Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 317.00 - Rates for Medicine Services
Section 317.04 - Maximum Allowable Fees - Medical Services
Current through Register 1518, March 29, 2024
(1) Drugs, Medications, Supplies, and Laboratory Specimen Collections.
Drugs and/or biologicals available free of charge from the Massachusetts Department of Public Health are not payable items. When an immunization or injection is the primary purpose of an office or other outpatient visit, the provider may bill only for the injectable material and its administration. Payment for both vaccine administration and an office visit is allowable only when the vaccine administration is a medically necessary, separately identifiable service.
(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2020 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine .
(3) Modifiers.
(4) Fee Schedule.
Code |
NFAC |
FAC |
Global |
PC |
TC |
Description (see medicine services code spreadsheet at http://www.mass.gov/regulations/101-CMR-31700- medicine) |
90281 |
- |
- |
I.C. |
- |
- |
|
90283 |
- |
- |
I.C. |
- |
- |
|
90284 |
- |
- |
I.C. |
- |
- |
|
90287 |
- |
- |
I.C. |
- |
- |
|
90288 |
- |
- |
I.C. |
- |
- |
|
90291 |
- |
- |
I.C. |
- |
- |
|
90296 |
- |
- |
I.C. |
- |
- |
|
90377 |
- |
- |
I.C. |
|||
90378 |
- |
- |
I.C. |
- |
- |
|
90384 |
- |
- |
I.C. |
- |
- |
|
90385 |
- |
- |
I.C. |
- |
- |
|
90386 |
- |
- |
I.C. |
- |
- |
|
90389 |
- |
- |
I.C. |
- |
- |
|
90393 |
- |
- |
I.C. |
- |
- |
|
90396 |
- |
- |
I.C. |
- |
- |
|
90399 |
- |
- |
I.C. |
- |
- |
|
90460 |
- |
- |
$20.45 |
- |
- |
|
90461 |
- |
- |
$9.84 |
- |
- |
|
90471 |
- |
- |
$20.45 |
- |
- |
|
90472 |
- |
- |
$9.84 |
- |
- |
|
90473 |
- |
- |
$20.45 |
- |
- |
|
90474 |
- |
- |
$9.84 |
- |
- |
|
90476 |
- |
- |
I.C. |
- |
- |
|
90477 |
- |
- |
I.C. |
- |
- |
|
90581 |
- |
- |
I.C. |
- |
- |
|
90586 |
- |
- |
I.C. |
- |
- |
|
90587 |
- |
- |
I.C. |
- |
- |
|
90619 |
- |
- |
I.C. |
- |
- |
|
90620 |
- |
- |
I.C. |
- |
- |
|
90621 |
- |
- |
I.C. |
- |
- |
|
90625 |
- |
- |
I.C. |
- |
- |
|
90630 |
- |
- |
I.C. |
- |
- |
|
90633 |
- |
- |
I.C. |
- |
- |
|
90634 |
- |
- |
I.C. |
- |
- |
|
90636 |
- |
- |
$122.36 |
- |
- |
|
90644 |
- |
- |
I.C. |
- |
- |
|
90647 |
- |
- |
I.C. |
- |
- |
|
90648 |
- |
- |
I.C. |
- |
- |
|
90649 |
- |
- |
I.C. |
- |
- |
|
90650 |
- |
- |
I.C. |
- |
- |
|
90651 |
- |
- |
I.C. |
- |
- |
|
90653 |
- |
- |
I.C. |
- |
- |
|
90654 |
- |
- |
I.C. |
- |
- |
|
90655 |
- |
- |
I.C. |
- |
- |
|
90656 |
- |
- |
I.C. |
- |
- |
|
90657 |
- |
- |
I.C. |
- |
- |
|
90658 |
- |
- |
I.C. |
- |
- |
|
90660 |
- |
- |
I.C. |
- |
- |
|
90661 |
- |
- |
I.C. |
- |
- |
|
90664 |
- |
- |
I.C. |
- |
- |
|
90666 |
- |
- |
I.C. |
- |
- |
|
90667 |
- |
- |
I.C. |
- |
- |
|
90668 |
- |
- |
I.C. |
- |
- |
|
90672 |
- |
- |
I.C. |
- |
- |
|
90673 |
- |
- |
I.C. |
- |
- |
|
90676 |
- |
- |
I.C. |
- |
- |
|
90680 |
- |
- |
I.C. |
- |
- |
|
90681 |
- |
- |
I.C. |
- |
- |
|
90682 |
- |
- |
I.C. |
- |
- |
|
90685 |
- |
- |
I.C. |
- |
- |
|
90687 |
- |
- |
I.C. |
- |
- |
|
90689 |
- |
- |
I.C. |
- |
- |
|
90690 |
- |
- |
I.C. |
- |
- |
|
90694 |
- |
- |
I.C. |
- |
- |
|
90696 |
- |
- |
I.C. |
- |
- |
|
90697 |
- |
- |
I.C. |
- |
- |
|
90698 |
- |
- |
I.C. |
- |
- |
|
90700 |
- |
- |
I.C. |
- |
- |
|
90702 |
- |
- |
I.C. |
- |
- |
|
90707 |
- |
- |
I.C. |
- |
- |
|
90710 |
- |
- |
I.C. |
- |
- |
|
90713 |
- |
- |
I.C. |
- |
- |
|
90716 |
- |
- |
I.C. |
- |
- |
|
90717 |
- |
- |
I.C. |
- |
- |
|
90723 |
- |
- |
I.C. |
- |
- |
|
90733 |
- |
- |
I.C. |
- |
- |
|
90734 |
- |
- |
I.C. |
- |
- |
|
90736 |
- |
- |
I.C. |
- |
- |
|
90738 |
- |
- |
I.C. |
- |
- |
|
90739 |
- |
- |
I.C. |
- |
- |
|
90743 |
- |
- |
I.C. |
- |
- |
|
90744 |
- |
- |
I.C. |
- |
- |
|
90748 |
- |
- |
I.C. |
- |
- |
|
90749 |
- |
- |
I.C. |
- |
- |
|
90750 |
- |
- |
I.C. |
- |
- |
|
90756 |
- |
- |
I.C. |
- |
- |
|
90785 |
$11.61 |
$10.45 |
- |
- |
- |
|
90791 |
$108.94 |
$94.74 |
- |
- |
- |
|
90792 |
$120.79 |
$106.30 |
- |
- |
- |
|
90832 |
$53.14 |
$47.35 |
- |
- |
- |
|
90833 |
$54.59 |
$49.38 |
- |
- |
- |
|
90834 |
$70.67 |
$63.13 |
- |
- |
- |
|
90836 |
$69.17 |
$62.51 |
- |
- |
- |
|
90837 |
$105.75 |
$94.45 |
- |
- |
- |
|
90838 |
$90.84 |
$82.15 |
- |
- |
- |
|
90839 |
$110.36 |
$98.77 |
- |
- |
- |
|
90840 |
$52.85 |
$47.35 |
- |
- |
- |
|
90845 |
$75.01 |
$67.77 |
- |
- |
- |
|
90846 |
$76.88 |
$76.31 |
- |
- |
- |
|
90847 |
$79.54 |
$79.25 |
- |
- |
- |
|
90849 |
$28.02 |
$22.23 |
- |
- |
- |
|
90853 |
$21.07 |
$18.75 |
- |
- |
- |
|
90863 |
$20.62 |
$19.17 |
- |
- |
- |
|
90865 |
$131.65 |
$97.16 |
- |
- |
- |
|
90867 |
- |
- |
I.C. |
- |
- |
|
90868 |
- |
- |
I.C. |
- |
- |
|
90869 |
- |
- |
I.C. |
- |
- |
|
90870 |
$138.08 |
$83.60 |
- |
- |
- |
|
90875 |
$47.66 |
$47.37 |
- |
- |
- |
|
90876 |
$83.93 |
$75.23 |
- |
- |
- |
|
90880 |
$83.49 |
$69.57 |
- |
- |
- |
|
90882 |
- |
- |
I.C. |
- |
- |
|
90885 |
- |
- |
$38.66 |
- |
- |
|
90887 |
$68.33 |
$58.47 |
- |
- |
- |
|
90889 |
- |
- |
I.C. |
- |
- |
|
90899 |
- |
- |
I.C. |
- |
- |
|
90901 |
$32.23 |
$15.42 |
- |
- |
- |
|
90912 |
$63.36 |
$34.08 |
- |
- |
- |
|
90913 |
$25.30 |
$18.93 |
- |
- |
- |
|
90935 |
- |
- |
$56.25 |
- |
- |
|
90937 |
- |
- |
$80.36 |
- |
- |
|
90940 |
- |
- |
I.C. |
- |
- |
|
90945 |
- |
- |
$66.48 |
- |
- |
|
90947 |
- |
- |
$95.74 |
- |
- |
|
90951 |
- |
- |
$720.32 |
- |
- |
|
90952 |
- |
- |
I.C. |
- |
- |
|
90953 |
- |
- |
I.C. |
- |
- |
|
90954 |
- |
- |
$624.95 |
- |
- |
|
90955 |
- |
- |
$352.86 |
- |
- |
|
90956 |
- |
- |
$246.03 |
- |
- |
|
90957 |
- |
- |
$496.14 |
- |
- |
|
90958 |
- |
- |
$337.49 |
- |
- |
|
90959 |
- |
- |
$228.72 |
- |
- |
|
90960 |
- |
- |
$219.78 |
- |
- |
|
90961 |
- |
- |
$184.88 |
- |
- |
|
90962 |
- |
- |
$142.99 |
- |
- |
|
90963 |
- |
- |
$419.27 |
- |
- |
|
90964 |
- |
- |
$366.89 |
- |
- |
|
90965 |
- |
- |
$350.74 |
- |
- |
|
90966 |
- |
- |
$184.59 |
- |
- |
|
90967 |
- |
- |
$13.83 |
- |
- |
|
90968 |
- |
- |
$12.22 |
- |
- |
|
90969 |
- |
- |
$11.66 |
- |
- |
|
90970 |
- |
- |
$6.28 |
- |
- |
|
90989 |
- |
- |
I.C. |
- |
- |
|
90993 |
- |
- |
I.C. |
- |
- |
|
90997 |
- |
- |
$69.18 |
- |
- |
|
90999 |
- |
- |
I.C. |
- |
- |
|
91010 |
- |
- |
$161.70 |
$51.37 |
$110.34 |
|
91013 |
- |
- |
$20.67 |
$7.34 |
$13.33 |
|
91020 |
- |
- |
$209.18 |
$57.68 |
$151.49 |
|
91022 |
- |
- |
$134.40 |
$57.68 |
$76.72 |
|
91030 |
- |
- |
$111.74 |
$36.47 |
$75.27 |
|
91034 |
- |
- |
$154.10 |
$39.08 |
$115.02 |
|
91035 |
- |
- |
$392.92 |
$64.29 |
$328.63 |
|
91037 |
- |
- |
$133.86 |
$38.84 |
$95.02 |
|
91038 |
- |
- |
$357.87 |
$44.03 |
$313.85 |
|
91040 |
- |
- |
$414.58 |
$39.57 |
$375.00 |
|
91065 |
- |
- |
$64.92 |
$7.87 |
$57.05 |
|
91110 |
- |
- |
$699.77 |
$99.56 |
$600.20 |
|
91111 |
- |
