|
558
|
MS_DRG
|
Tendonitis, Myositis And Bursitis Without Mcc
|
3
|
3
|
$82,981.97
|
$82,981.97
|
$78,003.05
|
$78,832.87
|
$78,832.87
|
2026-04-17
|
|
331
|
MS_DRG
|
Major Small And Large Bowel Procedures Without Cc/mcc
|
3
|
3
|
$65,887.50
|
$65,887.50
|
$61,934.25
|
$62,593.13
|
$62,593.13
|
2026-04-17
|
|
522
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc
|
3
|
3
|
$58,328.97
|
$58,328.97
|
$54,829.23
|
$55,412.52
|
$55,412.52
|
2026-04-17
|
|
880
|
MS_DRG
|
Acute Adjustment Reaction And Psychosocial Dysfunction
|
3
|
3
|
$35,798.79
|
$35,798.79
|
$33,650.86
|
$34,008.85
|
$34,008.85
|
2026-04-17
|
|
J1951
|
HCPCS
|
Injection, Leuprolide Acetate For Depot Suspension (fensolvi), 0.25 Mg
|
5
|
5
|
$34,770.12
|
$34,770.12
|
$17,732.76
|
$33,031.61
|
$32,683.91
|
2026-04-17
|
|
682
|
MS_DRG
|
Renal Failure With Mcc
|
3
|
3
|
$31,056.64
|
$31,056.64
|
$29,193.24
|
$29,503.80
|
$29,503.80
|
2026-04-17
|
|
948
|
MS_DRG
|
Signs And Symptoms Without Mcc
|
3
|
3
|
$30,848.34
|
$30,848.34
|
$28,997.44
|
$29,305.92
|
$29,305.92
|
2026-04-17
|
|
602
|
MS_DRG
|
Cellulitis With Mcc
|
3
|
3
|
$30,827.83
|
$30,827.83
|
$28,978.16
|
$29,286.44
|
$29,286.44
|
2026-04-17
|
|
308
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders With Mcc
|
3
|
3
|
$30,346.73
|
$30,346.73
|
$28,525.92
|
$28,829.39
|
$28,829.39
|
2026-04-17
|
|
J2350
|
HCPCS
|
Injection, Ocrelizumab, 1 Mg
|
5
|
5
|
$30,360.15
|
$30,360.15
|
$15,483.67
|
$28,842.14
|
$28,538.54
|
2026-04-17
|
|
947
|
MS_DRG
|
Signs And Symptoms With Mcc
|
3
|
3
|
$29,437.49
|
$29,437.49
|
$27,671.24
|
$27,965.61
|
$27,965.61
|
2026-04-17
|
|
417
|
MS_DRG
|
Laparoscopic Cholecystectomy Without C.d.e. With Mcc
|
3
|
3
|
$29,110.65
|
$29,110.65
|
$27,364.01
|
$27,655.12
|
$27,655.12
|
2026-04-17
|
|
605
|
MS_DRG
|
Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc
|
3
|
3
|
$28,817.71
|
$28,817.71
|
$27,088.65
|
$27,376.82
|
$27,376.82
|
2026-04-17
|
|
565
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc
|
3
|
3
|
$28,238.06
|
$28,238.06
|
$26,543.78
|
$26,826.16
|
$26,826.16
|
2026-04-17
|
|
199
|
MS_DRG
|
Pneumothorax With Mcc
|
3
|
3
|
$28,099.62
|
$28,099.62
|
$26,413.64
|
$26,694.64
|
$26,694.64
|
2026-04-17
|
|
796
|
MS_DRG
|
Vaginal Delivery With Sterilization And/or D&c With Mcc
|
3
|
3
|
$27,780.74
|
$27,780.74
|
$26,113.90
|
$26,391.70
|
$26,391.70
|
2026-04-17
|
|
787
|
MS_DRG
|
Cesarean Section Without Sterilization With Cc
|
3
|
3
|
$26,373.13
|
$26,373.13
|
$24,790.74
|
$25,054.47
|
$25,054.47
|
2026-04-17
|
|
785
|
MS_DRG
|
Cesarean Section With Sterilization Without Cc/mcc
|
3
|
3
|
$26,155.38
|
$26,155.38
|
$24,586.06
|
$24,847.61
|
$24,847.61
|
2026-04-17
|
|
784
|
MS_DRG
|
Cesarean Section With Sterilization With Cc
|
3
|
3
|
$25,274.75
|
$25,274.75
|
$23,758.26
|
$24,011.01
|
$24,011.01
|
2026-04-17
|
|
786
|
MS_DRG
|
Cesarean Section Without Sterilization With Mcc
|
3
|
3
|
$25,200.02
|
$25,200.02
|
$23,688.02
|
$23,940.02
|
$23,940.02
|
2026-04-17
|
|
872
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc
|
3
|
3
|
$24,067.04
|
$24,067.04
|
$22,623.02
|
$22,863.69
|
$22,863.69
|
2026-04-17
|
|
788
|
MS_DRG
|
Cesarean Section Without Sterilization Without Cc/mcc
|
3
|
3
|
$23,922.78
|
$23,922.78
|
$22,487.42
|
$22,726.65
|
$22,726.65
|
2026-04-17
|
|
204
|
MS_DRG
|
Respiratory Signs And Symptoms
|
3
|
3
|
$23,672.92
|
$23,672.92
|
$22,252.54
|
$22,489.27
|
$22,489.27
|
2026-04-17
|
|
291
|
MS_DRG
|
Heart Failure And Shock With Mcc
|
3
|
3
|
$23,626.88
|
$23,626.88
|
$22,209.26
|
$22,445.53
|
$22,445.53
|
2026-04-17
|
|
J3241
|
HCPCS
|
Injection, Teprotumumab-trbw, 10 Mg
|
5
|
5
|
$23,826.26
|
$23,826.26
|
$12,151.39
|
$22,634.95
|
$22,396.68
|
2026-04-17
|
|
377
|
MS_DRG
|
Gastrointestinal Hemorrhage With Mcc
|
3
|
3
|
$22,201.32
|
$22,201.32
|
$20,869.24
|
$21,091.25
|
$21,091.25
|
2026-04-17
|
|
J9298
|
HCPCS
|
Injection, Nivolumab And Relatlimab-rmbw, 3 Mg/1 Mg
|
5
|
5
|
$21,941.18
|
$21,941.18
|
$11,190.00
|
$20,844.12
|
$20,624.71
|
2026-04-17
|
|
66
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc
|
3
|
3
|
$21,520.70
|
$21,520.70
|
$20,229.46
|
$20,444.67
|
$20,444.67
|
2026-04-17
|
|
561
|
MS_DRG
|
Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc
|
3
|
3
|
$20,831.70
|
$20,831.70
|
$19,581.80
|
$19,790.12
|
$19,790.12
|
2026-04-17
|
|
445
|
MS_DRG
|
Disorders Of The Biliary Tract With Cc
|
3
|
3
|
$20,450.27
|
$20,450.27
|
$19,223.25
|
$19,427.76
|
$19,427.76
|
2026-04-17
|
|
9598152_1
|
CDM
|
Interstim X Ssmri Ins 97800
|
5
|
5
|
$20,423.00
|
$20,423.00
|
$10,415.73
|
$19,401.85
|
$19,197.62
|
2026-04-17
|
|
193
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Mcc
|
3
|
3
|
$19,955.38
|
$19,955.38
|
$18,758.06
|
$18,957.61
|
$18,957.61
|
2026-04-17
|
|
882
|
MS_DRG
|
Neuroses Except Depressive
|
3
|
3
|
$19,655.41
|
$19,655.41
|
$18,476.09
|
$18,672.64
|
$18,672.64
|
2026-04-17
|
|
552
|
MS_DRG
|
Medical Back Problems Without Mcc
|
3
|
3
|
$19,210.04
|
$19,210.04
|
$18,057.44
|
$18,249.54
|
$18,249.54
|
2026-04-17
|
|
177
|
MS_DRG
|
Respiratory Infections And Inflammations With Mcc
|
3
|
3
|
$17,783.39
|
$17,783.39
|
$16,716.38
|
$16,894.22
|
$16,894.22
|
2026-04-17
|
|
439
|
MS_DRG
|
Disorders Of Pancreas Except Malignancy With Cc
|
3
|
3
|
$17,559.87
|
$17,559.87
|
$16,506.28
|
$16,681.88
|
$16,681.88
|
2026-04-17
