durable medical equipment, (dmepos) hcpcs · appendix e durable medical equipment, prosthetics,...
TRANSCRIPT
Appendix E
Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies
(DMEPOS)
Note: Listing of a payment amount does not guarantee payment
Effective October 20, 2012
HCPCS
Maximum
Payment
A4216 $0.44
A4217 $3.62
A4221 $25.68
A4222 $50.95
A4233 $0.92
A4234 $4.19
A4235 $2.71
A4236 $1.93
A4253 $42.62
A4255 $4.75
A4256 $13.20
A4257 $14.71
A4258 $20.48
A4259 $13.91
A4265 $3.92
A4280 $5.98
A4310 $7.57
A4311 $14.54
A4312 $17.68
A4313 $18.17
A4314 $24.80
A4315 $25.87
A4316 $27.85
A4320 $6.14
A4322 $3.17
A4326 $11.96
A4327 $51.47
A4328 $11.40
A4330 $7.99
A4331 $3.67
A4332 $0.14
A4333 $2.55
A4334 $5.68
A4336 $1.66
A4338 $14.14
A4340 $36.63
A4344 $18.47
A4346 $22.60
A4349 $2.33
A4351 $2.09
A4352 $7.40
A4353 $8.08
A4354 $11.58
A4355 $10.28
A4356 $48.94
A4357 $11.19
A4358 $6.74
A4360 $0.52
A4361 $21.19
A4362 $3.39
A4363 $2.73
A4364 $3.38
A4366 $1.50
A4367 $8.48
A4368 $0.30
A4369 $2.37
A4371 $4.16
A4372 $4.83
A4373 $7.24
A4375 $19.82
A4376 $54.89
A4377 $4.95
A4378 $35.47
A4379 $17.32
A4380 $43.07
A4381 $5.33
A4382 $28.40
A4383 $32.52
A4384 $11.09
A4385 $5.89
A4388 $5.04
A4389 $7.17
A4390 $11.08
A4391 $8.15
A4392 $9.44
A4393 $10.43
A4394 $2.99
A4395 $0.05
A4396 $46.70
A4397 $4.69
A4398 $15.94
A4399 $14.14
A4400 $47.92
A4402 $1.85
A4404 $1.65
A4405 $3.93
A4406 $6.62
A4407 $10.11
A4408 $11.38
A4409 $7.17
A4410 $10.43
A4411 $5.89
A4412 $3.13
A4413 $6.35
A4414 $5.68
A4415 $6.92
A4416 $3.18
A4417 $4.30
A4418 $2.09
A4419 $2.01
A4422 $0.14
A4423 $2.15
A4424 $5.49
A4425 $4.13
A4426 $3.16
A4427 $3.21
A4428 $7.51
A4429 $9.52
A4430 $9.83
A4431 $7.17
A4432 $4.15
A4433 $3.86
A4434 $4.34
A4450 $0.13
A4452 $0.46
A4455 $1.65
A4456 $0.29
A4461 $3.79
A4463 $15.37
A4481 $0.44
A4556 $13.67
A4557 $24.35
A4558 $5.79
A4559 $0.12
A4561 $23.02
A4562 $57.31
A4595 $32.70
A4604 $66.43
A4605 $18.91
A4608 $57.82
A4611 $192.63
A4612 $92.21
A4613 $166.36
A4614 $27.44
A4615 $0.83
A4616 $0.08
A4617 $3.58
A4618 $8.83
A4619 $2.14
A4620 $0.68
A4623 $6.42
A4624 $3.04
A4625 $6.79
A4626 $3.14
A4628 $4.21
A4629 $5.33
A4630 $7.21
A4633 $47.34
A4635 $5.91
A4636 $4.87
A4637 $2.46
A4639 $331.33
A4640 $62.09
A5051 $2.38
A5052 $1.72
A5053 $2.01
A5054 $2.07
A5055 $1.66
A5056 $5.38
A5057 $11.08
A5061 $4.07
A5062 $2.41
A5063 $3.13
A5071 $6.93
A5072 $4.05
A5073 $3.67
A5081 $3.24
A5082 $11.72
A5083 $0.73
A5093 $1.92
A5102 $26.06
A5105 $39.97
A5112 $39.93
A5113 $4.62
A5114 $8.77
A5120 $0.25
A5121 $8.60
A5122 $12.60
A5126 $1.30
A5131 $15.55
A5200 $13.02
A5500 $73.34
A5501 $220.01
A5503 $36.01
A5504 $36.01
A5505 $36.01
A5506 $36.01
A5507 $36.01
A5512 $29.92
A5513 $44.66
A6010 $35.72
A6011 $2.63
A6021 $24.25
A6022 $24.25
A6023 $219.54
A6024 $7.14
A6154 $16.56
A6196 $8.48
A6197 $18.96
A6199 $6.09
A6203 $3.87
A6204 $7.19
A6207 $8.46
A6209 $8.62
A6210 $22.98
A6211 $33.88
A6212 $11.19
A6214 $11.87
A6216 $0.05
A6219 $1.10
A6220 $2.99
A6222 $2.46
A6223 $2.79
A6224 $4.17
A6229 $4.17
A6231 $5.40
A6232 $7.93
A6233 $22.14
A6234 $7.54
A6235 $19.40
A6236 $31.44
A6237 $9.13
