| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| U0004 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r |
126,446 |
118,139 |
$8.78M |
| 80050 |
General health panel |
187,675 |
181,027 |
$5.58M |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
118,097 |
112,866 |
$3.43M |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
118,191 |
112,992 |
$3.41M |
| 80061 |
Lipid panel |
265,927 |
251,292 |
$2.46M |
| 84443 |
Thyroid stimulating hormone (TSH) |
183,557 |
171,210 |
$2.11M |
| 80053 |
Comprehensive metabolic panel |
267,950 |
244,395 |
$1.83M |
| 36415 |
Collection of venous blood by venipuncture |
514,171 |
456,548 |
$1.77M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
311,128 |
280,400 |
$1.64M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
35,608 |
30,569 |
$1.58M |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
75,716 |
73,384 |
$1.49M |
| 83036 |
Hemoglobin; glycosylated (A1C) |
227,579 |
216,223 |
$1.48M |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
84,733 |
79,259 |
$1.30M |
| 87481 |
|
27,922 |
26,375 |
$1.28M |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
43,747 |
42,061 |
$1.22M |
| 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 |
16,096 |
13,964 |
$1.15M |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
48,385 |
47,392 |
$1.14M |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
36,349 |
35,413 |
$1.03M |
| 86481 |
|
11,994 |
11,568 |
$888K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
131,793 |
121,302 |
$800K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
21,798 |
19,940 |
$789K |
| 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 |
57,365 |
54,083 |
$730K |
| 86780 |
|
65,694 |
62,136 |
$691K |
| 86003 |
|
8,037 |
7,135 |
$675K |
| 86803 |
|
59,913 |
57,616 |
$675K |
| 84439 |
|
103,587 |
97,558 |
$653K |
| 82728 |
|
64,364 |
60,895 |
$620K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
9,057 |
8,430 |
$585K |
| 84403 |
|
30,155 |
28,488 |
$555K |
| 83013 |
|
8,770 |
8,590 |
$493K |
| 84466 |
|
52,978 |
50,176 |
$482K |
| 87653 |
|
15,393 |
14,989 |
$458K |
| 82607 |
|
44,451 |
41,793 |
$448K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16,012 |
15,681 |
$441K |
| 81513 |
|
23,761 |
22,904 |
$436K |
| 86235 |
|
6,377 |
4,739 |
$431K |
| 87340 |
|
51,223 |
49,136 |
$410K |
| 87077 |
|
62,308 |
57,668 |
$379K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25,572 |
25,019 |
$348K |
| 84153 |
|
26,518 |
24,856 |
$322K |
| 82746 |
|
31,315 |
29,614 |
$320K |
| 87186 |
|
52,486 |
48,470 |
$318K |
| 87902 |
|
1,679 |
1,538 |
$299K |
| 84481 |
|
25,577 |
24,020 |
