proposed 4/1/2012 page 1 of 29 appendix d72126 $241.82 72127 $270.72 72128 $120.46 72129 $241.82...

See OAR 436-009-0023

Effective April 1, 2015

HCPCS Code

Maximum

Payment

70010 packaged

70015 packaged

70030 packaged

70100 packaged

70110 packaged

70120 packaged

70130 packaged

70134 packaged

70140 packaged

70150 packaged

70160 packaged

70170 packaged

70190 packaged

70200 packaged

70210 packaged

70220 packaged

70240 packaged

70250 packaged

70260 packaged

70300 packaged

70310 packaged

70320 packaged

70328 packaged

70330 packaged

70332 packaged

70336 $287.50

70350 packaged

70355 packaged

70360 packaged

70370 $116.71

70371 $86.55

70373 packaged

70380 packaged

70390 packaged

70450 $120.46

70460 $191.44

70470 $232.74

70480 $120.46

70481 $241.82

70482 $270.72

70486 $120.46

70487 $203.24

70488 $258.32

70490 $120.46

70491 $241.82

70492 $270.72

70496 $282.99

70498 $282.99

70540 $287.50

70542 $428.65

Appendix D for Administrative Order 15-058

Ambulatory Surgery Center Fee Schedule Amounts for Ancillary ServicesNote: Listing of a payment amount does not guarantee payment.