A6238 $26.29
A6240 $14.12
A6241 $2.96
A6242 $6.99
A6243 $14.21
A6244 $45.31
A6245 $8.38
A6246 $11.45
A6247 $27.44
A6248 $18.73
A6251 $2.30
A6252 $3.75
A6253 $7.31
A6254 $1.40
A6255 $3.50
A6257 $1.77
A6258 $4.97
A6259 $12.63
A6266 $2.22
A6402 $0.14
A6403 $0.49
A6407 $2.17
A6410 $0.45
A6441 $0.77
A6442 $0.19
A6443 $0.33
A6444 $0.64
A6445 $0.38
A6446 $0.47
A6447 $0.77
A6448 $1.34
A6449 $2.02
A6452 $6.82
A6453 $0.71
A6454 $0.89
A6455 $1.61
A6456 $1.47
A6457 $1.32
A6531 $49.91
A6532 $70.33
A6545 $98.27
A6550 $27.28
A7000 $11.01
A7001 $38.16
A7002 $4.42
A7003 $3.17
A7004 $2.08
A7005 $35.57
A7006 $11.01
A7007 $5.33
A7008 $12.69
A7009 $48.50
A7010 $27.22
A7012 $4.37
A7013 $0.96
A7014 $5.18
A7015 $2.17
A7016 $8.36
A7017 $154.62
A7018 $0.44
A7020 $16.09
A7025 $501.75
A7026 $33.17
A7027 $206.91
A7028 $57.16
A7029 $23.35
A7030 $187.56
A7031 $69.37
A7032 $40.30
A7033 $28.25
A7034 $116.96
A7035 $39.51
A7036 $18.09
A7037 $40.78
A7038 $5.37
A7039 $15.24
A7040 $45.54
A7041 $85.59
A7042 $206.80
A7043 $32.43
A7044 $120.21
A7045 $19.35
A7046 $19.40
A7501 $121.16
A7502 $57.59
A7503 $13.08
A7504 $0.77
A7505 $5.40
A7506 $0.39
A7507 $2.87
A7508 $3.31
A7509 $1.63
A7520 $54.77
A7521 $54.27
A7522 $52.10
A7524 $89.29
A7525 $2.38
A7526 $3.89
A7527 $4.13
A8000 $176.91
A8001 $176.91
E0100 $22.82
E0105 $53.65
E0110 $85.42
E0111 $58.63
E0112 $40.73
E0113 $23.27
E0114 $51.96
E0116 $30.54
E0117 $212.18
E0130 $66.65
E0135 $79.07
E0140 $342.29
E0141 $109.41
E0143 $114.09
E0144 $302.19
E0147 $545.45
E0148 $120.57
E0149 $211.81
E0153 $76.39
E0154 $66.91
E0155 $28.11
E0156 $25.08
E0157 $77.75
E0158 $29.55
E0159 $16.95
E0160 $36.40
E0161 $28.87
E0162 $160.42
E0163 $117.28
E0165 $204.59
E0167 $13.09
E0168 $166.16
E0170 $1,769.56
E0171 $318.47
E0175 $65.50
E0181 $286.90
E0182 $288.23
E0184 $196.43
E0185 $352.15
E0186 $223.55
E0187 $255.53
E0188 $29.10
E0189 $48.64
E0191 $9.35
E0193 $8,573.20
E0194 $30,455.11
E0196 $357.73
E0197 $243.96
E0198 $243.96
E0199 $30.00
E0200 $87.29
E0202 $585.89
E0205 $181.61
E0210 $33.71
E0215 $66.30
E0217 $546.60
E0225 $427.89
E0235 $189.93
E0236 $414.00
E0239 $495.25
E0249 $93.21
E0250 $851.77
E0251 $597.47
E0255 $1,114.79
E0256 $790.89
E0260 $1,332.91
E0261 $1,299.49
E0265 $1,896.76
E0266 $1,614.17
E0271 $210.70
E0272 $163.23
E0275 $16.86
E0276 $14.55
E0277 $6,675.42
E0280 $36.25
E0290 $602.80
E0291 $515.27
E0292 $797.45
E0293 $678.65
E0294 $1,239.74
E0295 $1,208.37
E0296 $1,558.10
E0297 $1,334.86
E0300 $2,693.67
E0301 $2,568.96
E0302 $6,788.99
E0303 $2,884.56
E0304 $7,313.17
E0305 $143.50
E0310 $184.22
E0316 $1,914.29
E0325 $11.13
E0326 $9.83
E0371 $4,217.77
E0372 $5,117.93
E0373 $5,830.92
E0424 $1,804.61
E0431 $301.66
E0433 $529.21
E0434 $301.66
E0439 $1,804.61
E0441 $79.39
E0442 $79.39
E0443 $79.39
E0444 $79.39
E0450 $10,299.10
E0457 $676.56
E0459 $560.26
E0460 $8,076.49
E0461 $10,299.10
E0462 $3,208.25
E0463 $15,483.96
E0464 $15,483.96
E0470 $2,384.77
E0471 $6,093.73
E0472 $6,093.73
E0480 $461.66
E0482 $4,734.47
E0483 $11,704.78
E0484 $40.65
E0500 $1,124.73
E0550 $469.14
E0560 $138.34
E0561 $101.54