- |
$671.43 |
$40.22 |
$631.22 |
|
91112 |
- |
- |
$1,182.47 |
$84.04 |
$1,098.43 |
|
91117 |
- |
- |
$106.92 |
- |
- |
|
91120 |
- |
- |
$397.03 |
$38.26 |
$358.77 |
|
91122 |
- |
- |
$201.81 |
$69.16 |
$132.65 |
|
91132 |
- |
- |
$264.08 |
$20.95 |
$243.13 |
|
91133 |
- |
- |
$282.86 |
$26.40 |
$256.46 |
|
91200 |
- |
- |
$29.68 |
$10.89 |
$18.79 |
|
91299 |
- |
- |
I.C. |
- |
- |
|
91300 |
- |
- |
I.C. |
- |
- |
|
91301 |
- |
- |
I.C. |
- |
- |
|
92002 |
$66.44 |
$36.59 |
- |
- |
- |
|
92004 |
$117.91 |
$75.59 |
- |
- |
- |
|
92012 |
$69.78 |
$40.21 |
- |
- |
- |
|
92014 |
$99.18 |
$60.92 |
- |
- |
- |
|
92018 |
- |
- |
$111.04 |
- |
- |
|
92019 |
- |
- |
$56.55 |
- |
- |
|
92020 |
$21.65 |
$16.15 |
- |
- |
- |
|
92025 |
- |
- |
$29.19 |
$15.33 |
$13.87 |
|
92060 |
- |
- |
$50.10 |
$29.27 |
$20.82 |
|
92065 |
- |
- |
$42.19 |
$13.83 |
$28.36 |
|
92071 |
$29.13 |
$25.66 |
- |
- |
- |
|
92072 |
$99.95 |
$75.02 |
- |
- |
- |
|
92081 |
- |
- |
$26.71 |
$12.55 |
$14.16 |
|
92082 |
- |
- |
$37.77 |
$16.65 |
$21.11 |
|
92083 |
- |
- |
$50.27 |
$21.33 |
$28.94 |
|
92100 |
$65.94 |
$25.66 |
- |
- |
- |
|
92132 |
- |
- |
$24.97 |
$12.84 |
$12.13 |
|
92133 |
- |
- |
$29.36 |
$17.23 |
$12.13 |
|
92134 |
- |
- |
$32.14 |
$19.72 |
$12.42 |
|
92136 |
- |
- |
$49.60 |
$24.13 |
$25.46 |
|
92145 |
- |
- |
$11.84 |
$6.09 |
$5.75 |
|
92201 |
$19.51 |
$17.77 |
- |
- |
- |
|
92202 |
$12.36 |
$11.49 |
- |
- |
- |
|
92227 |
- |
- |
$10.97 |
- |
- |
|
92228 |
- |
- |
$26.83 |
$16.15 |
$10.68 |
|
92229 |
- |
- |
I.C. |
- |
- |
|
92230 |
$61.58 |
$25.93 |
- |
- |
- |
|
92235 |
- |
- |
$82.99 |
$33.47 |
$49.52 |
|
92240 |
- |
- |
$162.68 |
$36.65 |
$126.03 |
|
92242 |
- |
- |
$192.06 |
$42.26 |
$149.80 |
|
92250 |
- |
- |
$35.74 |
$16.65 |
$19.08 |
|
92260 |
$15.40 |
$8.45 |
- |
- |
- |
|
92265 |
- |
- |
$68.93 |
$36.22 |
$32.71 |
|
92270 |
- |
- |
$76.96 |
$32.95 |
$44.01 |
|
92273 |
- |
- |
$104.83 |
$28.69 |
$76.14 |
|
92274 |
- |
- |
$70.58 |
$25.41 |
$45.17 |
|
92283 |
- |
- |
$42.68 |
$7.07 |
$35.60 |
|
92284 |
- |
- |
$47.97 |
$9.80 |
$38.17 |
|
92285 |
- |
- |
$17.76 |
$2.44 |
$15.32 |
|
92286 |
- |
- |
$30.81 |
$17.23 |
$13.58 |
|
92287 |
- |
- |
$123.66 |
$36.22 |
$87.44 |
|
92310 |
$79.61 |
$46.28 |
- |
- |
- |
|
92311 |
$82.76 |
$41.89 |
- |
- |
- |
|
92312 |
$95.94 |
$48.12 |
- |
- |
- |
|
92313 |
$77.98 |
$34.51 |
- |
- |
- |
|
92314 |
$68.47 |
$27.60 |
- |
- |
- |
|
92315 |
$63.19 |
$16.53 |
- |
- |
- |
|
92316 |
$78.28 |
$24.95 |
- |
- |
- |
|
92317 |
$66.09 |
$16.53 |
- |
- |
- |
|
92325 |
- |
- |
$36.18 |
- |
- |
|
92326 |
- |
- |
$30.68 |
- |
- |
|
92352 |
$34.90 |
$14.61 |
- |
- |
- |
|
92353 |
$40.28 |
$19.99 |
- |
- |
- |
|
92354 |
- |
- |
$10.68 |
- |
- |
|
92355 |
- |
- |
$16.72 |
- |
- |
|
92358 |
- |
- |
$8.94 |
- |
- |
|
92371 |
- |
- |
$9.23 |
- |
- |
|
92499 |
- |
- |
I.C. |
- |
- |
|
92502 |
- |
- |
$73.85 |
- |
- |
|
92504 |
$23.28 |
$7.34 |
- |
- |
- |
|
92507 |
- |
- |
$61.80 |
- |
- |
|
92508 |
- |
- |
$18.85 |
- |
- |
|
92511 |
$90.44 |
$29.58 |
- |
- |
- |
|
92512 |
$47.41 |
$21.90 |
- |
- |
- |
|
92516 |
$55.04 |
$17.65 |
- |
- |
- |
|
92517 |
$70.51 |
$34.42 |
- |
- |
- |
|
92518 |
$65.56 |
$34.42 |
- |
- |
- |
|
92519 |
$109.62 |
$51.71 |
- |
- |
- |
|
92520 |
$64.02 |
$31.84 |
- |
- |
- |
|
92521 |
- |
- |
$88.38 |
- |
- |
|
92522 |
- |
- |
$71.89 |
- |
- |
|
92523 |
- |
- |
$151.55 |
- |
- |
|
92524 |
- |
- |
$70.15 |
- |
- |
|
92526 |
- |
- |
$68.36 |
- |
- |
|
92531 |
- |
- |
I.C. |
- |
- |
|
92532 |
- |
- |
I.C. |
- |
- |
|
92533 |
- |
- |
I.C. |
- |
- |
|
92534 |
- |
- |
I.C. |
- |
- |
|
92537 |
- |
- |
$32.64 |
$24.57 |
$8.07 |
|
92538 |
- |
- |
$17.72 |
$12.55 |
$5.17 |
|
92540 |
- |
- |
$84.16 |
$61.59 |
$22.56 |
|
92541 |
- |
- |
$19.80 |
$16.36 |
$3.43 |
|
92542 |
- |
- |
$23.08 |
$19.64 |
$3.43 |
|
92544 |
- |
- |
$13.74 |
$11.18 |
$2.56 |
|
92545 |
- |
- |
$12.92 |
$10.35 |
$2.56 |
|
92546 |
- |
- |
$90.45 |
$11.71 |
$78.75 |
|
92547 |
- |
- |
$6.96 |
- |
- |
|
92548 |
- |
- |
$39.09 |
$26.96 |
$12.13 |
|
92549 |
- |
- |
$49.90 |
$34.87 |
$15.03 |
|
92550 |
- |
- |
$17.31 |
- |
- |
|
92551 |
- |
- |
$9.52 |
- |
- |
|
92552 |
- |
- |
$25.75 |
- |
- |
|
92553 |
- |
- |
$31.26 |
- |
- |
|
92555 |
- |
- |
$19.37 |
- |
- |
|
92556 |
- |
- |
$30.97 |
- |
- |
|
92557 |
$29.69 |
$25.35 |
- |
- |
- |
|
92558 |
$7.65 |
$6.78 |
- |
- |
- |
|
92559 |
- |
- |
I.C. |
- |
- |
|
92560 |
- |
- |
I.C. |
- |
- |
|
92561 |
- |
- |
$31.79 |
- |
- |
|
92562 |
- |
- |
$36.18 |
- |
- |
|
92563 |
- |
- |
$24.88 |
- |
- |
|
92564 |
- |
- |
$19.37 |
- |
- |
|
92565 |
- |
- |
$12.71 |
- |
- |
|
92567 |
$12.51 |
$8.45 |
- |
- |
- |
|
92568 |
$12.24 |
$11.95 |
- |
- |
- |
|
92570 |
$25.76 |
$23.15 |
- |
- |
- |
|
92571 |
- |
- |
$21.98 |
- |
- |
|
92572 |
- |
- |
$28.31 |
- |
- |
|
92575 |
- |
- |
$53.24 |
- |
- |
|
92576 |
- |
- |
$29.52 |
- |
- |
|
92577 |
- |
- |
$11.26 |
- |
- |
|
92579 |
$36.40 |
$29.74 |
- |
- |
- |
|
92582 |
- |
- |
$59.91 |
- |
- |
|
92583 |
- |
- |
$39.37 |
- |
- |
|
92584 |
- |
- |
$60.20 |
- |
- |
|
92585 |
- |
- |
$109.31 |
$20.71 |
$88.60 |
|
92587 |
- |
- |
$17.31 |
$14.46 |
$2.85 |
|
92588 |
- |
- |
$26.38 |
$22.66 |
$3.72 |
|
92596 |
- |
- |
$53.28 |
- |
- |
|
92597 |
- |
- |
$56.92 |
- |
- |
|
92601 |
$131.04 |
$98.00 |
- |
- |
- |
|
92602 |
$82.37 |
$55.42 |
- |
- |
- |
|
92603 |
$121.89 |
$94.93 |
- |
- |
- |
|
92604 |
$73.22 |
$52.93 |
- |
- |
- |
|
92605 |
$73.37 |
$69.03 |
- |
- |
- |
|
92606 |
$65.34 |
$55.48 |
- |
- |
- |
|
92607 |
- |
- |
$101.18 |
- |
- |
|
92608 |
- |
- |
$40.75 |
- |
- |
|
92609 |
- |
- |
$85.32 |
- |
- |
|
92610 |
$68.13 |
$56.53 |
- |
- |
- |
|
92611 |
- |
- |
$72.24 |
- |
- |
|
92612 |
$160.86 |
$53.04 |
- |
- |
- |
|
92613 |
- |
- |
$29.33 |
- |
- |
|
92614 |
$118.79 |
$51.83 |
- |
- |
- |
|
92615 |
- |
- |
$25.76 |
- |
- |
|
92616 |
$172.85 |
$77.49 |
- |
- |
- |
|
92617 |
- |
- |
$32.04 |
- |
- |
|
92618 |
$26.00 |
$25.71 |
- |
- |
- |
|
92620 |
$73.43 |
$63.58 |
- |
- |
- |
|
92621 |
$17.65 |
$14.75 |
- |
- |
- |
|
92625 |
$54.92 |
$48.54 |
- |
- |
- |
|
92626 |
$70.54 |
$59.23 |
- |
- |
- |
|
92627 |
$16.82 |
$13.93 |
- |
- |
- |
|
92630 |
- |
- |
I.C. |
- |
- |
|
92633 |
- |
- |
I.C. |
- |
- |
|
92640 |
$89.32 |
$74.82 |
- |
- |
- |
|
92650 |
- |
- |
$23.40 |
- |
- |
|
92651 |
- |
- |
$73.44 |
- |
- |
|
92652 |
- |
- |
$95.50 |
- |
- |
|
92653 |
- |
- |
$70.12 |
- |
- |
|
92700 |
- |
- |
I.C. |
- |
- |
|
92920 |
- |
- |
$412.71 |
- |
- |
|
92921 |
- |
- |
I.C. |
- |
- |
|
92924 |
- |
- |
$491.92 |
- |
- |
|
92925 |
- |
- |
I.C. |
- |
- |
|
92928 |
- |
- |
$459.00 |
- |
- |
|
92929 |
- |
- |
I.C. |
- |
- |
|
92933 |
- |
- |
$515.16 |
- |
- |
|
92934 |
- |
- |
I.C. |
- |
- |
|
92937 |
- |
- |
$458.44 |
- |
- |
|
92938 |
- |
- |
I.C. |
- |
- |
|
92941 |
- |