CPT only copyright 2014 American Medical Association. All rights reserved

Proposed 4/1/2012 of 29 Appendix D

70543 $484.91

70544 $287.50

70545 $428.65

70546 $484.91

70547 $287.50

70548 $428.65

70549 $484.91

70551 $284.55

70552 $419.60

70553 $478.61

70554 $287.50

70555 $287.50

70557 $287.50

70558 $428.65

70559 $484.91

71010 $23.61

71015 $29.50

71020 $30.16

71021 packaged

71022 packaged

71023 packaged

71030 packaged

71034 $110.15

71035 packaged

71100 packaged

71101 packaged

71110 packaged

71111 packaged

71120 packaged

71130 packaged

71250 $120.46

71260 $241.82

71270 $270.72

71275 $282.99

71550 $287.50

71551 $428.65

71552 $484.91

72010 $84.57

72020 packaged

72040 packaged

72050 packaged

72052 packaged

72069 packaged

72070 packaged

72072 packaged

72074 packaged

72080 packaged

72090 packaged

72100 packaged

72110 packaged

72114 packaged

72120 packaged

72125 $120.46

72126 $241.82

72127 $270.72

72128 $120.46

72129 $241.82

72130 $270.72


72131 $120.46

72132 $241.82

72133 $270.72

72141 $272.09

72142 $427.46

72146 $272.09

72147 $422.88

72148 $269.46

72149 $419.60

72156 $482.55

72157 $483.21

72158 $479.27

72170 packaged

72190 packaged

72191 $282.99

72192 $120.46

72193 $241.82

72194 $270.72

72195 $287.50

72196 $428.65

72197 $484.91

72200 packaged

72202 packaged

72220 packaged

72240 packaged

72255 packaged

72265 packaged

72270 packaged

72275 packaged

72285 packaged

72295 packaged

73000 packaged

73010 packaged

73020 packaged

73030 packaged

73040 packaged

73050 packaged

73060 packaged

73070 packaged

73080 packaged

73085 packaged

73090 packaged

73092 packaged

73100 packaged

73110 packaged

73115 packaged

73120 packaged

73130 packaged

73140 packaged

73200 $120.46

73201 $241.82

73202 $270.72

73206 $282.99

73218 $287.50

73219 $428.65

73220 $484.91

73221 $287.50

73222 $428.65


73223 $484.91

73500 packaged

73510 packaged

73520 packaged

73525 packaged

73530 packaged

73540 packaged

73550 packaged

73560 packaged

73562 packaged

73564 packaged

73565 packaged

73580 packaged

73590 packaged

73592 packaged

73600 packaged

73610 packaged

73615 packaged

73620 packaged

73630 packaged

73650 packaged

73660 packaged

73700 $120.46

73701 $241.82

73702 $270.72

73706 $282.99

73718 $287.50

73719 $428.65

73720 $484.91

73721 $287.50

73722 $428.65

73723 $484.91

74000 packaged

74010 packaged

74020 packaged

74022 packaged

74150 $120.46

74160 $241.82

74170 $270.72

74174 $376.99

74175 $282.99

74176 $204.56

74177 $376.99

74178 $376.99

74181 $287.50

74182 $428.65

74183 $484.91

74190 packaged

74210 $102.08

74220 $102.08

74230 $102.08

74235 packaged

74240 $142.27

74241 $150.79

74245 $151.56

74246 $151.56

74247 $151.56

74249 $151.56


74250 $102.08

74251 $151.56

74260 $102.08

74261 $120.46

74262 $241.82

74270 $151.56

74280 $151.56

74283 $151.56

74290 $102.08

74300 packaged

74301 packaged

74305 packaged

74320 packaged

74327 packaged

74328 packaged

74329 packaged

74330 packaged

74340 packaged

74355 packaged

74360 packaged

74363 packaged

74400 $266.25

74410 $266.25

74415 $266.25

74420 $266.25

74425 packaged

74430 packaged

74440 packaged

74445 packaged

74450 packaged

74455 packaged

74470 packaged

74475 packaged

74480 packaged

74485 packaged

74710 packaged

74740 packaged

74742 packaged

74775 $266.25

75557 $287.50

75559 $287.50

75561 $484.91

75563 $649.73

75565 packaged

75571 packaged

75572 $216.86

75573 $216.86

