Contract : 5753 Vendor : Quest Diagnostics Description ...

Contract : 5753 Vendor : Quest Diagnostics

Pricing for frequently ordered tests is provided below. For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List

and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will prevail.

Frequently Ordered Tests

Description Cholesterol Comprehensive Metabolic Panel w/eGFR Chlamydia/GC DNA Amplified Drug Screen 7 Panel Drug Screen 9 Panel Drug Screen 10 Panel Hepatitis B Surface Antibody Quantitative Hepatitis C Antibody Hepatic Function Panel HIV 1/2 EIA Antibody with Reflexes HPV DNA (High Risk) Herpes Simplex Type 2 lgG, HerpeSelect Lipid Panel Pap, ThinPrep, No RESCRN Pap, ThinPrep, RESCRN Triglycerides TSH, 3rd Generation Urine Culture Varicella-Zoster lgG Surgical pathology, gross and microscpic exam Level IV profile 47 Nicotine Urine 6224 Hepatitis CaB 1590 QuantiFERON-TB 8 Panel Drug Screen Pregnancy, Urine PTT Culture, Wound Valproic Acid Vit D, 25 Hydroxy Gram Stain Culture, Aerobic Protime + INR Prothrombin Time EBV-VCA IGG AB T3 Free EBV AB IGM

Code 6165 944 17618 800 822 821 7292 1590 104 3200 110814 100051 1383 10090 1090 6440 7580 2400 123112 AC03

47 6224 1590 4399 819 4723 4023 2275 7590 17306 2025 2300 4021 111126 140465 1430 151599

Unite Price Time $3.75 24hr $6.43 24hr

$49.10 24hr $8.24 3-5 days $9.46 3-5 days

$10.11 3-5 days $9.75 24hr

$11.33 24hr $4.93 24hr $8.68 24hr

$33.48 24hr $24.44 24hr $12.10 24hr $20.00 5 days $20.00 5 days

$3.75 24hr $11.75 24hr

$8.43 24hr $18.00 6 days $64.43 24-48 hr $26.54 24hr $25.50 5 days $11.33 24hr $43.35 5 days

$8.87 3-5 days $8.60 24hr $4.50 24hr $21.00 varies $12.00 24hr $58.00 9 days $5.00 24hr $16.00 varies $5.00 24hr $5.00 4 days $18.25 4 days $5.62 24hr $18.25 4 days

Contract : 5753 Vendor : Quest Diagnostics

Pricing for frequently ordered tests is provided below. For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List

and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will prevail.

Frequently Ordered Tests

Description

Code

Tissue Transglutam IGA

1549

RA Diagnostic Panel

17669

Group A Strep Rapid Scn

2031

Strep Scn Group A

2032

Group A Strep No Rfx

2034

CMV AB Profile

3100

CMV IGG AB

3105

HIV- 1 WB W/RFX HIV-2

3214

Heterophile, Mono Scn

4317

Sed Rate Westergren

4542

HIV-1 AB West Blot

5233

Lithium

6315

HCG, Total, Quant

7275

Vitamin B12

7610

CMV AB IGM

3110

CMV AB IGM

12486

Western Blot HIV-1

3215

Percentage Discount Allowed off fee schedule for tests not listed

Unite Price

$68.00 $102.82

$7.50 $7.50 $7.50 $45.50 $13.00 $42.39 $18.25 $4.21 $42.39 $9.83 $24.62 $49.00 $32.50 $32.50 $42.39

65%

Time

4 days 3 days TBD TBD TBD 24hr 24hr TBD 24hr 24hr TBD 24hr 24hr 24hr 24hr 4 days TBD