E0562 $285.84
E0565 $671.79
E0570 $177.43
E0572 $419.33
E0574 $443.21
E0575 $1,100.85
E0580 $127.20
E0585 $386.01
E0600 $439.62
E0601 $1,060.05
E0602 $32.50
E0605 $29.10
E0606 $244.57
E0607 $73.56
E0610 $222.60
E0615 $448.09
E0617 $3,716.65
E0618 $3,086.69
E0620 $962.68
E0621 $105.69
E0627 $371.39
E0628 $371.39
E0629 $364.11
E0630 $1,121.66
E0635 $1,219.65
E0636 $11,610.48
E0650 $792.94
E0651 $1,011.16
E0652 $5,836.77
E0655 $118.83
E0656 $636.04
E0657 $597.54
E0660 $175.88
E0665 $150.83
E0666 $152.03
E0667 $356.46
E0668 $486.50
E0669 $201.82
E0671 $457.29
E0672 $355.32
E0673 $295.25
E0675 $4,233.86
E0691 $989.33
E0692 $1,242.32
E0693 $1,531.44
E0694 $4,874.41
E0705 $60.69
E0720 $343.99
E0730 $375.78
E0731 $392.71
E0740 $575.66
E0744 $1,008.19
E0745 $985.54
E0747 $4,311.51
E0748 $4,283.58
E0749 $3,130.86
E0760 $3,559.58
E0762 $1,029.01
E0764 $12,184.32
E0765 $92.63
E0776 $157.61
E0779 $184.19
E0780 $11.42
E0781 $2,916.13
E0782 $4,726.95
E0783 $9,013.60
E0784 $4,596.41
E0785 $520.22
E0786 $8,474.90
E0791 $3,481.31
E0840 $80.67
E0849 $567.35
E0850 $115.66
E0855 $544.12
E0856 $169.59
E0860 $36.06
E0870 $128.06
E0880 $138.22
E0890 $130.85
E0900 $141.07
E0910 $189.73
E0911 $472.93
E0912 $1,086.30
E0920 $479.09
E0930 $427.53
E0935 $250.31
E0940 $329.95
E0941 $477.85
E0942 $21.85
E0944 $50.50
E0945 $48.80
E0946 $651.39
E0947 $667.70
E0948 $626.76
E0950 $114.45
E0951 $20.90
E0952 $20.73
E0955 $222.60
E0956 $108.54
E0957 $151.86
E0958 $480.32
E0959 $48.67
E0960 $100.16
E0961 $28.66
E0966 $78.59
E0967 $71.11
E0968 $167.79
E0969 $172.45
E0971 $47.76
E0973 $126.58
E0974 $86.33
E0978 $39.98
E0980 $33.95
E0981 $51.92
E0982 $56.74
E0983 $2,751.71
E0984 $1,840.70
E0985 $223.34
E0986 $5,355.42
E0988 $3,168.99
E0990 $110.44
E0992 $104.77
E0994 $17.89
E0995 $33.48
E1002 $4,462.49
E1003 $4,834.73
E1004 $5,360.72
E1005 $5,802.56
E1006 $7,107.59
E1007 $9,623.94
E1008 $9,624.80
E1010 $1,259.28
E1014 $402.02
E1015 $126.29
E1016 $144.58
E1020 $267.99
E1028 $227.40
E1029 $406.85
E1030 $1,282.94
E1031 $556.16
E1035 $6,751.26
E1036 $9,464.54
E1037 $1,194.43
E1038 $198.44
E1039 $376.48
E1050 $1,121.14
E1060 $1,387.95
E1070 $1,025.00
E1083 $736.87
E1084 $1,059.54
E1087 $1,392.97
E1088 $1,411.02
E1092 $1,415.01
E1093 $1,169.11
E1100 $1,142.88
E1110 $1,119.20
E1150 $898.11
E1160 $688.08
E1161 $2,605.02
E1170 $983.39
E1171 $882.52
E1172 $1,078.51
E1180 $948.33
E1190 $1,095.62
E1195 $1,187.46
E1200 $957.96
E1221 $523.16
E1222 $746.40
E1223 $760.14
E1224 $759.42
E1225 $497.64
E1226 $600.75
E1227 $305.53
E1228 $308.53
E1230 $2,490.19
E1232 $2,354.33
E1233 $2,439.47
E1234 $2,123.73
E1235 $2,044.99
E1236 $1,804.20
E1237 $1,819.97
E1238 $1,804.20
E1240 $1,099.52
E1270 $832.51
E1280 $1,228.26
E1295 $1,166.35
E1296 $541.31
E1297 $115.17
E1298 $452.49
E1310 $2,009.60
E1353 $31.19
E1355 $23.49
E1372 $179.49
E1390 $1,804.61
E1391 $1,804.61
E1392 $529.21
E1405 $2,190.63
E1406 $1,982.04
E1700 $379.66
E1701 $11.68
E1702 $24.86
E1800 $1,348.70
E1801 $1,420.24
E1802 $3,598.06
E1805 $1,391.03
E1806 $1,166.14
E1810 $1,371.66
E1811 $1,476.72
E1812 $946.69