|
|
863
|
MS_DRG
|
Postoperative And Post-traumatic Infections Without Mcc
|
3
|
3
|
$17,544.16
|
$17,544.16
|
$16,491.51
|
$16,666.95
|
$16,666.95
|
2026-04-17
|
|
812
|
MS_DRG
|
Red Blood Cell Disorders Without Mcc
|
3
|
3
|
$17,263.61
|
$17,263.61
|
$16,227.79
|
$16,400.43
|
$16,400.43
|
2026-04-17
|
|
783
|
MS_DRG
|
Cesarean Section With Sterilization With Mcc
|
4
|
4
|
$17,296.75
|
$17,296.75
|
$12,972.56
|
$16,431.91
|
$16,345.43
|
2026-04-17
|
|
378
|
MS_DRG
|
Gastrointestinal Hemorrhage With Cc
|
3
|
3
|
$17,096.39
|
$17,096.39
|
$16,070.60
|
$16,241.57
|
$16,241.57
|
2026-04-17
|
|
178
|
MS_DRG
|
Respiratory Infections And Inflammations With Cc
|
3
|
3
|
$17,024.30
|
$17,024.30
|
$16,002.85
|
$16,173.09
|
$16,173.09
|
2026-04-17
|
|
394
|
MS_DRG
|
Other Digestive System Diagnoses With Cc
|
3
|
3
|
$16,762.63
|
$16,762.63
|
$15,756.87
|
$15,924.50
|
$15,924.50
|
2026-04-17
|
|
603
|
MS_DRG
|
Cellulitis Without Mcc
|
3
|
3
|
$16,556.41
|
$16,556.41
|
$15,563.02
|
$15,728.59
|
$15,728.59
|
2026-04-17
|
|
768
|
MS_DRG
|
Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c
|
3
|
3
|
$16,464.38
|
$16,464.38
|
$15,476.52
|
$15,641.17
|
$15,641.17
|
2026-04-17
|
|
690
|
MS_DRG
|
Kidney And Urinary Tract Infections Without Mcc
|
3
|
3
|
$15,803.73
|
$15,803.73
|
$14,855.50
|
$15,013.54
|
$15,013.54
|
2026-04-17
|
|
755
|
MS_DRG
|
Malignancy, Female Reproductive System With Cc
|
3
|
3
|
$15,766.20
|
$15,766.20
|
$14,820.23
|
$14,977.89
|
$14,977.89
|
2026-04-17
|
|
54
|
MS_DRG
|
Nervous System Neoplasms With Mcc
|
3
|
3
|
$15,258.18
|
$15,258.18
|
$14,342.69
|
$14,495.27
|
$14,495.27
|
2026-04-17
|
|
194
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Cc
|
3
|
3
|
$14,980.30
|
$14,980.30
|
$14,081.48
|
$14,231.29
|
$14,231.29
|
2026-04-17
|
|
J9144
|
HCPCS
|
Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj
|
5
|
5
|
$14,852.68
|
$14,852.68
|
$7,574.87
|
$14,110.05
|
$13,961.52
|
2026-04-17
|
|
J2267
|
HCPCS
|
Injection, Mirikizumab-mrkz, 1 Mg
|
5
|
5
|
$14,773.56
|
$14,773.56
|
$7,534.52
|
$14,034.88
|
$13,887.15
|
2026-04-17
|
|
J9119
|
HCPCS
|
Injection, Cemiplimab-rwlc, 1 Mg
|
5
|
5
|
$14,224.21
|
$14,224.21
|
$7,254.35
|
$13,513.00
|
$13,370.76
|
2026-04-17
|
|
446
|
MS_DRG
|
Disorders Of The Biliary Tract Without Cc/mcc
|
3
|
3
|
$13,795.76
|
$13,795.76
|
$12,968.01
|
$13,105.97
|
$13,105.97
|
2026-04-17
|
|
535
|
MS_DRG
|
Fractures Of Hip And Pelvis With Mcc
|
3
|
3
|
$13,784.45
|
$13,784.45
|
$12,957.38
|
$13,095.23
|
$13,095.23
|
2026-04-17
|
|
175
|
MS_DRG
|
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale
|
3
|
3
|
$13,487.56
|
$13,487.56
|
$12,678.30
|
$12,813.18
|
$12,813.18
|
2026-04-17
|
|
300
|
MS_DRG
|
Peripheral Vascular Disorders With Cc
|
3
|
3
|
$13,212.52
|
$13,212.52
|
$12,419.77
|
$12,551.89
|
$12,551.89
|
2026-04-17
|
|
292
|
MS_DRG
|
Heart Failure And Shock With Cc
|
3
|
3
|
$13,159.77
|
$13,159.77
|
$12,370.19
|
$12,501.79
|
$12,501.79
|
2026-04-17
|
|
689
|
MS_DRG
|
Kidney And Urinary Tract Infections With Mcc
|
3
|
3
|
$12,756.37
|
$12,756.37
|
$11,990.99
|
$12,118.55
|
$12,118.55
|
2026-04-17
|
|
310
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc
|
3
|
3
|
$12,723.26
|
$12,723.26
|
$11,959.86
|
$12,087.09
|
$12,087.09
|
2026-04-17
|
|
312
|
MS_DRG
|
Syncope And Collapse
|
3
|
3
|
$12,686.62
|
$12,686.62
|
$11,925.42
|
$12,052.29
|
$12,052.29
|
2026-04-17
|
|
J2323
|
HCPCS
|
Injection, Natalizumab, 1 Mg
|
5
|
5
|
$12,642.40
|
$12,642.40
|
$6,447.62
|
$12,010.28
|
$11,883.86
|
2026-04-17
|
|
309
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders With Cc
|
3
|
3
|
$12,430.51
|
$12,430.51
|
$11,684.68
|
$11,808.98
|
$11,808.98
|
2026-04-17
|
|
71
|
MS_DRG
|
Other Cerebrovascular Disorders With Cc
|
3
|
3
|
$12,374.21
|
$12,374.21
|
$11,631.76
|
$11,755.50
|
$11,755.50
|
2026-04-17
|
|
J9228
|
HCPCS
|
Injection, Ipilimumab, 1 Mg
|
5
|
5
|
$12,356.25
|
$12,356.25
|
$6,301.69
|
$11,738.44
|
$11,614.88
|
2026-04-17
|
|
311
|
MS_DRG
|
Angina Pectoris
|
3
|
3
|
$11,637.75
|
$11,637.75
|
$10,939.49
|
$11,055.86
|
$11,055.86
|
2026-04-17
|
|
562
|
MS_DRG
|
Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…
|
3
|
3
|
$11,634.43
|
$11,634.43
|
$10,936.36
|
$11,052.71
|
$11,052.71
|
2026-04-17
|
|
189
|
MS_DRG
|
Pulmonary Edema And Respiratory Failure
|
3
|
3
|
$11,447.89
|
$11,447.89
|
$10,761.01
|
$10,875.49
|
$10,875.49
|
2026-04-17
|
|
998
|
MS_DRG
|
Principal Diagnosis Invalid As Discharge Diagnosis
|
3
|
3
|
$11,431.74
|
$11,431.74
|
$10,745.84
|
$10,860.15
|
$10,860.15
|
2026-04-17
|
|
807
|
MS_DRG
|
Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc
|
3
|
3
|
$11,134.97
|
$11,134.97
|
$10,466.87
|
$10,578.22
|
$10,578.22
|
2026-04-17
|
|
935
|
MS_DRG
|
Non-extensive Burns
|
3
|
3
|
$11,127.78
|
$11,127.78
|
$10,460.11
|
$10,571.39
|
$10,571.39
|
2026-04-17
|
|
811
|
MS_DRG
|
Red Blood Cell Disorders With Mcc
|
3
|
3
|
$10,932.97
|
$10,932.97
|
$10,276.99
|
$10,386.32
|
$10,386.32
|
2026-04-17
|
|
806
|
MS_DRG
|
Vaginal Delivery Without Sterilization Or D&c With Cc
|
3
|
3
|
$10,715.72
|
$10,715.72
|
$10,072.78
|
$10,179.93
|
$10,179.93
|
2026-04-17
|
|
389
|
MS_DRG
|
Gastrointestinal Obstruction With Cc
|
3
|
3
|
$10,464.05
|
$10,464.05
|
$9,836.21
|
$9,940.85
|
$9,940.85
|
2026-04-17
|
|
540
|
MS_DRG
|
Osteomyelitis With Cc
|
3
|
3
|
$10,366.67
|