- |
$516.02 |
- |
- |
|
92943 |
- |
- |
$516.02 |
- |
- |
|
92944 |
- |
- |
I.C. |
- |
- |
|
92950 |
$253.91 |
$143.77 |
- |
- |
- |
|
92953 |
- |
- |
$0.80 |
- |
- |
|
92960 |
$125.22 |
$84.93 |
- |
- |
- |
|
92961 |
- |
- |
$192.96 |
- |
- |
|
92970 |
- |
- |
$146.94 |
- |
- |
|
92971 |
- |
- |
$78.28 |
- |
- |
|
92973 |
- |
- |
$137.10 |
- |
- |
|
92974 |
- |
- |
$125.39 |
- |
- |
|
92975 |
- |
- |
$292.73 |
- |
- |
|
92977 |
- |
- |
$43.27 |
- |
- |
|
92978 |
- |
- |
- |
$73.55 |
- |
|
92979 |
- |
- |
- |
$59.30 |
- |
|
92986 |
- |
- |
$1,028.64 |
- |
- |
|
92987 |
- |
- |
$1,060.97 |
- |
- |
|
92990 |
- |
- |
$848.38 |
- |
- |
|
92997 |
- |
- |
$496.57 |
- |
- |
|
92998 |
- |
- |
$250.87 |
- |
- |
|
93000 |
- |
- |
$13.40 |
- |
- |
|
93005 |
- |
- |
$6.91 |
- |
- |
|
93010 |
- |
- |
$6.49 |
- |
- |
|
93015 |
- |
- |
$55.95 |
- |
- |
|
93016 |
- |
- |
$17.06 |
- |
- |
|
93017 |
- |
- |
$27.49 |
- |
- |
|
93018 |
- |
- |
$11.39 |
- |
- |
|
93024 |
- |
- |
$86.66 |
$44.15 |
$42.52 |
|
93025 |
- |
- |
$113.33 |
$28.50 |
$84.83 |
|
93040 |
- |
- |
$9.98 |
- |
- |
|
93041 |
- |
- |
$4.59 |
- |
- |
|
93042 |
- |
- |
$5.38 |
- |
- |
|
93050 |
- |
- |
$12.82 |
$6.49 |
$6.33 |
|
93224 |
- |
- |
$70.71 |
- |
- |
|
93225 |
- |
- |
$20.82 |
- |
- |
|
93226 |
- |
- |
$29.52 |
- |
- |
|
93227 |
- |
- |
$20.37 |
- |
- |
|
93228 |
- |
- |
$20.53 |
- |
- |
|
93229 |
- |
- |
$574.38 |
- |
- |
|
93241 |
- |
- |
I.C. |
- |
- |
|
93242 |
- |
- |
$12.73 |
- |
- |
|
93243 |
- |
- |
I.C. |
- |
- |
|
93244 |
- |
- |
$19.30 |
- |
- |
|
93245 |
- |
- |
I.C. |
- |
- |
|
93246 |
- |
- |
$12.73 |
- |
- |
|
93247 |
- |
- |
I.C |
- |
- |
|
93248 |
- |
- |
$21.21 |
- |
- |
|
93260 |
- |
- |
$56.86 |
$33.43 |
$23.43 |
|
93261 |
- |
- |
$52.25 |
$28.82 |
$23.43 |
|
93264 |
$39.50 |
$27.91 |
- |
- |
- |
|
93268 |
- |
- |
$162.01 |
- |
- |
|
93270 |
- |
- |
$7.20 |
- |
- |
|
93271 |
- |
- |
$135.31 |
- |
- |
|
93272 |
- |
- |
$19.50 |
- |
- |
|
93278 |
- |
- |
$23.93 |
$9.78 |
$14.16 |
|
93279 |
- |
- |
$48.12 |
$24.98 |
$23.14 |
|
93280 |
- |
- |
$56.77 |
$29.86 |
$26.91 |
|
93281 |
- |
- |
$60.63 |
$33.14 |
$27.49 |
|
93282 |
- |
- |
$58.02 |
$33.14 |
$24.88 |
|
93283 |
- |
- |
$72.26 |
$45.06 |
$27.20 |
|
93284 |
- |
- |
$78.10 |
$48.88 |
$29.23 |
|
93285 |
- |
- |
$42.64 |
$20.37 |
$22.27 |
|
93286 |
- |
- |
$32.21 |
$11.97 |
$20.24 |
|
93287 |
- |
- |
$38.18 |
$17.93 |
$20.24 |
|
93288 |
- |
- |
$39.14 |
$16.29 |
$22.85 |
|
93289 |
- |
- |
$52.18 |
$29.04 |
$23.14 |
|
93290 |
- |
- |
$37.65 |
$16.82 |
$20.82 |
|
93291 |
- |
- |
$34.36 |
$14.41 |
$19.95 |
|
93292 |
- |
- |
$35.62 |
$16.53 |
$19.08 |
|
93293 |
- |
- |
$41.46 |
$11.66 |
$29.81 |
|
93294 |
- |
- |
$24.10 |
- |
- |
|
93295 |
- |
- |
$29.55 |
- |
- |
|
93296 |
- |
- |
$20.82 |
- |
- |
|
93297 |
- |
- |
$20.82 |
- |
- |
|
93298 |
- |
- |
$21.11 |
- |
- |
|
93303 |
- |
- |
$187.20 |
$49.04 |
$138.16 |
|
93304 |
- |
- |
$128.94 |
$28.17 |
$100.77 |
|
93306 |
- |
- |
$165.85 |
$56.38 |
$109.47 |
|
93307 |
- |
- |
$113.16 |
$34.71 |
$78.46 |
|
93308 |
- |
- |
$79.43 |
$19.77 |
$59.66 |
|
93312 |
- |
- |
$195.58 |
$84.38 |
$111.21 |
|
93313 |
- |
- |
$8.84 |
- |
- |
|
93314 |
- |
- |
$188.30 |
$69.85 |
$118.45 |
|
93315 |
- |
- |
- |
$99.36 |
$386.60 |
|
93316 |
- |
- |
$20.91 |
- |
- |
|
93317 |
- |
- |
- |
$70.63 |
- |
|
93318 |
- |
- |
- |
$80.26 |
$386.60 |
|
93320 |
- |
- |
$42.74 |
$14.09 |
$28.65 |
|
93321 |
- |
- |
$21.32 |
$5.67 |
$15.65 |
|
93325 |
- |
- |
$20.12 |
$2.44 |
$17.68 |
|
93350 |
- |
- |
$151.45 |
$54.74 |
$96.71 |
|
93351 |
- |
- |
$187.46 |
$65.57 |
$121.89 |
|
93352 |
- |
- |
$26.98 |
- |
- |
|
93355 |
- |
- |
$177.83 |
- |
- |
|
93356 |
$32.07 |
$9.17 |
- |
- |
- |
|
93451 |
- |
- |
$685.68 |
$102.09 |
$583.59 |
|
93452 |
- |
- |
$736.13 |
$183.93 |
$552.20 |
|
93453 |
- |
- |
$947.91 |
$246.16 |
$701.76 |
|
93454 |
- |
- |
$737.63 |
$186.01 |
$551.62 |
|
93455 |
- |
- |
$837.76 |
$216.58 |
$621.18 |
|
93456 |
- |
- |
$933.15 |
$242.12 |
$691.03 |
|
93457 |
- |
- |
$1,032.88 |
$273.16 |
$759.72 |
|
93458 |
- |
- |
$862.77 |
$229.70 |
$633.07 |
|
93459 |
- |
- |
$938.26 |
$260.27 |
$677.99 |
|
93460 |
- |
- |
$1,038.15 |
$291.18 |
$746.97 |
|
93461 |
- |
- |
$1,162.33 |
$322.04 |
$840.30 |
|
93462 |
- |
- |
$163.99 |
- |
- |
|
93463 |
- |
- |
$76.24 |
- |
- |
|
93464 |
- |
- |
$194.83 |
$68.79 |
$126.03 |
|
93503 |
- |
- |
$68.19 |
- |
- |
|
93505 |
- |
- |
$570.68 |
$173.69 |
$396.98 |
|
93530 |
- |
- |
- |
$158.82 |
- |
|
93531 |
- |
- |
- |
$329.88 |
- |
|
93532 |
- |
- |
- |
$410.11 |
- |
|
93533 |
- |
- |
- |
$274.68 |
- |
|
93561 |
- |
- |
- |
$35.50 |
- |
|
93562 |
- |
- |
- |
$28.70 |
- |
|
93563 |
- |
- |
$44.87 |
- |
- |
|
93564 |
- |
- |
$47.64 |
- |
- |
|
93565 |
- |
- |
$34.69 |
- |
- |
|
93566 |
$118.23 |
$35.91 |
- |
- |
- |
|
93567 |
$99.52 |
$40.97 |
- |
- |
- |
|
93568 |
$108.32 |
$36.74 |
- |
- |
- |
|
93571 |
- |
- |
- |
$56.88 |
- |
|
93572 |
- |
- |
- |
$41.08 |
- |
|
93580 |
- |
- |
$758.40 |
- |
- |
|
93581 |
- |
- |
$1,032.09 |
- |
- |
|
93582 |
- |
- |
$516.38 |
- |
- |
|
93583 |
- |
- |
$577.42 |
- |
- |
|
93590 |
- |
- |
$844.76 |
- |
- |
|
93591 |
- |
- |
$700.45 |
- |
- |
|
93592 |
- |
- |
$307.58 |
- |
- |
|
93600 |
- |
- |
- |
$92.98 |
- |
|
93602 |
- |
- |
- |
$91.00 |
- |
|
93603 |
- |
- |
- |
$91.00 |
- |
|
93609 |
- |
- |
- |
$216.87 |
- |
|
93610 |
- |
- |
- |
$127.53 |
- |
|
93612 |
- |
- |
- |
$126.22 |
- |
|
93613 |
- |
- |
$232.06 |
- |
- |
|
93615 |
- |
- |
- |
$29.69 |
- |
|
93616 |
- |
- |
- |
$46.58 |
- |
|
93618 |
- |
- |
- |
$171.96 |
- |
|
93619 |
- |
- |
- |
$305.19 |
- |
|
93620 |
- |
- |
- |
$489.17 |
- |
|
93621 |
- |
- |
- |
$91.58 |
- |
|
93622 |
- |
- |
- |
$134.11 |
- |
|
93623 |
- |
- |
- |
$123.65 |
- |
|
93624 |
- |
- |
- |
$186.68 |
- |
|
93631 |
- |
- |
- |
$306.53 |
- |
|
93640 |
- |
- |
- |
$139.14 |
- |
|
93641 |
- |
- |
- |
$243.64 |
- |
|
93642 |
- |
- |
$266.09 |
$199.23 |
$66.86 |
|
93644 |
- |
- |
$155.26 |
$112.99 |
$42.27 |
|
93650 |
- |
- |
$462.27 |
- |
- |
|
93653 |
- |
- |
$653.09 |
- |
- |
|
93654 |
- |
- |
$874.59 |
- |
- |
|
93655 |
- |
- |
$333.12 |
- |
- |
|
93656 |
- |
- |
$877.15 |
- |
- |
|
93657 |
- |
- |
$332.83 |
- |
- |
|
93660 |
- |
- |
$125.38 |
$72.48 |
$52.90 |
|
93662 |
- |
- |
- |
$110.97 |
- |
|
93668 |
- |
- |
$12.66 |
- |
- |
|
93701 |
- |
- |
$21.40 |
- |
- |
|
93702 |
- |
- |
$112.95 |
- |
- |
|
93724 |
- |
- |
$220.28 |
$189.02 |
$31.26 |
|
93740 |
- |
- |
$6.23 |
- |
- |
|
93745 |
- |
- |
I.C. |
- |
- |
|
93750 |
$44.78 |
$37.24 |
- |
- |
- |
|
93770 |
- |
- |
$6.23 |
- |
- |
|
93784 |
- |
- |
$36.90 |
- |
- |
|
93786 |
- |
- |
$18.50 |
- |
- |
|
93788 |
- |
- |
$4.01 |
- |
- |
|
93790 |
- |
- |
$14.38 |
- |
- |
|
93792 |
- |
- |
$53.19 |
- |
- |
|
93793 |
- |
- |
$9.08 |