E1815 $1,391.03
E1816 $1,499.98
E1818 $1,531.25
E1820 $84.90
E1821 $115.88
E1825 $1,391.03
E1830 $1,391.03
E1831 $699.56
E1840 $4,213.57
E1841 $4,987.34
E2000 $570.62
E2100 $601.91
E2101 $207.60
E2120 $3,121.54
E2201 $410.78
E2202 $521.84
E2203 $527.42
E2204 $895.54
E2205 $35.35
E2206 $44.05
E2207 $46.92
E2208 $128.60
E2209 $116.03
E2210 $7.21
E2211 $43.03
E2212 $6.37
E2213 $32.93
E2214 $33.69
E2215 $10.40
E2219 $46.07
E2220 $26.69
E2221 $27.65
E2222 $23.19
E2224 $107.96
E2225 $19.16
E2226 $41.78
E2227 $1,980.34
E2228 $1,030.80
E2231 $169.20
E2310 $1,288.40
E2311 $2,608.43
E2312 $2,722.91
E2313 $339.03
E2321 $2,456.29
E2322 $2,601.16
E2323 $76.15
E2324 $48.24
E2325 $1,482.84
E2326 $382.20
E2327 $3,766.20
E2328 $5,455.71
E2329 $1,944.48
E2330 $3,767.64
E2340 $394.54
E2341 $591.87
E2342 $493.22
E2343 $789.16
E2351 $769.18
E2359 $184.33
E2360 $105.13
E2361 $151.00
E2362 $99.58
E2363 $201.35
E2364 $105.13
E2365 $121.45
E2366 $290.24
E2367 $461.39
E2368 $568.73
E2369 $495.38
E2370 $883.91
E2371 $165.96
E2373 $1,148.15
E2374 $587.94
E2375 $943.05
E2376 $1,477.80
E2377 $534.76
E2381 $82.47
E2382 $22.47
E2383 $164.42
E2384 $87.61
E2385 $53.59
E2386 $162.92
E2387 $70.28
E2388 $55.48
E2389 $30.12
E2390 $47.12
E2391 $22.58
E2392 $59.32
E2394 $84.50
E2395 $60.05
E2396 $73.23
E2397 $455.96
E2402 $16,288.17
E2500 $430.54
E2502 $1,316.54
E2504 $1,736.70
E2506 $2,546.52
E2508 $3,937.76
E2510 $7,451.69
E2601 $67.34
E2602 $131.46
E2603 $166.90
E2604 $207.43
E2605 $296.36
E2606 $462.34
E2607 $319.12
E2608 $383.23
E2611 $343.89
E2612 $465.22
E2613 $432.72
E2614 $598.86
E2615 $498.01
E2616 $670.03
E2619 $56.51
E2620 $603.01
E2621 $632.80
E2622 $364.93
E2623 $464.38
E2624 $367.93
E2625 $465.78
E2626 $683.84
E2627 $1,091.19
E2628 $822.04
E2629 $1,040.27
E2630 $727.46
E2631 $247.35
E2632 $157.28
E2633 $156.95
K0001 $614.44
K0002 $933.84
K0003 $998.50
K0004 $1,310.39
K0005 $2,097.07
K0006 $1,446.79
K0007 $2,059.18
K0010 $4,914.19
K0011 $6,561.17
K0012 $3,748.37
K0015 $206.11
K0017 $57.97
K0018 $32.40
K0019 $19.88
K0020 $52.68
K0037 $55.56
K0038 $27.49
K0039 $61.12
K0040 $84.68
K0041 $60.05
K0042 $35.72
K0043 $22.15
K0044 $18.88
K0045 $65.32
K0046 $22.15
K0047 $86.73
K0050 $36.87
K0051 $59.67
K0052 $104.87
K0053 $115.72
K0056 $107.87
K0065 $50.42
K0069 $113.32
K0070 $207.78
K0071 $123.91
K0072 $70.10
K0073 $37.97
K0077 $66.73
K0098 $29.94
K0105 $112.78
K0195 $243.05
K0455 $3,055.53
K0552 $3.02
K0601 $1.28
K0602 $7.34
K0603 $0.66
K0604 $7.01
K0605 $16.84
K0606 $29,051.05
K0607 $248.76
K0608 $155.26
K0609 $1,032.44
K0672 $85.53
K0730 $1,988.84
K0733 $34.85
K0738 $554.51
K0800 $1,285.41
K0801 $2,072.34
K0802 $2,345.23
K0806 $1,554.99
K0807 $2,359.52
K0808 $3,650.69
K0813 $3,597.90
K0814 $4,605.74
K0815 $5,244.13
K0816 $5,022.45
K0820 $3,843.09
K0821 $4,933.31
K0822 $5,962.10
K0823 $6,001.40
K0824 $7,222.54
K0825 $6,612.19
K0826 $9,350.57
K0827 $7,950.71
K0828 $10,303.31
K0829 $9,461.51
K0835 $6,051.45
K0836 $6,275.70
K0837 $7,222.54
K0838 $6,461.29
K0839 $9,350.57
K0840 $14,165.95
K0841 $6,441.10
K0842 $6,441.10