$10,366.67
|
$9,744.67
|
$9,848.34
|
$9,848.34
|
2026-04-17
|
|
191
|
MS_DRG
|
Chronic Obstructive Pulmonary Disease With Cc
|
3
|
3
|
$10,245.27
|
$10,245.27
|
$9,630.55
|
$9,733.01
|
$9,733.01
|
2026-04-17
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
5
|
5
|
$10,326.95
|
$10,326.95
|
$5,266.74
|
$9,810.60
|
$9,707.33
|
2026-04-17
|
|
638
|
MS_DRG
|
Diabetes With Cc
|
3
|
3
|
$9,921.69
|
$9,921.69
|
$9,326.39
|
$9,425.61
|
$9,425.61
|
2026-04-17
|
|
641
|
MS_DRG
|
Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…
|
3
|
3
|
$9,543.92
|
$9,543.92
|
$8,971.29
|
$9,066.73
|
$9,066.73
|
2026-04-17
|
|
433
|
MS_DRG
|
Cirrhosis And Alcoholic Hepatitis With Cc
|
3
|
3
|
$9,472.28
|
$9,472.28
|
$8,903.94
|
$8,998.66
|
$8,998.66
|
2026-04-17
|
|
J9306
|
HCPCS
|
Injection, Pertuzumab, 1 Mg
|
5
|
5
|
$9,486.15
|
$9,486.15
|
$4,837.94
|
$9,011.84
|
$8,916.98
|
2026-04-17
|
|
315
|
MS_DRG
|
Other Circulatory System Diagnoses With Cc
|
3
|
3
|
$9,258.09
|
$9,258.09
|
$8,702.60
|
$8,795.19
|
$8,795.19
|
2026-04-17
|
|
J9332
|
HCPCS
|
Injection, Efgartigimod Alfa-fcab, 2mg
|
5
|
5
|
$9,346.26
|
$9,346.26
|
$4,766.59
|
$8,878.95
|
$8,785.48
|
2026-04-17
|
|
897
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc
|
3
|
3
|
$9,083.15
|
$9,083.15
|
$8,538.16
|
$8,628.99
|
$8,628.99
|
2026-04-17
|
|
832
|
MS_DRG
|
Other Antepartum Diagnoses Without O.r. Procedures With Cc
|
3
|
3
|
$8,988.25
|
$8,988.25
|
$8,448.95
|
$8,538.83
|
$8,538.83
|
2026-04-17
|
|
563
|
MS_DRG
|
Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…
|
3
|
3
|
$8,958.23
|
$8,958.23
|
$8,420.73
|
$8,510.31
|
$8,510.31
|
2026-04-17
|
|
65
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours
|
3
|
3
|
$8,671.22
|
$8,671.22
|
$8,150.95
|
$8,237.66
|
$8,237.66
|
2026-04-17
|
|
390
|
MS_DRG
|
Gastrointestinal Obstruction Without Cc/mcc
|
3
|
3
|
$8,235.36
|
$8,235.36
|
$7,741.24
|
$7,823.60
|
$7,823.60
|
2026-04-17
|
|
372
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Cc
|
3
|
3
|
$8,201.04
|
$8,201.04
|
$7,708.98
|
$7,790.99
|
$7,790.99
|
2026-04-17
|
|
440
|
MS_DRG
|
Disorders Of Pancreas Except Malignancy Without Cc/mcc
|
3
|
3
|
$8,171.96
|
$8,171.96
|
$7,681.64
|
$7,763.36
|
$7,763.36
|
2026-04-17
|
|
J2783
|
HCPCS
|
Injection, Rasburicase, 0.5 Mg
|
5
|
5
|
$8,191.85
|
$8,191.85
|
$4,177.84
|
$7,782.26
|
$7,700.34
|
2026-04-17
|
|
195
|
MS_DRG
|
Simple Pneumonia And Pleurisy Without Cc/mcc
|
3
|
3
|
$7,897.53
|
$7,897.53
|
$7,423.68
|
$7,502.66
|
$7,502.66
|
2026-04-17
|
|
J9271
|
HCPCS
|
Injection, Pembrolizumab, 1 Mg
|
5
|
5
|
$7,760.03
|
$7,760.03
|
$3,957.62
|
$7,372.03
|
$7,294.43
|
2026-04-17
|
|
914
|
MS_DRG
|
Traumatic Injury Without Mcc
|
3
|
3
|
$7,485.64
|
$7,485.64
|
$7,036.50
|
$7,111.36
|
$7,111.36
|
2026-04-17
|
|
176
|
MS_DRG
|
Pulmonary Embolism Without Mcc
|
3
|
3
|
$6,824.77
|
$6,824.77
|
$6,415.28
|
$6,483.53
|
$6,483.53
|
2026-04-17
|
|
9598154_1
|
CDM
|
Interstim Lead Kit 4.32mmx28cm
|
5
|
5
|
$6,794.00
|
$6,794.00
|
$3,464.94
|
$6,454.30
|
$6,386.36
|
2026-04-17
|
|
683
|
MS_DRG
|
Renal Failure With Cc
|
3
|
3
|
$6,718.14
|
$6,718.14
|
$6,315.05
|
$6,382.23
|
$6,382.23
|
2026-04-17
|
|
J2506
|
HCPCS
|
Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg
|
10
|
5
|
$6,448.97
|
$6,448.97
|
$3,281.37
|
$6,140.68
|
$6,062.03
|
2026-04-17
|
|
696
|
MS_DRG
|
Kidney And Urinary Tract Signs And Symptoms Without Mcc
|
3
|
3
|
$6,368.10
|
$6,368.10
|
$5,986.01
|
$6,049.70
|
$6,049.70
|
2026-04-17
|
|
J1162
|
HCPCS
|
Injection, Digoxin Immune Fab (ovine), Per Vial
|
5
|
5
|
$6,368.64
|
$6,368.64
|
$3,248.01
|
$6,050.21
|
$5,986.52
|
2026-04-17
|
|
J9305
|
HCPCS
|
Injection, Pemetrexed, Not Otherwise Specified, 10 Mg
|
5
|
5
|
$6,019.51
|
$6,019.51
|
$3,069.95
|
$5,718.53
|
$5,658.34
|
2026-04-17
|
|
J9173
|
HCPCS
|
Injection, Durvalumab, 10 Mg
|
5
|
5
|
$5,924.06
|
$5,924.06
|
$3,021.27
|
$5,627.86
|
$5,568.62
|
2026-04-17
|
|
6239479_1
|
CDM
|
Labor Room/delivery - General Classification
|
5
|
5
|
$5,793.00
|
$5,793.00
|
$2,954.43
|
$5,503.35
|
$5,445.42
|
2026-04-17
|
|
J9299
|
HCPCS
|
Injection, Nivolumab, 1 Mg
|
10
|
5
|
$8,214.39
|
$8,214.39
|
$2,803.04
|
$10,386.00
|
$5,398.49
|
2026-04-17
|
|
J9227
|
HCPCS
|
Injection, Isatuximab-irfc, 10 Mg
|
5
|
5
|
$5,659.38
|
$5,659.38
|
$2,886.28
|
$5,376.41
|
$5,319.82
|
2026-04-17
|
|
313
|
MS_DRG
|
Chest Pain
|
3
|
3
|
$5,572.06
|
$5,572.06
|
$5,237.74
|
$5,293.46
|
$5,293.46
|
2026-04-17
|
|
392
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc
|
3
|
3
|
$5,381.00
|
$5,381.00
|
$5,058.14
|
$5,111.95
|
$5,111.95
|
2026-04-17
|
|
789
|
MS_DRG
|
Neonates, Died Or Transferred To Another Acute Care Facility
|
3
|
3
|
$5,368.72
|
$5,368.72
|
$5,046.60
|
$5,100.28
|
$5,100.28
|
2026-04-17
|
|
64635
|
HCPCS
|
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,…
|
12
|
5
|
$5,707.00
|
$5,707.00
|
$170.50
|
$8,132.95
|
$4,909.01
|
2026-04-17
|
|
90375
|
HCPCS
|
Rabies Immune Globulin For Injection
|
5
|
5
|
$4,921.35
|
$4,921.35
|
$2,509.89
|
$4,675.28
|
$4,626.07
|
2026-04-17
|
|
6239478_1
|
CDM
|
Labor Room/delivery - General Classification
|
5
|
5
|
$4,878.00
|
$4,878.00
|
$2,487.78
|
$4,634.10
|
$4,585.32
|
2026-04-17
|
|
8104361_1
|
CDM
|
Rfa 3-17-150-4 Lumbar
|
5
|
5
|
$4,851.00
|
$4,851.00
|
$2,474.01
|
$4,608.45
|
$4,559.94
|
2026-04-17
|
|
J0840
|
HCPCS
|
Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram
|
5
|
5
|
$4,760.66
|
$4,760.66
|
$2,427.94
|
$4,522.63
|
$4,475.02
|
2026-04-17
|
|
26665
|
HCPCS
|
Treatment Of Broken Thumb At Wrist
|
7
|
5
|
$8,476.00
|
$8,476.00
|
$566.37
|
$8,052.20
|
$4,409.22
|
2026-04-17
|
|
19020
|
HCPCS
|
Drainage Of Abscess Of Breast
|
5
|
5
|
$4,678.00
|
$4,678.00
|
$2,385.78
|
$4,444.10
|
$4,397.32
|
2026-04-17
|
|
640
|
MS_DRG
|
Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…
|
3
|
3
|
$4,470.82
|
$4,470.82
|
$4,202.57
|
$4,247.28
|
$4,247.28
|
2026-04-17
|
|
8339183_1
|
CDM
|
Ryanodex 250 Mg Vial
|
5
|
5
|
$4,497.19
|
$4,497.19
|
$2,293.57
|
$4,272.33
|
$4,227.36
|
2026-04-17
|
|
192
|
MS_DRG
|
Chronic Obstructive Pulmonary Disease Without Cc/mcc
|
3
|
3
|
$4,376.38
|
$4,376.38
|
$4,113.80
|
$4,157.56
|
$4,157.56
|
2026-04-17
|
|
9490959_1
|
CDM
|
Mesh Vicryl Woven Vwml
|
5
|
5
|
$4,412.00
|
$4,412.00
|
$2,250.12
|
$4,191.40
|
$4,147.28
|
2026-04-17
|
|
684
|
MS_DRG
|
Renal Failure Without Cc/mcc
|
3
|
3
|
$4,248.92
|
$4,248.92
|
$3,993.98
|
$4,036.47
|
$4,036.47
|
2026-04-17
|
|
8028189_1
|
CDM
|
Coronary Care Unit - Myocardial Infarction
|
3
|
3
|
$4,211.00
|
$4,211.00
|
$3,958.34
|
$4,000.45
|
$4,000.45
|
2026-04-17
|
|
833
|
MS_DRG
|
Other Antepartum Diagnoses Without O.r. Procedures Without Cc/mcc
|
3
|
3
|
$4,205.99
|
$4,205.99
|
$3,953.63
|
$3,995.69
|
$3,995.69
|
2026-04-17
|
|
282
|
MS_DRG
|
Acute Myocardial Infarction, Discharged Alive Without Cc/mcc
|
3
|
3
|
$4,203.39
|
$4,203.39
|
$3,951.19
|
$3,993.22
|
$3,993.22
|
2026-04-17
|
|
8028141_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$4,165.00
|
$4,165.00
|
$3,915.10
|
$3,956.75
|
$3,956.75
|
2026-04-17
|
|
64633
|
HCPCS
|
Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,…
|
7
|
5
|
$7,485.00
|
$7,485.00
|
$170.08
|
$7,110.75
|
$3,893.70
|
2026-04-17
|
|
7363650_1
|
CDM
|
Speedbrg Imp Sys W/bio-comp Sw
|
5
|
5
|
$4,029.00
|
$4,029.00
|
$2,054.79
|
$3,827.55
|
$3,787.26
|
2026-04-17
|
|
J9303
|
HCPCS
|
Injection, Panitumumab, 10 Mg
|
10
|
5
|
$6,133.27
|
$6,133.27
|
$1,251.19
|
$9,322.57
|
$3,667.69
|
2026-04-17
|
|
9598153_1
|
CDM
|
Comm Handset Istim X
|
5
|
5
|
$3,900.00
|
$3,900.00
|
$1,989.00
|
$3,705.00
|
$3,666.00
|
2026-04-17
|
|
794
|
MS_DRG
|
Neonate With Other Significant Problems
|
3
|
3
|
$3,795.44
|
$3,795.44
|
$3,567.72
|
$3,605.67
|
$3,605.67
|
2026-04-17
|
|
J9358
|
HCPCS
|
Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg
|
5
|
5
|
$3,820.23
|
$3,820.23
|
$1,948.32
|
$3,629.22
|
$3,591.02
|
2026-04-17
|
|
6074331_1
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
5
|
5
|
$3,796.00
|
$3,796.00
|
$1,935.96
|
$3,606.20
|
$3,568.24
|
2026-04-17
|
|
6971095_1
|
CDM
|
Labor Room/delivery - General Classification
|
5
|
5
|
$3,696.00
|
$3,696.00
|
$1,884.96
|
$3,511.20
|
$3,474.24
|
2026-04-17
|
|
795
|
MS_DRG
|
Normal Newborn
|
3
|
3
|
$3,641.37
|
$3,641.37
|
$3,422.89
|
$3,459.30
|
$3,459.30
|
2026-04-17
|
|
7363261_1
|
CDM
|
Rfa 3-17-100-4 Lumbar
|
5
|
5
|
$3,648.00
|
$3,648.00
|
$1,860.48
|
$3,465.60
|
$3,429.12
|
2026-04-17
|
|
7363257_1
|
CDM
|
Rfa 3-17-75-4 Lumbar
|
5
|
5
|
$3,648.00
|
$3,648.00
|
$1,860.48
|
$3,465.60
|
$3,429.12
|
2026-04-17
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
3
|
3
|
$3,551.08
|
$3,551.08
|
$3,338.02
|
$3,373.53
|
$3,373.53
|
2026-04-17
|
|
9170685_1
|
CDM
|
Duraseal Exact Spine Sealant
|
5
|
5
|
$3,538.00
|
$3,538.00
|
$1,804.38
|
$3,361.10
|
$3,325.72
|
2026-04-17
|
|
66982
|
HCPCS
|
Complex Removal Of Cataract With Insertion Of Prosthetic Lens
|
7
|
5
|
$6,332.00
|
$6,332.00
|
$623.75
|
$6,015.40
|
$3,293.91
|
2026-04-17
|
|
101
|
MS_DRG
|
Seizures Without Mcc
|
3
|
3
|
$3,467.10
|
$3,467.10
|
$3,259.07
|
$3,293.75
|
$3,293.75
|
2026-04-17
|
|
J9317
|
HCPCS
|
Injection, Sacituzumab Govitecan-hziy, 2.5 Mg
|
5
|
5
|
$3,465.34
|
$3,465.34
|
$1,767.32
|
$3,292.07
|
$3,257.42
|
2026-04-17
|
|
J3262
|
HCPCS
|
Injection, Tocilizumab, 1 Mg
|
5
|
5
|
$3,462.17
|
$3,462.17
|
$1,765.71
|
$3,289.06
|
$3,254.44
|
2026-04-17
|
|
8028232_1
|
CDM
|
Coronary Care Unit - General Classification
|
3
|
3
|
$3,408.00
|
$3,408.00
|
$3,203.52
|
$3,237.60
|
$3,237.60
|
2026-04-17
|
|
64493
|
HCPCS
|
Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le…
|
12
|
5
|
$3,738.00
|
$3,738.00
|
$80.28
|
$5,326.65
|
$3,215.24
|
2026-04-17
|
|
J1459
|
HCPCS
|
Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…
|
5
|
5
|
$3,416.78
|
$3,416.78
|
$1,742.56
|
$3,245.94
|
$3,211.77
|
2026-04-17
|
|
57200
|
HCPCS
|
Suture Of Nonobstetrical Injury Of Vagina
|
7
|
5
|
$6,116.00
|
$6,116.00
|
$297.67
|
$5,810.20
|
$3,181.54
|
2026-04-17
|
|
G0390
|
HCPCS
|
Trauma Response Team Associated With Hospital Critical Care Service
|
10
|
5
|
$4,615.00
|
$4,615.00
|
$1,706.46
|
$5,589.80
|
$3,161.97
|
2026-04-17
|
|
202
|
MS_DRG
|
Bronchitis And Asthma With Cc/mcc
|
3
|
3
|
$3,234.91
|
$3,234.91
|
$3,040.82
|
$3,073.16
|
$3,073.16
|
2026-04-17
|
|
64490
|
HCPCS
|
Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le…
|
12
|
5
|
$3,556.00
|
$3,556.00
|
$92.71
|
$5,066.35
|
$3,058.43
|
2026-04-17
|
|
64483
|
HCPCS
|
Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I…
|
12
|
5
|
$3,548.00
|
$3,548.00
|
$98.06
|
$5,056.85
|
$3,052.07
|
2026-04-17
|
|
J9176
|
HCPCS
|
Injection, Elotuzumab, 1 Mg
|
10
|
5
|
$3,720.24
|
$3,720.24
|