- |
- |
|
93797 |
$12.85 |
$6.76 |
- |
- |
- |
|
93798 |
$20.09 |
$10.82 |
- |
- |
- |
|
93799 |
- |
- |
I.C. |
- |
- |
|
93880 |
- |
- |
$161.14 |
$30.52 |
$130.63 |
|
93882 |
- |
- |
$103.82 |
$19.28 |
$84.54 |
|
93886 |
- |
- |
$220.58 |
$36.62 |
$183.96 |
|
93888 |
- |
- |
$110.33 |
$20.28 |
$90.05 |
|
93890 |
- |
- |
$223.88 |
$39.93 |
$183.96 |
|
93892 |
- |
- |
$136.18 |
$46.38 |
$89.80 |
|
93893 |
- |
- |
$136.27 |
$46.47 |
$89.80 |
|
93895 |
- |
- |
I.C. |
- |
- |
|
93922 |
- |
- |
$68.77 |
$9.69 |
$59.08 |
|
93923 |
- |
- |
$106.98 |
$16.93 |
$90.05 |
|
93924 |
- |
- |
$132.36 |
$18.84 |
$113.53 |
|
93925 |
- |
- |
$205.44 |
$29.94 |
$175.50 |
|
93926 |
- |
- |
$108.59 |
$18.55 |
$90.05 |
|
93930 |
- |
- |
$166.51 |
$30.67 |
$135.84 |
|
93931 |
- |
- |
$103.96 |
$18.84 |
$85.12 |
|
93970 |
- |
- |
$157.62 |
$26.41 |
$131.21 |
|
93971 |
- |
- |
$98.42 |
$17.02 |
$81.40 |
|
93975 |
- |
- |
$223.55 |
$43.99 |
$179.56 |
|
93976 |
- |
- |
$120.61 |
$30.56 |
$90.05 |
|
93978 |
- |
- |
$151.73 |
$30.09 |
$121.64 |
|
93979 |
- |
- |
$97.54 |
$18.79 |
$78.75 |
|
93980 |
- |
- |
$96.94 |
$47.43 |
$49.52 |
|
93981 |
- |
- |
$59.07 |
$16.51 |
$42.56 |
|
93985 |
- |
- |
$215.74 |
$29.51 |
$186.23 |
|
93986 |
- |
- |
$109.04 |
$18.99 |
$90.05 |
|
93990 |
- |
- |
$108.99 |
$18.94 |
$90.05 |
|
93998 |
- |
- |
I.C. |
- |
- |
|
94002 |
- |
- |
$70.66 |
- |
- |
|
94003 |
- |
- |
$51.21 |
- |
- |
|
94004 |
- |
- |
$38.01 |
- |
- |
|
94005 |
- |
- |
$72.05 |
- |
- |
|
94010 |
- |
- |
$28.48 |
$6.49 |
$21.98 |
|
94011 |
- |
- |
$66.51 |
- |
- |
|
94012 |
- |
- |
$108.42 |
- |
- |
|
94013 |
- |
- |
$14.80 |
- |
- |
|
94014 |
- |
- |
$44.38 |
- |
- |
|
94015 |
- |
- |
$24.88 |
- |
- |
|
94016 |
- |
- |
$19.50 |
- |
- |
|
94060 |
- |
- |
$47.60 |
$10.02 |
$37.59 |
|
94070 |
- |
- |
$46.79 |
$21.91 |
$24.88 |
|
94150 |
- |
- |
$20.32 |
$2.97 |
$17.35 |
|
94200 |
- |
- |
$18.05 |
$3.60 |
$14.45 |
|
94375 |
- |
- |
$31.03 |
$11.37 |
$19.66 |
|
94450 |
- |
- |
$53.33 |
$14.58 |
$38.75 |
|
94452 |
- |
- |
$42.04 |
$11.08 |
$30.97 |
|
94453 |
- |
- |
$57.72 |
$14.58 |
$43.14 |
|
94610 |
- |
- |
$42.83 |
- |
- |
|
94617 |
- |
- |
$72.83 |
$25.68 |
$47.15 |
|
94618 |
- |
- |
$26.22 |
$17.57 |
$8.65 |
|
94619 |
- |
- |
$60.49 |
$18.45 |
$42.04 |
|
94621 |
- |
- |
$126.44 |
$53.83 |
$72.61 |
|
94640 |
- |
- |
$14.45 |
- |
- |
|
94642 |
- |
- |
I.C. |
- |
- |
|
94644 |
- |
- |
$43.72 |
- |
- |
|
94645 |
- |
- |
$13.58 |
- |
- |
|
94660 |
$50.32 |
$29.46 |
- |
- |
- |
|
94662 |
- |
- |
$27.72 |
- |
- |
|
94664 |
- |
- |
$13.58 |
- |
- |
|
94667 |
- |
- |
$20.20 |
- |
- |
|
94668 |
- |
- |
$23.39 |
- |
- |
|
94669 |
- |
- |
$23.97 |
- |
- |
|
94680 |
- |
- |
$43.04 |
$9.75 |
$33.29 |
|
94681 |
- |
- |
$42.60 |
$7.87 |
$34.74 |
|
94690 |
- |
- |
$41.18 |
$2.97 |
$38.21 |
|
94726 |
- |
- |
$43.04 |
$9.46 |
$33.58 |
|
94727 |
- |
- |
$34.92 |
$9.46 |
$25.46 |
|
94728 |
- |
- |
$32.60 |
$9.75 |
$22.85 |
|
94729 |
- |
- |
$45.53 |
$7.02 |
$38.50 |
|
94760 |
- |
- |
$1.98 |
- |
- |
|
94761 |
- |
- |
$3.14 |
- |
- |
|
94762 |
- |
- |
$21.40 |
- |
- |
|
94772 |
- |
- |
I.C. |
- |
- |
|
94774 |
- |
- |
I.C. |
- |
- |
|
94775 |
- |
- |
I.C. |
- |
- |
|
94776 |
- |
- |
I.C. |
- |
- |
|
94777 |
- |
- |
I.C. |
- |
- |
|
94780 |
$40.13 |
$18.40 |
- |
- |
- |
|
94781 |
$15.77 |
$6.49 |
- |
- |
- |
|
94799 |
- |
- |
I.C. |
- |
- |
|
95004 |
- |
- |
$3.41 |
- |
- |
|
95012 |
- |
- |
$16.19 |
- |
- |
|
95017 |
$6.74 |
$2.97 |
- |
- |
- |
|
95018 |
$17.00 |
$5.41 |
- |
- |
- |
|
95024 |
$6.60 |
$0.80 |
- |
- |
- |
|
95027 |
- |
- |
$3.99 |
- |
- |
|
95028 |
- |
- |
$10.39 |
- |
- |
|
95044 |
- |
- |
$4.30 |
- |
- |
|
95052 |
- |
- |
$5.17 |
- |
- |
|
95056 |
- |
- |
$37.92 |
- |
- |
|
95060 |
- |
- |
$28.65 |
- |
- |
|
95065 |
- |
- |
$21.11 |
- |
- |
|
95070 |
- |
- |
$26.86 |
- |
- |
|
95076 |
$93.72 |
$57.78 |
- |
- |
- |
|
95079 |
$65.95 |
$53.19 |
- |
- |
- |
|
95115 |
- |
- |
$7.49 |
- |
- |
|
95117 |
- |
- |
$8.65 |
- |
- |
|
95120 |
- |
- |
I.C. |
- |
- |
|
95125 |
- |
- |
I.C. |
- |
- |
|
95130 |
- |
- |
I.C. |
- |
- |
|
95131 |
- |
- |
I.C. |
- |
- |
|
95132 |
- |
- |
I.C. |
- |
- |
|
95133 |
- |
- |
I.C. |
- |
- |
|
95134 |
- |
- |
I.C. |
- |
- |
|
95144 |
$11.98 |
$2.42 |
- |
- |
- |
|
95145 |
$25.02 |
$2.42 |
- |
- |
- |
|
95146 |
$46.18 |
$2.42 |
- |
- |
- |
|
95147 |
$46.47 |
$2.42 |
- |
- |
- |
|
95148 |
$67.92 |
$2.42 |
- |
- |
- |
|
95149 |
$90.24 |
$2.42 |
- |
- |
- |
|
95165 |
$11.69 |
$2.42 |
- |
- |
- |
|
95170 |
$8.79 |
$2.42 |
- |
- |
- |
|
95180 |
$106.83 |
$80.16 |
- |
- |
- |
|
95199 |
- |
- |
I.C. |
- |
- |
|
95249 |
- |
- |
$44.50 |
- |
- |
|
95250 |
- |
- |
$122.37 |
- |
- |
|
95251 |
- |
- |
$27.62 |
- |
- |
|
95700 |
- |
- |
I.C. |
- |
- |
|
95705 |
- |
- |
I.C. |
- |
- |
|
95706 |
- |
- |
I.C. |
- |
- |
|
95707 |
- |
- |
I.C. |
- |
- |
|
95708 |
- |
- |
I.C. |
- |
- |
|
95709 |
- |
- |
I.C. |
- |
- |
|
95710 |
- |
- |
I.C. |
- |
- |
|
95711 |
- |
- |
I.C. |
- |
- |
|
95712 |
- |
- |
I.C. |
- |
- |
|
95713 |
- |
- |
I.C. |
- |
- |
|
95714 |
- |
- |
I.C. |
- |
- |
|
95715 |
- |
- |
I.C. |
- |
- |
|
95716 |
- |
- |
I.C. |
- |
- |
|
95717 |
$79.76 |
$78.60 |
- |
- |
- |
|
95718 |
$105.22 |
$103.48 |
- |
- |
- |
|
95719 |
$123.56 |
$122.11 |
- |
- |
- |
|
95720 |
$162.87 |
$160.26 |
- |
- |
- |
|
95721 |
$164.32 |
$160.84 |
- |
- |
- |
|
95722 |
$199.33 |
$195.56 |
- |
- |
- |
|
95723 |
$203.76 |
$199.12 |
- |
- |
- |
|
95724 |
$254.57 |
$249.35 |
- |
- |
- |
|
95725 |
$232.66 |
$226.57 |
- |
- |
- |
|
95726 |
$321.74 |
$315.07 |
- |
- |
- |
|
95782 |
- |
- |
$731.14 |
$97.26 |
$633.88 |
|
95783 |
- |
- |
$777.11 |
$105.68 |
$671.43 |
|
95800 |
- |
- |
$133.38 |
$31.98 |
$101.40 |
|
95801 |
- |
- |
$70.77 |
$31.98 |
$38.79 |
|
95803 |
- |
- |
$119.92 |
$34.46 |
$85.46 |
|
95805 |
- |
- |
$335.82 |
$45.52 |
$290.30 |
|
95806 |
- |
- |
$93.18 |
$34.68 |
$58.50 |
|
95807 |
- |
- |
$329.25 |
$47.35 |
$281.89 |
|
95808 |
- |
- |
$528.93 |
$67.63 |
$461.30 |
|
95810 |
- |
- |
$491.77 |
$93.45 |
$398.32 |
|
95811 |
- |
- |
$513.84 |
$96.97 |
$416.87 |
|
95812 |
- |
- |
$266.24 |
$44.66 |
$221.59 |
|
95813 |
- |
- |
$330.17 |
$67.81 |
$262.37 |
|
95816 |
- |
- |
$295.52 |
$44.66 |
$250.86 |
|
95819 |
- |
- |
$351.37 |
$44.95 |
$306.42 |
|
95822 |
- |
- |
$318.33 |
$44.95 |
$273.38 |
|
95824 |
- |
- |
- |
$30.51 |
- |
|
95829 |
- |
- |
$1,516.06 |
$261.73 |
$1,254.34 |
|
95830 |
$407.68 |
$72.05 |
- |
- |
- |
|
95836 |
- |
- |
$86.02 |
- |
- |
|
95851 |
$17.53 |
$6.23 |
- |
- |
- |
|
95852 |
$15.34 |
$4.61 |
- |
- |
- |
|
95857 |
$43.98 |
$23.40 |
- |
- |
- |
|
95860 |
- |
- |
$95.92 |
$40.60 |
$55.31 |
|
95861 |
- |
- |
$136.96 |
$64.26 |
$72.70 |
|
95863 |
- |
- |
$169.48 |
$77.65 |
$91.83 |
|
95864 |
- |
- |
$199.58 |
$82.82 |
$116.76 |
|
