| 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 |
119,298 |
110,880 |
$8.11M |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
129,141 |
127,346 |
$2.12M |
| 86003 |
|
18,954 |
17,321 |
$1.88M |
| 80053 |
Comprehensive metabolic panel |
275,501 |
263,906 |
$1.84M |
| 84443 |
Thyroid stimulating hormone (TSH) |
179,467 |
176,805 |
$1.67M |
| 80061 |
Lipid panel |
222,913 |
220,391 |
$1.50M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
308,688 |
290,858 |
$1.33M |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
63,034 |
61,426 |
$1.26M |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
61,921 |
60,383 |
$1.06M |
| 83036 |
Hemoglobin; glycosylated (A1C) |
208,164 |
205,257 |
$1.03M |
| 80050 |
General health panel |
33,540 |
32,974 |
$830K |
| 86480 |
|
20,470 |
20,300 |
$634K |
| 86235 |
|
10,827 |
10,629 |
$624K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
33,881 |
33,408 |
$564K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
16,098 |
15,146 |
$532K |
| 84439 |
|
94,854 |
93,547 |
$518K |
| 80074 |
|
21,077 |
20,866 |
$491K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
43,954 |
43,168 |
$462K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
17,860 |
17,354 |
$371K |
| 36415 |
Collection of venous blood by venipuncture |
100,436 |
94,130 |
$364K |
| 82607 |
|
49,539 |
48,566 |
$363K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
71,737 |
69,291 |
$336K |
| 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 |
24,202 |
22,704 |
$328K |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
2,006 |
2,002 |
$251K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
11,232 |
10,440 |
$229K |
| 80081 |
|
4,680 |
4,547 |
$228K |
| 82746 |
|
25,503 |
25,016 |
$215K |
| 86038 |
|
30,626 |
30,025 |
$215K |
| 84403 |
|
14,270 |
14,055 |
$210K |
| 87522 |
Neg quan hep c or qual rna |
8,075 |
7,948 |
$189K |
| 84481 |
|
17,043 |
16,909 |
$186K |
| 84153 |
|
19,934 |
19,722 |
$186K |
| 83970 |
|
8,756 |
8,601 |
$183K |
| 86803 |
|
26,278 |
25,781 |
$180K |
| 86331 |
|
21,226 |
19,999 |
$174K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
11,037 |
10,899 |
$171K |
| 82043 |
|
57,079 |
56,341 |
$167K |
| 84480 |
|
16,605 |
16,241 |
$163K |
| 83516 |
|
10,030 |
9,524 |
$141K |
| 81001 |
|
80,850 |
78,900 |
$140K |
| 82728 |
|
20,632 |
20,213 |
$140K |
| 87536 |
|
3,572 |
3,520 |
$137K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
28,340 |
25,975 |
$137K |
| 86147 |
|
3,746 |
3,662 |
$134K |
| 83735 |
|
30,064 |
27,188 |
$132K |
| 86140 |
|
42,111 |
38,535 |
$131K |
| 87481 |
|
5,953 |
4,121 |
$129K |
| 86160 |
|
9,611 |
9,460 |
$127K |
| 83540 |
|
32,671 |
32,119 |
$123K |
| 82670 |
|
6,947 |
6,840 |