$1,626.28
|
$4,039.11
|
$3,013.40
|
2026-04-17
|
|
81162
|
HCPCS
|
Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat…
|
5
|
5
|
$3,169.00
|
$3,169.00
|
$1,616.19
|
$3,010.55
|
$2,978.86
|
2026-04-17
|
|
J1950
|
HCPCS
|
Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg
|
10
|
5
|
$4,806.75
|
$4,806.75
|
$1,181.42
|
$6,932.15
|
$2,961.07
|
2026-04-17
|
|
J9036
|
HCPCS
|
Injection, Bendamustine Hydrochloride, (belrapzo/bendamustine), 1 Mg
|
5
|
5
|
$3,132.54
|
$3,132.54
|
$1,597.60
|
$2,975.91
|
$2,944.59
|
2026-04-17
|
|
8028225_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$3,095.00
|
$3,095.00
|
$2,909.30
|
$2,940.25
|
$2,940.25
|
2026-04-17
|
|
8028202_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$3,095.00
|
$3,095.00
|
$2,909.30
|
$2,940.25
|
$2,940.25
|
2026-04-17
|
|
8028199_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$3,095.00
|
$3,095.00
|
$2,909.30
|
$2,940.25
|
$2,940.25
|
2026-04-17
|
|
10140
|
HCPCS
|
Drainage Of Blood Or Fluid Accumulation
|
7
|
5
|
$5,535.00
|
$5,535.00
|
$113.74
|
$5,258.25
|
$2,879.31
|
2026-04-17
|
|
7363216_1
|
CDM
|
Rfa 2-17-50-4 Lumbar
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
7363201_1
|
CDM
|
Rfa 2-17-100-4 Lumbar
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
7363207_1
|
CDM
|
Rfa 2-17-50-2 Cervical
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
7363236_1
|
CDM
|
Rfa 2-17-75-4 Lumbar
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
7363247_1
|
CDM
|
Rfa 2-17-75-5.5 Knee
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
7363226_1
|
CDM
|
Rfa 2-17-75-2 Cervical
|
5
|
5
|
$3,039.00
|
$3,039.00
|
$1,549.89
|
$2,887.05
|
$2,856.66
|
2026-04-17
|
|
885
|
MS_DRG
|
Psychoses
|
3
|
3
|
$2,956.53
|
$2,956.53
|
$2,779.14
|
$2,808.70
|
$2,808.70
|
2026-04-17
|
|
6079497_1
|
CDM
|
Hsmh Misc Supply
|
5
|
5
|
$2,918.47
|
$2,918.47
|
$1,488.42
|
$2,772.54
|
$2,743.36
|
2026-04-17
|
|
566
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/mcc
|
3
|
3
|
$2,871.00
|
$2,871.00
|
$2,698.74
|
$2,727.45
|
$2,727.45
|
2026-04-17
|
|
J3358
|
HCPCS
|
Ustekinumab, For Intravenous Injection, 1 Mg
|
5
|
5
|
$2,895.15
|
$2,895.15
|
$1,476.53
|
$2,750.39
|
$2,721.44
|
2026-04-17
|
|
7361028_1
|
CDM
|
Rfa 2-17-150-4 Lumbar
|
5
|
5
|
$2,895.00
|
$2,895.00
|
$1,476.45
|
$2,750.25
|
$2,721.30
|
2026-04-17
|
|
77021
|
HCPCS
|
Review By Radiologist Of MRI Guidance For Needle Placement
|
5
|
5
|
$2,888.00
|
$2,888.00
|
$1,472.88
|
$2,743.60
|
$2,714.72
|
2026-04-17
|
|
7363648_1
|
CDM
|
Meniscal Root Kit
|
5
|
5
|
$2,880.00
|
$2,880.00
|
$1,468.80
|
$2,736.00
|
$2,707.20
|
2026-04-17
|
|
5770872_1
|
CDM
|
CT Neck Angiography
|
5
|
5
|
$2,849.00
|
$2,849.00
|
$1,452.99
|
$2,706.55
|
$2,678.06
|
2026-04-17
|
|
94002
|
HCPCS
|
Initial Hospital Inpatient Or Observation Ventilation Assistance And Management
|
5
|
5
|
$2,836.00
|
$2,836.00
|
$1,446.36
|
$2,694.20
|
$2,665.84
|
2026-04-17
|
|
36569
|
HCPCS
|
Insertion Of Tube For Infusion (5 Years Or Older)
|
10
|
5
|
$3,073.00
|
$3,073.00
|
$1,433.10
|
$3,169.20
|
$2,655.45
|
2026-04-17
|
|
9484106_1
|
CDM
|
Ascope 5 Uretero
|
5
|
5
|
$2,790.00
|
$2,790.00
|
$1,422.90
|
$2,650.50
|
$2,622.60
|
2026-04-17
|
|
15823
|
HCPCS
|
Removal Of Excessive Skin And Fat Of Upper Eyelid
|
5
|
5
|
$2,786.00
|
$2,786.00
|
$1,420.86
|
$2,646.70
|
$2,618.84
|
2026-04-17
|
|
64999
|
HCPCS
|
Other Procedure On Nervous System
|
6
|
5
|
$3,577.00
|
$3,577.00
|
$294.00
|
$3,398.15
|
$2,611.57
|
2026-04-17
|
|
J9312
|
HCPCS
|
Injection, Rituximab, 10 Mg
|
10
|
5
|
$4,340.57
|
$4,340.57
|
$737.88
|
$6,872.59
|
$2,531.99
|
2026-04-17
|
|
Q5108
|
HCPCS
|
Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg
|
5
|
5
|
$2,679.97
|
$2,679.97
|
$1,366.78
|
$2,545.97
|
$2,519.17
|
2026-04-17
|
|
P9037
|
HCPCS
|
Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit
|
5
|
5
|
$2,664.00
|
$2,664.00
|
$1,358.64
|
$2,530.80
|
$2,504.16
|
2026-04-17
|
|
78452
|
HCPCS
|
Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect
|
7
|
5
|
$4,774.00
|
$4,774.00
|
$73.96
|
$4,535.30
|
$2,483.43
|
2026-04-17
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
7
|
5
|
$4,773.00
|
$4,773.00
|
$97.82
|
$4,534.35
|
$2,482.91
|
2026-04-17
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
12
|
5
|
$3,314.00
|
$3,314.00
|
$98.49
|
$3,299.35
|
$2,460.90
|
2026-04-17
|
|
59510
|
HCPCS
|
Cesarean Delivery With Care Before And After Delivery
|
2
|
2
|
$5,217.00
|
$5,217.00
|
$2,360.44
|
$2,407.65
|
$2,384.05
|
2026-04-17
|
|
8028201_1
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
3
|
3
|
$2,505.00
|
$2,505.00
|
$2,354.70
|
$2,379.75
|
$2,379.75
|
2026-04-17
|
|
8028197_1
|
CDM
|
Room & Board - Private (one Bed) - Obstetrics (ob)
|
3
|
3
|
$2,505.00
|
$2,505.00
|
$2,354.70
|
$2,379.75
|
$2,379.75
|
2026-04-17
|
|
8028224_1
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
3
|
3
|
$2,505.00
|
$2,505.00
|
$2,354.70
|
$2,379.75
|
$2,379.75
|
2026-04-17
|
|
21315
|
HCPCS
|
Closed Treatment Of Broken Nose Bone With Manipulation
|
7
|
5
|
$4,515.00
|
$4,515.00
|
$52.39
|
$4,289.25
|
$2,348.70
|
2026-04-17
|
|
93306
|
HCPCS
|
Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…
|
12
|
5
|
$3,112.00
|
$3,112.00
|
$67.04
|
$3,125.50
|
$2,318.37
|
2026-04-17
|
|
5599866_1
|
CDM
|
Operating Room Services - General Classification
|
5
|
5
|
$2,445.00