$298K |
| 87511 |
|
16,376 |
15,998 |
$283K |
| 84702 |
|
22,338 |
17,346 |
$279K |
| 84270 |
|
17,767 |
16,829 |
$279K |
| 82570 |
|
85,853 |
78,953 |
$279K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
53,264 |
47,080 |
$275K |
| 82670 |
|
12,999 |
12,331 |
$266K |
| 86762 |
|
21,841 |
21,103 |
$265K |
| 87632 |
|
1,572 |
1,544 |
$258K |
| 83540 |
|
55,015 |
52,075 |
$252K |
| 82043 |
|
58,167 |
55,261 |
$232K |
| 86706 |
|
27,294 |
26,001 |
$224K |
| 87070 |
|
33,983 |
32,273 |
$223K |
| 81001 |
|
96,297 |
87,739 |
$218K |
| 83516 |
|
24,148 |
12,910 |
$217K |
| 83001 |
|
14,719 |
14,189 |
$209K |
| 86850 |
|
28,908 |
27,778 |
$208K |
| 87480 |
|
13,134 |
12,396 |
$207K |
| 87510 |
|
13,130 |
12,397 |
$207K |
| 87660 |
|
13,139 |
12,403 |
$206K |
| 82274 |
|
15,123 |
14,682 |
$201K |
| 86704 |
|
22,073 |
21,052 |
$200K |
| 83970 |
|
9,011 |
8,156 |
$199K |
| 83655 |
|
17,158 |
16,910 |
$196K |
| 83880 |
|
9,540 |
8,355 |
$190K |
| 86038 |
|
20,193 |
18,925 |
$184K |
| 87046 |
|
11,368 |
6,440 |
$181K |
| 87522 |
Neg quan hep c or qual rna |
6,890 |
6,497 |
$181K |
| 84146 |
|
11,675 |
11,100 |
$175K |
| 87521 |
Neg quan hep c or qual rna |
7,073 |
6,501 |
$175K |
| G0483 |
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; 22 or more drug class(es), including metabolite(s) if performed |
1,545 |
1,202 |
$172K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
2,686 |
2,501 |
$170K |
| 87536 |
|
3,066 |
2,872 |
$170K |
| 83002 |
|
11,357 |
10,957 |
$162K |
| 86696 |
|
10,511 |
10,011 |
$152K |
| 86140 |
|
38,344 |
35,226 |
$142K |
| 84144 |
|
8,868 |
8,121 |
$137K |
| 87081 |
|
22,671 |
22,316 |
$135K |
| 80074 |
|
3,705 |
3,621 |
$131K |
| 82105 |
|
8,959 |
8,635 |
$124K |
| 87529 |
|
2,285 |
2,168 |
$120K |
| 85651 |
|
39,495 |
36,519 |
$115K |
| 86787 |
|
10,655 |
9,327 |
$114K |
| 86376 |
|
10,661 |
10,156 |
$114K |
| 87631 |
|
1,198 |
1,178 |
$102K |
| 82627 |
|
6,453 |
6,150 |
$102K |
| 88141 |
|
5,359 |
5,163 |
$100K |
| 86800 |
|
8,664 |
8,155 |
$100K |
| 87493 |
|
4,107 |
3,836 |
$99K |
| 87338 |
|
8,472 |
8,249 |
$98K |
| 87088 |
|
17,894 |
16,226 |
$98K |
| 86695 |
|
9,612 |
9,147 |
$96K |
| 86665 |
|
5,937 |
3,468 |
$95K |
| 87210 |
|
19,707 |
18,762 |
$92K |
| 87209 |
|
6,350 |
5,801 |
$90K |
| 84703 |
|
13,690 |
13,032 |
$89K |
| 86709 |
|
10,672 |
10,084 |
$87K |
| 83690 |
|
15,756 |
15,072 |
$84K |
| 83735 |
|
20,576 |
17,929 |
$83K |
| 82950 |
|
19,837 |
19,422 |
$81K |
| 86317 |
|
5,417 |
5,162 |
$80K |
| 86141 |
|
8,003 |
7,651 |
$76K |
| 86360 |
|
2,004 |
1,943 |
$76K |
| 82784 |
|
8,913 |
8,101 |
$75K |
| 87535 |
|
2,598 |
2,449 |
$74K |
| 82671 |
