| 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 |
47,090 |
44,824 |
$3.81M |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
100,970 |
92,590 |
$2.63M |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
100,864 |
92,474 |
$2.51M |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
70,241 |
64,642 |
$1.76M |
| 84443 |
Thyroid stimulating hormone (TSH) |
142,184 |
134,405 |
$1.68M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
36,321 |
29,641 |
$1.64M |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
76,539 |
72,784 |
$1.43M |
| 80053 |
Comprehensive metabolic panel |
186,758 |
172,038 |
$1.41M |
| 80061 |
Lipid panel |
131,754 |
125,292 |
$1.24M |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
58,588 |
55,838 |
$1.15M |
| 81220 |
CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants |
3,642 |
3,320 |
$1.13M |
| 87625 |
|
39,895 |
35,902 |
$1.11M |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
8,879 |
8,467 |
$1.10M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
181,229 |
161,878 |
$999K |
| 36415 |
Collection of venous blood by venipuncture |
459,011 |
402,832 |
$992K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
124,167 |
118,392 |
$845K |
| 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 |
28,206 |
26,766 |
$670K |
| 87480 |
|
42,511 |
38,922 |
$610K |
| 86703 |
|
59,810 |
55,877 |
$590K |
| 87510 |
|
42,501 |
38,912 |
$579K |
| 86803 |
|
52,033 |
48,646 |
$532K |
| 82607 |
|
49,883 |
47,280 |
$524K |
| 80055 |
|
13,661 |
12,729 |
$471K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
79,956 |
73,462 |
$469K |
| 87660 |
|
28,416 |
25,993 |
$416K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
12,735 |
12,022 |
$400K |
| 82728 |
|
40,983 |
38,359 |
$383K |
| 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 |
5,288 |
4,105 |
$376K |
| G0482 |
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; 15-21 drug class(es), including metabolite(s) if performed |
2,749 |
2,491 |
$360K |
| 87653 |
|
14,642 |
13,997 |
$349K |
| 85027 |
|
72,050 |
66,624 |
$334K |
| 87507 |
|
1,288 |
1,253 |
$299K |
| 82746 |
|
28,966 |
27,238 |
$294K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
48,935 |
44,118 |
$273K |
| 84702 |
|
23,072 |
18,008 |
$264K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
5,291 |
5,211 |
$259K |
| 86780 |
|
25,434 |
23,700 |
$259K |
| 84153 |
|
19,206 |
18,265 |
$243K |
| 83550 |
|
39,761 |
37,371 |
$238K |
| 87902 |
|
1,222 |
1,118 |
$230K |