|
$2,445.00
|
$1,246.95
|
$2,322.75
|
$2,298.30
|
2026-04-17
|
|
5010466_1
|
CDM
|
Operating Room Services - General Classification
|
5
|
5
|
$2,445.00
|
$2,445.00
|
$1,246.95
|
$2,322.75
|
$2,298.30
|
2026-04-17
|
|
5378707_1
|
CDM
|
Operating Room Services - General Classification
|
5
|
5
|
$2,445.00
|
$2,445.00
|
$1,246.95
|
$2,322.75
|
$2,298.30
|
2026-04-17
|
|
78451
|
HCPCS
|
Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect
|
7
|
5
|
$4,386.00
|
$4,386.00
|
$62.69
|
$4,166.70
|
$2,281.60
|
2026-04-17
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
7
|
5
|
$4,382.00
|
$4,382.00
|
$104.42
|
$4,162.90
|
$2,279.52
|
2026-04-17
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
7
|
5
|
$4,370.00
|
$4,370.00
|
$104.42
|
$4,151.50
|
$2,273.27
|
2026-04-17
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
7
|
5
|
$4,367.00
|
$4,367.00
|
$104.42
|
$4,148.65
|
$2,271.71
|
2026-04-17
|
|
66984
|
HCPCS
|
Removal Of Cataract With Insertion Of Prosthetic Lens
|
7
|
5
|
$4,353.00
|
$4,353.00
|
$457.91
|
$4,135.35
|
$2,264.43
|
2026-04-17
|
|
8028231_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$2,380.00
|
$2,380.00
|
$2,237.20
|
$2,261.00
|
$2,261.00
|
2026-04-17
|
|
73706
|
HCPCS
|
CT Scan Of Blood Vessels Of Lower Leg With Contrast
|
8
|
5
|
$3,096.00
|
$3,096.00
|
$85.80
|
$2,941.20
|
$2,260.39
|
2026-04-17
|
|
J9355
|
HCPCS
|
Injection, Trastuzumab, Excludes Biosimilar, 10 Mg
|
5
|
5
|
$2,399.97
|
$2,399.97
|
$1,223.98
|
$2,279.97
|
$2,255.97
|
2026-04-17
|
|
8580045_1
|
CDM
|
Werewolf Coblation Wand
|
5
|
5
|
$2,380.00
|
$2,380.00
|
$1,213.80
|
$2,261.00
|
$2,237.20
|
2026-04-17
|
|
27266
|
HCPCS
|
Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia
|
7
|
5
|
$4,285.00
|
$4,285.00
|
$543.73
|
$4,070.75
|
$2,229.06
|
2026-04-17
|
|
12037
|
HCPCS
|
Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha…
|
5
|
5
|
$2,358.00
|
$2,358.00
|
$1,202.58
|
$2,240.10
|
$2,216.52
|
2026-04-17
|
|
7362823_1
|
CDM
|
Ventralex Hernia Patch M 6.4cm
|
5
|
5
|
$2,347.00
|
$2,347.00
|
$1,196.97
|
$2,229.65
|
$2,206.18
|
2026-04-17
|
|
442
|
MS_DRG
|
Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc
|
3
|
3
|
$2,315.88
|
$2,315.88
|
$2,176.93
|
$2,200.09
|
$2,200.09
|
2026-04-17
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
8
|
5
|
$3,009.00
|
$3,009.00
|
$82.55
|
$2,858.55
|
$2,196.87
|
2026-04-17
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
7
|
5
|
$4,221.00
|
$4,221.00
|
$104.08
|
$4,009.95
|
$2,195.76
|
2026-04-17
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
10
|
5
|
$3,337.30
|
$3,337.30
|
$1,135.22
|
$4,226.23
|
$2,191.73
|
2026-04-17
|
|
24605
|
HCPCS
|
Repair Of Dislocated Elbow Under Anesthesia
|
12
|
5
|
$2,741.00
|
$2,741.00
|
$277.50
|
$3,233.80
|
$2,173.65
|
2026-04-17
|
|
46040
|
HCPCS
|
Drainage Of Deep Abscess In Rectum
|
7
|
5
|
$4,161.00
|
$4,161.00
|
$424.46
|
$3,952.95
|
$2,164.55
|
2026-04-17
|
|
59400
|
HCPCS
|
Vaginal Delivery With Care Before And After Delivery
|
2
|
2
|
$4,536.00
|
$4,536.00
|
$2,122.95
|
$2,165.41
|
$2,144.18
|
2026-04-17
|
|
7363115_1
|
CDM
|
Rfa Single 50-4
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363137_1
|
CDM
|
Rfa Single 75-4
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363105_1
|
CDM
|
Rfa Single 50-2
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363094_1
|
CDM
|
Rfa Single 150-4
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363083_1
|
CDM
|
Rfa Single100-4
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363148_1
|
CDM
|
Rfa Single 75-5.5
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7363126_1
|
CDM
|
Rfa Single 75-2
|
5
|
5
|
$2,280.00
|
$2,280.00
|
$1,162.80
|
$2,166.00
|
$2,143.20
|
2026-04-17
|
|
7361151_1
|
CDM
|
Parietex Composite Patch 8.6cm
|
5
|
5
|
$2,266.00
|
$2,266.00
|
$1,155.66
|
$2,152.70
|
$2,130.04
|
2026-04-17
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
7
|
5
|
$4,086.00
|
$4,086.00
|
$102.75
|
$3,881.70
|
$2,125.54
|
2026-04-17
|
|
64495
|
HCPCS
|
Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And…
|
12
|
5
|
$2,469.00
|
$2,469.00
|
$44.40
|
$3,518.80
|
$2,123.84
|
2026-04-17
|
|
J9264
|
HCPCS
|
Injection, Paclitaxel Protein-bound Particles, 1 Mg
|
5
|
5
|
$2,252.37
|
$2,252.37
|
$1,148.71
|
$2,139.75
|
$2,117.23
|
2026-04-17
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
7
|
5
|
$4,069.00
|
$4,069.00
|
$100.41
|
$3,865.55
|
$2,116.69
|
2026-04-17
|
|
64492
|
HCPCS
|
Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Third And…
|
12
|
5
|
$2,455.00
|
$2,455.00
|
$50.32
|
$3,498.85
|
$2,111.80
|
2026-04-17
|
|
J7327
|
HCPCS
|
Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose
|
5
|
5
|
$2,234.08
|
$2,234.08
|
$1,139.38
|
$2,122.38
|
$2,100.04
|
2026-04-17
|
|
43247
|
HCPCS
|
Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using …
|
7
|
5
|
$4,027.00
|
$4,027.00
|
$154.02
|
$3,825.65
|
$2,094.85
|
2026-04-17
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
7
|
5
|
$4,027.00
|
$4,027.00
|
$81.72
|
$3,825.65
|
$2,094.85
|
2026-04-17
|
|
951
|
MS_DRG
|
Other Factors Influencing Health Status
|
3
|
3
|
$2,205.00
|
$2,205.00
|
$2,072.70
|
$2,094.75
|
$2,094.75
|
2026-04-17
|
|
P9035
|
HCPCS
|
Platelets, Pheresis, Leukocytes Reduced, Each Unit
|
5
|
5
|
$2,216.00
|
$2,216.00
|
$1,130.16
|
$2,105.20
|
$2,083.04
|
2026-04-17
|
|
73219