Stat Testing Charge per specimen

$16.95

Stat Courier Charge

$7.74

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION ELECTROLYTES PANEL PROFILE 68 (SPRUE PANEL) PROFILE 88 PROFILE 101 ANEMIA PROFILE 103 ELECTROLYTES AMA HEPATIC FUNCTION PNL OBSTETRIC PANEL HEPATITIS B SURVEILLANCE NEEDLESTICK/EXPO PROF 145 ALLERGEN PROFILE 184 RAST FOODS COMPREHENSIVE RAST HOUSEHOLD INHALANTS REGIONAL PLANTS PROFILE PROFILE 193 RAST MYELOMA PROFILE 222 AUTOIMMUNE PROFILE 224 PROFILE 271 PRENATAL ALLERGEN PROFILE 279 PROFILE 283 IMMUNE COMPET C3, C4, COMPLEMENT CH50 ALLERGEN GRASSES PROFILE ALLERGEN WEEDS PROFILE ALLERGEN INDOOR INHALANTS ALLERGEN TREES PROFILE ALLERGEN MOLDS PROFILE ALLERGEN PEDIATRIC FOOD ALLERGEN MEATS PROFILE ALLERGEN GRAINS PROFILE ALLERGEN PROFILE 311 T-HELPER PANEL IRON,TIBC AND FERRITIN HEPATITIS PANEL, ACUTE ALLERGEN PROF 392 (RAST) GLUCOSE TOLERANCE 2HR GLUCOSE TOLERANCE 1HR GLUCOSE TOLERANCE 2 HOUR GLUCOSE TOLERANCE 3HR GLUCOSE FAST AND GEST ALLERGEN PROF 427 (RAST) GTT,GESTATIONAL,4 SPEC GLUCOSE TOLERANCE 5 HOUR CSF PROFILE MYELOMA PROFILE 635 PROFILE 688 ZINC ALUMINUM SERUM DIARRHEA PROFILE 786 PROFILE 800 7 PANEL TOX PROFILE 819 8 PANEL TOX PROFILE 821 10 PANEL TOX PROFILE 822 9 PANEL TOX PROFILE 866 7 PANEL TOX THYROGLOBULIN PANEL RENAL FUNCTION PANEL COMP METAB WITH EGFR THYROID PANEL (T3U,T4,T7) BASIC METABOLIC PAP 1 SLIDE (SCRN) HUMORAL IMMUNITY STATUS PAP INTERP BY DR ERA/PRA IMMUNOPEROXIDASE ERA/PRA IMMUNO NON-BREAST

CODE 42 68 88 101 103 104 125 133 145 184 187 188 189 193 222 224 271 279 283 284 300 301 302 303 304 305 306 307 311 346 359 365 392 406 410 412 418 425 427 428 441 480 635 688 784 786 800 819 821 822 866 900 916 944 975 982

1000 1048 1081 1088 1089

Quest Fee Schedule

PRICE

DESCRIPTION

$3.52 $101.85

$12.78 $24.96

HIV1 RNA QNT RLTM PCR CSF INTERFERON BETA 1A INTERFERON BETA 1B AB BUPRENORPHINE W/O CONF,UR

$4.73 $4.05 $50.16 $53.24 $44.17

ANTIMICROBIAL,RIFABUTIN MAGNESIUM, 24 HOUR URINE OPIATES CONF, UR MDMA/MDA, QUANT, UR HEPATOCELLULAR CARCINOMA

$189.00 $119.00

$56.00 $98.00 $182.00

C-KIT MUTATIONS W/REFLEX ARBOVIRUS AB PNL, CSF INFLUENZA A H1/H3 RT PCR RESPIRATORY PNL W/H1N1 BASE PROF W/CONF, UR

$89.57 $154.00

$61.18 $189.00 $198.35

$65.49 $35.00 $28.00 $42.00

BASE PROF W/O CONF, UR PROCALCITONIN FUNGITELL(1-3)-B-D-GLUCAN SRA ASSAY LMWH SRA ASSAY FONDAPARINUX PLATELET AB SCR INDIRECT QUANT HIV-1 RT PCR (NIH) GTT GESTATIONAL 4 SPEC IGF-1 ELECTROCHEM

$35.00 $35.00 $35.00 $28.00 $35.00

OPIATES EXPANDED,QUANT,UR FRAGILE X DNA ANLYS FETUS CAMPYLOBACTER SPECIES AG BUPRENORPHINE SCR W/CONF XSENSE FRAGILE X W/RFLX