| 83970 |
|
8,785 |
8,330 |
$219K |
| 86480 |
|
4,767 |
4,511 |
$208K |
| 84439 |
|
32,864 |
31,065 |
$206K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
2,714 |
2,591 |
$198K |
| 87522 |
Neg quan hep c or qual rna |
6,500 |
6,050 |
$195K |
| 84403 |
|
10,798 |
10,104 |
$193K |
| 83540 |
|
40,764 |
38,234 |
$185K |
| 87506 |
|
1,096 |
1,021 |
$175K |
| 87340 |
|
22,601 |
21,026 |
$166K |
| 87070 |
|
24,747 |
23,581 |
$164K |
| 83013 |
|
3,107 |
2,950 |
$150K |
| 87077 |
|
21,975 |
20,602 |
$137K |
| 80050 |
General health panel |
5,197 |
5,001 |
$131K |
| 87186 |
|
20,546 |
19,291 |
$129K |
| 82670 |
|
6,105 |
5,669 |
$122K |
| 82570 |
|
33,829 |
31,874 |
$122K |
| 88342 |
|
2,375 |
2,221 |
$118K |
| 80346 |
|
6,172 |
4,699 |
$118K |
| 83001 |
|
8,046 |
7,562 |
$112K |
| 80348 |
|
11,994 |
8,610 |
$109K |
| 82043 |
|
26,893 |
25,635 |
$108K |
| 80361 |
|
6,328 |
4,806 |
$106K |
| 86787 |
|
10,881 |
10,117 |
$106K |
| 84146 |
|
7,263 |
6,780 |
$106K |
| 86038 |
|
11,592 |
11,013 |
$102K |
| 82105 |
|
7,922 |
7,452 |
$101K |
| 80074 |
|
3,693 |
3,513 |
$100K |
| 86235 |
|
4,175 |
3,895 |
$96K |
| 83021 |
|
6,729 |
6,220 |
$91K |
| 84481 |
|
7,327 |
6,974 |
$90K |
| 82677 |
|
4,326 |
4,145 |
$89K |
| 88341 |
|
1,145 |
1,066 |
$88K |
| 83880 |
|
3,669 |
3,412 |
$87K |
| 81001 |
|
37,449 |
34,914 |
$83K |
| 87529 |
|
1,883 |
1,753 |
$80K |
| 86706 |
|
9,265 |
8,705 |
$73K |
| 83735 |
|
16,983 |
13,795 |
$73K |
| 83002 |
|
5,147 |
4,832 |
$71K |
| 86140 |
|
19,330 |
16,622 |
$71K |
| 87536 |
|
1,219 |
1,153 |
$68K |
| 84207 |
|
3,488 |
3,317 |
$67K |
| 82784 |
|
5,807 |
5,391 |
$66K |
| 82950 |
|
17,303 |
16,494 |
$63K |
| 84270 |
|
4,225 |
3,952 |
$62K |
| 0097U |
|
246 |
242 |
$62K |
| 80076 |
|
10,802 |
9,988 |
$62K |
| 86147 |
|
1,558 |
1,458 |
$60K |
| 80349 |
|
6,630 |
5,056 |
$60K |
| 80354 |
|
6,298 |
4,778 |
$60K |
| 80365 |
|
6,302 |
4,786 |
$59K |
| 86696 |
|
4,179 |
3,946 |
$58K |
| 86762 |
|
5,564 |
5,086 |
$58K |
| 80353 |
|
6,350 |
4,820 |
$57K |
| 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 |
1,067 |
897 |
$57K |
| 80373 |
|
6,146 |
4,658 |
$57K |
| 82565 |
|
15,580 |
12,904 |
$56K |
| 86336 |
|
4,471 |
4,279 |
$55K |
| 80356 |
|
6,142 |
4,658 |
$55K |
| 84154 |
|
4,216 |
4,045 |
$54K |
| 86592 |
|
17,401 |
16,388 |
$54K |
| 86704 |
|
6,076 |
5,737 |
$53K |
| 80358 |
|
5,883 |
4,396 |
$53K |
| 80321 |
|
4,508 |
3,538 |
$53K |
| 80359 |
|
5,868 |
4,443 |
$53K |
| 80324 |
|
5,285 |
3,898 |
$50K |
| 85652 |
|
24,899 |