75574 $216.86

75600 packaged

75605 packaged

75625 packaged

75630 packaged

75635 packaged

75658 packaged

75705 packaged

75710 packaged

75716 packaged

75726 packaged


75731 packaged

75733 packaged

75736 packaged

75741 packaged

75743 packaged

75746 packaged

75756 packaged

75774 packaged

75791 packaged

75801 packaged

75803 packaged

75805 packaged

75807 packaged

75809 packaged

75810 packaged

75820 packaged

75822 packaged

75825 packaged

75827 packaged

75831 packaged

75833 packaged

75840 packaged

75842 packaged

75860 packaged

75870 packaged

75872 packaged

75880 packaged

75885 packaged

75887 packaged

75889 packaged

75891 packaged

75893 packaged

75894 packaged

75896 packaged

75898 packaged

75901 packaged

75902 packaged

75945 packaged

75946 packaged

75962 packaged

75964 packaged

75966 packaged

75968 packaged

75970 packaged

75978 packaged

75980 packaged

75982 packaged

75984 packaged

75989 packaged

76000 $69.50

76001 packaged

76010 packaged

76080 packaged

76098 packaged

76100 packaged

76101 $177.67

76102 $254.39

76120 $128.50


76125 packaged

76376 packaged

76377 packaged

76380 packaged

76496 $160.13

76497 packaged

76498 $287.50

76499 packaged

76506 $135.37

76510 packaged

76511 $89.83

76512 $72.78

76513 $110.15

76514 packaged

76516 packaged

76519 packaged

76529 $85.89

76536 $135.37

76604 $111.45

76641 packaged

76642 packaged

76700 $135.37

76705 $135.37

76770 $135.37

76775 $52.45

76776 $135.37

76800 packaged

76801 $134.40

76802 packaged

76805 $135.37

76810 packaged

76811 $152.77

76812 packaged

76813 $110.15

76814 packaged

76815 $94.40

76816 packaged

76817 $108.17

76818 $122.61

76819 $89.83

76820 packaged

76821 packaged

76825 $354.70

76826 $225.54

76827 packaged

76828 packaged

76830 $135.37

76831 $150.13

76856 $135.37

76857 $41.30

76870 $64.26

76872 $110.15

76873 $163.26

76881 $135.37

76882 packaged

76885 packaged

76886 packaged

76930 packaged


76932 packaged

76936 $318.63

76937 packaged

76940 packaged

76941 packaged

76942 packaged

76945 packaged

76946 packaged

76948 packaged

76965 packaged

76970 packaged

76975 packaged

76977 $7.22

76998 packaged

76999 packaged

77001 packaged

77002 packaged

77003 packaged

77011 packaged

77012 packaged

77013 packaged

77014 packaged

77021 packaged

77022 packaged

77053 packaged

77054 packaged

77071 packaged

77072 packaged

77073 packaged

77074 packaged

77075 $108.83

77076 packaged

77077 packaged

77078 $59.59

77080 $54.43

77081 $30.82

77084 $287.50

77085 packaged

77086 packaged

77280 $113.60

77285 $315.73

77290 $315.73

77295 $485.82

77299 $113.60

77300 $56.39

77301 $1,042.43

77306 $113.60

77307 $113.60

77316 $113.60

77317 $271.43

77318 $315.73

77321 $78.67

77331 $34.10

77332 $99.00

77333 $16.39

77334 $160.62

77336 $113.60

77338 $315.73


77370 $113.60

77371 $3,558.39

77372 $1,946.56

77373 $1,910.39

77385 $509.67

77386 $509.67

77387 packaged

77399 $113.60

77401 $37.38

77402 $100.52

77407 $100.52

77412 $193.97

77417 packaged

77422 $60.32

77423 $118.67

77424 $5,448.07

77425 $5,448.07

77435 packaged

77470 $85.89

77520 $509.67

77522 $1,076.40

77523 $1,076.40

77525 $1,076.40

77600 $193.97

77605 $509.67

77610 $509.67

77615 $509.67

77620 $509.67

77750 $193.97

77761 $348.13

77762 $397.41

77763 $397.41

77776 $397.41

77777 $356.00

77778 $524.50

77785 $302.90

77786 $586.78

77787 $732.43

77789 $109.49

77790 packaged

77799 $397.41

78012 $189.87

78013 $190.64