|
HCPCS
|
MRI Scan Of Arm With Contrast
|
12
|
5
|
$2,820.00
|
$2,820.00
|
$74.12
|
$2,731.25
|
$2,073.19
|
2026-04-17
|
|
7363330_1
|
CDM
|
Thunderbeat 9cm Open Fine Jaw
|
5
|
5
|
$2,205.00
|
$2,205.00
|
$1,124.55
|
$2,094.75
|
$2,072.70
|
2026-04-17
|
|
64417
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Upper Arm And Shoulder Nerve (…
|
7
|
5
|
$3,947.00
|
$3,947.00
|
$60.33
|
$3,749.65
|
$2,053.23
|
2026-04-17
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
7
|
5
|
$3,935.00
|
$3,935.00
|
$98.49
|
$3,738.25
|
$2,046.99
|
2026-04-17
|
|
64640
|
HCPCS
|
Destruction Of Peripheral Nerve Or Branch
|
7
|
5
|
$3,899.00
|
$3,899.00
|
$109.65
|
$3,704.05
|
$2,028.26
|
2026-04-17
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
7
|
5
|
$3,846.00
|
$3,846.00
|
$108.25
|
$3,653.70
|
$2,000.69
|
2026-04-17
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
7
|
5
|
$3,843.00
|
$3,843.00
|
$100.41
|
$3,650.85
|
$1,999.13
|
2026-04-17
|
|
64520
|
HCPCS
|
Injection Of Anesthetic Agent Into Middle Or Lower Spine Sympathetic Nerve
|
7
|
5
|
$3,827.00
|
$3,827.00
|
$75.78
|
$3,635.65
|
$1,990.81
|
2026-04-17
|
|
70546
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Before And After Contrast
|
7
|
5
|
$3,821.00
|
$3,821.00
|
$67.11
|
$3,629.95
|
$1,987.68
|
2026-04-17
|
|
7362824_1
|
CDM
|
Ventralex Hernia Patch 8.0cm
|
5
|
5
|
$2,111.00
|
$2,111.00
|
$1,076.61
|
$2,005.45
|
$1,984.34
|
2026-04-17
|
|
64624
|
HCPCS
|
Destruction Of Nerve Branches Of Knee Using Imaging Guidance
|
7
|
5
|
$3,759.00
|
$3,759.00
|
$131.36
|
$3,571.05
|
$1,955.43
|
2026-04-17
|
|
72142
|
HCPCS
|
MRI Scan Of Upper Spinal Canal With Contrast
|
7
|
5
|
$3,741.00
|
$3,741.00
|
$81.88
|
$3,553.95
|
$1,946.07
|
2026-04-17
|
|
64445
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Lower Back And Leg Nerve (scia…
|
7
|
5
|
$3,721.00
|
$3,721.00
|
$64.83
|
$3,534.95
|
$1,935.66
|
2026-04-17
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
7
|
5
|
$3,692.00
|
$3,692.00
|
$98.16
|
$3,507.40
|
$1,920.58
|
2026-04-17
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
7
|
5
|
$3,671.00
|
$3,671.00
|
$81.38
|
$3,487.45
|
$1,909.65
|
2026-04-17
|
|
7362822_1
|
CDM
|
Ventralex Hernia Patch 4.3cm
|
5
|
5
|
$2,025.00
|
$2,025.00
|
$1,032.75
|
$1,923.75
|
$1,903.50
|
2026-04-17
|
|
6239480_1
|
CDM
|
Labor Room/delivery - General Classification
|
5
|
5
|
$2,017.00
|
$2,017.00
|
$1,028.67
|
$1,916.15
|
$1,895.98
|
2026-04-17
|
|
72149
|
HCPCS
|
MRI Scan Of Lower Spinal Canal With Contrast
|
7
|
5
|
$3,641.00
|
$3,641.00
|
$81.38
|
$3,458.95
|
$1,894.05
|
2026-04-17
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
7
|
5
|
$3,635.00
|
$3,635.00
|
$98.16
|
$3,453.25
|
$1,890.93
|
2026-04-17
|
|
Q5117
|
HCPCS
|
Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg
|
5
|
5
|
$1,999.66
|
$1,999.66
|
$1,019.83
|
$1,899.68
|
$1,879.68
|
2026-04-17
|
|
7361810_1
|
CDM
|
Anchor Y-knot 1.3mm
|
5
|
5
|
$1,992.00
|
$1,992.00
|
$1,015.92
|
$1,892.40
|
$1,872.48
|
2026-04-17
|
|
43235
|
HCPCS
|
Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible…
|
12
|
5
|
$2,228.00
|
$2,228.00
|
$108.47
|
$2,977.30
|
$1,862.32
|
2026-04-17
|
|
74182
|
HCPCS
|
MRI Scan Of Abdomen With Contrast
|
7
|
5
|
$3,575.00
|
$3,575.00
|
$78.38
|
$3,396.25
|
$1,859.72
|
2026-04-17
|
|
64510
|
HCPCS
|
Injection Of Anesthetic Agent Into Sympathetic Nerve Bundle
|
7
|
5
|
$3,555.00
|
$3,555.00
|
$68.85
|
$3,377.25
|
$1,849.31
|
2026-04-17
|
|
99291
|
HCPCS
|
Critical Care, First 30-74 Minutes
|
7
|
5
|
$3,530.00
|
$3,530.00
|
$195.07
|
$3,353.50
|
$1,836.31
|
2026-04-17
|
|
7363664_1
|
CDM
|
Proximal Tenodesis Implant Sys
|
5
|
5
|
$1,953.00
|
$1,953.00
|
$996.03
|
$1,855.35
|
$1,835.82
|
2026-04-17
|
|
J9035
|
HCPCS
|
Injection, Bevacizumab, 10 Mg
|
10
|
5
|
$3,068.22
|
$3,068.22
|
$625.92
|
$4,663.69
|
$1,834.80
|
2026-04-17
|
|
J2802
|
HCPCS
|
Injection, Romiplostim, 1 Microgram
|
10
|
5
|
$2,754.38
|
$2,754.38
|
$936.50
|
$3,488.86
|
$1,808.71
|
2026-04-17
|
|
8748060_1
|
CDM
|
Carpal Tunnel Release Kit 4m
|
5
|
5
|
$1,917.00
|
$1,917.00
|
$977.67
|
$1,821.15
|
$1,801.98
|
2026-04-17
|
|
64494
|
HCPCS
|
Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le…
|
12
|
5
|
$2,090.00
|
$2,090.00
|
$43.06
|
$2,978.25
|
$1,797.71
|
2026-04-17
|
|
64421
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region…
|
7
|
5
|
$3,444.00
|
$3,444.00
|
$21.28
|
$3,271.80
|
$1,791.57
|
2026-04-17
|
|
8028212_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
3
|
3
|
$1,885.00
|
$1,885.00
|
$1,771.90
|
$1,790.75
|
$1,790.75
|
2026-04-17
|
|
J0129
|
HCPCS
|
Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…
|
5
|
5
|
$1,903.64
|
$1,903.64
|
$970.86
|
$1,808.46
|
$1,789.42
|
2026-04-17
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
7
|
5
|
$3,423.00
|
$3,423.00
|
$65.86
|
$3,251.85
|
$1,780.64
|
2026-04-17
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
12
|
5
|
$2,418.00
|
$2,418.00
|
$62.19
|
$2,307.55
|
$1,768.24
|
2026-04-17
|
|
64636
|
HCPCS
|
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,…
|
7
|
5
|
$3,378.00
|
$3,378.00
|
$49.81
|
$3,209.10
|
$1,757.24
|
2026-04-17
|
|
7363296_1
|
CDM
|
Powerport Implant 9.6f
|
5
|
5
|
$1,862.00
|
$1,862.00
|
$949.62
|
$1,768.90
|
$1,750.28
|
2026-04-17
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
12
|
5
