-05-12
|
|
64400
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Face Nerve
|
37
|
25
|
$905.00
|
$905.00
|
$7.00
|
$1,439.25
|
$773.78
|
2026-05-12
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
37
|
25
|
$1,159.00
|
$1,159.00
|
$60.83
|
$1,159.00
|
$772.59
|
2026-05-12
|
|
AM200
|
OTHER
|
Dificid 200 Mg Tablet
|
25
|
25
|
$811.95
|
$811.95
|
$509.09
|
$3,247.80
|
$771.35
|
2026-05-12
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
37
|
25
|
$1,157.00
|
$1,157.00
|
$64.75
|
$1,157.00
|
$771.26
|
2026-05-12
|
|
J7699
|
HCPCS
|
Noc Drugs, Inhalation Solution Administered Through Dme
|
25
|
25
|
$797.16
|
$797.16
|
$499.82
|
$797.16
|
$757.30
|
2026-05-12
|
|
77075
|
HCPCS
|
Complete X-ray Of Body Bones
|
37
|
25
|
$991.50
|
$991.50
|
$24.89
|
$991.50
|
$754.30
|
2026-05-12
|
|
16025
|
HCPCS
|
Dressing Change Or Removal Of Burn Tissue, 5-10% Of Total Body Surface
|
17
|
12
|
$785.00
|
$785.00
|
$17.00
|
$2,587.80
|
$745.75
|
2026-05-12
|
|
13122
|
HCPCS
|
Complicated Repair Of Wound Of Scalp, Arms, Or Legs, Each Additional 5.0 Cm Or L…
|
37
|
25
|
$849.00
|
$849.00
|
$26.00
|
$897.75
|
$725.90
|
2026-05-12
|
|
9257028_1
|
CDM
|
Recovery Room - General Classification
|
23
|
23
|
$759.59
|
$759.59
|
$476.27
|
$759.59
|
$721.61
|
2026-05-12
|
|
15271
|
HCPCS
|
Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C…
|
37
|
25
|
$1,011.00
|
$1,011.00
|
$25.00
|
$1,011.00
|
$715.35
|
2026-05-12
|
|
10140
|
HCPCS
|
Drainage Of Blood Or Fluid Accumulation
|
42
|
25
|
$883.00
|
$883.00
|
$40.00
|
$2,294.25
|
$700.15
|
2026-05-12
|
|
9440218_5
|
CDM
|
Esophageal Balloon Dilator Cath
|
23
|
23
|
$735.00
|
$735.00
|
$460.85
|
$735.00
|
$698.25
|
2026-05-12
|
|
73721
|
HCPCS
|
MRI Scan Of Leg Joint Without Contrast
|
37
|
25
|
$1,045.50
|
$1,045.50
|
$60.83
|
$1,045.50
|
$696.93
|
2026-05-12
|
|
12001
|
HCPCS
|
Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, …
|
37
|
25
|
$1,024.00
|
$1,024.00
|
$40.65
|
$1,024.00
|
$675.84
|
2026-05-12
|
|
87507
|
HCPCS
|
Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S…
|
25
|
25
|
$789.00
|
$789.00
|
$478.26
|
$789.00
|
$674.60
|
2026-05-12
|
|
76805
|
HCPCS
|
Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Single Or First Fetus
|
37
|
25
|
$872.39
|
$872.39
|
$45.71
|
$872.39
|
$672.60
|
2026-05-12
|
|
57454
|
HCPCS
|
Biopsy And Scraping Of Cervix Using An Endoscope
|
25
|
25
|
$786.00
|
$786.00
|
$86.14
|
$786.00
|
$672.03
|
2026-05-12
|
|
27552
|
HCPCS
|
Closed Treatment Of Dislocated Knee Under Anesthesia