78014 $283.06

78015 $378.75

78016 $378.75

78018 $378.75

78020 packaged

78070 $283.06

78071 $378.75

78072 $378.75

78075 $1,193.22

78099 $190.64

78102 $371.00

78103 $371.00

78104 $371.00

78110 $630.55

78111 $630.55


78120 $630.55

78121 $630.55

78122 $630.55

78130 $630.55

78135 $630.55

78140 $630.55

78185 $371.00

78190 $281.32

78191 $281.32

78195 $371.00

78199 $371.00

78201 $374.46

78202 $374.46

78205 $374.46

78206 $374.46

78215 $374.46

78216 $374.46

78226 $374.46

78227 $374.46

78230 $328.19

78231 $328.19

78232 $328.19

78258 $328.19

78261 $328.19

78262 $328.19

78264 $328.19

78270 $281.32

78271 $281.32

78272 $281.32

78278 $328.19

78282 $328.19

78290 $328.19

78291 $328.19

78299 $328.19

78300 $333.57

78305 $333.57

78306 $333.57

78315 $333.57

78320 $333.57

78399 $333.57

78414 $374.98

78428 $374.98

78445 $338.30

78451 $1,144.83

78452 $1,144.83

78453 $1,144.83

78454 $1,144.83

78456 $816.26

78457 $338.30

78458 $338.30

78459 $1,291.06

78466 $374.98

78468 $374.98

78469 $374.98

78472 $374.98

78473 $374.98

78481 $374.98

78483 $1,144.83


78491 $1,291.06

78492 $1,291.06

78494 $374.98

78496 packaged

78499 $374.98

78579 $317.07

78580 $317.07

78582 $442.00

78597 $317.07

78598 $442.00

78599 $317.07

78600 $177.73

78601 $559.35

78605 $559.35

78606 $559.35

78607 $1,193.22

78608 $1,291.06

78610 $559.35

78630 $559.35

78635 $559.35

78645 $559.35

78647 $559.35

78650 $559.35

78660 $177.73

78699 $177.73

78700 $422.24

78701 $422.24

78707 $422.24

78708 $422.24

78709 $422.24

78710 $422.24

78725 $281.32

78730 packaged

78740 $422.24

78761 $422.24

78799 $422.24

78800 $378.75

78801 $378.75

78802 $709.39

78803 $709.39

78804 $1,193.22

78805 $709.39

78806 $709.39

78807 $709.39

78808 packaged

78811 $1,291.06

78812 $1,291.06

78813 $1,291.06

78814 $1,291.06

78815 $1,291.06

78816 $1,291.06

78999 $189.87

79005 $89.83

79101 $87.85

79200 $94.40

79300 $277.97

79403 $146.21

79440 $73.43


79445 $277.97

79999 $277.97

90371 $214.96

90375 $453.37

90376 $435.52

90378 $3,566.98

90385 packaged

90396 $218.75

90476 packaged

90581 $172.23

90585 $223.34

90632 packaged

90633 packaged

90634 packaged

90636 packaged

90645 packaged

90646 packaged

90647 packaged

90648 packaged

90654 packaged

90655 packaged

90656 packaged

90657 packaged

90660 packaged

90661 packaged

90662 packaged

90669 packaged

90670 packaged

90672 packaged

90673 packaged

90675 $409.81

90676 $315.53

90680 packaged

90687 packaged

90688 packaged

90690 packaged

90691 packaged

90692 packaged

90696 packaged

90698 packaged

90700 packaged

90702 packaged

90703 packaged

90704 packaged

90705 packaged

90707 packaged

90708 packaged

90710 packaged

90712 packaged

90713 packaged

90714 packaged

90715 packaged

90717 packaged

90719 packaged

90720 packaged

90721 packaged

90732 packaged

90733 $195.01


90734 packaged

90735 $198.31

90740 80%of billed

90743 80%of billed

90744 80%of billed

90746 80%of billed

90747 80%of billed

90749 packaged

91035 $329.96

91200 $38.68

92071 packaged

92072 packaged

93261 packaged

93355 packaged

93644 packaged

93895 packaged

95940 packaged

95941 packaged

99497 packaged

99498 packaged

0042T packaged

0174T packaged

0175T packaged

0182T $732.43

0286T packaged

0287T packaged

0291T packaged

0292T packaged

0331T $1,144.83

0332T $1,144.83

0346T packaged

A4218 packaged

A4220 packaged

A4248 packaged

A4262 packaged

A4263 packaged

A4270 packaged

