| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | AF | AG | AH | AI | AJ | AK | AL | AM | AN | AO | AP | AQ | AR | AS | AT | AU | AV | AW | AX | AY | AZ | BA | BB | BC | BD | BE | BF | BG | BH | BI | BJ | BK | BL | BM | ||
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2 | propose | propose | propose | Final/Propose | HCPCS | Descriptor | Median | CA1 | CA2 | HI | NV | AK | ID | OR | WA | AZ | MT | ND | SD | UT | WY | CO | NM | OK | TX | IA | KS | KS | MO2 | MO1 | NE | IL | MN | WI | AR | LA | MS | IN | MI | FL | PR | AL | GA | TN | SC | VA | WV | NC | DE | DC | MD | NJ | PA | CT | NY2 | NY1 | NY3 | ME | MA | NH | RI | VT | KY | OH | ||
3 | 81524 | Oncology (central nervous system tumor), DNA methylation analysis of at least 10,000 methylation sites, utilizing DNA extracted from formalin-fixed tumor tissue, algorithm(s) reported as probability of matching a reference tumor family and class, and MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation status, if performed | 1995.69 | 125% | Price was increased to better reflect consideration of similar existing services (i.e., 0020M). | 81524 | Oncology (central nervous system tumor), DNA methylation analysis of at least 10,000 methylation sites, utilizing DNA extracted from formalin-fixed tumor tissue, algorithm(s) reported as probability of matching a reference tumor family and class, and MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation status, if performed | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,500.00 | $2,500.00 | $2,100.00 | $2,100.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,100.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | $2,500.00 | |
4 | 87182 | Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative, per isolate | 9.65 | 329% | Price was increased to $31.75 based on updated information provided to reflect resources required to perform the test. | 87182 | Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative, per isolate | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $13.41 | $13.41 | $13.41 | $13.41 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $13.41 | $13.41 | $13.41 | $31.75 | $31.75 | $13.41 | $13.41 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $13.41 | $13.41 | $13.41 | $13.41 | $13.41 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | $31.75 | |
5 | 0526U | Nephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time | 162.65 | 100% | 0526U | Nephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $239.54 | $239.54 | $239.54 | $239.54 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $239.54 | $239.54 | $239.54 | $162.65 | $162.65 | $239.54 | $239.54 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $239.54 | $239.54 | $239.54 | $239.54 | $239.54 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | $162.65 | ||
6 | 0529U | Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE | 268.76 | 100% | 0529U | Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $139.06 | $139.06 | $139.06 | $139.06 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $139.06 | $139.06 | $139.06 | $268.76 | $268.76 | $139.06 | $139.06 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $139.06 | $139.06 | $139.06 | $139.06 | $139.06 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | $268.76 | ||
7 | 0531U | Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma | 2126 | 100% | 0531U | Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,180.00 | $2,180.00 | $2,180.00 | $2,180.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.20 | $2,126.20 | $2,126.20 | $2,180.00 | $2,180.00 | $2,180.00 | $2,126.00 | $2,126.00 | $2,180.00 | $2,180.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,126.00 | $2,180.00 | $2,180.00 | $2,180.00 | $2,180.00 | $2,180.00 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.20 | $2,126.00 | $2,126.00 | ||
8 | 0534U | Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score | 464.88 | 105% | Updated gapfill was considered. The language of the code descriptor does not accurately reflect the test performed. Crosswalk to 0401U based on comparable methodology. | 0534U | Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $779.06 | $779.06 | $779.06 | $779.06 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $779.06 | $779.06 | $779.06 | $489.68 | $489.68 | $779.06 | $779.06 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $779.06 | $779.06 | $779.06 | $779.06 | $779.06 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | $489.68 | |
9 | 0541U | Cardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, and C4), serum, algorithm reported as prediction of coronary artery disease (pCAD) score | 150.15 | 100% | 0541U | Cardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, and C4), serum, algorithm reported as prediction of coronary artery disease (pCAD) score | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $120.45 | $120.45 | $120.45 | $120.45 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $120.45 | $120.45 | $120.45 | $150.15 | $150.15 | $120.45 | $120.45 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $120.45 | $120.45 | $120.45 | $120.45 | $120.45 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | $150.15 | ||
10 | 0542U | Nephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of BK virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm reported as a probability score for allograft injury status | 218.32 | 475% | The price has been increased on the basis of information in the newly-provided gapfill documentation and reflects resources required to perform the test. | 0542U | Nephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of BK virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm reported as a probability score for allograft injury status | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $306.00 | $306.00 | $306.00 | $306.00 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $306.00 | $306.00 | $306.00 | $1,037.91 | $1,037.91 | $306.00 | $306.00 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $306.00 | $306.00 | $306.00 | $306.00 | $306.00 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | $1,037.91 | |