|
$2,129.00
|
$2,129.00
|
$66.19
|
$2,697.05
|
$1,739.05
|
2026-04-17
|
|
72127
|
HCPCS
|
CT Scan Of Upper Spine Before And After Contrast
|
7
|
5
|
$3,329.00
|
$3,329.00
|
$57.51
|
$3,162.55
|
$1,731.75
|
2026-04-17
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
7
|
5
|
$3,292.00
|
$3,292.00
|
$81.05
|
$3,127.40
|
$1,712.50
|
2026-04-17
|
|
64491
|
HCPCS
|
Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Second Le…
|
12
|
5
|
$1,963.00
|
$1,963.00
|
$49.81
|
$2,797.75
|
$1,688.61
|
2026-04-17
|
|
8102086_1
|
CDM
|
Prevena Wound Vac Kit
|
5
|
5
|
$1,793.00
|
$1,793.00
|
$914.43
|
$1,703.35
|
$1,685.42
|
2026-04-17
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
7
|
5
|
$3,236.00
|
$3,236.00
|
$57.51
|
$3,074.20
|
$1,683.37
|
2026-04-17
|
|
73722
|
HCPCS
|
MRI Scan Of Leg Joint With Contrast
|
7
|
5
|
$3,227.00
|
$3,227.00
|
$74.46
|
$3,065.65
|
$1,678.69
|
2026-04-17
|
|
72159
|
HCPCS
|
MRI Scan Of Blood Vessels Of Spinal Canal
|
7
|
5
|
$3,219.00
|
$3,219.00
|
$81.72
|
$3,058.05
|
$1,674.52
|
2026-04-17
|
|
7361150_1
|
CDM
|
Parietex Composite Patch 6.6cm
|
5
|
5
|
$1,764.00
|
$1,764.00
|
$899.64
|
$1,675.80
|
$1,658.16
|
2026-04-17
|
|
27134
|
HCPCS
|
Revision Of Thigh Bone And Hip Joint Prosthesis
|
2
|
2
|
$27,560.00
|
$27,560.00
|
$1,640.89
|
$1,673.71
|
$1,657.30
|
2026-04-17
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
7
|
5
|
$3,170.00
|
$3,170.00
|
$63.52
|
$3,011.50
|
$1,649.03
|
2026-04-17
|
|
64625
|
HCPCS
|
Destruction Of Nerves Supplying Joint Between Spine And Pelvis Using Imaging Gui…
|
7
|
5
|
$3,154.00
|
$3,154.00
|
$173.82
|
$2,996.30
|
$1,640.71
|
2026-04-17
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
7
|
5
|
$3,141.00
|
$3,141.00
|
$74.46
|
$2,983.95
|
$1,633.95
|
2026-04-17
|
|
7362273_1
|
CDM
|
Gelport
|
5
|
5
|
$1,733.00
|
$1,733.00
|
$883.83
|
$1,646.35
|
$1,629.02
|
2026-04-17
|
|
8028229_1
|
CDM
|
Room & Board - Semi-private (two Beds) - Other
|
3
|
3
|
$1,707.00
|
$1,707.00
|
$1,604.58
|
$1,621.65
|
$1,621.65
|
2026-04-17
|
|
78278
|
HCPCS
|
Nuclear Medicine Study To Assess Blood Loss
|
7
|
5
|
$3,104.00
|
$3,104.00
|
$44.66
|
$2,948.80
|
$1,614.70
|
2026-04-17
|
|
72191
|
HCPCS
|
CT Scan Of Blood Vessels Of Pelvis With Contrast
|
7
|
5
|
$3,092.00
|
$3,092.00
|
$81.54
|
$2,937.40
|
$1,608.46
|
2026-04-17
|
|
32408
|
HCPCS
|
Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr…
|
12
|
5
|
$1,933.00
|
$1,933.00
|
$127.64
|
$2,505.15
|
$1,594.39
|
2026-04-17
|
|
48102
|
HCPCS
|
Needle Biopsy Of Pancreas
|
10
|
5
|
$2,008.50
|
$2,008.50
|
$851.19
|
$2,230.60
|
$1,577.20
|
2026-04-17
|
|
Q0138
|
HCPCS
|
Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd …
|
5
|
5
|
$1,676.14
|
$1,676.14
|
$854.83
|
$1,592.33
|
$1,575.57
|
2026-04-17
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
7
|
5
|
$3,023.00
|
$3,023.00
|
$67.78
|
$2,871.85
|
$1,572.56
|
2026-04-17
|
|
73202
|
HCPCS
|
CT Scan Of Arm Before And After Contrast
|
7
|
5
|
$3,012.00
|
$3,012.00
|
$55.17
|
$2,861.40
|
$1,566.84
|
2026-04-17
|
|
43239
|
HCPCS
|
Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop…
|
7
|
5
|
$3,002.00
|
$3,002.00
|
$121.24
|
$2,851.90
|
$1,561.64
|
2026-04-17
|
|
73719
|
HCPCS
|
MRI Scan Of Leg With Contrast
|
7
|
5
|
$3,000.00
|
$3,000.00
|
$73.46
|
$2,850.00
|
$1,560.60
|
2026-04-17
|
|
72198
|
HCPCS
|
MRI Scan Of Blood Vessels Of Pelvis
|
7
|
5
|
$2,990.00
|
$2,990.00
|
$81.05
|
$2,840.50
|
$1,555.40
|
2026-04-17
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
7
|
5
|
$2,982.00
|
$2,982.00
|
$67.44
|
$2,832.90
|
$1,551.24
|
2026-04-17
|
|
22551
|
HCPCS
|
Fusion Of Upper Spine Bone With Removal Of Disc And Release Of Spinal Cord Or Ne…
|
2
|
2
|
$4,105.00
|
$4,105.00
|
$1,533.36
|
$1,564.03
|
$1,548.69
|
2026-04-17
|
|
27487
|
HCPCS
|
Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis
|
2
|
2
|
$12,078.00
|
$12,078.00
|
$1,525.89
|
$1,556.41
|
$1,541.15
|
2026-04-17
|
|
Q5107
|
HCPCS
|
Injection, Bevacizumab-awwb, Biosimilar, (mvasi), 10 Mg
|
10
|
5
|
$2,571.08
|
$2,571.08
|
$524.50
|
$3,908.03
|
$1,537.51
|
2026-04-17
|
|
72133
|
HCPCS
|
CT Scan Of Lower Spine Before And After Contrast
|
7
|
5
|
$2,944.00
|
$2,944.00
|
$57.84
|
$2,796.80
|
$1,531.47
|
2026-04-17
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
7
|
5
|
$2,937.00
|
$2,937.00
|
$67.44
|
$2,790.15
|
$1,527.83
|
2026-04-17
|
|
64420
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Rib Nerve
|
7
|
5
|
$2,923.00
|
$2,923.00
|
$51.66
|
$2,776.85
|
$1,520.54
|
2026-04-17
|
|
Q5115
|
HCPCS
|
Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg
|
10
|
5
|
$2,578.60
|
$2,578.60
|
$463.24
|
$4,036.45
|
$1,514.91
|
2026-04-17
|
|
64488
|
HCPCS
|
Injection Of Local Anesthetic For Abdominal Wall Pain Control On Both Sides Usin…
|
7
|
5
|
$2,894.00
|
$2,894.00
|
$55.74
|
$2,749.30
|
$1,505.46
|
2026-04-17
|
|
64454
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin…
|
7
|
5
|
$2,891.00
|
$2,891.00
|
$72.02
|
$2,746.45
|
$1,503.90
|
2026-04-17
|
|
19287
|
HCPCS
|
Placement Of Locating Device In Breast Using MRI Guidance, First Growth
|
7
|
5
|
$2,888.00
|
$2,888.00
|
$103.88
|
$2,743.60
|
$1,502.34
|
2026-04-17
|
|
19085
|
HCPCS
|
Biopsy Of Breast And Placement Of Locating Device Using Mri, First Growth
|
7
|
5
|
$2,888.00
|
$2,888.00
|
$148.27
|
$2,743.60
|
$1,502.34
|
2026-04-17
|