95865 |
- |
- |
$121.53 |
$65.35 |
$56.18 |
|
95866 |
- |
- |
$107.67 |
$52.06 |
$55.60 |
|
95867 |
- |
- |
$86.19 |
$33.19 |
$52.99 |
|
95868 |
- |
- |
$112.77 |
$49.05 |
$63.72 |
|
95869 |
- |
- |
$77.50 |
$15.52 |
$61.98 |
|
95870 |
- |
- |
$73.15 |
$15.52 |
$57.63 |
|
95872 |
- |
- |
$156.35 |
$118.42 |
$37.92 |
|
95873 |
- |
- |
$61.94 |
$15.57 |
$46.37 |
|
95874 |
- |
- |
$63.68 |
$15.28 |
$48.40 |
|
95875 |
- |
- |
$106.59 |
$45.77 |
$60.82 |
|
95885 |
- |
- |
$50.40 |
$14.46 |
$35.94 |
|
95886 |
- |
- |
$77.46 |
$35.72 |
$41.74 |
|
95887 |
- |
- |
$67.68 |
$29.42 |
$38.26 |
|
95905 |
- |
- |
$44.13 |
$2.15 |
$41.98 |
|
95907 |
- |
- |
$75.82 |
$41.95 |
$33.87 |
|
95908 |
- |
- |
$96.36 |
$52.35 |
$44.01 |
|
95909 |
- |
- |
$115.41 |
$62.71 |
$52.70 |
|
95910 |
- |
- |
$151.73 |
$83.95 |
$67.78 |
|
95911 |
- |
- |
$181.51 |
$103.88 |
$77.63 |
|
95912 |
- |
- |
$207.40 |
$123.72 |
$83.67 |
|
95913 |
- |
- |
$239.84 |
$146.90 |
$92.95 |
|
95921 |
- |
- |
$68.04 |
$35.04 |
$33.00 |
|
95922 |
- |
- |
$78.19 |
$37.42 |
$40.78 |
|
95923 |
- |
- |
$103.02 |
$35.53 |
$67.49 |
|
95924 |
- |
- |
$118.73 |
$68.10 |
$50.63 |
|
95925 |
- |
- |
$112.93 |
$21.73 |
$91.21 |
|
95926 |
- |
- |
$107.47 |
$21.19 |
$86.28 |
|
95927 |
- |
- |
$107.14 |
$20.90 |
$86.24 |
|
95928 |
- |
- |
$180.92 |
$62.13 |
$118.79 |
|
95929 |
- |
- |
$186.42 |
$62.13 |
$124.29 |
|
95930 |
- |
- |
$53.54 |
$14.46 |
$39.08 |
|
95933 |
- |
- |
$65.90 |
$24.50 |
$41.40 |
|
95937 |
- |
- |
$75.32 |
$26.96 |
$48.36 |
|
95938 |
- |
- |
$283.80 |
$35.92 |
$247.87 |
|
95939 |
- |
- |
$423.96 |
$92.90 |
$331.06 |
|
95940 |
- |
- |
$25.55 |
- |
- |
|
95941 |
- |
- |
I.C. |
- |
- |
|
95943 |
- |
- |
I.C. |
- |
- |
|
95954 |
- |
- |
$312.91 |
$87.40 |
$225.51 |
|
95955 |
- |
- |
$169.41 |
$41.93 |
$127.48 |
|
95957 |
- |
- |
$204.44 |
$79.94 |
$124.49 |
|
95958 |
- |
- |
$465.73 |
$176.25 |
$289.47 |
|
95961 |
- |
- |
$246.26 |
$125.49 |
$120.77 |
|
95962 |
- |
- |
$206.86 |
$134.20 |
$72.66 |
|
95965 |
- |
- |
- |
$326.90 |
- |
|
95966 |
- |
- |
- |
$165.90 |
- |
|
95967 |
- |
- |
- |
$144.95 |
- |
|
95970 |
$14.95 |
$14.66 |
- |
- |
- |
|
95971 |
$39.46 |
$31.64 |
- |
- |
- |
|
95972 |
$44.58 |
$32.12 |
- |
- |
- |
|
95976 |
$32.05 |
$31.47 |
- |
- |
- |
|
95977 |
$41.85 |
$41.27 |
- |
- |
- |
|
95980 |
- |
- |
$35.48 |
- |
- |
|
95981 |
$28.31 |
$13.82 |
- |
- |
- |
|
95982 |
$44.57 |
$28.63 |
- |
- |
- |
|
95983 |
$39.68 |
$39.10 |
- |
- |
- |
|
95984 |
$35.02 |
$34.44 |
- |
- |
- |
|
95990 |
- |
- |
$73.68 |
- |
- |
|
95991 |
$91.61 |
$31.32 |
- |
- |
- |
|
95992 |
$34.74 |
$29.24 |
- |
- |
- |
|
95999 |
- |
- |
I.C. |
- |
- |
|
96000 |
- |
- |
$72.43 |
- |
- |
|
96001 |
- |
- |
$85.63 |
- |
- |
|
96002 |
- |
- |
$17.12 |
- |
- |
|
96003 |
- |
- |
$13.25 |
- |
- |
|
96004 |
- |
- |
$87.84 |
- |
- |
|
96020 |
- |
- |
- |
$125.86 |
- |
|
96040 |
- |
- |
$37.16 |
- |
- |
|
96105 |
- |
- |
$80.22 |
- |
- |
|
96110 |
- |
- |
$10.27 |
- |
- |
|
96112 |
$105.87 |
$98.63 |
- |
- |
- |
|
96113 |
$47.31 |
$44.70 |
- |
- |
- |
|
96116 |
$75.02 |
$64.59 |
- |
- |
- |
|
96121 |
$64.67 |
$59.74 |
- |
- |
- |
|
96125 |
- |
- |
$85.31 |
- |
- |
|
96127 |
- |
- |
$10.27 |
- |
- |
|
96130 |
$91.27 |
$82.58 |
- |
- |
- |
|
96131 |
$70.14 |
$63.47 |
- |
- |
- |
|
96132 |
$102.87 |
$81.42 |
- |
- |
- |
|
96133 |
$77.14 |
$62.65 |
- |
- |
- |
|
96136 |
$37.06 |
$18.80 |
- |
- |
- |
|
96137 |
$34.14 |
$14.72 |
- |
- |
- |
|
96138 |
- |
- |
$30.97 |
- |
- |
|
96139 |
- |
- |
$30.97 |
- |
- |
|
96146 |
- |
- |
$1.69 |
- |
- |
|
96156 |
$74.72 |
$67.19 |
- |
- |
- |
|
96158 |
$50.99 |
$45.78 |
- |
- |
- |
|
96159 |
$17.81 |
$15.78 |
- |
- |
- |
|
96160 |
- |
- |
$2.03 |
- |
- |
|
96161 |
- |
- |
$2.03 |
- |
- |
|
96164 |
$7.55 |
$6.69 |
- |
- |
- |
|
96165 |
$3.52 |
$2.94 |
- |
- |
- |
|
96167 |
$54.76 |
$48.96 |
- |
- |
- |
|
96168 |
$19.43 |
$17.40 |
- |
- |
- |
|
96170 |
$62.48 |
$59.30 |
- |
- |
- |
|
96171 |
$22.79 |
$21.64 |
- |
- |
- |
|
96360 |
- |
- |
$27.32 |
- |
- |
|
96361 |
- |
- |
$10.75 |
- |
- |
|
96365 |
- |
- |
$57.23 |
- |
- |
|
96366 |
- |
- |
$17.19 |
- |
- |
|
96367 |
- |
- |
$24.66 |
- |
- |
|
96368 |
- |
- |
$16.64 |
- |
- |
|
96369 |
- |
- |
$129.53 |
- |
- |
|
96370 |
- |
- |
$11.98 |
- |
- |
|
96371 |
- |
- |
$51.88 |
- |
- |
|
96372 |
- |
- |
$11.13 |
- |
- |
|
96373 |
- |
- |
$14.61 |
- |
- |
|
96374 |
- |
- |
$31.64 |
- |
- |
|
96375 |
- |
- |
$13.04 |
- |
- |
|
96376 |
- |
- |
I.C. |
- |
- |
|
96377 |
- |
- |
$15.77 |
- |
- |
|
96379 |
- |
- |
I.C. |
- |
- |
|
96401 |
- |
- |
$63.60 |
- |
- |
|
96402 |
- |
- |
$25.24 |
- |
- |
|
96405 |
$66.70 |
$22.93 |
- |
- |
- |
|
96406 |
$102.40 |
$35.73 |
- |
- |
- |
|
96409 |
- |
- |
$87.45 |
- |
- |
|
96411 |
- |
- |
$47.40 |
- |
- |
|
96413 |
- |
- |
$113.39 |
- |
- |
|
96415 |
- |
- |
$24.08 |
- |
- |
|
96416 |
- |
- |
$113.56 |
- |
- |
|
96417 |
- |
- |
$54.91 |
- |
- |
|
96420 |
- |
- |
$84.10 |
- |
- |
|
96422 |
- |
- |
$138.50 |
- |
- |
|
96423 |
- |
- |
$63.95 |
- |
- |
|
96425 |
- |
- |
$146.90 |
- |
- |
|
96440 |
$724.17 |
$96.10 |
- |
- |
- |
|
96446 |
$163.00 |
$19.53 |
- |
- |
- |
|
96450 |
$142.94 |
$61.21 |
- |
- |
- |
|
96521 |
- |
- |
$118.78 |
- |
- |
|
96522 |
- |
- |
$99.07 |
- |
- |
|
96523 |
- |
- |
$22.42 |
- |
- |
|
96542 |
$105.62 |
$32.87 |
- |
- |
- |
|
96549 |
- |
- |
I.C. |
- |
- |
|
96567 |
- |
- |
$109.22 |
- |
- |
|
96570 |
- |
- |
$43.69 |
- |
- |
|
96571 |
- |
- |
$20.16 |
- |
- |
|
96573 |
- |
- |
$173.50 |
- |
- |
|
96574 |
- |
- |
$216.99 |
- |
- |
|
96900 |
- |
- |
$18.21 |
- |
- |
|
96902 |
$17.41 |
$16.25 |
- |
- |
- |
|
96904 |
- |
- |
$55.85 |
- |
- |
|
96910 |
- |
- |
$94.98 |
- |
- |
|
96912 |
- |
- |
$81.11 |
- |
- |
|
96913 |
- |
- |
$117.58 |
- |
- |
|
96920 |
$130.57 |
$51.44 |
- |
- |
- |
|
96921 |
$142.95 |
$57.74 |
- |
- |
- |
|
96922 |
$194.14 |
$93.27 |
- |
- |
- |
|
96931 |
- |
- |
$139.01 |
- |
- |
|
96932 |
- |
- |
$103.43 |
- |
- |
|
96933 |
- |
- |
$35.58 |
- |
- |
|
96934 |
- |
- |
$84.08 |
- |
- |
|
96935 |
- |
- |
$50.14 |
- |
- |
|
96936 |
- |
- |
$33.94 |
- |
- |
|
96999 |
- |
- |
I.C. |
- |
- |
|
97010 |
- |
- |
$5.02 |
- |
- |
|
97012 |
- |
- |
$11.80 |
- |
- |
|
97014 |
- |
- |
$11.40 |
- |
- |
|
97016 |
- |
- |
$9.66 |
- |
- |
|
97018 |
- |
- |
$4.73 |
- |
- |
|
97022 |
- |
- |
$14.32 |
- |
- |
|
97024 |
- |
- |
$5.60 |
- |
- |
|
97026 |
- |
- |
$5.02 |
- |
- |
|
97028 |
- |
- |
$6.42 |
- |
- |
|
97032 |
- |
- |
$11.51 |
- |
- |
|
97033 |
- |
- |
$16.42 |
- |
- |
|
97034 |
- |
- |
$11.90 |
- |
- |
|
97035 |
- |
- |
$11.32 |
- |
- |
|
97036 |
- |
- |
$28.25 |
- |
- |
|
97039 |
- |
- |
I.C. |
- |
- |
|
97110 |
- |
- |
$24.02 |
- |
- |
|
97112 |
- |
- |
$27.67 |
- |
- |
|
97113 |
- |
- |
$30.61 |
- |
- |
|
97116 |
- |
- |
$23.73 |
- |
- |
|
97124 |
- |
- |