A4300 packaged

A4301 packaged

A4305 packaged

A4306 packaged

A4459 packaged

A4602 packaged

A4641 packaged

A4642 packaged

A4648 packaged

A4650 packaged

A7048 packaged

A9500 packaged

A9501 packaged

A9502 packaged

A9503 packaged

A9504 packaged

A9505 packaged

A9507 packaged

A9508 packaged

A9509 packaged

A9510 packaged


A9512 packaged

A9516 packaged

A9520 $439.51

A9521 packaged

A9524 packaged

A9526 packaged

A9527 $24.26

A9528 packaged

A9529 packaged

A9531 packaged

A9532 packaged

A9536 packaged

A9537 packaged

A9538 packaged

A9539 packaged

A9540 packaged

A9541 packaged

A9542 packaged

A9544 packaged

A9546 packaged

A9547 packaged

A9548 packaged

A9550 packaged

A9551 packaged

A9552 packaged

A9553 packaged

A9554 packaged

A9555 packaged

A9556 packaged

A9557 packaged

A9558 packaged

A9559 packaged

A9560 packaged

A9561 packaged

A9562 packaged

A9566 packaged

A9567 packaged

A9568 packaged

A9569 packaged

A9570 packaged

A9571 packaged

A9572 packaged

A9575 packaged

A9576 packaged

A9577 packaged

A9578 packaged

A9579 packaged

A9580 packaged

A9581 packaged

A9582 packaged

A9583 packaged

A9584 packaged

A9585 packaged

A9586 $5,047.05

A9599 packaged

A9606 $220.95

A9698 packaged

C1713 packaged


C1714 packaged

C1715 packaged

C1716 $68.29

C1717 $498.61

C1719 $98.36

C1721 packaged

C1722 packaged

C1724 packaged

C1725 packaged

C1726 packaged

C1727 packaged

C1728 packaged

C1729 packaged

C1730 packaged

C1731 packaged

C1732 packaged

C1733 packaged

C1749 packaged

C1750 packaged

C1751 packaged

C1752 packaged

C1753 packaged

C1754 packaged

C1755 packaged

C1756 packaged

C1757 packaged

C1758 packaged

C1759 packaged

C1760 packaged

C1762 packaged

C1763 packaged

C1764 packaged

C1765 packaged

C1766 packaged

C1767 packaged

C1768 packaged

C1769 packaged

C1770 packaged

C1771 packaged

C1772 packaged

C1773 packaged

C1776 packaged

C1777 packaged

C1778 packaged

C1779 packaged

C1780 packaged

C1781 packaged

C1782 packaged

C1783 packaged

C1784 packaged

C1785 packaged

C1786 packaged

C1787 packaged

C1788 packaged

C1789 packaged

C1813 packaged

C1814 packaged

C1815 packaged


C1816 packaged

C1817 packaged

C1818 packaged

C1819 packaged

C1820 packaged

C1821 packaged

C1830 packaged

C1840 packaged

C1841 80%of billed

C1874 packaged

C1875 packaged

C1876 packaged

C1877 packaged

C1878 packaged

C1880 packaged

C1881 packaged

C1882 packaged

C1883 packaged

C1884 packaged

C1885 packaged

C1886 packaged

C1887 packaged

C1888 packaged

C1891 packaged

C1892 packaged

C1893 packaged

C1894 packaged

C1895 packaged

C1896 packaged

C1897 packaged

C1898 packaged

C1899 packaged

C1900 packaged

C2614 packaged

C2615 packaged

C2616 $28,525.35

C2617 packaged

C2618 packaged

C2619 packaged

C2620 packaged

C2621 packaged

C2622 packaged

C2624 80%of billed

C2625 packaged

C2626 packaged

C2627 packaged

C2628 packaged

C2629 packaged

C2630 packaged

C2631 packaged

C2634 $157.09

C2635 $47.25

C2636 $35.58

C2638 $77.65

C2639 $67.81

C2640 $119.91

C2641 $124.34

C2642 $192.93


C2643 $100.15

C2644 $24.26

C2698 $77.65

C2699 $35.58

C8900 $428.65

C8901 $287.50

C8902 $484.91

C8903 $428.65

C8904 $287.50

C8905 $484.91

C8906 $428.65

C8907 $287.50

C8908 $484.91

C8909 $428.65

C8910 $287.50

C8911 $484.91

C8912 $428.65

C8913 $287.50

C8914 $484.91

C8918 $428.65

C8919 $287.50

C8920 $484.91

C8931 $428.65

C8932 $287.50

C8933 $484.91

C8934 $428.65

C8935 $287.50

C8936 $484.91

C9027 $83.78