$91.00 $172.83

$29.44 $98.31 $252.00

BUPRENORPHINE QUANT URINE HEMOGLOBIN A1C WITH EAG OSTEOCALCIN, N-MID XSENSE(R)FRAGILE X W/RFLX LINEZOLID, HPLC

$7.60 $7.32 $15.79 $15.79 $8.96

THROMBOPOIETIN (TPO) GENOMIC ALTER PRENATAL EML4-ALK GENE FUSION PCR HISTAMINE, PLASMA S PNEUMONIAE IGG AB,MAID

$259.00 $15.79 $26.29 $17.85

$132.34

C DIFFICILE TOXON B CATECHOLAMINES SUPINE CATECHOLAMINES FRAC CMV IGG/IGM CSF ENCEPHALITIS AB PANEL

$9.49 $70.70 $121.07

$8.24 $8.87

FENTANYL SCREEN UR W/RFLX EBV PANEL, CSF HIV-1 GENOTYPE TROPISM HIV-1 VIRTUAL PHENOTYPE PNH W/FLAER

$10.11 $9.46 $8.24

$66.33 $4.57

CORTISOL FREE RESPONSE X3 CHRONIC URTICARIA PANEL JC POLYOMA VIRUS DNA, CSF JC POLYOMA DNA, CSF JC POLYOMA VIRUS DNA, UR

$5.27 $11.52

$4.22 $12.00 $316.40

$0.84 $89.18 $96.01

JC POLYOMA VIRUS DNA, UR TSH RECEPTOR ANTIBODY PROF 1 W/CONF, UR PROF 2 W/CONF, UR PROF 3 W/CONF, UR BASE PROF W/CONF, UR LUNG CANCER MUTATION PNL STEPWISE PART 1

CODE 16186 16201 16202 16207 16208 16213 16215 16216 16222 16237 16240 16251 16255 16259 16260 16265 16283 16284 16285 16288 16290 16292 16293 16298 16300 16302 16310 16313 16314 16320 16322 16326 16328 16336 16340 16344 16354 16374 16377 16381 16382 16385 16405 16407 16420 16430 16431 16433 16434 16440 16441 16442 16446 16447 16453 16454 16455 16456 16457 16461 16463

PRICE $101.85 $162.40 $162.40 $60.00 $64.05 $24.17 $100.00 $100.00 $143.50 $350.00 $241.15 $104.30 $417.20 $159.39 $159.39 $85.75 $96.25 $91.00 $91.00 $80.50 $103.25 $14.98 $54.25 $100.00 $133.00 $33.95 $21.00 $105.00 $35.00 $16.45 $50.75 $327.25 $64.05 $43.75 $556.50 $192.50 $47.95 $108.15 $42.00 $52.85 $52.85 $59.15 $281.40 $12.25 $104.65

$1,690.00 $591.50 $196.88 $131.25 $128.10 $104.30 $122.15 $122.15 $104.30 $80.50 $259.00 $159.39 $192.59 $159.39 $459.90 $68.25

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

PAP,THIN LYR,RESCRN(DIAG) PAP,THIN LYR,RESCRN(SCRN) FACTOR VII AG. AMINOLEVULINIC ACID,RND POLIOVIRUS POST VACCINE 11-DEOXYCORTISOL DRAW AND PROCESS REFERRED DRAW AND SHIP SPECIMEN ACETYLCHOLINE RECEPT.BIND FLUVOXAMINE (LUVOX) ACTH, PLASMA CORTISOL, PRE ACTH CORTISOL, POST ACTH ACTH STIMULATION,PRE/POST ALUMINUM ANDROSTENEDIONE,LC/MS/MS STINGING INSECT,IGE W/O T ANTI-DNASE GLOMERULAR BASEMENT MEMB. G6PD QUANTITATIVE CHROMIUM, RANDOM URINE OXALATE ARSENIC, QUANTITATIVE BCR/ABL GENE REARRANGEMEN MESTINON PORPHYRINS,FRACTION, PL ARSENIC,QUANTITATIVE,UR EPIDERMAL AB W/REFLEX VITAMIN B-12 BINDING BETA-2-MICROGLOBULIN ANGIOTENSIN II BETA 2 MICROGLOBULIN B. HERMSII IGG/IGM AB BRUCELLA ANTIBODY STRONGYLOIDES IGG ABS C1 INHIBITOR, PROTEIN KETAMINE COMPLEMENT C2 ADRENAL AB W/RFL TITER COMPLEMENT C5 IGG/ALBUMIN RATIO FUNGAL SUSCEPT MIC PANEL CA 125 ALPHA 2 ANTIPLASMIN CA 19-9 CA 27.29 CALCITONIN NEOPTERIN CARNITINE VON WILLEBRANDS FACTOR AG B. HENSELAE IgG,IgM REFLX CATECHOLAMINES, FRACT. ALLERGEN WHITE ASH CATECHOLAMINES, 24 HR UR CHLAMYDOPHILA PSITTACI AB ALLERGEN ITALIAN CYPRESS BACTERIAL ANTIGEN PANEL CATECHOLAMINES, FRACT METHYLMALONIC/HOMOCYSTEIN COPPER, URINE PLASMINOGEN