$23.15 |
- |
- |
|
97129 |
$18.39 |
$18.10 |
- |
- |
- |
|
97130 |
- |
- |
$17.57 |
- |
- |
|
97139 |
- |
- |
I.C. |
- |
- |
|
97140 |
- |
- |
$22.04 |
- |
- |
|
97150 |
- |
- |
$14.31 |
- |
- |
|
97151 |
- |
- |
I.C. |
- |
- |
|
97152 |
- |
- |
I.C. |
- |
- |
|
97153 |
- |
- |
I.C. |
- |
- |
|
97154 |
- |
- |
I.C. |
- |
- |
|
97155 |
- |
- |
I.C. |
- |
- |
|
97156 |
- |
- |
I.C. |
- |
- |
|
97157 |
- |
- |
I.C. |
- |
- |
|
97158 |
- |
- |
I.C. |
- |
- |
|
97161 |
- |
- |
$67.26 |
- |
- |
|
97162 |
- |
- |
$67.26 |
- |
- |
|
97163 |
- |
- |
$67.26 |
- |
- |
|
97164 |
- |
- |
$46.43 |
- |
- |
|
97165 |
- |
- |
$71.61 |
- |
- |
|
97166 |
- |
- |
$71.32 |
- |
- |
|
97167 |
- |
- |
$71.32 |
- |
- |
|
97168 |
- |
- |
$49.61 |
- |
- |
|
97169 |
- |
- |
I.C. |
- |
- |
|
97170 |
- |
- |
I.C. |
- |
- |
|
97171 |
- |
- |
I.C. |
- |
- |
|
97172 |
- |
- |
I.C. |
- |
- |
|
97530 |
- |
- |
$31.29 |
- |
- |
|
97533 |
- |
- |
$41.34 |
- |
- |
|
97535 |
- |
- |
$26.92 |
- |
- |
|
97537 |
- |
- |
$25.69 |
- |
- |
|
97542 |
- |
- |
$25.98 |
- |
- |
|
97545 |
- |
- |
I.C. |
- |
- |
|
97546 |
- |
- |
I.C. |
- |
- |
|
97597 |
$77.25 |
$28.27 |
- |
- |
- |
|
97598 |
$36.47 |
$19.95 |
- |
- |
- |
|
97602 |
- |
- |
I.C. |
- |
- |
|
97605 |
$34.50 |
$20.01 |
- |
- |
- |
|
97606 |
$40.75 |
$21.62 |
- |
- |
- |
|
97607 |
$273.98 |
$17.47 |
- |
- |
- |
|
97608 |
$274.68 |
$19.62 |
- |
- |
- |
|
97610 |
$263.88 |
$14.33 |
- |
- |
- |
|
97750 |
- |
- |
$27.50 |
- |
- |
|
97755 |
- |
- |
$29.98 |
- |
- |
|
97760 |
- |
- |
$39.26 |
- |
- |
|
97761 |
- |
- |
$33.17 |
- |
- |
|
97763 |
- |
- |
$42.21 |
- |
- |
|
97799 |
- |
- |
I.C. |
- |
- |
|
97802 |
$29.33 |
$26.43 |
- |
- |
- |
|
97803 |
$25.47 |
$22.28 |
- |
- |
- |
|
97804 |
$13.25 |
$12.38 |
- |
- |
- |
|
97810 |
$28.73 |
$23.81 |
- |
- |
- |
|
97811 |
$21.73 |
$19.99 |
- |
- |
- |
|
97813 |
$32.09 |
$25.71 |
- |
- |
- |
|
97814 |
$26.25 |
$21.90 |
- |
- |
- |
|
98925 |
$24.53 |
$18.44 |
- |
- |
- |
|
98926 |
$35.42 |
$27.88 |
- |
- |
- |
|
98927 |
$46.11 |
$36.55 |
- |
- |
- |
|
98928 |
$56.18 |
$45.74 |
- |
- |
- |
|
98929 |
$67.02 |
$56.01 |
- |
- |
- |
|
98940 |
$22.01 |
$17.38 |
- |
- |
- |
|
98941 |
$31.54 |
$26.62 |
- |
- |
- |
|
98942 |
$41.03 |
$36.10 |
- |
- |
- |
|
98943 |
$21.54 |
$18.64 |
- |
- |
- |
|
98960 |
- |
- |
$22.23 |
- |
- |
|
98961 |
- |
- |
$10.68 |
- |
- |
|
98962 |
- |
- |
$7.78 |
- |
- |
|
98966 |
$10.89 |
$10.02 |
- |
- |
- |
|
98967 |
$21.15 |
$19.99 |
- |
- |
- |
|
98968 |
$30.93 |
$29.77 |
- |
- |
- |
|
98970 |
- |
- |
I.C. |
- |
- |
|
98971 |
- |
- |
I.C. |
- |
- |
|
98972 |
- |
- |
I.C. |
- |
- |
|
99000 |
- |
- |
I.C. |
- |
- |
|
99001 |
- |
- |
I.C. |
- |
- |
|
99002 |
- |
- |
I.C. |
- |
- |
|
99024 |
- |
- |
I.C. |
- |
- |
|
99026 |
- |
- |
I.C. |
- |
- |
|
99027 |
- |
- |
I.C. |
- |
- |
|
99050 |
- |
- |
I.C. |
- |
- |
|
99051 |
- |
- |
I.C. |
- |
- |
|
99053 |
- |
- |
I.C. |
- |
- |
|
99056 |
- |
- |
I.C. |
- |
- |
|
99058 |
- |
- |
I.C. |
- |
- |
|
99060 |
- |
- |
I.C. |
- |
- |
|
99070 |
- |
- |
I.C. |
- |
- |
|
99071 |
- |
- |
I.C. |
- |
- |
|
99075 |
- |
- |
I.C. |
- |
- |
|
99078 |
- |
- |
I.C. |
- |
- |
|
99080 |
- |
- |
I.C. |
- |
- |
|
99082 |
- |
- |
I.C. |
- |
- |
|
99091 |
- |
- |
$44.47 |
- |
- |
|
99100 |
- |
- |
I.C. |
- |
- |
|
99116 |
- |
- |
I.C. |
- |
- |
|
99135 |
- |
- |
I.C. |
- |
- |
|
99140 |
- |
- |
I.C. |
- |
- |
|
99151 |
$59.41 |
$17.97 |
- |
- |
- |
|
99152 |
$40.74 |
$9.44 |
- |
- |
- |
|
99153 |
- |
- |
$8.65 |
- |
- |
|
99155 |
- |
- |
$64.82 |
- |
- |
|
99156 |
- |
- |
$59.62 |
- |
- |
|
99157 |
- |
- |
$48.99 |
- |
- |
|
99170 |
$125.05 |
$66.51 |
- |
- |
- |
|
99172 |
- |
- |
I.C. |
- |
- |
|
99174 |
- |
- |
$4.59 |
- |
- |
|
99175 |
- |
- |
$20.24 |
- |
- |
|
99177 |
- |
- |
$3.72 |
- |
- |
|
99183 |
- |
- |
$85.19 |
- |
- |
|
99184 |
- |
- |
$171.07 |
- |
- |
|
99188 |
- |
- |
$26.00 |
- |
- |
|
99190 |
- |
- |
I.C. |
- |
- |
|
99191 |
- |
- |
I.C. |
- |
- |
|
99192 |
- |
- |
I.C. |
- |
- |
|
99195 |
- |
- |
$82.33 |
- |
- |
|
99199 |
- |
- |
I.C. |
- |
- |
|
99202 |
$59.34 |
$38.76 |
- |
- |
- |
|
99203 |
$84.35 |
$58.59 |
- |
- |
- |
|
99204 |
$128.18 |
$99.46 |
- |
- |
- |
|
99205 |
$160.51 |
$129.50 |
- |
- |
- |
|
99211 |
$18.35 |
$7.10 |
- |
- |
- |
|
99212 |
$35.70 |
$19.75 |
- |
- |
- |
|
99213 |
$58.41 |
$39.28 |
- |
- |
- |
|
99214 |
$84.51 |
$60.45 |
- |
- |
- |
|
99215 |
$113.27 |
$85.44 |
- |
- |
- |
|
99217 |
- |
- |
$55.87 |
- |
- |
|
99218 |
- |
- |
$76.30 |
- |
- |
|
99219 |
- |
- |
$103.81 |
- |
- |
|
99220 |
- |
- |
$141.38 |
- |
- |
|
99221 |
- |
- |
$77.90 |
- |
- |
|
99222 |
- |
- |
$105.35 |
- |
- |
|
99223 |
- |
- |
$154.76 |
- |
- |
|
99224 |
- |
- |
$30.33 |
- |
- |
|
99225 |
- |
- |
$55.60 |
- |
- |
|
99226 |
- |
- |
$80.01 |
- |
- |
|
99231 |
- |
- |
$30.04 |
- |
- |
|
99232 |
- |
- |
$55.31 |
- |
- |
|
99233 |
- |
- |
$79.72 |
- |
- |
|
99234 |
- |
- |
$102.04 |
- |
- |
|
99235 |
- |
- |
$129.26 |
- |
- |
|
99236 |
- |
- |
$166.29 |
- |
- |
|
99238 |
- |
- |
$56.16 |
- |
- |
|
99239 |
- |
- |
$82.32 |
- |
- |
|
99241 |
$37.33 |
$25.16 |
- |
- |
- |
|
99242 |
$70.12 |
$53.02 |
- |
- |
- |
|
99243 |
$95.86 |
$74.12 |
- |
- |
- |
|
99244 |
$143.04 |
$119.28 |
- |
- |
- |
|
99245 |
$174.02 |
$147.35 |
- |
- |
- |
|
99251 |
- |
- |
$38.01 |
- |
- |
|
99252 |
- |
- |
$57.56 |
- |
- |
|
99253 |
- |
- |
$88.97 |
- |
- |
|
99254 |
- |
- |
$129.54 |
- |
- |
|
99255 |
- |
- |
$155.68 |
- |
- |
|
99281 |
- |
- |
$17.15 |
- |
- |
|
99282 |
- |
- |
$32.96 |
- |
- |
|
99283 |
- |
- |
$49.26 |
- |
- |
|
99284 |
- |
- |
$90.36 |
- |
- |
|
99285 |
- |
- |
$131.18 |
- |
- |
|
99288 |
- |
- |
I.C. |
- |
- |
|
99291 |
$215.83 |
$169.16 |
- |
- |
- |
|
99292 |
$94.68 |
$85.12 |
- |
- |
- |
|
99304 |
- |
- |
$69.39 |
- |
- |
|
99305 |
- |
- |
$99.43 |
- |
- |
|
99306 |
- |
- |
$128.14 |
- |
- |
|
99307 |
- |
- |
$33.85 |
- |
- |
|
99308 |
- |
- |
$53.31 |
- |
- |
|
99309 |
- |
- |
$70.28 |
- |
- |
|
99310 |
- |
- |
$103.49 |
- |
- |
|
99315 |
- |
- |
$56.45 |
- |
- |
|
99316 |
- |
- |
$80.92 |
- |
- |
|
99318 |
- |
- |
$73.85 |
- |
- |
|
99324 |
- |
- |
$41.93 |
- |
- |
|
99325 |
- |
- |
$60.83 |
- |
- |
|
99326 |
- |
- |
$105.99 |
- |
- |
|
99327 |
- |
- |
$142.52 |
- |
- |
|
99328 |
- |
- |
$168.53 |
- |
- |
|
99334 |
- |
- |
$46.37 |
- |
- |
|
99335 |
- |
- |
$73.34 |
- |
- |
|
99336 |
- |
- |
$103.51 |
- |
- |
|
99337 |
- |
- |
$149.05 |
- |
- |
|
99339 |
- |
- |
$60.00 |
- |
- |
|
99340 |
- |
- |
$83.39 |
- |
- |
|
99341 |
- |
- |
$41.93 |
- |
- |
|
99342 |
- |
- |
$59.96 |
- |
- |
|
99343 |
- |
- |
$98.41 |
- |
- |
|
99344 |
- |
- |
$139.98 |
- |
- |
|
99345 |
- |
- |
$170.42 |
- |
- |
|
99347 |
- |
- |
$41.95 |
- |
- |
|
99348 |
- |
- |
$64.46 |
- |
- |
|
99349 |
- |
- |
$98.90 |
- |
- |
|
99350 |
- |
- |