|
2,867 |
2,761 |
$70K |
| 82951 |
|
6,195 |
6,057 |
$69K |
| 86900 |
|
27,945 |
26,817 |
$68K |
| 86694 |
|
6,086 |
5,816 |
$67K |
| 86901 |
|
27,957 |
26,841 |
$67K |
| 86431 |
|
15,303 |
14,704 |
$67K |
| 82533 |
|
5,741 |
5,143 |
$64K |
| 82677 |
|
2,927 |
2,853 |
$63K |
| 83525 |
|
7,579 |
7,170 |
$63K |
| 86359 |
|
2,005 |
1,944 |
$61K |
| 81003 |
|
29,790 |
27,897 |
$60K |
| 87205 |
|
19,108 |
17,928 |
$59K |
| 80076 |
|
11,083 |
10,353 |
$59K |
| 86160 |
|
7,061 |
3,450 |
$56K |
| 84480 |
|
6,136 |
5,712 |
$54K |
| 84550 |
|
17,856 |
16,414 |
$54K |
| 85027 |
|
12,157 |
11,388 |
$52K |
| 85610 |
|
21,812 |
15,478 |
$52K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
1,224 |
1,203 |
$50K |
| 87045 |
|
6,667 |
6,409 |
$49K |
| 86200 |
|
4,789 |
4,606 |
$47K |
| 87177 |
|
6,416 |
5,847 |
$45K |
| 86682 |
|
3,538 |
2,087 |
$45K |
| 84154 |
|
4,252 |
3,896 |
$44K |
| 83721 |
|
8,117 |
7,535 |
$43K |
| 87075 |
|
6,292 |
5,966 |
$43K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
801 |
780 |
$42K |
| 86336 |
|
2,827 |
2,756 |
$39K |
| 82150 |
|
7,612 |
7,267 |
$39K |
| 80164 |
|
5,295 |
4,564 |
$38K |
| 83520 |
|
2,939 |
2,693 |
$36K |
| 84436 |
|
8,406 |
7,900 |
$36K |
| 88142 |
|
1,813 |
1,781 |
$35K |
| 82785 |
|
3,043 |
2,871 |
$34K |
| 83090 |
|
2,959 |
2,773 |
$34K |
| 87517 |
|
986 |
960 |
$33K |
| 84425 |
|
2,562 |
2,349 |
$33K |
| 82024 |
|
1,335 |
1,220 |
$33K |
| 84681 |
|
2,294 |
2,163 |
$33K |
| 86735 |
|
2,736 |
2,666 |
$32K |
| 86765 |
|
2,762 |
2,709 |
$31K |
| 83993 |
|
2,115 |
2,053 |
$31K |
| 86708 |
|
3,040 |
2,890 |
$30K |
| 80069 |
|
6,582 |
5,624 |
$29K |
| 82140 |
|
3,340 |
2,633 |
$29K |
| 85014 |
|
12,647 |
12,431 |
$28K |
| 84156 |
|
11,504 |
9,929 |
$27K |
| 86060 |
|
4,596 |
4,394 |
$26K |
| 80178 |
|
5,787 |
5,050 |
$26K |
| 82977 |
|
5,910 |
5,325 |
$26K |
| 87516 |
|
835 |
813 |
$25K |
| 80305 |
|
2,330 |
1,484 |
$25K |
| 83519 |
|
1,983 |
1,818 |
$25K |
| 83498 |
|
1,245 |
1,215 |
$25K |
| 87147 |
|
4,208 |
4,054 |
$25K |
| 86769 |
|
1,372 |
1,309 |
$25K |
| 85379 |
|
3,450 |
3,227 |
$25K |
| 84479 |
|
5,391 |
5,096 |
$24K |
| 87420 |
|
1,994 |
1,940 |
$24K |
| 86664 |
|
2,146 |
2,030 |
$24K |
| 84445 |
|
689 |
654 |
$24K |
| 82550 |
|
5,570 |
5,065 |
$24K |
| 36416 |
|
9,322 |
8,532 |
$23K |
| 86812 |
|
1,237 |
1,164 |
$23K |
| 84482 |
|
2,122 |
2,034 |
$23K |
| 82247 |
|
5,602 |
4,138 |
$23K |
| 87329 |
|
2,464 |
2,353 |
$23K |
| 84460 |
|
5,447 |
5,154 |
$22K |
| 85730 |
|
5,137 |
4,749 |
$22K |
| 84100 |
|
7,935 |
6,806 |
$22K |
| 82652 |
|
969 |
896 |
$21K |
| 86318 |
|
1,599 |
1,541 |
$21K |
| 86663 |
|
2,161 |
2,044 |
$21K |