|
12
|
12
|
$776.00
|
$776.00
|
$10.00
|
$737.20
|
$667.01
|
2026-05-12
|
|
99282
|
HCPCS
|
Emergency Department Visit With Straightforward Medical Decision Making
|
37
|
25
|
$1,003.00
|
$1,003.00
|
$19.20
|
$1,003.00
|
$661.98
|
2026-05-12
|
|
25260
|
HCPCS
|
Primary Repair Of Tendon Or Muscle Of Palm Side Of Forearm Or Wrist
|
12
|
12
|
$718.00
|
$718.00
|
$75.00
|
$686.83
|
$660.15
|
2026-05-12
|
|
93882
|
HCPCS
|
Ultrasound Of One Side Of Head And Neck Blood Flow
|
37
|
25
|
$999.00
|
$999.00
|
$22.05
|
$999.00
|
$659.34
|
2026-05-12
|
|
64653
|
HCPCS
|
Injection Of Chemical For Paralysis Of Sweat Glands
|
25
|
25
|
$771.00
|
$771.00
|
$58.45
|
$771.00
|
$659.21
|
2026-05-12
|
|
29405
|
HCPCS
|
Application Of Short Leg Cast
|
37
|
25
|
$763.00
|
$763.00
|
$16.00
|
$2,880.40
|
$652.37
|
2026-05-12
|
|
24620
|
HCPCS
|
Closed Treatment Of Broken And Dislocated Forearm Bones At Elbow With Manipulati…
|
11
|
11
|
$811.00
|
$811.00
|
$547.09
|
$770.45
|
$650.74
|
2026-05-12
|
|
1648924_1
|
CDM
|
Monitored Anesthesia Care
|
23
|
23
|
$682.78
|
$682.78
|
$428.11
|
$682.78
|
$648.64
|
2026-05-12
|
|
30901
|
HCPCS
|
Simple Control Of Nose Bleed
|
37
|
25
|
$748.00
|
$748.00
|
$28.00
|
$2,909.85
|
$639.54
|
2026-05-12
|
|
57415
|
HCPCS
|
Removal Of Impacted Foreign Body In Vagina Under Anesthesia
|
17
|
12
|
$672.00
|
$672.00
|
$94.25
|
$9,190.30
|
$638.40
|
2026-05-12
|
|
10120
|
HCPCS
|
Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple
|
37
|
25
|
$737.00
|
$737.00
|
$39.00
|
$2,177.40
|
$630.14
|
2026-05-12
|
|
1167881_3
|
CDM
|
CT Angio Pelvis
|
6
|
6
|
$654.00
|
$654.00
|
$457.80
|
$621.30
|
$621.30
|
2026-05-12
|
|
76801
|
HCPCS
|
Ultrasound Scan Of Pregnant Uterus (less Than 14 Weeks), Single Or First Fetus
|
60
|
25
|
$738.22
|
$738.22
|
$45.02
|
$849.00
|
$620.97
|
2026-05-12
|
|
10160
|
HCPCS
|
Aspiration Of Abscess, Blood, Or Cyst
|
42
|
25
|
$735.00
|
$735.00
|
$3.00
|
$3,494.10
|
$618.45
|
2026-05-12
|
|
93923
|
HCPCS
|
Complete Ultrasound Study Of Arm And Leg Arteries
|
25
|
25
|
$719.00
|
$719.00
|
$139.65
|
$719.00
|
$614.75
|
2026-05-12
|
|
11044
|
HCPCS
|
Removal Of Bone, 20.0 Sq Cm Or Less
|
17
|
12
|
$1,548.00
|
$1,548.00
|
$187.96
|
$1,470.60
|
$614.65
|
2026-05-12
|
|
84445
|
HCPCS
|
Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level
|
25
|
25
|
$716.00
|
$716.00
|
$58.35
|
$716.00
|
$612.18
|
2026-05-12
|
|
27266
|
HCPCS
|
Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia
|
12
|
12
|
$935.00
|
$935.00