$137.61 |
- |
- |
|
99354 |
$99.68 |
$93.31 |
- |
- |
- |
|
99355 |
$75.73 |
$70.23 |
- |
- |
- |
|
99356 |
- |
- |
$70.95 |
- |
- |
|
99357 |
- |
- |
$71.53 |
- |
- |
|
99358 |
- |
- |
$85.56 |
- |
- |
|
99359 |
- |
- |
$41.82 |
- |
- |
|
99360 |
- |
- |
$47.37 |
- |
- |
|
99366 |
$33.57 |
$32.99 |
- |
- |
- |
|
99367 |
- |
- |
$43.56 |
- |
- |
|
99368 |
- |
- |
$28.68 |
- |
- |
|
99374 |
$54.28 |
$43.56 |
- |
- |
- |
|
99375 |
$80.96 |
$68.49 |
- |
- |
- |
|
99377 |
$54.28 |
$43.56 |
- |
- |
- |
|
99378 |
$80.96 |
$68.49 |
- |
- |
- |
|
99379 |
$54.28 |
$43.56 |
- |
- |
- |
|
99380 |
$80.96 |
$68.49 |
- |
- |
- |
|
99381 |
$86.71 |
$59.30 |
- |
- |
- |
|
99382 |
$90.60 |
$63.35 |
- |
- |
- |
|
99383 |
$94.36 |
$67.12 |
- |
- |
- |
|
99384 |
$106.53 |
$79.29 |
- |
- |
- |
|
99385 |
$103.30 |
$76.05 |
- |
- |
- |
|
99386 |
$119.26 |
$92.30 |
- |
- |
- |
|
99387 |
$129.72 |
$99.28 |
- |
- |
- |
|
99391 |
$78.16 |
$54.40 |
- |
- |
- |
|
99392 |
$83.15 |
$59.30 |
- |
- |
- |
|
99393 |
$82.86 |
$59.30 |
- |
- |
- |
|
99394 |
$90.89 |
$67.12 |
- |
- |
- |
|
99395 |
$93.08 |
$69.03 |
- |
- |
- |
|
99396 |
$99.00 |
$75.23 |
- |
- |
- |
|
99397 |
$106.53 |
$79.29 |
- |
- |
- |
|
99401 |
$31.06 |
$19.17 |
- |
- |
- |
|
99402 |
$50.81 |
$39.21 |
- |
- |
- |
|
99403 |
$69.25 |
$57.65 |
- |
- |
- |
|
99404 |
$88.44 |
$77.14 |
- |
- |
- |
|
99406 |
$11.78 |
$9.46 |
- |
- |
- |
|
99407 |
$58.08 |
$54.04 |
- |
- |
- |
|
99408 |
$27.74 |
$25.71 |
- |
- |
- |
|
99409 |
$53.70 |
$51.67 |
- |
- |
- |
|
99411 |
$15.82 |
$5.96 |
- |
- |
- |
|
99412 |
$19.87 |
$10.02 |
- |
- |
- |
|
99415 |
- |
- |
$8.07 |
- |
- |
|
99416 |
- |
- |
$3.48 |
- |
- |
|
99417 |
- |
- |
I.C. |
- |
- |
|
99421 |
$11.76 |
$10.02 |
- |
- |
- |
|
99422 |
$23.47 |
$20.57 |
- |
- |
- |
|
99423 |
$37.96 |
$32.75 |
- |
- |
- |
|
99429 |
- |
- |
I.C. |
- |
- |
|
99439 |
$29.82 |
$21.96 |
- |
- |
- |
|
99441 |
$10.89 |
$10.02 |
- |
- |
- |
|
99442 |
$21.15 |
$19.99 |
- |
- |
- |
|
99443 |
$30.93 |
$29.77 |
- |
- |
- |
|
99446 |
- |
- |
$13.79 |
- |
- |
|
99447 |
- |
- |
$27.86 |
- |
- |
|
99448 |
- |
- |
$41.65 |
- |
- |
|
99449 |
- |
- |
$55.48 |
- |
- |
|
99450 |
- |
- |
I.C. |
- |
- |
|
99451 |
- |
- |
$28.20 |
- |
- |
|
99452 |
- |
- |
$28.20 |
- |
- |
|
99453 |
- |
- |
$15.03 |
- |
- |
|
99454 |
- |
- |
$50.10 |
- |
- |
|
99455 |
- |
- |
I.C. |
- |
- |
|
99456 |
- |
- |
I.C. |
- |
- |
|
99457 |
$39.72 |
$24.65 |
- |
- |
- |
|
99458 |
$32.19 |
$24.65 |
- |
- |
- |
|
99460 |
- |
- |
$100.99 |
- |
- |
|
99461 |
$70.99 |
$48.09 |
- |
- |
- |
|
99462 |
- |
- |
$43.82 |
- |
- |
|
99463 |
- |
- |
$125.76 |
- |
- |
|
99464 |
- |
- |
$57.07 |
- |
- |
|
99465 |
- |
- |
$160.43 |
- |
- |
|
99466 |
- |
- |
$182.19 |
- |
- |
|
99467 |
- |
- |
$91.40 |
- |
- |
|
99468 |
- |
- |
$702.35 |
- |
- |
|
99469 |
- |
- |
$304.15 |
- |
- |
|
99471 |
- |
- |
$607.96 |
- |
- |
|
99472 |
- |
- |
$307.49 |
- |
- |
|
99473 |
- |
- |
$8.94 |
- |
- |
|
99474 |
$11.69 |
$6.76 |
- |
- |
- |
|
99475 |
- |
- |
$427.94 |
- |
- |
|
99476 |
- |
- |
$265.26 |
- |
- |
|
99477 |
- |
- |
$266.81 |
- |
- |
|
99478 |
- |
- |
$104.89 |
- |
- |
|
99479 |
- |
- |
$95.16 |
- |
- |
|
99480 |
- |
- |
$91.40 |
- |
- |
|
99483 |
$203.50 |
$138.87 |
- |
- |
- |
|
99484 |
$36.83 |
$24.65 |
- |
- |
- |
|
99485 |
- |
- |
$59.30 |
- |
- |
|
99486 |
- |
- |
$51.67 |
- |
- |
|
99487 |
$71.47 |
$40.17 |
- |
- |
- |
|
99489 |
$34.58 |
$19.80 |
- |
- |
- |
|
99490 |
$32.19 |
$24.65 |
- |
- |
- |
|
99491 |
- |
- |
$63.57 |
- |
- |
|
99492 |
$121.41 |
$67.79 |
- |
- |
- |
|
99493 |
$97.28 |
$61.05 |
- |
- |
- |
|
99494 |
$49.06 |
$32.54 |
- |
- |
- |
|
99495 |
$144.33 |
$94.48 |
- |
- |
- |
|
99496 |
$190.65 |
$124.57 |
- |
- |
- |
|
99497 |
$65.76 |
$60.54 |
- |
- |
- |
|
99498 |
$57.31 |
$57.02 |
- |
- |
- |
|
99499 |
- |
- |
I.C. |
- |
- |
|
99500 |
- |
- |
I.C. |
- |
- |
|
99501 |
- |
- |
I.C. |
- |
- |
|
99502 |
- |
- |
I.C. |
- |
- |
|
99503 |
- |
- |
I.C. |
- |
- |
|
99504 |
- |
- |
I.C. |
- |
- |
|
99505 |
- |
- |
I.C. |
- |
- |
|
99506 |
- |
- |
I.C. |
- |
- |
|
99507 |
- |
- |
I.C. |
- |
- |
|
99509 |
- |
- |
I.C. |
- |
- |
|
99510 |
- |
- |
I.C. |
- |
- |
|
99511 |
- |
- |
I.C. |
- |
- |
|
99512 |
- |
- |
I.C. |
- |
- |
|
99600 |
- |
- |
I.C. |
- |
- |
|
99601 |
- |
- |
I.C. |
- |
- |
|
99602 |
- |
- |
I.C. |
- |
- |
|
99605 |
- |
- |
I.C. |
- |
- |
|
99606 |
- |
- |
I.C. |
- |
- |
|
99607 |
- |
- |
I.C. |
- |
- |
|
90460-SL |
- |
- |
$17.70 |
- |
- |
|
90461-SL |
- |
- |
$8.52 |
- |
- |
|
90471-SL |
- |
- |
$17.70 |
- |
- |
|
90473-SL |
- |
- |
$17.70 |
- |
- |
|
G0108 |
- |
- |
$43.36 |
- |
- |
|
G0109 |
- |
- |
$12.09 |
- |
- |
|
G0270 |
$25.47 |
$22.28 |
- |
- |
- |
|
G0271 |
$13.25 |
$12.38 |
- |
- |
- |
|
G0399 |
- |
- |
I.C. |
- |
- |
|
J0131 |
- |
- |
I.C. |
- |
- |
|
J0135 |
- |
- |
I.C. |
- |
- |
|
J0215 |
- |
- |
I.C. |
- |
- |
|
J0222 |
- |
- |
I.C. |
- |
- |
|
J0291 |
- |
- |
I.C. |
- |
- |
|
J0364 |
- |
- |
I.C. |
- |
- |
|
J0400 |
- |
- |
I.C. |
- |
- |
|
J0565 |
- |
- |
I.C. |
- |
- |
|
J0567 |
- |
- |
I.C. |
- |
- |
|
J0571 |
- |
- |
I.C. |
- |
- |
|
J0572 |
- |
- |
I.C. |
- |
- |
|
J0573 |
- |
- |
I.C. |
- |
- |
|
J0574 |
- |
- |
I.C. |
- |
- |
|
J0575 |
- |
- |
I.C. |
- |
- |
|
J0584 |
- |
- |
I.C. |
- |
- |
|
J0593 |
- |
- |
I.C. |
- |
- |
|
J0599 |
- |
- |
I.C. |
- |
- |
|
J0604 |
- |
- |
I.C. |
- |
- |
|
J0715 |
- |
- |
I.C. |
- |
- |
|
J0716 |
- |
- |
I.C. |
- |
- |
|
J0841 |
- |
- |
I.C. |
- |
- |
|
J0883 |
- |
- |
I.C. |
- |
- |
|
J0884 |
- |
- |
I.C. |
- |
- |
|
J0890 |
- |
- |
I.C. |
- |
- |
|
J1094 |
- |
- |
I.C. |
- |
- |
|
J1096 |
- |
- |
I.C. |
- |
- |
|
J1097 |
- |
- |
I.C. |
- |
- |
|
J1130 |
- |
- |
I.C. |
- |
- |
|
J1260 |
- |
- |
I.C. |
- |
- |
|
J1301 |
- |
- |
I.C. |
- |
- |
|
J1320 |
- |
- |
I.C. |
- |
- |
|
J1322 |
- |
- |
I.C. |
- |
- |
|
J1324 |
- |
- |
I.C. |
- |
- |
|
J1428 |
- |
- |
I.C. |
- |
- |
|
J1438 |
- |
- |
I.C. |
- |
- |
|
J1444 |
- |
- |
I.C. |
- |
- |
|
J1455 |
- |
- |
I.C. |
- |
- |
|
J1562 |
- |
- |
I.C. |
- |
- |
|
J1573 |
- |
- |
I.C. |
- |
- |
|
J1595 |
- |
- |
I.C. |
- |
- |
|
J1599 |
- |
- |
I.C. |
- |
- |
|
J1628 |
- |
- |
I.C. |
- |
- |
|
J1655 |
- |
- |
I.C. |
- |
- |
|
J1700 |
- |
- |
I.C. |
- |
- |
|
J1710 |
- |
- |
I.C. |
- |
- |
|
J1726 |
- |
- |
I.C. |
- |
- |
|
J1741 |
- |
- |
I.C. |
- |
- |
|
J1744 |
- |
- |
I.C. |
- |
- |
|
J1746 |
- |
- |
I.C. |
- |
- |
|
J1790 |
- |
- |
I.C. |
- |
- |
|
J1826 |
- |
- |
I.C. |
- |
- |
|
J1830 |
- |
- |
I.C. |
- |
- |
|
J1840 |
- |
- |
I.C. |
- |
- |
|
J1850 |
- |
- |
I.C. |
- |
- |
|
J1890 |
- |
- |
I.C. |
- |
- |
|
J1990 |
- |
- |
I.C. |
- |
- |
|
J2062 |
- |
- |
I.C. |
- |
- |
|
J2170 |
- |
- |
I.C. |
- |
- |
|
J2182 |
- |
- |
I.C. |
- |
- |
|
J2212 |
- |
- |
I.C. |
- |
- |
|
J2265 |
- |
- |
I.C. |
- |
- |
|
J2326 |
