| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
94,098 |
66,741 |
$7.80M |
| 80050 |
General health panel |
88,950 |
88,085 |
$4.22M |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
77,812 |
76,032 |
$2.70M |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
77,805 |
76,025 |
$2.70M |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
90,035 |
89,051 |
$2.50M |
| 80061 |
Lipid panel |
169,021 |
167,107 |
$2.12M |
| 80053 |
Comprehensive metabolic panel |
197,990 |
187,378 |
$1.93M |
| 84443 |
Thyroid stimulating hormone (TSH) |
113,833 |
111,997 |
$1.75M |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
3,697 |
3,616 |
$1.46M |
| 83036 |
Hemoglobin; glycosylated (A1C) |
139,812 |
138,168 |
$1.27M |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
50,877 |
50,138 |
$1.18M |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
11,131 |
10,323 |
$1.13M |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
14,300 |
13,711 |
$1.10M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
17,409 |
15,828 |
$1.10M |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
41,971 |
35,818 |
$987K |
| 81420 |
Fetal chromosomal aneuploidy genomic sequence analysis panel |
1,414 |
1,402 |
$986K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
138,491 |
126,653 |
$985K |
| 87902 |
|
3,728 |
3,646 |
$964K |
| 80074 |
|
18,846 |
18,572 |
$857K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
32,048 |
31,811 |
$826K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
16,143 |
11,130 |
$804K |
| 84439 |
|
93,204 |
91,856 |
$796K |
| 81511 |
|
4,732 |
4,693 |
$775K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
22,144 |
21,966 |
$757K |
| 81514 |
|
3,512 |
3,441 |
$731K |
| 87481 |
|
7,202 |
6,916 |
$721K |
| 86780 |
|
49,248 |
47,844 |
$645K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
78,723 |
75,231 |
$612K |
| 36415 |
Collection of venous blood by venipuncture |
226,968 |
209,611 |
$605K |
| 87522 |
Neg quan hep c or qual rna |
14,196 |
13,930 |
$596K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
7,456 |
7,257 |
$523K |
| 85027 |
|
79,822 |
77,937 |
$477K |
| 86803 |
|
33,837 |
33,360 |
$459K |
| 82607 |
|
32,164 |
31,739 |
$454K |
| 82728 |
|
33,633 |
33,059 |
$429K |
| 84403 |
|
16,737 |
16,350 |
$426K |
| 88307 |
|
1,896 |
1,721 |
$409K |
| 84481 |
|
25,222 |
24,897 |
$407K |
| 86003 |
|
5,598 |
3,974 |
$361K |
| 87505 |
|
3,040 |
2,886 |
$357K |
| 87631 |
|
2,357 |
2,342 |
$308K |
| 81508 |
|
2,980 |
2,956 |
$292K |
| 82670 |
|
9,097 |
8,828 |
$289K |
| 87653 |
|
8,247 |
8,168 |
$273K |
| 83970 |
|
7,972 |
7,791 |
$269K |
| 83550 |
|
32,672 |