|
$92.33
|
$888.25
|
$611.50
|
2026-05-12
|
|
99205
|
HCPCS
|
New Patient Office Or Other Outpatient Visit With A High Level Of Medical Decisi…
|
55
|
25
|
$837.00
|
$837.00
|
$82.70
|
$961.00
|
$602.55
|
2026-05-12
|
|
69200
|
HCPCS
|
Removal Of Foreign Body In Ear Canal
|
37
|
25
|
$698.00
|
$698.00
|
$8.00
|
$1,100.10
|
$596.79
|
2026-05-12
|
|
57420
|
HCPCS
|
Exam Of Vagina And Cervix Using An Endoscope
|
40
|
25
|
$627.00
|
$627.00
|
$136.30
|
$787.00
|
$595.65
|
2026-05-12
|
|
26410
|
HCPCS
|
Repair Of Tendon On Top Of Hand
|
11
|
11
|
$394.00
|
$394.00
|
$374.30
|
$708.40
|
$595.56
|
2026-05-12
|
|
64650
|
HCPCS
|
Injection Of Chemical For Paralysis Of Underarm Sweat Glands
|
25
|
25
|
$692.00
|
$692.00
|
$51.01
|
$692.00
|
$591.66
|
2026-05-12
|
|
J3489
|
HCPCS
|
Injection, Zoledronic Acid, 1 Mg
|
50
|
25
|
$717.12
|
$717.12
|
$390.04
|
$812.16
|
$590.98
|
2026-05-12
|
|
64450
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Other Nerve Or Branch
|
37
|
25
|
$691.00
|
$691.00
|
$36.92
|
$1,395.55
|
$590.81
|
2026-05-12
|
|
51700
|
HCPCS
|
Simple Bladder Irrigation And/or Instillation
|
36
|
25
|
$691.00
|
$691.00
|
$24.41
|
$4,137.25
|
$590.81
|
2026-05-12
|
|
58100
|
HCPCS
|
Biopsy Of Lining Of Uterus
|
25
|
25
|
$690.00
|
$690.00
|
$41.04
|
$690.00
|
$589.95
|
2026-05-12
|
|
57456
|
HCPCS
|
Scraping Of Cervix Using An Endoscope
|
25
|
25
|
$682.00
|
$682.00
|
$74.99
|
$682.00
|
$583.11
|
2026-05-12
|
|
90710
|
HCPCS
|
Measles, Mumps, Rubella, And Varicella Vaccine
|
50
|
25
|
$720.41
|
$720.41
|
$320.40
|
$3,719.32
|
$583.00
|
2026-05-12
|
|
90651
|
HCPCS
|
Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent
|
25
|
25
|
$608.00
|
$608.00
|
$381.22
|
$2,432.00
|
$577.60
|
2026-05-12
|
|
25680
|
HCPCS
|
Closed Treatment Of Broken And Dislocated Wrist Bones With Manipulation
|
12
|
12
|
$1,451.00
|
$1,451.00
|
$253.16
|
$1,378.45
|
$576.12
|
2026-05-12
|
|
P9040
|
HCPCS
|
Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit
|
48
|
25
|
$622.00
|
$622.00
|
$344.64
|
$652.00
|
$574.18
|
2026-05-12
|
|
94729
|
HCPCS
|
Test To Examine How Well The Lungs Exchange Gases
|
25
|
25
|
$670.00
|
$670.00
|
$69.14
|
$670.00
|
$572.85
|
2026-05-12
|
|
87522
|
HCPCS
|
Detection Test By Nucleic Acid For Hepatitis C Virus, Quantification
|
25
|
25
|
$669.00
|
$669.00
|
$49.16
|
$669.00
|
$572.00
|
2026-05-12
|
|
93970
|
HCPCS
|
Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers
|
91
|
25
|
$618.67
|
$618.67
|
$30.62
|
$917.11
|
$566.24
|