C9113 packaged

C9121 $38.70

C9132 $2.55

C9136 $3.85

C9248 $7.73

C9250 packaged

C9254 packaged

C9257 $12.75

C9275 packaged

C9285 packaged

C9290 packaged

C9293 $409.94

C9349 $199.94

C9352 packaged

C9353 packaged

C9354 packaged

C9355 packaged

C9356 packaged

C9358 packaged

C9359 packaged

C9360 packaged

C9361 packaged

C9362 packaged

C9363 packaged

C9364 packaged

C9399 80%of billed

C9442 $58.24

C9443 $57.85

C9444 $46.92


C9446 $2.29

C9447 $766.76

C9497 $281.47

C9733 packaged

G0130 $41.95

G0288 packaged

G0453 packaged

G0464 packaged

G0472 packaged

J0120 $179.41

J0129 $59.06

J0130 $1,353.64

J0131 packaged

J0132 $4.01

J0133 packaged

J0135 $1,045.56

J0153 packaged

J0171 packaged

J0178 $1,795.59

J0180 $279.00

J0200 $71.16

J0207 $569.02

J0210 packaged

J0215 $76.26

J0220 $378.40

J0221 $281.36

J0256 $7.53

J0257 $7.29

J0278 packaged

J0280 packaged

J0282 packaged

J0285 packaged

J0287 $19.06

J0288 packaged

J0289 $30.82

J0290 packaged

J0295 packaged

J0300 $268.30

J0330 packaged

J0348 packaged

J0360 packaged

J0380 packaged

J0390 packaged

J0400 packaged

J0401 $7.09

J0456 packaged

J0461 packaged

J0470 packaged

J0475 $298.13

J0476 $139.71

J0480 $4,974.13

J0485 $6.98

J0490 $72.30

J0500 packaged

J0515 packaged

J0520 packaged

J0558 packaged

J0561 packaged


J0583 $6.26

J0585 $10.18

J0586 $13.61

J0587 $20.69

J0588 $8.20

J0592 packaged

J0594 $53.00

J0595 packaged

J0597 $68.93

J0598 $94.97

J0600 $6,368.35

J0610 packaged

J0620 packaged

J0630 $126.89

J0636 packaged

J0637 $21.68

J0638 $166.57

J0640 packaged

J0641 $3.24

J0670 packaged

J0690 packaged

J0692 packaged

J0694 packaged

J0696 packaged

J0697 packaged

J0698 packaged

J0702 packaged

J0706 packaged

J0712 packaged

J0713 packaged

J0715 packaged

J0716 $2,216.42

J0717 $12.01

J0720 packaged

J0725 $33.09

J0735 packaged

J0740 $1,076.99

J0743 packaged

J0744 packaged

J0745 packaged

J0760 packaged

J0770 packaged

J0775 $70.07

J0780 packaged

J0795 $14.14

J0800 $6,088.91

J0833 $155.07

J0834 packaged

J0840 $4,565.64

J0850 $1,856.70

J0878 $1.23

J0881 $6.90

J0885 $21.33

J0888 packaged

J0894 $51.73

J0895 packaged

J0897 $26.46

J0945 packaged


J1000 packaged

J1020 packaged

J1030 packaged

J1040 packaged

J1050 packaged

J1071 packaged

J1094 packaged

J1100 packaged

J1110 packaged

J1120 packaged

J1160 packaged

J1162 $3,757.14

J1165 packaged

J1170 packaged

J1190 $265.28

J1200 packaged

J1205 $224.61

J1212 packaged

J1230 packaged

J1240 packaged

J1245 packaged

J1250 packaged

J1260 packaged

J1265 packaged

J1267 packaged

J1270 packaged

J1290 $687.91

J1300 $377.50

J1320 packaged

J1322 $406.79

J1324 $34.12

J1325 packaged

J1327 $44.12

J1330 packaged

J1335 packaged

J1364 $82.43

J1380 packaged

J1410 $329.89

J1430 $569.64

J1436 packaged

J1438 $522.41

J1439 $1.92

J1442 $1.81

J1446 $7.31

J1450 packaged

J1451 $17.31

J1452 packaged

J1453 $3.17

J1455 packaged

J1457 packaged

J1458 $657.66

J1459 $67.81

J1460 packaged

J1556 $66.31

J1557 $65.63

J1559 $14.54

J1560 packaged

J1561 $73.29


J1566 $48.99

J1568 $67.61

J1569 $72.08

J1570 packaged

J1571 $98.34

J1572 $69.15

J1573 $124.73

J1580 packaged

J1590 packaged

J1595 $345.00

J1599 packaged

J1600 $7.82

J1602 $44.24

J1610 $267.50

J1626 packaged

J1630 packaged

J1631 packaged

J1640 $37.96

J1642 packaged

J1644 packaged

J1645 packaged

J1650 packaged

J1652 packaged

J1670 $597.59

J1700 packaged

J1710 packaged

J1720 packaged

J1725 $2.66