32,144 |
$265K |
| 88342 |
|
3,172 |
3,036 |
$263K |
| 84153 |
|
15,482 |
15,291 |
$263K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
7,396 |
7,198 |
$260K |
| 82746 |
|
18,515 |
18,280 |
$255K |
| 87077 |
|
29,022 |
28,146 |
$253K |
| 84270 |
|
11,713 |
11,416 |
$248K |
| 87340 |
|
24,332 |
23,930 |
$240K |
| 83540 |
|
35,825 |
35,230 |
$216K |
| 86038 |
|
18,565 |
18,288 |
$212K |
| 83001 |
|
11,931 |
11,804 |
$210K |
| 84702 |
|
14,572 |
11,998 |
$209K |
| 86480 |
|
3,656 |
3,614 |
$208K |
| 87480 |
|
10,248 |
10,048 |
$203K |
| 87510 |
|
10,238 |
10,038 |
$202K |
| 87660 |
|
10,223 |
10,031 |
$201K |
| 82570 |
|
40,974 |
40,018 |
$196K |
| 86762 |
|
14,057 |
13,751 |
$195K |
| 87186 |
|
22,041 |
21,396 |
$195K |
| 88341 |
|
1,117 |
1,052 |
$195K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
3,806 |
3,712 |
$189K |
| 86235 |
|
3,311 |
3,017 |
$188K |
| 86376 |
|
13,171 |
13,043 |
$187K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
22,980 |
22,117 |
$180K |
| 87650 |
|
8,503 |
8,376 |
$176K |
| 83520 |
|
2,326 |
2,184 |
$166K |
| 82043 |
|
30,044 |
29,617 |
$160K |
| 83516 |
|
7,620 |
5,712 |
$158K |
| 83880 |
|
4,545 |
4,385 |
$149K |
| 87632 |
|
655 |
647 |
$145K |
| 86140 |
|
29,545 |
27,579 |
$143K |
| 84146 |
|
7,420 |
7,325 |
$141K |
| 84480 |
|
10,451 |
10,336 |
$141K |
| 86147 |
|
1,941 |
1,894 |
$138K |
| 87536 |
|
1,686 |
1,662 |
$137K |
| 88312 |
|
1,234 |
1,205 |
$135K |
| 86146 |
|
1,756 |
1,733 |
$123K |
| 86850 |
|
14,426 |
14,095 |
$122K |
| 82105 |
|
7,244 |
7,127 |
$116K |
| 86706 |
|
10,538 |
10,400 |
$112K |
| 83002 |
|
6,101 |
6,041 |
$108K |
| 84144 |
|
5,459 |
5,191 |
$105K |
| 88141 |
|
4,348 |
4,315 |
$104K |
| 83735 |
|
15,511 |
13,580 |
$100K |
| 81001 |
|
33,833 |
32,690 |
$100K |
| 82274 |
|
5,711 |
5,673 |
$99K |
| 86696 |
|
5,200 |
5,121 |
$97K |
| 88304 |
|
3,002 |
2,925 |
$97K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
817 |
806 |
$95K |
| 87338 |
|
6,520 |
6,470 |
$91K |
| 80076 |
|
11,076 |
10,725 |
$86K |
| 87529 |
|
1,840 |
1,801 |
$83K |
| 85652 |
|
31,296 |
29,327 |
$79K |
| 86431 |
|
14,735 |
14,562 |
$79K |
| 86160 |
|
3,502 |
3,083 |
$79K |
| 86787 |
|
6,002 |
5,838 |
$79K |
| 83655 |
|
6,347 |
6,257 |
$79K |
| 82731 |
|
1,212 |
951 |
$75K |
| 84436 |
|
11,287 |
11,174 |
$74K |
| 86704 |
|
6,217 |
6,148 |
$74K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
340 |
336 |
$69K |
| 86694 |
|
1,784 |
1,752 |
$68K |
| 86800 |
|
4,212 |
4,163 |
$67K |
| 82784 |
|
6,453 |
6,228 |
$67K |
| 86665 |
|
1,908 |
1,883 |
$67K |
| 86695 |
|
5,208 |
5,130 |
$66K |
| 86708 |
|
5,428 |
5,358 |
$66K |
| 82533 |
|
2,369 |