| 84484 |
|
2,315 |
2,092 |
$20K |
| 86592 |
|
6,036 |
5,747 |
$19K |
| 84207 |
|
1,231 |
1,122 |
$19K |
| 84402 |
|
1,035 |
988 |
$19K |
| 88342 |
|
242 |
234 |
$18K |
| 86308 |
|
3,896 |
3,750 |
$17K |
| 82952 |
|
4,744 |
4,634 |
$16K |
| 84630 |
|
2,125 |
2,033 |
$16K |
| 86645 |
|
1,214 |
1,176 |
$16K |
| 87634 |
|
380 |
360 |
$16K |
| 84450 |
|
4,174 |
3,902 |
$16K |
| 82248 |
|
3,690 |
2,861 |
$15K |
| 85018 |
|
6,749 |
6,524 |
$14K |
| 82310 |
|
9,298 |
8,330 |
$14K |
| 82947 |
|
4,283 |
4,099 |
$14K |
| 86644 |
|
1,205 |
1,163 |
$13K |
| 82525 |
|
1,612 |
1,508 |
$13K |
| 82239 |
|
906 |
783 |
$13K |
| 80159 |
|
1,569 |
1,086 |
$13K |
| 83615 |
|
3,627 |
3,009 |
$12K |
| 86747 |
|
501 |
482 |
$12K |
| 80503 |
|
1,722 |
1,593 |
$12K |
| 84165 |
|
1,944 |
1,753 |
$12K |
| 83088 |
|
534 |
514 |
$11K |
| 83921 |
|
882 |
829 |
$11K |
| 88312 |
|
220 |
191 |
$11K |
| 85045 |
|
4,058 |
3,788 |
$11K |
| 80177 |
|
1,483 |
1,294 |
$11K |
| 81015 |
|
8,026 |
7,481 |
$11K |
| 80197 |
|
1,448 |
962 |
$10K |
| 86256 |
|
1,150 |
1,054 |
$10K |
| 82390 |
|
1,287 |
1,231 |
$10K |
| 83021 |
|
592 |
578 |
$9K |
| 82172 |
|
757 |
699 |
$9K |
| 83704 |
|
437 |
415 |
$9K |
| 80175 |
|
1,180 |
1,041 |
$9K |
| 86304 |
|
679 |
607 |
$8K |
| 82365 |
|
917 |
879 |
$8K |
| 86147 |
|
212 |
203 |
$8K |
| 85060 |
|
608 |
592 |
$8K |
| 81050 |
|
3,267 |
2,914 |
$7K |
| 87252 |
|
350 |
334 |
$7K |
| 83883 |
|
795 |
721 |
$7K |
| 85245 |
|
420 |
294 |
$7K |
| 80500 |
|
621 |
565 |
$6K |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
2,422 |
2,000 |
$6K |
| 88304 |
|
181 |
174 |
$6K |
| 86255 |
|
747 |
566 |
$6K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
127 |
124 |
$6K |
| 86870 |
|
248 |
211 |
$6K |
| 82565 |
|
1,964 |
1,695 |
$6K |
| 84075 |
|
2,532 |
2,385 |
$5K |
| 86341 |
|
320 |
210 |
$5K |
| 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 |
38 |
31 |
$5K |
| 86593 |
|
839 |
785 |
$5K |
| 87220 |
|
1,272 |
1,244 |
$5K |
| 80156 |
|
641 |
577 |
$5K |
| 87109 |
|
566 |
539 |
$5K |
| 84134 |
|
568 |
475 |
$5K |
| 86777 |
|
422 |
416 |
$5K |
| 82088 |
|
168 |
162 |
$5K |
| 82330 |
|
551 |
512 |
$5K |
| 99001 |
|
1,772 |
1,250 |
$5K |
| 87102 |
|
735 |
707 |
$5K |
| 84520 |
|
1,952 |
1,703 |
$4K |
| 87076 |
|
628 |
583 |
$4K |
| 83020 |
|
376 |
365 |
$4K |
| 86617 |
|
161 |
155 |
$4K |
| 87185 |
|
837 |
800 |
$3K |
| 85613 |
|
511 |
331 |
$3K |
| 85240 |
|
250 |
239 |
$3K |
| 84244 |
|
213 |
208 |
$3K |
| 87184 |
|
871 |
802 |
$3K |
| 82378 |
|
322 |
259 |
$3K |
| 84155 |
|
1,912 |
1,721 |
$3K |
| 82553 |
|
292 |
276 |
$3K |
| 85246 |
|
136 |
129 |
$2K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