$120K |
| 83550 |
|
26,614 |
26,123 |
$120K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
3,929 |
2,895 |
$118K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
1,700 |
1,689 |
$117K |
| 83880 |
|
6,632 |
6,368 |
$110K |
| 86376 |
|
13,243 |
13,098 |
$109K |
| 87186 |
|
21,903 |
21,356 |
$106K |
| 82274 |
|
13,404 |
10,897 |
$106K |
| 86592 |
|
38,740 |
37,998 |
$106K |
| 81514 |
|
742 |
736 |
$104K |
| 82785 |
|
8,101 |
8,075 |
$101K |
| 86769 |
|
2,933 |
2,894 |
$99K |
| 83655 |
|
14,128 |
14,014 |
$99K |
| 87077 |
|
21,122 |
20,606 |
$97K |
| 84270 |
|
8,297 |
8,209 |
$95K |
| 87340 |
|
16,205 |
15,917 |
$94K |
| 80076 |
|
21,437 |
21,213 |
$93K |
| 82652 |
|
3,927 |
3,846 |
$91K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
2,448 |
2,329 |
$88K |
| 85652 |
|
53,011 |
50,148 |
$88K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
1,020 |
1,009 |
$88K |
| 86225 |
|
10,982 |
10,830 |
$81K |
| 82105 |
|
5,359 |
5,261 |
$77K |
| 86696 |
|
7,345 |
7,220 |
$76K |
| 82570 |
|
33,264 |
32,491 |
$74K |
| 85730 |
|
19,904 |
19,329 |
$74K |
| 87070 |
|
12,204 |
11,910 |
$73K |
| 86706 |
|
12,563 |
12,331 |
$73K |
| 86431 |
|
21,172 |
20,933 |
$71K |
| 86780 |
|
11,166 |
10,781 |
$69K |
| 84550 |
|
24,754 |
24,154 |
$67K |
| 83690 |
|
14,201 |
14,059 |
$66K |
| 85610 |
|
26,232 |
24,441 |
$62K |
| 84100 |
|
20,139 |
18,014 |
$61K |
| 86635 |
|
6,706 |
6,391 |
$58K |
| 82784 |
|
6,825 |
6,728 |
$55K |
| 83001 |
|
6,753 |
6,717 |
$53K |
| 86762 |
|
7,379 |
7,169 |
$53K |
| 86039 |
|
8,214 |
8,142 |
$52K |
| 86695 |
|
7,278 |
7,152 |
$52K |
| 86665 |
|
2,428 |
2,279 |
$50K |
| 84436 |
|
14,383 |
14,107 |
$49K |
| 81003 |
|
28,448 |
27,688 |
$49K |
| 82977 |
|
9,930 |
9,713 |
$48K |
| 83013 |
|
2,723 |
2,704 |
$48K |
| 87902 |
|
559 |
549 |
$47K |
| 84144 |
|
3,722 |
3,596 |
$47K |
| 82248 |
|
18,001 |
16,437 |
$46K |
| 84425 |
|
3,259 |
3,243 |
$44K |
| 84702 |
|
6,440 |
5,315 |
$44K |
| 82950 |
|
13,754 |
13,200 |
$43K |
| 87493 |
|
2,067 |
1,867 |
$42K |
| 83002 |
|
5,595 |
5,565 |
$42K |
| 84154 |
|
4,225 |
4,202 |
$40K |
| 84445 |
|
1,136 |
1,134 |
$39K |
| 86800 |
|
4,166 |
4,142 |
$39K |
| 87209 |
|
3,714 |
3,223 |
$39K |
| 83993 |
|
2,709 |
2,693 |
$39K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
2,508 |
2,475 |
$39K |
| 86787 |
|
4,941 |
4,810 |
$38K |
| 86694 |
|
5,395 |
5,364 |
$38K |
| 87653 |
|
2,496 |
2,421 |
$38K |
| 86200 |
|
8,262 |
8,204 |
$37K |
| 82627 |
|
2,808 |
2,793 |
$36K |
| 84146 |
|
4,572 |
4,524 |
$34K |
| 84681 |
|
2,662 |
2,632 |
$33K |
| 85027 |
|
11,646 |
11,443 |
$32K |
| 86704 |
|
5,998 |
5,938 |
$32K |
| 84207 |
|
1,555 |
1,546 |
$31K |
| 80069 |
|
5,952 |
5,759 |
$28K |
| 87075 |
|
5,000 |
4,821 |
$27K |