2,182 |
$64K |
| 85610 |
|
16,409 |
14,783 |
$63K |
| 83690 |
|
9,226 |
8,955 |
$61K |
| 86200 |
|
4,942 |
4,907 |
$60K |
| 87081 |
|
8,909 |
8,760 |
$59K |
| 88185 |
|
237 |
226 |
$57K |
| 84207 |
|
1,151 |
1,133 |
$57K |
| 84425 |
|
1,352 |
1,336 |
$56K |
| 80069 |
|
7,301 |
6,781 |
$55K |
| 84550 |
|
13,048 |
12,491 |
$54K |
| 87581 |
|
1,696 |
1,665 |
$53K |
| 87486 |
|
1,694 |
1,663 |
$53K |
| 84445 |
|
849 |
838 |
$53K |
| 82248 |
|
10,940 |
9,532 |
$52K |
| 87070 |
|
6,187 |
5,989 |
$52K |
| 83525 |
|
4,706 |
4,654 |
$51K |
| 82671 |
|
1,343 |
1,341 |
$50K |
| 85060 |
|
2,289 |
2,270 |
$49K |
| 82627 |
|
2,370 |
2,338 |
$49K |
| 86304 |
|
2,254 |
2,064 |
$43K |
| 88360 |
|
235 |
223 |
$43K |
| 84156 |
|
12,799 |
12,036 |
$42K |
| 87075 |
|
4,463 |
4,336 |
$41K |
| 85730 |
|
7,185 |
7,039 |
$41K |
| 86900 |
|
14,423 |
14,095 |
$40K |
| 86901 |
|
14,380 |
14,047 |
$40K |
| 80164 |
|
2,715 |
2,539 |
$39K |
| 82950 |
|
8,592 |
8,500 |
$39K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
467 |
453 |
$38K |
| 82150 |
|
6,019 |
5,832 |
$38K |
| 80197 |
|
3,031 |
2,156 |
$37K |
| 86255 |
|
2,028 |
1,875 |
$36K |
| 82785 |
|
2,306 |
2,275 |
$36K |
| 84154 |
|
2,107 |
2,086 |
$35K |
| 0225U |
|
84 |
84 |
$35K |
| 85390 |
|
1,072 |
1,060 |
$34K |
| 83615 |
|
6,149 |
5,581 |
$34K |
| 86225 |
|
2,603 |
2,553 |
$33K |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
207 |
199 |
$33K |
| 82626 |
|
604 |
597 |
$33K |
| 81003 |
|
15,697 |
15,356 |
$33K |
| 86769 |
|
842 |
836 |
$33K |
| 88112 |
|
782 |
700 |
$32K |
| 84630 |
|
857 |
844 |
$32K |
| 82140 |
|
2,326 |
2,186 |
$30K |
| 86039 |
|
2,869 |
2,808 |
$30K |
| G0452 |
Molecular pathology procedure; physician interpretation and report |
1,707 |
1,570 |
$30K |
| 82951 |
|
2,508 |
2,490 |
$30K |
| 82977 |
|
3,920 |
3,576 |
$30K |
| 84100 |
|
7,172 |
5,912 |
$29K |
| 82247 |
|
5,967 |
4,622 |
$29K |
| 83498 |
|
584 |
579 |
$27K |
| 86141 |
|
2,281 |
2,251 |
$27K |
| 88313 |
|
340 |
322 |
$27K |
| 87205 |
|
6,438 |
6,232 |
$27K |
| 81374 |
|
377 |
374 |
$26K |
| 82378 |
|
1,495 |
1,332 |
$25K |
| 82024 |
|
678 |
649 |
$24K |
| 82550 |
|
3,836 |
3,401 |
$24K |
| 82397 |
|
1,791 |
1,775 |
$23K |
| 82525 |
|
583 |
572 |
$23K |
| 84460 |
|
4,494 |
4,136 |
$22K |
| 84165 |
|
2,425 |
2,348 |
$22K |
| 84450 |
|
4,459 |
4,106 |
$22K |
| 82565 |
|
4,539 |
4,190 |
$21K |
| 84681 |
|
1,022 |
1,013 |
$20K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
262 |
254 |
$19K |
| 80178 |
|
3,061 |
2,858 |
$19K |
| 83090 |
|
1,155 |
1,141 |
$18K |
| 84432 |
|
716 |
698 |
$17K |
| 84163 |
|
206 |
205 |
$17K |
| 85613 |
|
1,907 |
1,880 |
$17K |
| 86765 |