21,808 |
$48K |
| 84425 |
|
3,275 |
3,121 |
$48K |
| 86334 |
|
3,337 |
3,101 |
$46K |
| 86376 |
|
4,328 |
4,114 |
$46K |
| 86850 |
|
8,027 |
7,322 |
$46K |
| 84460 |
|
12,170 |
11,049 |
$45K |
| 87205 |
|
14,204 |
13,377 |
$45K |
| 86200 |
|
4,772 |
4,538 |
$45K |
| 80069 |
|
8,461 |
7,326 |
$44K |
| 84450 |
|
12,097 |
10,982 |
$44K |
| 80345 |
|
4,808 |
3,499 |
$44K |
| 87147 |
|
6,749 |
6,375 |
$43K |
| 84144 |
|
2,993 |
2,615 |
$43K |
| 85610 |
|
15,304 |
12,515 |
$42K |
| 86146 |
|
1,161 |
1,061 |
$41K |
| 84550 |
|
12,276 |
11,310 |
$39K |
| 87081 |
|
8,233 |
7,758 |
$39K |
| 86695 |
|
3,905 |
3,694 |
$38K |
| 84402 |
|
1,697 |
1,593 |
$38K |
| 80362 |
|
2,684 |
1,534 |
$38K |
| 83520 |
|
2,633 |
2,411 |
$37K |
| 80355 |
|
3,935 |
2,972 |
$36K |
| 83992 |
|
2,912 |
2,630 |
$36K |
| 82248 |
|
10,965 |
9,602 |
$36K |
| 86431 |
|
8,486 |
8,089 |
$36K |
| 83521 |
|
1,498 |
1,355 |
$35K |
| 86800 |
|
3,019 |
2,855 |
$35K |
| 86225 |
|
3,535 |
3,340 |
$34K |
| 82951 |
|
3,671 |
3,517 |
$33K |
| 83615 |
|
7,690 |
6,888 |
$33K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
886 |
800 |
$32K |
| 82627 |
|
1,971 |
1,881 |
$32K |
| 86160 |
|
2,452 |
2,281 |
$31K |
| 80372 |
|
3,368 |
3,078 |
$30K |
| 86708 |
|
3,097 |
2,877 |
$28K |
| 83721 |
|
4,731 |
4,440 |
$26K |
| 83516 |
|
2,371 |
2,165 |
$26K |
| 84480 |
|
2,637 |
2,488 |
$26K |
| 84165 |
|
3,944 |
3,672 |
$26K |
| 86003 |
|
504 |
484 |
$26K |
| 82330 |
|
2,444 |
1,770 |
$24K |
| 86255 |
|
1,276 |
1,174 |
$24K |
| 83690 |
|
4,706 |
4,445 |
$24K |
| 88304 |
|
1,153 |
1,114 |
$24K |
| 82533 |
|
2,045 |
1,815 |
$23K |
| 84630 |
|
2,877 |
2,756 |
$23K |
| 82652 |
|
1,078 |
1,009 |
$23K |
| 83525 |
|
2,665 |
2,497 |
$22K |
| 82378 |
|
1,546 |
1,338 |
$21K |
| 80369 |
|
2,290 |
2,173 |
$21K |
| 80366 |
|
2,254 |
2,123 |
$21K |
| 84156 |
|
8,531 |
7,634 |
$21K |
| 84703 |
|
3,353 |
3,131 |
$20K |
| 84445 |
|
522 |
507 |
$20K |
| 80320 |
|
1,636 |
1,539 |
$20K |
| 80363 |
|
1,151 |
1,123 |
$19K |
| 80164 |
|
2,271 |
2,089 |
$19K |
| 83883 |
|
1,111 |
1,040 |
$19K |
| 83655 |
|
1,878 |
1,779 |
$19K |
| 81025 |
|
3,119 |
2,914 |
$19K |
| 82550 |
|
3,899 |
3,262 |
$18K |
| 84590 |
|
2,282 |
2,171 |
$18K |
| 82947 |
|
6,694 |
5,849 |
$18K |
| 84100 |
|
5,772 |
4,482 |
$18K |
| 82172 |
|
1,314 |
1,269 |
$18K |
| 83704 |
|
750 |
716 |
$18K |
| 85730 |
|
4,351 |
4,075 |
$17K |
| 85045 |
|
6,288 |
5,767 |
$17K |
| 86705 |
|
1,690 |
1,587 |
$17K |
| 86901 |
|
7,996 |
7,285 |
$17K |
| 83921 |
|
1,192 |