| 82550 |
|
7,953 |
7,573 |
$27K |
| 82103 |
|
2,837 |
2,800 |
$27K |
| 82140 |
|
2,763 |
2,692 |
$27K |
| 80164 |
|
3,726 |
3,620 |
$27K |
| 86812 |
|
1,444 |
1,433 |
$26K |
| 83520 |
|
3,150 |
3,077 |
$25K |
| 82378 |
|
3,195 |
2,993 |
$25K |
| 87899 |
|
4,712 |
3,305 |
$25K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
84 |
84 |
$24K |
| 85045 |
|
8,018 |
7,773 |
$23K |
| 87480 |
|
1,741 |
1,729 |
$23K |
| 86341 |
|
1,242 |
1,214 |
$23K |
| 88142 |
|
2,169 |
2,165 |
$23K |
| 87799 |
|
1,379 |
1,109 |
$22K |
| 86171 |
|
3,379 |
3,298 |
$22K |
| 82533 |
|
2,257 |
2,182 |
$22K |
| 87081 |
|
4,883 |
4,867 |
$21K |
| 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 |
645 |
581 |
$21K |
| 83721 |
|
5,609 |
5,544 |
$21K |
| 87177 |
|
3,720 |
3,238 |
$20K |
| 86850 |
|
9,091 |
8,957 |
$20K |
| 86708 |
|
4,234 |
4,117 |
$20K |
| 86141 |
|
3,763 |
3,704 |
$19K |
| 86334 |
|
1,502 |
1,488 |
$18K |
| 84156 |
|
9,007 |
8,614 |
$18K |
| 86256 |
|
2,256 |
2,240 |
$18K |
| 82150 |
|
5,053 |
4,959 |
$18K |
| 83630 |
|
1,280 |
1,246 |
$17K |
| 86301 |
|
1,653 |
1,624 |
$17K |
| 86300 |
|
1,708 |
1,608 |
$17K |
| 88304 |
|
2,028 |
1,975 |
$17K |
| 82247 |
|
4,757 |
3,381 |
$16K |
| 84165 |
|
2,873 |
2,831 |
$16K |
| 87510 |
|
1,740 |
1,728 |
$16K |
| 87147 |
|
5,601 |
5,484 |
$15K |
| 84479 |
|
5,828 |
5,775 |
$15K |
| 80177 |
|
2,094 |
2,033 |
$15K |
| 87529 |
|
340 |
338 |
$14K |
| 82024 |
|
630 |
620 |
$14K |
| 87205 |
|
5,787 |
5,581 |
$14K |
| 86360 |
|
603 |
602 |
$14K |
| 86255 |
|
1,744 |
1,704 |
$14K |
| 83525 |
|
1,979 |
1,973 |
$14K |
| 82951 |
|
1,742 |
1,738 |
$13K |
| 88342 |
|
1,025 |
971 |
$13K |
| 80197 |
|
2,083 |
1,734 |
$13K |
| 88112 |
|
620 |
536 |
$13K |
| 82947 |
|
5,229 |
5,163 |
$12K |
| 83615 |
|
3,742 |
3,526 |
$12K |
| 87660 |
|
1,532 |
1,519 |
$12K |
| 82390 |
|
1,655 |
1,653 |
$12K |
| 86901 |
|
8,184 |
7,876 |
$12K |
| 84432 |
|
1,210 |
1,193 |
$12K |
| 82172 |
|
1,391 |
1,387 |
$12K |
| 83498 |
|
809 |
807 |
$12K |
| 84305 |
|
948 |
940 |
$11K |
| 82565 |
|
3,728 |
3,690 |
$11K |
| 88141 |
|
1,716 |
1,709 |
$11K |
| 80202 |
|
1,193 |
548 |
$11K |
| 86900 |
|
7,384 |
7,237 |
$11K |
| 86738 |
|
629 |
625 |
$11K |
| 84466 |
|
1,412 |
1,386 |
$10K |
| 86703 |
|
941 |
935 |
$10K |
| 84134 |
|
1,135 |
856 |
$10K |
| 82671 |
|
566 |
563 |
$10K |
| 83020 |
|
1,351 |
1,335 |
$10K |
| 83090 |
|
1,135 |
1,111 |
$10K |
| 87015 |
|
1,878 |
1,852 |
$9K |
| 84630 |
|
1,148 |
1,144 |
$9K |
| 86735 |
|
1,599 |
1,547 |
$9K |
| 87512 |
|
776 |
770 |
$9K |
| 86361 |
|
735 |
723 |
$9K |
| 81025 |
|
2,806 |
2,727 |
$8K |
| 86765 |
|
1,638 |
1,577 |
$8K |
| 85246 |
|
577 |
569 |
$8K |
| 85245 |
|
570 |
562 |
$8K |
| 86664 |
|
815 |
809 |
$8K |
| 80055 |