|
1,254 |
1,238 |
$17K |
| 84484 |
|
932 |
858 |
$16K |
| 86735 |
|
1,152 |
1,117 |
$16K |
| 83020 |
|
1,133 |
588 |
$16K |
| 87328 |
|
1,213 |
1,182 |
$15K |
| 86361 |
|
593 |
585 |
$15K |
| 87329 |
|
1,231 |
1,198 |
$15K |
| 83921 |
|
816 |
809 |
$15K |
| 88142 |
|
729 |
724 |
$15K |
| 82040 |
|
3,164 |
2,828 |
$15K |
| 86632 |
|
243 |
242 |
$14K |
| 87449 |
|
1,106 |
1,090 |
$13K |
| 86631 |
|
243 |
242 |
$13K |
| 86664 |
|
859 |
849 |
$13K |
| 88173 |
|
111 |
105 |
$13K |
| 86256 |
|
853 |
834 |
$12K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
84 |
84 |
$12K |
| 82652 |
|
258 |
250 |
$12K |
| 80177 |
|
1,002 |
967 |
$12K |
| 88184 |
|
249 |
238 |
$12K |
| 88302 |
|
405 |
387 |
$12K |
| 86593 |
|
2,835 |
2,761 |
$12K |
| 86644 |
|
668 |
614 |
$12K |
| 86334 |
|
658 |
642 |
$12K |
| 85379 |
|
1,213 |
1,179 |
$11K |
| 86663 |
|
859 |
849 |
$11K |
| 82390 |
|
1,093 |
1,079 |
$11K |
| 84134 |
|
768 |
554 |
$10K |
| 86060 |
|
1,409 |
1,389 |
$10K |
| 83993 |
|
556 |
547 |
$10K |
| 87324 |
|
831 |
821 |
$10K |
| 88189 |
|
173 |
165 |
$9K |
| 86689 |
|
357 |
339 |
$9K |
| 87088 |
|
1,111 |
1,091 |
$9K |
| 81025 |
|
1,119 |
1,079 |
$9K |
| 81408 |
|
12 |
12 |
$9K |
| 86645 |
|
488 |
478 |
$8K |
| 86618 |
|
212 |
210 |
$8K |
| 83789 |
|
42 |
38 |
$8K |
| 84305 |
|
317 |
249 |
$7K |
| 80156 |
|
484 |
460 |
$7K |
| 87799 |
|
188 |
147 |
$7K |
| 85018 |
|
3,135 |
3,083 |
$7K |
| 86258 |
|
667 |
645 |
$7K |
| 85046 |
|
1,318 |
1,291 |
$7K |
| 88311 |
|
522 |
465 |
$6K |
| G0475 |
Hiv antigen/antibody, combination assay, screening |
472 |
451 |
$6K |
| 82952 |
|
1,696 |
1,680 |
$6K |
| 82085 |
|
274 |
273 |
$6K |
| 86705 |
|
541 |
529 |
$6K |
| 84482 |
|
135 |
134 |
$6K |
| 86364 |
|
652 |
644 |
$6K |
| 81513 |
|
61 |
60 |
$6K |
| 84478 |
|
1,025 |
566 |
$6K |
| 87147 |
|
616 |
610 |
$6K |
| 83521 |
|
247 |
243 |
$6K |
| 84466 |
|
432 |
427 |
$5K |
| 86300 |
|
262 |
224 |
$5K |
| 82947 |
|
1,375 |
1,358 |
$5K |
| 84520 |
|
1,183 |
1,171 |
$5K |
| 86341 |
|
50 |
43 |
$5K |
| 82575 |
|
571 |
567 |
$5K |
| 85014 |
|
2,135 |
2,096 |
$5K |
| 82310 |
|
955 |
926 |
$5K |
| 84155 |
|
1,435 |
1,415 |
$4K |
| 80185 |
|
376 |
347 |
$4K |
| 86777 |
|
298 |
291 |
$4K |
| 87102 |
|
538 |
523 |
$4K |
| 86008 |
|
12 |
12 |
$4K |
| 84166 |
|
276 |
144 |
$4K |
| 81404 |
|
20 |
20 |
$4K |
| 86308 |
|
716 |
712 |
$4K |
| 82103 |
|
222 |
217 |
$4K |
| 82330 |
|
303 |
293 |
$4K |
| 84132 |
|
750 |
699 |
$3K |
| 83519 |
|
28 |
26 |
$3K |
| 87209 |
|
178 |
170 |
$3K |
| U0001 |
Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
86 |
85 |
$3K |
| 84300 |
|
689 |
683 |
$3K |
| 81161 |
|
25 |
25 |
$3K |