1,127 |
$16K |
| 86900 |
|
7,693 |
6,997 |
$16K |
| 80368 |
|
1,791 |
1,736 |
$16K |
| 87517 |
|
526 |
500 |
$16K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
586 |
565 |
$15K |
| 86765 |
|
1,424 |
1,377 |
$15K |
| 86735 |
|
1,387 |
1,341 |
$15K |
| 80323 |
|
1,626 |
1,300 |
$14K |
| 86364 |
|
1,685 |
1,540 |
$14K |
| 84520 |
|
5,326 |
4,233 |
$14K |
| 80051 |
|
3,421 |
2,805 |
$14K |
| 82310 |
|
3,595 |
3,380 |
$13K |
| 81596 |
|
330 |
276 |
$12K |
| 82977 |
|
2,344 |
1,821 |
$12K |
| 87254 |
|
668 |
629 |
$12K |
| 82040 |
|
3,706 |
3,342 |
$12K |
| 80197 |
|
1,949 |
999 |
$12K |
| 86769 |
|
326 |
320 |
$12K |
| 87106 |
|
1,597 |
1,501 |
$12K |
| 81241 |
|
272 |
245 |
$11K |
| 80360 |
|
1,179 |
1,083 |
$11K |
| 82952 |
|
3,652 |
3,501 |
$11K |
| 82140 |
|
1,013 |
930 |
$10K |
| 86304 |
|
736 |
661 |
$10K |
| 83498 |
|
523 |
497 |
$10K |
| 88185 |
|
51 |
37 |
$10K |
| 86709 |
|
1,210 |
1,119 |
$10K |
| 80325 |
|
987 |
906 |
$9K |
| 87075 |
|
1,405 |
1,321 |
$9K |
| 84436 |
|
1,924 |
1,842 |
$9K |
| 80364 |
|
536 |
518 |
$9K |
| 84681 |
|
638 |
609 |
$9K |
| 86870 |
|
402 |
362 |
$9K |
| 80352 |
|
1,003 |
943 |
$9K |
| 85018 |
|
4,795 |
4,377 |
$8K |
| 84134 |
|
886 |
763 |
$8K |
| 86812 |
|
509 |
467 |
$8K |
| 86481 |
|
121 |
119 |
$8K |
| 85613 |
|
1,206 |
1,121 |
$8K |
| 81003 |
|
4,005 |
3,689 |
$8K |
| 80177 |
|
725 |
676 |
$7K |
| 84432 |
|
628 |
588 |
$7K |
| 88112 |
|
348 |
325 |
$7K |
| 82150 |
|
1,542 |
1,391 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
612 |
547 |
$7K |
| 88307 |
|
56 |
54 |
$7K |
| 85007 |
|
2,529 |
1,997 |
$7K |
| 86036 |
|
416 |
375 |
$7K |
| 85379 |
|
891 |
859 |
$6K |
| 85014 |
|
3,557 |
3,190 |
$6K |
| 86039 |
|
670 |
651 |
$6K |
| 82525 |
|
715 |
666 |
$6K |
| 82785 |
|
454 |
443 |
$5K |
| 80178 |
|
1,126 |
1,011 |
$5K |
| 84132 |
|
1,664 |
1,528 |
$5K |
| 82077 |
|
916 |
822 |
$5K |
| 84075 |
|
1,725 |
1,183 |
$5K |
| 82390 |
|
677 |
622 |
$5K |
| 84155 |
|
2,007 |
1,890 |
$5K |
| 80371 |
|
488 |
477 |
$5K |
| 86677 |
|
461 |
420 |
$5K |
| 80357 |
|
461 |
450 |
$4K |
| 80175 |
|
424 |
407 |
$4K |
| 80336 |
|
439 |
428 |
$4K |
| 87563 |
|
180 |
156 |
$4K |
| 82088 |
|
172 |
161 |
$4K |
| 82247 |
|
1,606 |
1,019 |
$4K |
| 87350 |
|
529 |
482 |
$4K |
| 80332 |
|
429 |
420 |
$4K |
| 88184 |
|
97 |
71 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
359 |
332 |
$4K |
| 81050 |
|
1,602 |
1,517 |
$4K |
| 83519 |
|
128 |
112 |
$4K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
139 |
139 |