K0843 $7,754.92
K0848 $7,881.33
K0849 $7,577.71
K0850 $9,142.21
K0851 $8,790.15
K0852 $10,563.22
K0853 $10,851.16
K0854 $14,375.27
K0855 $13,579.55
K0856 $8,459.90
K0857 $8,629.37
K0858 $10,496.31
K0859 $10,010.11
K0860 $14,995.19
K0861 $10,914.95
K0862 $10,496.31
K0863 $14,995.19
K0864 $17,844.40
L0112 $1,420.99
L0113 $300.80
L0120 $34.41
L0130 $191.46
L0140 $83.02
L0150 $110.56
L0160 $152.33
L0170 $738.91
L0172 $133.36
L0174 $280.77
L0180 $409.37
L0190 $575.95
L0200 $643.12
L0220 $128.13
L0430 $1,303.24
L0450 $223.24
L0454 $352.12
L0456 $1,009.77
L0458 $905.44
L0460 $1,019.12
L0462 $1,267.65
L0464 $1,509.11
L0466 $458.88
L0468 $550.80
L0470 $661.10
L0472 $469.47
L0480 $1,618.78
L0482 $1,649.80
L0484 $1,728.48
L0486 $1,833.81
L0488 $1,019.12
L0490 $287.21
L0491 $779.72
L0492 $512.86
L0621 $117.53
L0622 $311.95
L0625 $55.91
L0626 $79.13
L0627 $417.33
L0628 $85.18
L0630 $164.43
L0631 $1,042.25
L0633 $291.14
L0635 $1,072.82
L0636 $1,398.80
L0637 $1,141.13
L0638 $1,339.03
L0639 $1,141.13
L0640 $1,062.37
L0700 $1,966.35
L0710 $2,220.96
L0810 $2,674.20
L0820 $2,626.27
L0830 $3,683.71
L0859 $1,184.88
L0861 $218.83
L0970 $111.17
L0972 $100.09
L0974 $180.17
L0976 $190.39
L0978 $199.58
L0980 $18.06
L0982 $16.86
L0984 $66.49
L1000 $2,365.03
L1005 $3,249.48
L1010 $67.71
L1020 $99.25
L1025 $121.28
L1030 $63.57
L1040 $93.86
L1050 $99.68
L1060 $109.60
L1070 $99.06
L1080 $61.24
L1085 $159.85
L1090 $96.68
L1100 $175.68
L1110 $290.71
L1120 $47.81
L1200 $2,031.90
L1210 $254.49
L1220 $263.60
L1230 $552.89
L1240 $80.72
L1250 $73.84
L1260 $77.94
L1270 $75.36
L1280 $87.29
L1290 $78.09
L1300 $1,643.04
L1310 $1,840.33
L1600 $125.34
L1610 $42.70
L1620 $137.30
L1630 $178.02
L1640 $469.49
L1650 $225.18
L1652 $361.90
L1660 $180.38
L1680 $1,580.08
L1685 $1,156.91
L1686 $899.67
L1690 $1,963.25
L1700 $1,597.43
L1710 $1,932.73
L1720 $1,348.26
L1730 $1,150.35
L1755 $1,539.89
L1810 $110.89
L1820 $140.31
L1830 $108.75
L1831 $298.81
L1832 $591.33
L1834 $755.00
L1836 $135.47
L1840 $1,034.50
L1843 $910.96
L1844 $2,046.32
L1845 $825.61
L1846 $1,243.52
L1847 $583.95
L1850 $312.62
L1860 $1,276.04
L1900 $289.27
L1902 $95.21
L1904 $457.38
L1906 $116.97
L1907 $571.27
L1910 $329.01
L1920 $435.83
L1930 $268.72
L1932 $905.98
L1940 $516.71
L1945 $1,015.97
L1950 $965.94
L1951 $852.66
L1960 $539.11
L1970 $719.45
L1971 $475.88
L1980 $456.52
L1990 $551.64
L2000 $1,315.36
L2005 $4,160.27
L2010 $1,187.39
L2020 $1,514.24
L2030 $1,304.08
L2034 $2,058.80
L2035 $182.69
L2036 $2,327.95
L2037 $1,920.52
L2038 $1,617.85
L2040 $222.23
L2050 $469.90
L2060 $665.29
L2070 $130.81
L2080 $403.29
L2090 $568.64
L2106 $681.64
L2108 $1,165.55
L2112 $470.48
L2114 $577.33
L2116 $692.41
L2126 $1,164.67
L2128 $2,223.71
L2132 $784.60
L2134 $983.73
L2136 $1,150.22
L2180 $113.91
L2182 $104.81
L2184 $120.49
L2186 $168.58
L2188 $315.63
L2190 $84.94
L2192 $346.79
L2200 $61.65
L2210 $68.53
L2220 $94.13
L2230 $91.63
L2232 $101.04
L2240 $82.10
L2250 $460.81
L2260 $194.98
L2265 $114.55
L2270 $69.65
L2275 $152.12
L2280 $441.08
L2300 $326.50
L2310 $159.53
L2320 $255.65
L2330 $451.83