| 80175 |
|
232 |
230 |
$3K |
| 84479 |
|
428 |
423 |
$3K |
| 88365 |
|
30 |
25 |
$3K |
| 86778 |
|
153 |
149 |
$3K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
86 |
80 |
$3K |
| 82610 |
|
52 |
50 |
$3K |
| 88331 |
|
29 |
27 |
$2K |
| 83825 |
|
104 |
101 |
$2K |
| 85045 |
|
622 |
602 |
$2K |
| 85306 |
|
157 |
156 |
$2K |
| 81241 |
|
39 |
39 |
$2K |
| 82239 |
|
54 |
49 |
$2K |
| 80165 |
|
72 |
71 |
$2K |
| 81406 |
|
13 |
13 |
$2K |
| 82175 |
|
78 |
77 |
$2K |
| 85303 |
|
151 |
150 |
$2K |
| 85300 |
|
165 |
163 |
$2K |
| 86870 |
|
128 |
124 |
$2K |
| 86381 |
|
69 |
67 |
$2K |
| 86709 |
|
138 |
136 |
$2K |
| 82668 |
|
87 |
87 |
$2K |
| 87177 |
|
178 |
170 |
$2K |
| 86036 |
|
141 |
139 |
$1K |
| 81243 |
|
48 |
47 |
$1K |
| 80348 |
|
61 |
57 |
$1K |
| 81400 |
|
31 |
31 |
$1K |
| 88291 |
|
41 |
41 |
$1K |
| 87206 |
|
199 |
191 |
$1K |
| 86747 |
|
12 |
12 |
$915.60 |
| 81222 |
|
79 |
79 |
$870.14 |
| 86015 |
|
89 |
88 |
$808.06 |
| 86738 |
|
26 |
26 |
$756.78 |
| 86635 |
|
12 |
12 |
$746.03 |
| 81270 |
|
12 |
12 |
$678.06 |
| 85246 |
|
28 |
27 |
$677.03 |
| 82164 |
|
25 |
25 |
$655.70 |
| 87040 |
|
54 |
51 |
$633.59 |
| 82553 |
|
63 |
63 |
$614.66 |
| 83883 |
|
25 |
25 |
$606.93 |
| 82985 |
|
27 |
27 |
$585.28 |
| G0145 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
22 |
22 |
$581.70 |
| 85245 |
|
25 |
24 |
$581.37 |
| 81257 |
|
12 |
12 |
$569.05 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
42 |
41 |
$553.41 |
| 83721 |
|
61 |
61 |
$534.99 |
| 85240 |
|
28 |
27 |
$526.63 |
| 82679 |
|
12 |
12 |
$513.91 |
| 84590 |
|
16 |
16 |
$467.36 |
| 87517 |
|
14 |
14 |
$456.61 |
| 85384 |
|
50 |
50 |
$428.53 |
| 86880 |
|
39 |
37 |
$372.56 |
| 88300 |
|
31 |
31 |
$353.95 |
| 80361 |
|
179 |
172 |
$335.65 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
127 |
123 |
$332.90 |
| 80365 |
|
179 |
172 |
$297.70 |
| 82465 |
|
70 |
69 |
$292.39 |
| 85130 |
|
25 |
24 |
$268.25 |
| G0328 |
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
13 |
13 |
$256.75 |
| 81250 |
|
12 |
12 |
$210.59 |
| 80356 |
|
179 |
172 |
$197.43 |
| 76098 |
|
79 |
79 |
$188.50 |
| 81255 |
|
12 |
12 |
$185.25 |
| 81290 |
|
12 |
12 |
$171.02 |
| 81251 |
|
12 |
12 |
$170.13 |
| 81200 |
|
12 |
12 |
$170.13 |
| 81330 |
|
12 |
12 |
$169.20 |
| 87184 |
|
27 |
26 |
$168.04 |
| 82272 |
|
41 |
41 |
$157.17 |
| 89051 |
|
27 |
26 |
$149.18 |
| 81260 |
|
12 |
12 |
$141.54 |
| 81209 |
|
12 |
12 |
$141.54 |
| 85660 |
|
26 |
26 |
$126.58 |
| 83010 |
|
13 |
12 |
$119.26 |
| 89060 |
|
13 |
13 |
$107.65 |
| 86886 |
|
14 |
12 |
$92.08 |
| 80051 |
|
13 |
13 |
$77.83 |
| 82340 |
|
13 |
13 |
$70.45 |
| 84075 |
|
12 |
12 |
$62.87 |