CODE

1090 1091 1112 1147 1156 1205 1206 1216 1229 1231 1232 1233 1236 1237 1241 1253 1255 1256 1259 1262 1263 1267 1271 1272 1275 1276 1277 1279 1286 1289 1291 1292 1293 1295 1299 1301 1303 1307 1308 1310 1311 1312 1313 1315 1319 1320 1322 1323 1328 1332 1334 1340 1341 1343 1346 1347 1349 1350 1356 1364 1366

Quest Fee Schedule

PRICE

DESCRIPTION

$22.66 $69.50 $180.00

STEPWISE PART 2 GENOMIC ALTERATIONS PROF 4 W/CONF, UR

$25.20 $28.18 $57.75 $28.50 $65.50

PROF 4 W/CONF, UR HISTOPLASMA AB PANEL, CSF PROF 4 W/O CONF, UR HYPERSENSITIVITY PNEUMO HE4,OVARIAN CANCER MONITR

$57.75 $101.00

$38.50 $21.42 $21.42

INFLM BWL DIS DIFF PANEL METHYLMALONIC ACID URINE KRAS MUTATION ANALYSIS PHOSPHOLIPIDS, SERUM UGT1A1 GENOTYPING

$42.84 $45.85 $58.45 $35.00 $22.75

FISH TOP2A GENE AMP BIOTINIDASE DEFICIENCY LEPTOSPIRA AB W/RFLX RETICULIN IGG SCRN W/RFLX 1911A>G MUT ANALYSIS

$49.70 $23.80 $32.55 $127.00 $45.85 $151.20 $272.00 $43.75 $45.85

JAK2 EXONS 12-13 MUTATION BIOTINIDASE ACTIVITY JAK2 V617F,QL,LEUMETA W/R JAK2 V617F MUTATION BK VIRUS DNA,QL,RT,PCR UR CPK W/CKMB IF INDICATED VITAMIN D 1,25-DIHYDROXY THYROGLOBULIN FN ASPIRATE PTH, INTACT, FNA

$17.50 $27.65 $32.55 $31.15 $31.50

FUNGAL ID,PHENOTYPE & SEQ FUNGAL SEQUENCING ITS REG BK VIRUS DNA,QNT,RT,PCR U FISH,LYMPHOID MYB del6q23 TREPONEMA PALLIDUM DNA

$66.50 $49.00 $53.20 $33.25 $101.00

C. BURNETII DNA,QL,RLTM IODINE, SERUM & PLASMA IODINE 24-HOUR URINE ETHYL GLUCURONIDE SULFATE CYP2C19 GENOTYPING

$31.50 $24.50 $33.60 $33.25 $188.30

HUMAN METAPNEUMOVIRUS HEXA MUTATION ANALYSIS PHOSPHATIDY IgG,IgA,IgM NUCLEAR MATRIX PROTEINS LYME DISEASE AB, TOTAL

$32.48 $35.35 $34.30 $40.60 $54.25

CELIAC DISEASE PANEL 1 RETT SYN REARRANGE DELDUP FISH, DUPLICATION 22Q11.2 PHOSPHATIDYLCHOLINE IGG PHOSPHATICYLCHOLINE IGM

$45.85 $58.45 $51.45 $52.15 $52.85

PHOSPHATIDYLCHOLINE IGA PHOSPHATIDYLETHANOLA IgG PHOSPHATIDYLETHANOLAM IgM PHOSPHATIDYLETHANOLAM IgA HSV AB IGM W/RFL TITER

$7.00 $49.35 $36.75

$7.00 $54.43 $64.75 $98.00 $26.25 $49.00

PHOSPHATIDYLINOSITOL IgM PHOSPHATIDYLINOSITOL IgA EPSTEIN-BARR VIRUS ISH IGG,IGA INDRCT IMMUNFLOR ORGANIC ACID URINE QUANT HEP B VIRUS DNA, W/RFLX IMMUNOGLOBULIN CSF PROF INSCAPE ER/PR/HER2 QNT HIV-1 CORECEPTOR TROPISM