L2335 $241.91
L2340 $536.78
L2350 $977.74
L2360 $67.10
L2370 $266.80
L2375 $109.90
L2380 $121.90
L2385 $130.28
L2387 $197.51
L2390 $106.47
L2395 $152.18
L2397 $128.54
L2405 $88.51
L2415 $123.29
L2425 $145.53
L2430 $145.53
L2492 $102.84
L2500 $329.44
L2510 $803.65
L2520 $473.47
L2525 $1,262.09
L2526 $888.26
L2530 $238.62
L2540 $518.67
L2550 $304.78
L2570 $477.24
L2580 $533.48
L2600 $231.37
L2610 $278.85
L2620 $305.89
L2622 $298.27
L2624 $322.08
L2627 $1,667.36
L2628 $2,172.69
L2630 $254.42
L2640 $396.51
L2650 $155.63
L2660 $181.27
L2670 $171.53
L2680 $152.20
L2750 $95.51
L2755 $132.67
L2760 $60.35
L2768 $132.27
L2780 $87.76
L2785 $34.03
L2795 $102.45
L2800 $118.93
L2810 $75.97
L2820 $84.46
L2830 $91.38
L2840 $42.49
L2850 $60.23
L3000 $318.92
L3001 $134.28
L3002 $163.97
L3003 $176.92
L3010 $176.92
L3020 $201.43
L3030 $77.49
L3040 $47.77
L3050 $47.77
L3060 $74.88
L3070 $32.24
L3080 $32.24
L3090 $41.33
L3100 $43.90
L3140 $90.40
L3150 $82.64
L3170 $51.68
L3224 $57.19
L3225 $65.80
L3300 $52.92
L3310 $82.64
L3330 $574.58
L3332 $74.88
L3334 $38.74
L3340 $86.53
L3350 $23.26
L3360 $36.15
L3370 $50.33
L3380 $50.33
L3390 $50.33
L3400 $41.33
L3410 $94.25
L3420 $55.52
L3430 $162.70
L3440 $77.49
L3450 $107.18
L3455 $41.33
L3460 $34.85
L3465 $59.41
L3470 $63.26
L3480 $63.26
L3500 $29.69
L3510 $29.69
L3520 $32.24
L3530 $32.24
L3540 $51.68
L3550 $9.02
L3560 $23.26
L3570 $86.53
L3580 $65.84
L3590 $54.22
L3595 $42.61
L3600 $77.49
L3610 $101.99
L3620 $77.49
L3630 $101.99
L3640 $43.90
L3650 $60.16
L3660 $97.82
L3670 $111.86
L3671 $832.59
L3674 $1,092.18
L3675 $162.14
L3702 $266.80
L3710 $117.66
L3720 $743.57
L3730 $1,000.38
L3740 $1,021.21
L3760 $462.07
L3762 $99.35
L3763 $683.11
L3764 $767.01
L3765 $1,184.77
L3766 $1,254.57
L3806 $419.71
L3807 $231.05
L3808 $332.95
L3900 $1,386.06
L3901 $1,713.60
L3904 $2,787.17
L3905 $916.32
L3906 $394.43
L3908 $76.04
L3912 $120.35
L3913 $250.25
L3915 $491.14
L3917 $97.62
L3919 $250.25
L3921 $296.80
L3923 $90.99
L3925 $59.07
L3927 $32.30
L3929 $90.14
L3931 $178.02
L3933 $197.14
L3935 $204.12
L3960 $786.50
L3961 $1,552.39
L3962 $849.94
L3967 $1,832.85
L3971 $1,739.81
L3973 $1,832.85
L3975 $1,552.39
L3976 $1,552.39
L3977 $1,739.81
L3978 $1,832.85
L3980 $294.23
L3982 $355.31
L3984 $341.91
L3995 $34.54
L4000 $1,408.87
L4010 $778.45
L4020 $932.00
L4030 $642.66
L4040 $529.36
L4045 $321.84
L4050 $483.79
L4055 $263.76
L4060 $393.01
L4070 $323.99
L4080 $116.51
L4090 $117.01
L4100 $135.27
L4110 $109.98
L4130 $643.40
L4350 $95.76
L4360 $359.08
L4370 $244.83
L4386 $160.97
L4392 $23.49
L4394 $17.13
L4396 $167.53
L4398 $77.13
L4631 $1,553.12
L5000 $546.40
L5010 $1,316.57
L5020 $2,441.59
L5050 $2,915.10
L5060 $3,868.26
L5100 $3,021.52
L5105 $4,264.38
L5150 $4,409.33
L5160 $5,379.51
L5200 $4,405.11
L5210 $3,498.87
L5220 $3,977.10
L5230 $5,319.12
L5250 $6,921.77
L5270 $7,415.80
L5280 $7,341.64
L5301 $3,029.68
L5312 $4,756.08
L5321 $4,680.35
L5331 $6,640.86
L5341 $6,931.25
L5400 $1,446.18
L5410 $555.91
L5420 $1,746.77
L5430 $545.24
L5450 $477.13
L5460 $631.75
L5500 $1,388.90
L5505 $1,880.93
L5510 $1,706.00