- |
- |
I.C. |
- |
- |
|
J2440 |
- |
- |
I.C. |
- |
- |
|
J2460 |
- |
- |
I.C. |
- |
- |
|
J2502 |
- |
- |
I.C. |
- |
- |
|
J2760 |
- |
- |
I.C. |
- |
- |
|
J2786 |
- |
- |
I.C. |
- |
- |
|
J2793 |
- |
- |
I.C. |
- |
- |
|
J2797 |
- |
- |
I.C. |
- |
- |
|
J2840 |
- |
- |
I.C. |
- |
- |
|
J2910 |
- |
- |
I.C. |
- |
- |
|
J2940 |
- |
- |
I.C. |
- |
- |
|
J2941 |
- |
- |
I.C. |
- |
- |
|
J3030 |
- |
- |
I.C. |
- |
- |
|
J3031 |
- |
- |
I.C. |
- |
- |
|
J3110 |
- |
- |
I.C. |
- |
- |
|
J3145 |
- |
- |
I.C. |
- |
- |
|
J3245 |
- |
- |
I.C. |
- |
- |
|
J3302 |
- |
- |
I.C. |
- |
- |
|
J3303 |
- |
- |
I.C. |
- |
- |
|
J3316 |
- |
- |
I.C. |
- |
- |
|
J3397 |
- |
- |
I.C. |
- |
- |
|
J3398 |
- |
- |
I.C. |
- |
- |
|
J3472 |
- |
- |
I.C. |
- |
- |
|
J3490 |
- |
- |
I.C. |
- |
- |
|
J3590 |
- |
- |
I.C. |
- |
- |
|
J3591 |
- |
- |
I.C. |
- |
- |
|
J7131 |
- |
- |
I.C. |
- |
- |
|
J7175 |
- |
- |
I.C. |
- |
- |
|
J7177 |
- |
- |
I.C. |
- |
- |
|
J7178 |
- |
- |
I.C. |
- |
- |
|
J7179 |
- |
- |
I.C. |
- |
- |
|
J7181 |
- |
- |
I.C. |
- |
- |
|
J7202 |
- |
- |
I.C. |
- |
- |
|
J7203 |
- |
- |
I.C. |
- |
- |
|
J7207 |
- |
- |
I.C. |
- |
- |
|
J7209 |
- |
- |
I.C. |
- |
- |
|
J7210 |
- |
- |
I.C. |
- |
- |
|
J7211 |
- |
- |
I.C. |
- |
- |
|
J7296 |
- |
- |
I.C. |
- |
- |
|
J7297 |
- |
- |
I.C. |
- |
- |
|
J7298 |
- |
- |
I.C. |
- |
- |
|
J7301 |
- |
- |
I.C. |
- |
- |
|
J7303 |
- |
- |
I.C. |
- |
- |
|
J7304 |
- |
- |
I.C. |
- |
- |
|
J7307 |
- |
- |
I.C. |
- |
- |
|
J7309 |
- |
- |
I.C. |
- |
- |
|
J7310 |
- |
- |
I.C. |
- |
- |
|
J7314 |
- |
- |
I.C. |
- |
- |
|
J7315 |
- |
- |
I.C. |
- |
- |
|
J7318 |
- |
- |
I.C. |
- |
- |
|
J7322 |
- |
- |
I.C. |
- |
- |
|
J7328 |
- |
- |
I.C. |
- |
- |
|
J7329 |
- |
- |
I.C. |
- |
- |
|
J7331 |
- |
- |
I.C. |
- |
- |
|
J7332 |
- |
- |
I.C. |
- |
- |
|
J7340 |
- |
- |
I.C. |
- |
- |
|
J7342 |
- |
- |
I.C. |
- |
- |
|
J7345 |
- |
- |
I.C. |
- |
- |
|
J7401 |
- |
- |
I.C. |
- |
- |
|
J7599 |
- |
- |
I.C. |
- |
- |
|
J7633 |
- |
- |
I.C. |
- |
- |
|
J7665 |
- |
- |
I.C. |
- |
- |
|
J7669 |
- |
- |
I.C. |
- |
- |
|
J7676 |
- |
- |
I.C. |
- |
- |
|
J7677 |
- |
- |
I.C. |
- |
- |
|
J7699 |
- |
- |
I.C. |
- |
- |
|
J7799 |
- |
- |
I.C. |
- |
- |
|
J7999 |
- |
- |
I.C. |
- |
- |
|
J8562 |
- |
- |
I.C. |
- |
- |
|
J8670 |
- |
- |
I.C. |
- |
- |
|
J9015 |
- |
- |
I.C. |
- |
- |
|
J9020 |
- |
- |
I.C. |
- |
- |
|
J9022 |
- |
- |
I.C. |
- |
- |
|
J9023 |
- |
- |
I.C. |
- |
- |
|
J9057 |
- |
- |
I.C. |
- |
- |
|
J9118 |
- |
- |
I.C. |
- |
- |
|
J9160 |
- |
- |
I.C. |
- |
- |
|
J9173 |
- |
- |
I.C. |
- |
- |
|
J9199 |
- |
- |
I.C. |
- |
- |
|
J9210 |
- |
- |
I.C. |
- |
- |
|
J9212 |
- |
- |
I.C. |
- |
- |
|
J9213 |
- |
- |
I.C. |
- |
- |
|
J9215 |
- |
- |
I.C. |
- |
- |
|
J9216 |
- |
- |
I.C. |
- |
- |
|
J9219 |
- |
- |
I.C. |
- |
- |
|
J9229 |
- |
- |
I.C. |
- |
- |
|
J9262 |
- |
- |
I.C. |
- |
- |
|
J9269 |
- |
- |
I.C. |
- |
- |
|
J9313 |
- |
- |
I.C. |
- |
- |
|
J9340 |
- |
- |
I.C. |
- |
- |
|
J9999 |
- |
- |
I.C. |
- |
- |
|
Q2009 |
- |
- |
I.C. |
- |
- |
|
Q2017 |
- |
- |
I.C. |
- |
- |
|
Q2028 |
- |
- |
I.C. |
- |
- |
|
Q2036 |
- |
- |
I.C. |
- |
- |
|
Q2038 |
- |
- |
I.C. |
- |
- |
|
Q2042 |
- |
- |
I.C. |
- |
- |
|
Q2049 |
- |
- |
I.C. |
- |
- |
|
Q4103 |
- |
- |
I.C. |
- |
- |
|
Q4104 |
- |
- |
I.C. |
- |
- |
|
Q4108 |
- |
- |
I.C. |
- |
- |
|
Q4110 |
- |
- |
I.C. |
- |
- |
|
Q4161 |
- |
- |
I.C. |
- |
- |
|
Q4162 |
- |
- |
I.C. |
- |
- |
|
Q4163 |
- |
- |
I.C. |
- |
- |
|
Q4164 |
- |
- |
I.C. |
- |
- |
|
Q4165 |
- |
- |
I.C. |
- |
- |
|
Q4183 |
- |
- |
I.C. |
- |
- |
|
Q4184 |
- |
- |
I.C. |
- |
- |
|
Q4185 |
- |
- |
I.C. |
- |
- |
|
Q4187 |
- |
- |
I.C. |
- |
- |
|
Q4188 |
- |
- |
I.C. |
- |
- |
|
Q4189 |
- |
- |
I.C. |
- |
- |
|
Q4190 |
- |
- |
I.C. |
- |
- |
|
Q4191 |
- |
- |
I.C. |
- |
- |
|
Q4192 |
- |
- |
I.C. |
- |
- |
|
Q4193 |
- |
- |
I.C. |
- |
- |
|
Q4194 |
- |
- |
I.C. |
- |
- |
|
Q4197 |
- |
- |
I.C. |
- |
- |
|
Q4198 |
- |
- |
I.C. |
- |
- |
|
Q4200 |
- |
- |
I.C. |
- |
- |
|
Q4201 |
- |
- |
I.C. |
- |
- |
|
Q4202 |
- |
- |
I.C. |
- |
- |
|
Q4203 |
- |
- |
I.C. |
- |
- |
|
Q4204 |
- |
- |
I.C. |
- |
- |
|
Q4205 |
- |
- |
I.C. |
- |
- |
|
Q4206 |
- |
- |
I.C. |
- |
- |
|
Q4208 |
- |
- |
I.C. |
- |
- |
|
Q4209 |
- |
- |
I.C. |
- |
- |
|
Q4210 |
- |
- |
I.C. |
- |
- |
|
Q4211 |
- |
- |
I.C. |
- |
- |
|
Q4212 |
- |
- |
I.C. |
- |
- |
|
Q4213 |
- |
- |
I.C. |
- |
- |
|
Q4214 |
- |
- |
I.C. |
- |
- |
|
Q4215 |
- |
- |
I.C. |
- |
- |
|
Q4216 |
- |
- |
I.C. |
- |
- |
|
Q4217 |
- |
- |
I.C. |
- |
- |
|
Q4218 |
- |
- |
I.C. |
- |
- |
|
Q4219 |
- |
- |
I.C. |
- |
- |
|
Q4220 |
- |
- |
I.C. |
- |
- |
|
Q4221 |
- |
- |
I.C. |
- |
- |
|
Q4222 |
- |
- |
I.C. |
- |
- |
|
Q4226 |
- |
- |
I.C. |
- |
- |
|
Q5107 |
- |
- |
I.C. |
- |
- |
|
Q5109 |
- |
- |
I.C. |
- |
- |
|
Q5112 |
- |
- |
I.C. |
- |
- |
|
Q5113 |
- |
- |
I.C. |
- |
- |
|
Q5114 |
- |
- |
I.C. |
- |
- |
|
Q5115 |
- |
- |
I.C. |
- |
- |
|
Q5116 |
- |
- |
I.C. |
- |
- |
|
Q5118 |
- |
- |
I.C. |
- |
- |
|
S0302 |
- |
- |
I.C. |
- |
- |
|
S3005-U1 |
- |
- |
$10.27 |
- |
- |
|
S3005-U2 |
- |
- |
$10.27 |
- |
- |
|
T1023 |
- |
- |
I.C. |
- |
- |
|
G2212 |
$26.08 |
$25.21 |
- |
- |
- |
|
J0179 |
- |
- |
I.C. |
- |
- |
|
J0223 |
- |
- |
I.C. |
- |
- |
|
J0693 |
- |
- |
I.C. |
- |
- |
|
J0742 |
- |
- |
I.C. |
- |
- |
|
J1201 |
- |
- |
I.C. |
- |
- |
|
J1429 |
- |
- |
I.C. |
- |
- |
|
J1610 |
- |
- |
I.C. |
- |
- |
|
J1823 |
- |
- |
I.C. |
- |
- |
|
J3032 |
- |
- |
I.C. |
- |
- |
|
J3241 |
- |
- |
I.C. |
- |
- |
|
J3398 |
- |
- |
I.C. |
- |
- |
|
J7192 |
- |
- |
I.C. |
- |
- |
|
J7212 |
- |
- |
I.C. |
- |
- |
|
J7351 |
- |
- |
I.C. |
- |
- |
|
J7352 |
- |
- |
I.C. |
- |
- |
|
J8499 |
- |
- |
I.C. |
- |
- |
|
J8999 |
- |
- |
I.C. |
- |
- |
|
J9118 |
- |
- |
I.C. |
- |
- |
|
J9144 |
- |
- |
I.C. |
- |
- |
|
J9223 |
- |
- |
I.C. |
- |
- |
|
J9281 |
- |
- |
I.C. |
- |
- |
|
J9316 |
- |
- |
I.C. |
- |
- |
|
J9317 |
- |
- |
I.C. |
- |
- |
|
Q5115 |
- |
- |
I.C. |
- |
- |
|
Q5119 |
- |
- |
I.C. |
- |
- |
|
G2066 |
- |
- |
I.C. |
- |
- |
|
G2211 |
- |
- |
I.C. |
- |
- |
|
99607 |
- |
- |
I.C. |
- |
- |
Tobacco Cessation Codes
Code |
NFAC |
FAC |
Description (see medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine) |
99407 |
$58.08 |
$54.04 |
|
99407 SA |
$58.08 |
$54.04 |
|
99407 TD |
$49.37 |
$45.93 |
|
99407 U1 |
$49.37 |
$45.93 |
|
99407 TF |
$87.12 |
$81.06 |
|
99407 U2 |
$74.05 |
$68.90 |
|
99407 HQ |
$37.03 |
$34.45 |
|
99407 U3 |
$31.47 |
$29.28 |
Behavioral Health and Developmental Screening Services
Code |
NFAC |
FAC |
Global |
PC |
TC |
Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) |
96110 U1 |
- |
- |
$10.27 |
- |
- |
|
96110 U2 |
- |
- |
$10.27 |
- |
- |
|
96127 U1 |
- |
- |
$10.27 |
- |
- |
|
96127 U2 |
- |
- |
$10.27 |
- |
- |