CODE

16465 16478 16483 16484 16485 16486 16490 16500 16503 16508 16510 16513 16521 16523 16526 16529 16530 16533 16536 16537 16538 16539 16553 16555 16558 16559 16560 16578 16579 16581 16593 16595 16596 16599 16602 16604 16605 16607 16612 16619 16645 16646 16652 16662 16672 16677 16678 16679 16680 16681 16682 16684 16685 16686 16688 16690 16693 16694 16705 16707 16710

PRICE

$169.75 $840.00 $242.40 $242.40

$58.45 $242.40 $161.70

$89.60 $175.00

$49.70 $203.00

$27.65 $113.75 $157.50 $262.15

$33.60 $22.75 $104.65 $175.00 $35.70 $175.00 $175.00 $107.80

$8.16 $79.45 $31.50 $52.50 $105.00 $105.00 $122.15 $207.55 $104.30 $104.30 $28.35 $35.00 $40.95 $542.50 $38.15 $441.00 $108.50 $43.75 $17.50 $124.60 $323.75 $128.80 $36.17 $36.17 $36.17 $36.17 $36.17 $36.17 $26.25 $36.17 $36.17 $57.75 $64.75 $132.65 $113.75 $42.00 $210.00 $437.50

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

CREATINE, URINE CYSTINE QUANTITATIVE, UR CHLAMYDIA DNA PROBE GONORRHEA DNA PROBE (GC) DHEA,LC/MS/MS CHLAMYDIA DNA SCRN W/RFLX GROUP B STREP DNA PRB CUL LIPID PANEL MULTIPLE SCLEROSIS PANEL ALPHA SUBUNIT 3HR GTT/INSULIN TOLERANCE PORPHYRINS, 24HR QUANT. PTH INTACT/IONIZ CALCIUM REVERSE T3 POLIO VIRUS ANTIBODY COXSACKIE A VIRUS PANEL HIV 1&2 ANTIBODIES T3, FREE MAG AUTOANTIBODY NEURONAL NUCLEAR (RI) YO (PURKINJE CELL) AB NEURONAL NUCLEAR (HU) HU AND YO AUTOANTIBODY GIARDIA ANTIBODIES (IFA) HEP C SUPPLEMENTAL (RIBA) HALOPERIDOL (HALDOL) HAEMOPHILUS INFLUENZA B ANTI GLIADIN ANTIBODIES HEAVY METALS, URINE HISTAMINE, URINE LATEX RIA PANEL IGG SUBCLASSES INSULIN INSULIN, SPECIMEN 2 HANTAVIRUS (SIN NOMBRE) A1-ANTITRYP.QNT/PHENO GROUP B STREP DNA PRB CUL NEURONTIN (GABAPENTIN) INTRINSIC FACTOR BLOCKING INSULIN, SPECIMEN 3 CALCIUM,IONIZED LEAD, BLOOD HSV 1 & 2, IGM DRVVT SCREEN W/REFLEXES THYROID STIM IMMUNO (TSI) LYSOZYME, SERUM T4 FREE, DIRECT DIALYSIS PARVOVIRUS AB IGG/M,B-19 CHROMOGRANIN A HOMOCYSTEINE CARDIOVASCUL TRYPTASE HERBICIDES PANEL 1 MENINGOENCEPHALOMYELITIS CORTICOSTERONE NTX 24HR URINE MERCURY IMM. COMPLEX BY C1Q BIND. MERCURY, URINE VITAMIN B2 M.HOMINIS/UREAPLASMA CULT METANEPHRINES,FRAC,24HR

CODE

1367 1376 1377 1378 1379 1380 1381 1383 1387 1391 1392 1393 1396 1411 1425 1428 1429 1430 1431 1432 1435 1437 1438 1439 1450 1451 1454 1456 1457 1461 1468 1472 1475 1476 1477 1480 1481 1483 1484 1485 1487 1493 1509 1513 1515 1517 1519 1524 1527 1529 1531 1534 1535 1536 1537 1538 1540 1541 1543 1545 1547