2026-05-12
|
|
23675
|
HCPCS
|
Closed Treatment Of Dislocated Shoulder And Broken Neck Of Upper Arm Bone With M…
|
12
|
12
|
$1,048.00
|
$1,048.00
|
$237.90
|
$995.60
|
$565.81
|
2026-05-12
|
|
9294427_5
|
CDM
|
Maye Omni 300 100 Ml
|
23
|
23
|
$594.00
|
$594.00
|
$372.44
|
$594.00
|
$564.30
|
2026-05-12
|
|
76856
|
HCPCS
|
Complete Ultrasound Scan Of Pelvis
|
37
|
25
|
$712.75
|
$712.75
|
$31.34
|
$712.75
|
$563.35
|
2026-05-12
|
|
9449853_5
|
CDM
|
Cartridge, Snap Plus Lg Cannister (125mmHg)
|
23
|
23
|
$589.50
|
$589.50
|
$369.62
|
$589.50
|
$560.03
|
2026-05-12
|
|
76604
|
HCPCS
|
Ultrasound Scan Of Chest
|
25
|
25
|
$651.00
|
$651.00
|
$99.17
|
$651.00
|
$556.61
|
2026-05-12
|
|
29540
|
HCPCS
|
Placement Of Strapping To Ankle Or Foot
|
25
|
25
|
$650.00
|
$650.00
|
$25.10
|
$650.00
|
$555.75
|
2026-05-12
|
|
65222
|
HCPCS
|
Removal Of Foreign Body In Cornea Using Slit Lamp
|
37
|
25
|
$648.00
|
$648.00
|
$15.00
|
$692.55
|
$554.04
|
2026-05-12
|
|
76881
|
HCPCS
|
Complete Ultrasound Scan Of Joint
|
37
|
25
|
$823.00
|
$823.00
|
$41.60
|
$823.00
|
$548.61
|
2026-05-12
|
|
25675
|
HCPCS
|
Closed Treatment Of Dislocated Forearm Bone At Wrist With Manipulation
|
12
|
12
|
$1,162.00
|
$1,162.00
|
$229.71
|
$1,103.90
|
$547.82
|
2026-05-12
|
|
59409
|
HCPCS
|
Vaginal Delivery
|
12
|
12
|
$462.00
|
$462.00
|
$40.00
|
$766.12
|
$541.49
|
2026-05-12
|
|
29505
|
HCPCS
|
Application Of Long Leg Splint From Thigh To Ankle Or Toe
|
37
|
25
|
$627.00
|
$627.00
|
$53.05
|
$1,256.85
|
$536.09
|
2026-05-12
|
|
99151
|
HCPCS
|
Use Of A Drug To Induce Depression Of Consciousness By Physician Performing A Pr…
|
37
|
25
|
$726.00
|
$726.00
|
$20.12
|
$726.00
|
$535.80
|
2026-05-12
|
|
J3301
|
HCPCS
|
Injection, Triamcinolone Acetonide, Not Otherwise Specified, 10 Mg
|
50
|
25
|
$845.26
|
$845.26
|
$2.51
|
$1,686.53
|
$530.73
|
2026-05-12
|
|
24505
|
HCPCS
|
Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation
|
12
|
12
|
$1,270.00
|
$1,270.00
|
$269.17
|
$1,206.50
|
$526.41
|
2026-05-12
|
|
10180
|
HCPCS
|
Complex Drainage Of Wound Infection After Surgery
|
17
|
12
|
$1,039.00
|
$1,039.00
|
$117.65
|
$987.05
|
$526.30
|
2026-05-12
|
|
27825
|
HCPCS
|
Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint With Manipula…
|
12
|
12
|
$1,034.00
|
$1,034.00
|
$15.00
|
$982.30
|
$525.91
|
2026-05-12
|
|
11102
|
HCPCS
|
Biopsy Of Related Skin Growth, First Growth
|
17
|
12
|
$552.00
|
$552.00
|
$12.00
|
$584.25
|
$524.40
|
2026-05-12
|
|
27840
|
HCPCS
|