L5520 $1,555.14
L5530 $2,170.22
L5535 $2,241.66
L5540 $2,392.68
L5560 $2,337.54
L5570 $2,458.63
L5580 $2,816.53
L5585 $3,121.67
L5590 $2,732.89
L5595 $4,881.75
L5600 $6,153.12
L5610 $2,872.42
L5611 $1,907.92
L5613 $2,650.23
L5614 $1,791.45
L5616 $1,468.74
L5617 $593.98
L5618 $337.82
L5620 $320.78
L5622 $452.42
L5624 $407.32
L5626 $591.34
L5628 $653.84
L5629 $343.67
L5630 $547.68
L5631 $475.15
L5632 $320.16
L5634 $381.42
L5636 $339.94
L5637 $321.96
L5638 $596.59
L5639 $1,366.55
L5640 $905.07
L5642 $893.35
L5643 $1,932.23
L5644 $713.16
L5645 $862.86
L5646 $634.27
L5647 $860.22
L5648 $711.98
L5649 $2,176.40
L5650 $620.61
L5651 $1,298.69
L5652 $471.47
L5653 $773.53
L5654 $418.97
L5655 $375.42
L5656 $534.87
L5658 $524.27
L5661 $658.09
L5665 $553.71
L5666 $76.82
L5668 $121.34
L5670 $320.30
L5671 $717.21
L5672 $348.96
L5673 $774.63
L5676 $456.51
L5677 $581.14
L5678 $51.17
L5679 $645.53
L5680 $383.42
L5681 $1,396.45
L5682 $683.74
L5683 $1,396.45
L5684 $69.39
L5685 $135.98
L5686 $68.94
L5688 $75.48
L5690 $114.77
L5692 $168.64
L5694 $260.56
L5695 $176.36
L5696 $266.78
L5697 $115.75
L5698 $135.23
L5699 $265.83
L5700 $3,948.69
L5701 $4,798.50
L5702 $5,745.76
L5703 $2,649.81
L5704 $659.46
L5705 $1,082.62
L5706 $1,073.02
L5707 $1,525.35
L5710 $492.05
L5711 $666.12
L5712 $598.00
L5714 $452.33
L5716 $788.18
L5718 $985.15
L5722 $1,147.05
L5724 $1,736.88
L5726 $2,102.03
L5728 $2,797.51
L5780 $1,238.12
L5781 $4,247.75
L5782 $4,478.08
L5785 $671.19
L5790 $808.15
L5795 $1,161.11
L5810 $601.25
L5811 $788.70
L5812 $682.57
L5814 $3,942.77
L5816 $919.69
L5818 $1,038.51
L5822 $1,841.55
L5824 $1,658.43
L5826 $3,444.00
L5828 $3,053.86
L5830 $2,662.73
L5840 $4,364.81
L5845 $1,902.82
L5848 $1,141.60
L5850 $138.34
L5855 $445.30
L5856 $25,485.30
L5857 $9,043.16
L5858 $19,730.57
L5910 $391.67
L5920 $573.79
L5925 $471.64
L5930 $3,573.36
L5940 $674.44
L5950 $969.42
L5960 $1,108.01
L5961 $5,246.47
L5962 $847.53
L5964 $1,220.09
L5966 $1,581.79
L5968 $3,857.88
L5970 $265.27
L5971 $265.27
L5972 $423.95
L5973 $18,662.81
L5974 $336.00
L5975 $492.16
L5976 $677.02
L5978 $382.62
L5979 $3,259.67
L5980 $4,384.08
L5981 $3,542.32
L5982 $826.38
L5984 $781.24
L5985 $299.80
L5986 $826.88
L5987 $7,637.08
L5988 $2,120.83
L5990 $1,926.02
L6000 $1,915.82
L6010 $2,132.00
L6020 $1,987.76
L6025 $8,495.56
L6050 $2,347.86
L6055 $3,505.72
L6100 $2,528.95
L6110 $2,579.36
L6120 $3,243.46
L6130 $3,732.66
L6200 $3,830.71
L6205 $4,799.32
L6250 $3,572.40
L6300 $5,025.03
L6310 $4,171.18
L6320 $1,848.08
L6350 $5,647.79
L6360 $4,592.68
L6370 $2,196.45
L6380 $1,478.81
L6382 $1,740.90
L6384 $2,203.97
L6386 $499.20
L6388 $548.67
L6400 $2,799.77
L6450 $3,800.64
L6500 $3,844.08
L6550 $5,142.29
L6570 $5,732.17
L6580 $1,948.02
L6582 $1,548.02
L6584 $2,630.20
L6586 $2,247.90
L6588 $3,806.14
L6590 $3,507.05
L6600 $219.80
L6605 $207.36
L6610 $189.11
L6611 $437.11
L6615 $231.12
L6616 $84.23
L6620 $362.00
L6621 $2,428.27
L6623 $778.72
L6624 $3,998.21
L6625 $665.99
L6628 $625.44
L6629 $158.51
L6630 $233.06
L6632 $70.26
L6635 $204.34
L6637 $469.88
L6638 $2,654.86
L6640 $372.57