J1740 $277.99

J1741 packaged

J1742 $205.65

J1743 $884.61

J1744 $351.94

J1745 $136.14

J1750 $22.27

J1756 packaged

J1786 $76.93

J1790 packaged

J1800 packaged

J1815 packaged

J1817 packaged

J1830 $445.88

J1840 packaged

J1850 packaged

J1885 packaged

J1890 packaged

J1930 $75.82

J1931 $53.93

J1940 packaged

J1945 $431.31

J1950 $1,519.46

J1953 packaged

J1956 packaged

J1960 packaged

J1980 packaged

J1990 packaged

J2001 packaged

J2010 packaged


J2020 $83.62

J2060 packaged

J2150 packaged

J2170 packaged

J2175 packaged

J2180 packaged

J2185 packaged

J2210 packaged

J2212 packaged

J2248 $1.79

J2250 packaged

J2260 packaged

J2265 packaged

J2270 packaged

J2274 packaged

J2278 $12.58

J2280 packaged

J2300 packaged

J2310 packaged

J2315 $5.27

J2320 $224.85

J2323 $27.30

J2325 $101.22

J2353 $259.81

J2354 packaged

J2355 $589.46

J2357 $51.00

J2358 $5.04

J2360 packaged

J2370 packaged

J2400 packaged

J2405 packaged

J2410 packaged

J2425 $27.19

J2426 $14.49

J2430 packaged

J2440 packaged

J2469 $36.64

J2501 packaged

J2503 $1,893.60

J2504 $515.33

J2505 $6,232.89

J2507 $1,568.76

J2510 packaged

J2515 $65.60

J2540 packaged

J2543 packaged

J2550 packaged

J2560 packaged

J2562 $551.59

J2590 packaged

J2597 $9.30

J2650 packaged

J2675 packaged

J2680 packaged

J2690 packaged

J2700 packaged

J2704 packaged


J2710 packaged

J2720 packaged

J2724 $26.59

J2730 $163.28

J2760 $207.67

J2765 packaged

J2770 $449.07

J2778 $725.98

J2780 packaged

J2783 $400.60

J2785 packaged

J2788 packaged

J2790 packaged

J2791 $8.79

J2792 $34.52

J2793 $0.27

J2794 $11.28

J2795 packaged

J2796 $98.21

J2800 packaged

J2805 packaged

J2810 packaged

J2820 $55.18

J2850 $63.69

J2910 packaged

J2916 packaged

J2920 packaged

J2930 packaged

J2941 $92.08

J2950 packaged

J2993 $4,215.48

J2995 packaged

J2997 $117.75

J3000 packaged

J3010 packaged

J3030 packaged

J3060 $58.49

J3070 $256.60

J3095 $8.28

J3101 $157.88

J3105 packaged

J3121 packaged

J3145 $2.11

J3230 packaged

J3240 $2,619.54

J3243 $3.66

J3246 $18.02

J3250 packaged

J3260 packaged

J3262 $6.74

J3265 packaged

J3280 packaged

J3285 $112.15

J3300 $6.83

J3301 packaged

J3302 packaged

J3303 packaged

J3310 packaged


J3315 $312.73

J3350 $73.20

J3355 $239.86

J3357 $297.20

J3360 packaged

J3364 packaged

J3370 packaged

J3385 $647.09

J3396 $19.76

J3410 packaged

J3411 packaged

J3415 packaged

J3420 packaged

J3430 packaged

J3465 $7.27

J3470 packaged

J3471 packaged

J3472 packaged

J3473 packaged

J3475 packaged

J3480 packaged

J3485 $2.75

J3486 packaged

J3489 $86.95

J3490 packaged

J3530 packaged

J3590 packaged

J7030 packaged

J7040 packaged

J7042 packaged

J7050 packaged

J7060 packaged

J7070 packaged

J7100 packaged

J7110 packaged

J7120 packaged

J7131 packaged

J7178 $1.65

J7180 packaged

J7181 $25.07

J7183 $1.74

J7185 $2.14

J7186 $1.72

J7187 $1.74

J7189 $3.17

J7190 $1.70

J7191 $0.37

J7192 $2.09

J7193 $1.85

J7194 $2.05

J7195 $2.47

J7196 $189.26

J7197 $5.99

J7198 $3.11

J7200 $2.23

J7201 $5.53

J7308 $443.72

J7309 $194.72


J7310 $31,058.78

J7311 $35,968.58

J7312 $368.66

J7315 $105.68

J7316 $1,916.91

J7321 $166.30

J7323 $293.78

J7324 $342.25

J7325 $22.89

J7326 $1,029.33

J7327 $1,790.86

J7336 $4.85

J7500 packaged

J7501 $397.94

J7502 packaged

J7504 $1,561.53

J7505 packaged

J7506 packaged

J7507 packaged

J7508 $0.73

J7509 packaged

J7510 packaged

J7511 $1,089.14

J7515 packaged

J7516 packaged

J7517 packaged

J7518 packaged