$4K |
| 80343 |
|
397 |
390 |
$4K |
| 82024 |
|
132 |
126 |
$4K |
| 81240 |
|
94 |
91 |
$4K |
| 86618 |
|
308 |
276 |
$4K |
| 84478 |
|
906 |
741 |
$4K |
| 85240 |
|
285 |
261 |
$4K |
| 86707 |
|
448 |
402 |
$3K |
| 86381 |
|
214 |
187 |
$3K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
83 |
83 |
$3K |
| 83010 |
|
363 |
327 |
$3K |
| 88312 |
|
52 |
49 |
$3K |
| 82166 |
|
120 |
114 |
$3K |
| 80202 |
|
277 |
125 |
$3K |
| 81206 |
|
44 |
28 |
$3K |
| 82523 |
|
234 |
229 |
$2K |
| 85660 |
|
487 |
444 |
$2K |
| 84305 |
|
117 |
109 |
$2K |
| 84410 |
|
60 |
54 |
$2K |
| 86341 |
|
104 |
93 |
$2K |
| 86360 |
|
56 |
53 |
$2K |
| 82239 |
|
131 |
110 |
$2K |
| 87210 |
|
631 |
571 |
$2K |
| 86015 |
|
254 |
226 |
$2K |
| 82103 |
|
203 |
183 |
$2K |
| 86593 |
|
505 |
457 |
$2K |
| 84244 |
|
106 |
98 |
$1K |
| 82679 |
|
85 |
81 |
$1K |
| 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 |
13 |
12 |
$1K |
| 83020 |
|
122 |
101 |
$1K |
| 83090 |
|
121 |
112 |
$1K |
| 87206 |
|
319 |
276 |
$1K |
| 86665 |
|
51 |
49 |
$1K |
| 84466 |
|
119 |
89 |
$1K |
| 83695 |
|
117 |
116 |
$970.93 |
| 85306 |
|
80 |
64 |
$937.94 |
| 81329 |
|
13 |
12 |
$883.09 |
| 86361 |
|
53 |
49 |
$870.09 |
| 87102 |
|
148 |
128 |
$809.00 |
| 82274 |
|
52 |
49 |
$808.55 |
| 83835 |
|
66 |
64 |
$789.06 |
| 82664 |
|
17 |
16 |
$771.01 |
| 82164 |
|
75 |
66 |
$700.30 |
| 85303 |
|
73 |
60 |
$654.58 |
| 84484 |
|
84 |
79 |
$630.42 |
| 85576 |
|
13 |
12 |
$629.16 |
| 88302 |
|
26 |
25 |
$605.43 |
| 87338 |
|
49 |
48 |
$585.92 |
| 86256 |
|
59 |
50 |
$498.86 |
| 80347 |
|
19 |
17 |
$434.11 |
| 86308 |
|
93 |
88 |
$419.17 |
| 82465 |
|
108 |
87 |
$378.11 |
| 83993 |
|
24 |
24 |
$353.30 |
| 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 |
329 |
307 |
$349.02 |
| 87088 |
|
39 |
37 |
$260.51 |
| 80156 |
|
26 |
25 |
$258.63 |
| 85300 |
|
28 |
27 |
$246.68 |
| 83789 |
|
16 |
15 |
$228.24 |
| 86301 |
|
14 |
12 |
$209.47 |
| 86694 |
|
14 |
12 |
$169.44 |
| 82668 |
|
12 |
12 |
$161.69 |
| 86664 |
|
13 |
12 |
$144.63 |
| 85049 |
|
41 |
39 |
$131.94 |
| 84446 |
|
13 |
13 |
$129.92 |
| 80201 |
|
14 |
14 |
$123.75 |
| 83068 |
|
16 |
15 |
$111.57 |
| 80185 |
|
14 |
12 |
$110.35 |
| 82270 |
|
25 |
25 |
$71.68 |
| 85384 |
|
16 |
12 |
$60.02 |
| 80339 |
|
18 |
13 |
$17.64 |
| 3052F |
|
14 |
14 |
$0.00 |
| 3044F |
|
130 |
130 |
$0.00 |
| 81511 |
|
15 |
15 |
$0.00 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
47 |
39 |
$0.00 |
| 3051F |
|
29 |
29 |
$0.00 |
| 3046F |
|
19 |
19 |
$0.00 |