L6641 $185.70
L6642 $251.17
L6645 $428.71
L6646 $3,348.37
L6647 $551.23
L6648 $3,453.37
L6650 $369.74
L6655 $108.32
L6660 $114.66
L6665 $53.33
L6670 $55.13
L6672 $209.34
L6675 $129.87
L6676 $159.66
L6677 $314.93
L6680 $257.27
L6682 $327.32
L6684 $501.52
L6686 $719.00
L6687 $623.77
L6688 $763.84
L6689 $934.88
L6690 $991.47
L6691 $428.93
L6692 $604.76
L6693 $3,013.97
L6694 $774.63
L6695 $645.53
L6696 $1,396.45
L6697 $1,396.45
L6698 $717.21
L6703 $357.04
L6704 $677.69
L6706 $431.07
L6707 $1,520.81
L6708 $1,061.21
L6709 $1,521.78
L6711 $713.75
L6712 $1,314.14
L6713 $1,658.60
L6714 $1,404.83
L6721 $2,496.91
L6722 $2,152.53
L6805 $457.40
L6810 $216.43
L6881 $4,340.20
L6882 $3,292.23
L6883 $2,216.08
L6884 $3,028.26
L6885 $4,592.68
L6890 $200.81
L6895 $670.43
L6900 $2,099.83
L6905 $2,117.01
L6910 $1,737.51
L6915 $785.24
L6920 $8,414.90
L6925 $9,202.91
L6930 $9,130.07
L6935 $9,649.19
L6940 $10,931.28
L6945 $12,111.80
L6950 $11,417.39
L6955 $12,915.97
L6960 $14,066.95
L6965 $15,885.56
L6970 $15,772.44
L6975 $17,281.59
L7007 $3,772.90
L7008 $6,534.56
L7009 $4,080.40
L7040 $3,257.28
L7045 $1,747.93
L7170 $6,603.26
L7180 $39,620.70
L7181 $42,537.43
L7185 $6,935.90
L7186 $9,565.76
L7190 $8,616.51
L7191 $9,995.65
L7260 $2,454.57
L7261 $5,144.45
L7360 $287.01
L7362 $297.50
L7364 $563.52
L7366 $728.39
L7367 $413.33
L7368 $535.79
L7400 $325.38
L7401 $364.26
L7402 $393.37
L7403 $390.96
L7404 $590.07
L7405 $771.73
L7900 $574.85
L8000 $44.65
L8001 $133.15
L8002 $175.13
L8015 $66.09
L8020 $260.55
L8030 $341.17
L8031 $341.17
L8032 $43.19
L8035 $3,889.43
L8040 $2,654.24
L8041 $3,199.43
L8042 $3,594.84
L8043 $4,026.23
L8044 $4,457.61
L8045 $2,798.22
L8046 $2,875.87
L8047 $1,473.87
L8300 $113.34
L8310 $158.75
L8320 $60.44
L8330 $53.40
L8400 $20.06
L8410 $28.60
L8415 $29.37
L8417 $79.84
L8420 $21.69
L8430 $24.79
L8435 $30.32
L8440 $45.23
L8460 $94.38
L8465 $52.75
L8470 $7.22
L8480 $13.27
L8485 $15.55
L8500 $844.27
L8501 $130.63
L8507 $44.48
L8509 $115.95
L8510 $268.25
L8511 $77.21
L8512 $2.30
L8513 $5.52
L8514 $100.11
L8515 $67.00
L8600 $788.66
L8603 $476.36
L8606 $241.55
L8609 $6,916.98
L8610 $717.39
L8612 $783.19
L8613 $325.51
L8614 $20,315.39
L8615 $478.81
L8616 $111.53
L8617 $97.40
L8618 $27.85
L8619 $8,721.25
L8621 $0.66
L8622 $0.35
L8623 $68.67
L8624 $171.21
L8627 $7,356.95
L8628 $1,364.30
L8629 $190.09
L8630 $364.33
L8631 $2,304.70
L8641 $504.73
L8642 $332.14
L8658 $440.07
L8659 $2,048.62
L8670 $601.97
L8680 $506.60
L8681 $1,166.63
L8682 $6,574.73
L8683 $5,787.27
L8684 $856.54
L8685 $14,421.52
L8686 $9,202.10
L8687 $18,768.14
L8688 $11,975.59
L8689 $1,831.25
L8690 $5,050.36
L8691 $2,830.88
L8693 $1,609.77
L8695 $17.67
Q0478 $178.78
Q0479 $11,749.89
Q0480 $87,619.99
Q0481 $14,136.45
Q0482 $4,427.81
Q0483 $18,240.58
Q0484 $3,542.27
Q0485 $341.99
Q0486 $284.65
Q0487 $332.09
Q0489 $15,813.60
Q0490 $684.02
Q0491 $1,075.36
Q0492 $86.62
Q0493 $246.69
Q0494 $208.75
Q0495 $4,063.68
Q0496 $1,458.52
Q0497 $455.44
Q0498 $499.72
Q0499 $162.36
Q0500 $29.71
Q0501 $496.83
Q0502 $632.53
Q0503 $1,265.09
Q0504 $667.56
Q0506 $830.95