|
325 |
317 |
$8K |
| 83883 |
|
1,022 |
1,008 |
$7K |
| 83695 |
|
883 |
857 |
$7K |
| 86663 |
|
831 |
825 |
$7K |
| 85240 |
|
640 |
631 |
$7K |
| 87631 |
|
285 |
283 |
$7K |
| 82465 |
|
2,558 |
2,522 |
$7K |
| 87046 |
|
3,231 |
3,147 |
$7K |
| 80178 |
|
1,698 |
1,636 |
$7K |
| 87807 |
|
825 |
820 |
$7K |
| 86337 |
|
402 |
400 |
$6K |
| 84520 |
|
2,884 |
2,844 |
$6K |
| 85007 |
|
4,817 |
4,690 |
$6K |
| 85018 |
|
3,768 |
3,675 |
$6K |
| 85651 |
|
3,254 |
2,446 |
$6K |
| 87338 |
|
2,483 |
2,461 |
$6K |
| 84460 |
|
3,410 |
3,375 |
$6K |
| 82397 |
|
568 |
567 |
$6K |
| 82330 |
|
730 |
592 |
$6K |
| 84478 |
|
1,374 |
716 |
$5K |
| 87563 |
|
201 |
201 |
$5K |
| 82525 |
|
599 |
587 |
$5K |
| 82310 |
|
1,610 |
1,572 |
$5K |
| 86304 |
|
1,016 |
980 |
$5K |
| 82164 |
|
449 |
445 |
$5K |
| 85613 |
|
413 |
340 |
$5K |
| 87511 |
|
831 |
819 |
$5K |
| 87797 |
|
205 |
205 |
$4K |
| 80159 |
|
549 |
448 |
$4K |
| 82985 |
|
414 |
413 |
$4K |
| 84450 |
|
3,009 |
2,979 |
$4K |
| 86644 |
|
547 |
537 |
$4K |
| 87517 |
|
274 |
269 |
$4K |
| 86709 |
|
872 |
871 |
$4K |
| 88312 |
|
184 |
175 |
$4K |
| 80175 |
|
506 |
503 |
$4K |
| 82952 |
|
2,209 |
2,202 |
$4K |
| 84703 |
|
1,887 |
1,859 |
$4K |
| 83986 |
|
1,242 |
1,232 |
$4K |
| 82088 |
|
149 |
148 |
$4K |
| 86593 |
|
1,928 |
1,875 |
$4K |
| 86146 |
|
136 |
121 |
$4K |
| 84482 |
|
304 |
304 |
$4K |
| 84446 |
|
365 |
362 |
$4K |
| 85379 |
|
666 |
651 |
$3K |
| 86645 |
|
381 |
373 |
$3K |
| 80156 |
|
545 |
538 |
$3K |
| 84484 |
|
524 |
522 |
$3K |
| 86705 |
|
400 |
400 |
$3K |
| 84376 |
|
710 |
707 |
$3K |
| 87497 |
|
198 |
178 |
$3K |
| 82626 |
|
161 |
161 |
$3K |
| 84155 |
|
1,662 |
1,627 |
$3K |
| 87210 |
|
839 |
838 |
$3K |
| 86308 |
|
693 |
688 |
$2K |
| 86359 |
|
206 |
206 |
$2K |
| 84166 |
|
203 |
201 |
$2K |
| 85598 |
|
194 |
193 |
$2K |
| 87581 |
|
84 |
84 |
$2K |
| 87486 |
|
84 |
84 |
$2K |
| 80354 |
|
278 |
195 |
$2K |
| 80051 |
|
359 |
357 |
$2K |
| 84132 |
|
774 |
720 |
$2K |
| 87088 |
|
324 |
322 |
$2K |
| 82040 |
|
657 |
642 |
$2K |
| 86060 |
|
441 |
441 |
$2K |
| 85014 |
|
1,348 |
1,283 |
$2K |
| 84244 |
|
128 |
127 |
$2K |
| 83014 |
|
432 |
432 |
$2K |
| 82668 |
|
211 |
208 |
$2K |
| 86701 |
|
2,132 |
2,080 |
$2K |
| U0001 |
Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
106 |
104 |
$2K |
| 82705 |
|
456 |
456 |
$2K |
| 80324 |
|
614 |
483 |
$2K |
| P9011 |
Blood, split unit |
672 |
668 |
$2K |
| 88341 |
|
17 |
14 |
$2K |
| 85525 |
|
181 |
180 |
$2K |
| 86702 |
|
2,125 |
2,072 |
$2K |
| 80185 |
|
202 |
191 |
$1K |
| 84590 |
|
161 |
161 |
$1K |
| 80348 |
|
651 |
485 |
$1K |
| 87106 |
|
157 |
155 |
$1K |
| 83010 |
|
142 |
140 |
$1K |
| 85635 |
|
181 |
180 |
$1K |
| 87040 |
|
148 |
144 |
$1K |
| 85049 |
|