11 | 0552U | Testing for genetic disorders from outer layer of embryo cells, reported as low-risk or high-risk for familial genetic disorder in preimplantation genetic assessment | 1160 | 100% | 0552U | Testing for genetic disorders from outer layer of embryo cells, reported as low-risk or high-risk for familial genetic disorder in preimplantation genetic assessment | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,324.75 | $1,324.75 | $1,324.75 | $1,324.75 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $324.18 | $324.18 | $324.18 | $1,324.75 | $1,324.75 | $1,324.75 | $1,160.00 | $1,160.00 | $1,324.75 | $1,324.75 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,160.00 | $1,324.75 | $1,324.75 | $1,324.75 | $1,324.75 | $1,324.75 | $324.18 | $324.18 | $324.18 | $324.18 | $324.18 | $324.18 | $324.18 | $324.18 | $324.18 | $1,160.00 | $1,160.00 | ||
12 | 0569U | Next-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA (ctDNA) in whole blood, algorithm reported as presence or absence of ctDNA in solid tumor cancer | 1644.25 | 100% | 0569U | Next-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA (ctDNA) in whole blood, algorithm reported as presence or absence of ctDNA in solid tumor cancer | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | $1,644.25 | ||
13 | 0572U | High-throughput telomere length quantification by FISH testing in whole blood, diagnostic algorithm reported as risk of prostate cancer | 21.42 | 100% | 0572U | High-throughput telomere length quantification by FISH testing in whole blood, diagnostic algorithm reported as risk of prostate cancer | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $212.00 | $212.00 | $212.00 | $212.00 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $212.00 | $212.00 | $212.00 | $21.42 | $21.42 | $212.00 | $212.00 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $212.00 | $212.00 | $212.00 | $212.00 | $212.00 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | $21.42 | ||
14 | 0573U | Testing for 3 biomarkers in pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous in pancreatic cancer | 853.14 | 100% | 0573U | Testing for 3 biomarkers in pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous in pancreatic cancer | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $591.76 | $591.76 | $591.76 | $591.76 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $591.76 | $591.76 | $591.76 | $853.14 | $853.14 | $591.76 | $591.76 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $591.76 | $591.76 | $591.76 | $591.76 | $591.76 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | $853.14 | ||
15 | 0574U | Culture filtrate protein-10-kDa testing in serum or plasma for tuberculosis | 24.11 | 100% | 0574U | Culture filtrate protein-10-kDa testing in serum or plasma for tuberculosis | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.09 | $24.09 | $24.09 | $24.09 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.09 | $24.09 | $24.09 | $24.11 | $24.11 | $24.09 | $24.09 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.09 | $24.09 | $24.09 | $24.09 | $24.09 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | $24.11 | ||
16 | 0590U | Infectious disease (bacterial and fungal), DNA of 44 organisms (34 bacteria, 10 fungi), urine, next-generation sequencing, reported as positive or negative for each organism | 650 | 100% | 0590U | Infectious disease (bacterial and fungal), DNA of 44 organisms (34 bacteria, 10 fungi), urine, next-generation sequencing, reported as positive or negative for each organism | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $547.16 | $547.16 | $547.16 | $547.16 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $547.16 | $547.16 | $547.16 | $650.00 | $650.00 | $547.16 | $547.16 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $547.16 | $547.16 | $547.16 | $547.16 | $547.16 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | $650.00 | ||
17 | 0594U | Infectious disease (sepsis), semiquantitative measurement of pancreatic stone protein concentration, whole blood, reported as risk of sepsis | 12.05 | 100% | 0594U | Infectious disease (sepsis), semiquantitative measurement of pancreatic stone protein concentration, whole blood, reported as risk of sepsis | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.47 | $12.47 | $12.47 | $12.47 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.47 | $12.47 | $12.47 | $12.05 | $12.05 | $12.47 | $12.47 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.47 | $12.47 | $12.47 | $12.47 | $12.47 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | $12.05 | ||
18 | 0596U | Neurology (Alzheimer disease), plasma, 3 distinct isoform-specific peptides (APOE2, APOE3, and APOE4) by liquid chromatography with tandem mass spectrometry (LC-MS/MS), reported as an APOE prototype | 137 | 100% | 0596U | Neurology (Alzheimer disease), plasma, 3 distinct isoform-specific peptides (APOE2, APOE3, and APOE4) by liquid chromatography with tandem mass spectrometry (LC-MS/MS), reported as an APOE prototype | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $150.36 | $150.36 | $150.36 | $150.36 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $114.43 | $114.43 | $114.43 | $150.36 | $150.36 | $150.36 | $137.00 | $137.00 | $150.36 | $150.36 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $137.00 | $150.36 | $150.36 | $150.36 | $150.36 | $150.36 | $114.43 | $114.43 | $114.43 | $114.43 | $114.43 | $114.43 | $114.43 | $114.43 | $114.43 | $137.00 | $137.00 | ||
19 | 0597U | Oncology (breast), RNA expression profiling of 329 genes by targeted next-generation sequencing and 20 proteins by multiplex immunofluorescence, formalin-fixed paraffin-embedded (FFPE) tissue, algorithmic analyses to determine tumor-recurrence risk score | 2510.21 | 154% | The price has been increased. The crosswalk was updated from 81520 to better reflect the typical rate for similar existing services (81518, 81519, 81521). | 0597U | Oncology (breast), RNA expression profiling of 329 genes by targeted next-generation sequencing and 20 proteins by multiplex immunofluorescence, formalin-fixed paraffin-embedded (FFPE) tissue, algorithmic analyses to determine tumor-recurrence risk score | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $2,871.25 | $2,871.25 | $2,871.25 | $2,871.25 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $2,871.25 | $2,871.25 | $2,871.25 | $3,873.00 | $3,873.00 | $2,871.25 | $2,871.25 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $2,871.25 | $2,871.25 | $2,871.25 | $2,871.25 | $2,871.25 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | $3,873.00 | |
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