2,962 |
2,458 |
$2K |
| 82948 |
|
579 |
545 |
$2K |
| 86778 |
|
190 |
184 |
$2K |
| 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 |
1,275 |
1,044 |
$2K |
| 87276 |
|
157 |
152 |
$2K |
| 83695 |
|
187 |
184 |
$2K |
| 82340 |
|
395 |
361 |
$2K |
| 87641 |
|
80 |
68 |
$1K |
| 84590 |
|
199 |
189 |
$1K |
| 87275 |
|
157 |
152 |
$1K |
| 80185 |
|
243 |
193 |
$1K |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
13,903 |
9,272 |
$1K |
| G0432 |
Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening |
716 |
601 |
$1K |
| 82653 |
|
56 |
50 |
$1K |
| 87040 |
|
177 |
155 |
$1K |
| G0328 |
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
1,086 |
944 |
$1K |
| 83789 |
|
80 |
76 |
$1K |
| 83521 |
|
44 |
42 |
$1K |
| 82626 |
|
63 |
63 |
$1K |
| 86618 |
|
120 |
106 |
$1K |
| 82103 |
|
128 |
119 |
$1K |
| 87280 |
|
122 |
118 |
$1K |
| 84132 |
|
398 |
349 |
$1K |
| 81241 |
|
59 |
56 |
$1K |
| 84300 |
|
331 |
311 |
$1K |
| 87328 |
|
91 |
88 |
$963.65 |
| 86334 |
|
99 |
83 |
$938.04 |
| 81269 |
|
56 |
56 |
$914.78 |
| 87260 |
|
90 |
86 |
$864.33 |
| 83835 |
|
78 |
73 |
$845.89 |
| G0471 |
Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
9,539 |
6,158 |
$763.73 |
| 83986 |
|
331 |
284 |
$727.49 |
| 87279 |
|
118 |
86 |
$653.29 |
| 86702 |
|
69 |
65 |
$644.03 |
| 84311 |
|
141 |
116 |
$599.12 |
| 86361 |
|
28 |
25 |
$529.74 |
| 84140 |
|
52 |
47 |
$515.42 |
| 83945 |
|
53 |
52 |
$475.76 |
| 83874 |
|
44 |
37 |
$442.01 |
| 86701 |
|
69 |
65 |
$421.88 |
| 81291 |
|
186 |
165 |
$418.47 |
| 86658 |
|
14 |
14 |
$396.48 |
| 82465 |
|
131 |
121 |
$387.04 |
| 80162 |
|
124 |
89 |
$382.47 |
| 84478 |
|
84 |
80 |
$378.14 |
| 87181 |
|
175 |
138 |
$377.20 |
| 82157 |
|
14 |
14 |
$369.66 |
| 82040 |
|
137 |
113 |
$317.12 |
| 87350 |
|
25 |
25 |
$262.02 |
| 82542 |
|
15 |
14 |
$258.66 |
| 86788 |
|
21 |
12 |
$245.18 |
| 84133 |
|
81 |
79 |
$244.85 |
| 82507 |
|
15 |
14 |
$230.74 |
| 86335 |
|
13 |
12 |
$211.26 |
| 83630 |
|
20 |
18 |
$210.79 |
| 85049 |
|
57 |
54 |
$188.79 |
| 86789 |
|
19 |
12 |
$187.05 |
| 82397 |
|
14 |
14 |
$173.45 |
| 85306 |
|
14 |
13 |
$172.85 |
| 82530 |
|
16 |
12 |
$172.45 |
| 82436 |
|
42 |
40 |
$146.57 |
| 84432 |
|
12 |
12 |
$141.84 |
| 84105 |
|
38 |
37 |
$136.16 |
| 84560 |
|
40 |
38 |
$134.42 |
| 82955 |
|
14 |
14 |
$130.32 |
| 82668 |
|
12 |
12 |
$124.85 |
| 87341 |
|
13 |
13 |
$112.35 |
| 86707 |
|
13 |
12 |
$98.79 |
| 85384 |
|
14 |
12 |
$96.70 |
| 86705 |
|
15 |
12 |
$89.32 |
| 83718 |
|
13 |
13 |
$87.06 |
| 86001 |
|
12 |
12 |
$77.54 |
| 84446 |
|
12 |
12 |
$73.72 |
| 84392 |
|
14 |
13 |
$41.70 |
| 84145 |
|
90 |
61 |
$0.00 |