Quest Fee Schedule

PRICE

DESCRIPTION

$26.25 $45.50 $13.13

HGB A1C W/RFLX GLYCOMARK HSV TYPE 1 & 2 W/INTERP PYRAZINAMIDE, HPLC

$11.10 $62.30 $37.66 $27.58

$7.21

RUBELLA RNA,QL,RT,PCR TAMOXIFEN P450 GENOTYPE METHYLMALONIC ACID QNT QNS HPV HIGH RISK C DIF DNA/TOXIN B GENE QL

$247.00 $47.60

$114.63 $49.00 $77.00

VIT D,25-HYDROXY,1,25-D SLOS & STSD SCREEN BRAF MUTATION ANALYSIS YERSINIA ENTEROC IGG,IGA HLA-A29 DNA TYPING

$60.90 $44.10 $56.00 $26.25 $55.65

HLA-B51 DNA TYPING CF MUTATION SCREEN CALPROTECTIN, STOOL GENOMIC ALTERATIONS CGH HEMOGLOBIN A1C W/EAG

$44.10 $70.00 $49.00 $87.50 $136.50 $58.10 $96.25 $39.55 $34.30

INFLUENZA A H1N1,RT,PCR CELLSEARCH TUMOR, COLON CELLSEARCH, PROSTATE ANA SCREEN W/REFLEXES OXALATE, RANDOM URINE NRAS MUTATION ANALYSIS FETOMATERNAL BLEED, FLOW FISH, HES/LEUKEMIA 4q12 HISTAMINE RELEASE-CHRONIC

$59.50 $136.50

$57.75 $94.30 $91.35

ANTIMULLERIAN HORMONE CHROMOSOME,NEONATAL BLOOD ANTIMIC,ETHAMBUTOL, HPLC ALDOSTERONE/PRA-LC/MS/MS PLASMA RENIN ACTIVITY

$25.66 $25.66 $51.45 $67.90 $27.58

FISH,NHL,BCL6 3q27 REARNG PROF 2 W/CONF, UR PROF 2 W/O CONF, UR PROF 3 W/CONF, UR PROF 3 W/O CONF, UR

$31.50 $28.00 $25.66 $17.50 $22.75

PROF 1 W/CONF, UR PROF 1 W/O CONF, UR PDGFRA MUTATION ANALYSIS BAC ID PHENOTYPIC INFLUENZA A/B RT-PCR W/RF

$42.00 $15.75 $100.10 $31.85 $32.90

FISH,B-CELL LYMPH/LEUKEM SELENIUM, 24 HR URINE SELENIUM, RANDOM URINE HIV-1 INTERGRASE GENOTYPE FISH,IGH/FGFR3, t(4,14)

$49.00 $38.50 $56.00 $40.25 $211.00

BCR-ABL1 KINASE DOMAIN HIV-1,RNA,QUAL,CSF GENOMIC ALTERATIONS POC AMPHETAMINE, W/CONF, UR BARBITURATE, W/CONF, UR

$723.10 $35.35 $58.80 $38.50 $37.10 $38.50 $48.30 $51.80 $41.65

BENZODIAZEPINES W/CONF,UR COCAINE SCRN, W/CONF, UR MARIJUANA MET SCRN W/CON METHADONE SCRN W/CONF, UR OPIATES SCRN W/CONF, UR OXYCODONE SCRN W/CONF, UR PHENCYCLIDINE W/CONF, UR PROPOXYPHENE W/CONF, UR WILMS TUMOR(WT1)MUT ANLYS

CODE

16715 16720 16726 16730 16731 16732 16737 16739 16761 16764 16767 16768 16773 16775 16790 16796 16800 16802 16807 16811 16812 16814 16817 16818 16828 16837 16838 16842 16843 16844 16845 16846 16851 16852 16853 16854 16855 16856 16858 16859 16860 16861 16864 16866 16867 16868 16872 16876 16879 16884 16885 16886 16887 16888 16889 16890 16891 16892 16893 16894 16896

PRICE

$9.00 $57.75 $19.35 $104.30 $542.50 $49.70 $32.50 $104.30 $147.70 $166.25 $166.25 $59.50 $66.50 $66.50 $99.75 $61.25 $556.50

$9.00 $104.30 $203.00 $203.00

$19.25 $24.17 $138.25 $61.25 $181.30 $52.50 $54.60 $222.25 $64.05 $73.50 $31.50 $133.00 $159.39 $55.79 $192.59 $192.59 $259.00 $259.00 $199.50 $84.00 $104.30 $253.75 $48.30 $48.30 $154.00 $133.00 $162.75 $122.15 $556.50 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $297.50

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