Closed Treatment Of Dislocated Ankle
|
11
|
11
|
$987.00
|
$987.00
|
$440.73
|
$937.65
|
$524.24
|
2026-05-12
|
|
26350
|
HCPCS
|
Repair Of Finger Tendon Of Under Side Of Hand Other Than Upper Most Part Of Palm…
|
12
|
12
|
$331.00
|
$331.00
|
$30.00
|
$871.83
|
$523.70
|
2026-05-12
|
|
10060
|
HCPCS
|
Simple Or Single Drainage Of Skin Abscess
|
88
|
25
|
$685.00
|
$685.00
|
$42.44
|
$1,041.20
|
$516.80
|
2026-05-12
|
|
27810
|
HCPCS
|
Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation
|
12
|
12
|
$1,620.00
|
$1,620.00
|
$250.19
|
$1,539.00
|
$515.85
|
2026-05-12
|
|
93880
|
HCPCS
|
Ultrasound Of Both Sides Of Head And Neck Blood Flow
|
37
|
25
|
$768.67
|
$768.67
|
$35.75
|
$768.67
|
$512.40
|
2026-05-12
|
|
90670
|
HCPCS
|
Pneumococcal Vaccine, 13-valent
|
25
|
25
|
$538.00
|
$538.00
|
$337.33
|
$2,152.00
|
$511.10
|
2026-05-12
|
|
97608
|
HCPCS
|
Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq…
|
25
|
25
|
$537.00
|
$537.00
|
$336.70
|
$2,148.00
|
$510.15
|
2026-05-12
|
|
90671
|
HCPCS
|
Pneumococcal Conjugate Vaccine, 15 Valent (pcv15), For Intramuscular Use
|
25
|
25
|
$533.00
|
$533.00
|
$334.19
|
$2,132.00
|
$506.35
|
2026-05-12
|
|
93931
|
HCPCS
|
Ultrasound Of One Arm Arteries Or Artery Grafts
|
60
|
25
|
$530.00
|
$530.00
|
$21.53
|
$937.00
|
$503.50
|
2026-05-12
|
|
76816
|
HCPCS
|
Follow-up Ultrasound Scan Of Pregnant Uterus
|
37
|
25
|
$634.54
|
$634.54
|
$39.63
|
$634.54
|
$502.55
|
2026-05-12
|
|
25624
|
HCPCS
|
Closed Treatment Of Broken Wrist Bone Near Base Of Thumb With Manipulation
|
12
|
12
|
$1,816.00
|
$1,816.00
|
$236.04
|
$1,725.20
|
$499.33
|
2026-05-12
|
|
25660
|
HCPCS
|
Closed Treatment Of Dislocated Wrist Bones With Manipulation
|
12
|
12
|
$976.00
|
$976.00
|
$167.91
|
$927.20
|
$497.30
|
2026-05-12
|
|
27502
|
HCPCS
|
Closed Treatment Of Broken Thigh Bone At Midportion With Manipulation
|
12
|
12
|
$298.00
|
$298.00
|
$55.00
|
$845.68
|
$497.04
|
2026-05-12
|
|
J2997
|
HCPCS
|
Injection, Alteplase Recombinant, 1 Mg
|
25
|
25
|
$580.44
|
$580.44
|
$131.81
|
$580.44
|
$496.28
|
2026-05-12
|
|
J2792
|
HCPCS
|
Injection, Rho D Immune Globulin, Intravenous, Human, Solvent Detergent, 100 Iu
|
25
|
25
|
$577.38
|
$577.38
|
$58.57
|
$577.38
|
$493.66
|
2026-05-12
|
|
2596316_1
|
CDM
|
Urinary Catheter Activity:
|
23
|
23
|
$516.50
|
$516.50
|
$323.85
|
$516.50
|
$490.68
|
2026-05-12
|
|
23605
|
HCPCS
|
Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation
|
12
|
12
|
$901.00
|
$901.00
|
$17.00
|
$855.95
|
$490.51
|
2026-05-12
|