681 |
641 |
$1K |
| 87076 |
|
158 |
153 |
$1K |
| 83921 |
|
187 |
186 |
$1K |
| 80299 |
|
111 |
110 |
$1K |
| 87428 |
|
17 |
17 |
$998.27 |
| 80183 |
|
107 |
107 |
$997.80 |
| 82157 |
|
59 |
59 |
$970.36 |
| 85041 |
|
473 |
438 |
$825.49 |
| 85670 |
|
210 |
209 |
$791.48 |
| 82239 |
|
60 |
49 |
$764.33 |
| 84066 |
|
110 |
110 |
$688.81 |
| 85732 |
|
154 |
153 |
$666.61 |
| 82681 |
|
45 |
45 |
$641.49 |
| 84560 |
|
134 |
104 |
$615.24 |
| 87449 |
|
80 |
76 |
$603.31 |
| 85048 |
|
459 |
427 |
$592.99 |
| 80358 |
|
629 |
493 |
$566.54 |
| 80349 |
|
696 |
557 |
$559.66 |
| 82340 |
|
143 |
139 |
$556.47 |
| 85380 |
|
142 |
139 |
$511.48 |
| 84295 |
|
221 |
215 |
$504.05 |
| 87184 |
|
66 |
65 |
$503.16 |
| 86355 |
|
53 |
53 |
$493.10 |
| 86008 |
|
13 |
13 |
$412.22 |
| 86788 |
|
22 |
22 |
$403.48 |
| 87280 |
|
52 |
52 |
$388.96 |
| 83704 |
|
12 |
12 |
$373.92 |
| 86357 |
|
54 |
54 |
$364.21 |
| 82085 |
|
81 |
80 |
$363.47 |
| 82608 |
|
32 |
32 |
$353.50 |
| 86671 |
|
26 |
25 |
$352.20 |
| 86789 |
|
22 |
22 |
$344.52 |
| 88300 |
|
12 |
12 |
$339.92 |
| 84075 |
|
145 |
145 |
$335.43 |
| 83605 |
|
54 |
54 |
$323.07 |
| 82747 |
|
44 |
44 |
$317.68 |
| 80346 |
|
645 |
509 |
$309.60 |
| 87260 |
|
32 |
32 |
$292.90 |
| 87299 |
|
32 |
32 |
$292.90 |
| 87279 |
|
32 |
32 |
$292.90 |
| 86677 |
|
75 |
68 |
$284.90 |
| 81015 |
|
180 |
178 |
$279.05 |
| 87252 |
|
12 |
12 |
$255.48 |
| 87328 |
|
25 |
24 |
$252.50 |
| 87329 |
|
25 |
24 |
$252.50 |
| 84402 |
|
13 |
13 |
$246.36 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
182 |
182 |
$245.26 |
| 82104 |
|
25 |
25 |
$244.10 |
| 86713 |
|
14 |
14 |
$241.76 |
| G0328 |
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
26 |
26 |
$212.28 |
| 86356 |
|
16 |
14 |
$208.76 |
| 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 |
44 |
44 |
$185.76 |
| 87102 |
|
41 |
38 |
$179.98 |
| 82553 |
|
36 |
36 |
$176.18 |
| 87276 |
|
32 |
32 |
$173.13 |
| 87275 |
|
32 |
32 |
$171.97 |
| 86001 |
|
47 |
47 |
$157.20 |
| 86727 |
|
24 |
23 |
$154.49 |
| 83519 |
|
13 |
13 |
$147.24 |
| 80353 |
|
618 |
486 |
$123.60 |
| 86335 |
|
12 |
12 |
$109.99 |
| 81329 |
|
49 |
49 |
$109.60 |
| 83835 |
|
14 |
12 |
$108.40 |
| 80361 |
|
677 |
545 |
$105.05 |
| 82365 |
|
12 |
12 |
$100.99 |
| 80165 |
|
12 |
12 |
$95.96 |
| 80359 |
|
137 |
124 |
$87.50 |
| 87185 |
|
90 |
88 |
$86.44 |
| 80345 |
|
617 |
485 |
$74.10 |
| 85060 |
|
12 |
12 |
$63.41 |
| 82270 |
|
93 |
93 |
$33.89 |
| 80373 |
|
423 |
369 |
$21.39 |
| 80369 |
|
462 |
403 |
$20.33 |
| 80365 |
|
134 |
122 |
$17.50 |
| 86777 |
|
49 |
46 |
$14.61 |
| 86778 |
|
47 |
45 |
$12.80 |
| 85008 |
|
14 |
14 |
$7.28 |
| 87254 |
|
15 |
15 |
$5.41 |
| 80321 |
|
376 |
325 |
$0.00 |
| 36416 |
|
14 |
14 |
$0.00 |