J7520 packaged

J7525 $258.40

J7527 packaged

J7599 packaged

J7665 packaged

J7674 packaged

J7799 packaged

J8501 $14.06

J8510 packaged

J8520 $15.88

J8521 $52.43

J8530 packaged

J8540 packaged

J8560 $104.55

J8597 packaged

J8600 packaged

J8610 packaged

J8650 $52.05

J8700 $9.87

J8705 $173.50

J9000 packaged

J9015 $3,865.19

J9017 $98.12

J9019 $649.67

J9020 $118.23

J9025 $7.47

J9027 $245.58

J9031 $223.34

J9033 $40.67

J9035 $122.06

J9040 packaged


J9041 $84.39

J9042 $202.94

J9043 $260.81

J9045 packaged

J9047 $54.59

J9050 $3,408.26

J9055 $97.59

J9060 packaged

J9065 $38.84

J9070 $115.66

J9098 $1,028.07

J9100 packaged

J9120 $1,478.20

J9130 packaged

J9150 $41.31

J9151 $437.53

J9155 $6.50

J9171 $8.53

J9175 packaged

J9178 packaged

J9179 $181.32

J9181 packaged

J9185 $129.99

J9190 packaged

J9200 $101.91

J9201 packaged

J9202 $412.08

J9206 packaged

J9207 $128.58

J9208 $61.18

J9209 packaged

J9211 $89.93

J9213 $1,343.38

J9214 $38.77

J9215 packaged

J9216 $544.21

J9217 $419.84

J9218 packaged

J9225 $5,496.80

J9226 $33,544.29

J9228 $244.68

J9230 $347.27

J9245 $2,246.32

J9250 packaged

J9260 packaged

J9261 $254.31

J9262 $4.54

J9263 $1.06

J9264 $17.76

J9266 $11,392.13

J9267 packaged

J9268 $2,716.31

J9270 packaged

J9280 $38.24

J9293 $59.22

J9301 $99.38

J9302 $87.46

J9303 $173.59


J9305 $110.37

J9306 $18.72

J9307 $360.99

J9310 $1,297.80

J9315 $495.62

J9320 $614.00

J9328 $10.40

J9330 $107.74

J9340 $748.10

J9351 $3.35

J9354 $53.36

J9355 $151.06

J9357 $1,987.49

J9360 packaged

J9370 packaged

J9371 $3,933.99

J9390 packaged

J9395 $167.14

J9400 $14.87

J9600 $29,724.96

J9999 packaged

P9041 $19.98

P9045 $99.88

P9046 $41.19

P9047 $97.86

Q0138 $1.36

Q0161 packaged

Q0162 packaged

Q0163 packaged

Q0164 packaged

Q0166 packaged

Q0167 packaged

Q0169 packaged

Q0173 packaged

Q0175 packaged

Q0177 packaged

Q0180 packaged

Q0181 packaged

Q0507 packaged

Q0508 packaged

Q0509 packaged

Q2004 packaged

Q2009 packaged

Q2017 $4.38

Q2034 packaged

Q2035 packaged

Q2036 packaged

Q2037 packaged

Q2038 packaged

Q2039 packaged

Q2043 $64,267.72

Q2049 $931.09

Q2050 $898.23

Q3027 $66.60

Q3031 packaged

Q4100 packaged

Q4101 packaged

Q4102 packaged


Q4103 packaged

Q4104 packaged

Q4105 packaged

Q4106 packaged

Q4107 packaged

Q4108 packaged

Q4110 packaged

Q4111 packaged

Q4112 packaged

Q4113 packaged

Q4114 packaged

Q4115 packaged

Q4116 packaged

Q4118 packaged

Q4119 packaged

Q4121 $59.37

Q4122 $238.49

Q4123 packaged

Q4124 packaged

Q4125 packaged

Q4127 $8.52

Q4128 packaged

Q4130 packaged

Q4131 packaged

Q4132 packaged

Q4133 packaged

Q4137 packaged

Q4138 packaged

Q4139 packaged

Q4140 packaged

Q4141 packaged

Q4142 packaged

Q4143 packaged

Q4145 packaged

Q4146 packaged

Q4147 packaged

Q4148 packaged

Q4149 packaged

Q4150 packaged

Q4151 packaged

Q4152 packaged

Q4153 packaged

Q4154 packaged

Q4155 packaged

Q4156 packaged

Q4157 packaged

Q4158 packaged

Q4159 packaged

Q4160 packaged

Q9951 packaged

Q9953 packaged

Q9954 packaged

Q9955 packaged

Q9956 packaged

Q9957 packaged

Q9958 packaged

Q9959 packaged

Q9960 packaged


Q9961 packaged

Q9962 packaged

Q9963 packaged

Q9964 packaged

Q9965 packaged

Q9966 packaged

Q9967 packaged

Q9968 $8.04

V2630 packaged

V2631 packaged

V2632 packaged

V2785 80%of billed

V2790 packaged


proposed 4/1/2012 page 1 of 29 appendix d72126 $241.82 72127 $270.72 72128 $120.46 72129 $241.82...

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