independent radiology fee schedule · arkansas medicaid radiology fee schedule provider type: 10...
TRANSCRIPT
Procedure Code Mod 1 Mod 2 Mod 3 Mod 4
Provider
Program
Medicaid
Maximum
Allowed
Amount
70010 $83.60
70010 26 $78.33
70015 $83.60
70015 26 $78.79
70030 $28.60
70030 26 $11.66
70030 TC $16.94
70100 $35.20
70100 26 $16.00
70100 TC $19.20
70110 $47.56
70110 26 $19.00
70110 TC $28.56
70120 $36.30
70120 26 $11.00
Arkansas Medicaid Radiology Fee Schedule
Provider Type: 10
This fee schedule does not address the various coverage limitations routinely applied by Arkansas
Medicaid before final payment is determined (e.g., beneficiary and provider eligibility, benefit limits,
billing instructions, frequency of services, third party liability, age restrictions, prior authorization,
co-payments/coinsurance where applicable). Procedure codes and/or fee schedule amounts listed
do not guarantee payment, coverage or amount allowed.
Although every effort is made to ensure the accuracy of this information, discrepancies may occur.
This fee schedule may be changed or updated at any time to correct such discrepancies. The
reimbursement rates reflected in this fee schedule are in effect as of the date of this report. The
reimbursement rate applied to a claim depends on the claim’s date of service because Arkansas
Medicaid’s reimbursement rates are date-of-service effective. This fee schedule reflects only
procedure codes that are currently payable. Any procedure code reflecting a Medicaid maximum of
$0.00 is manually priced.
Please note that Arkansas Medicaid will reimburse the lesser of the amount billed or the Medicaid
maximum. For a full explanation of the procedure codes and modifiers listed here, refer to your
Arkansas Medicaid provider manual and provider notices.
Run Date 6/10/20
70120 TC $25.30
70130 $61.54
70130 26 $22.38
70130 TC $39.16
70134 $51.70
70134 26 $22.38
70134 TC $29.32
70140 $40.70
70140 26 $17.00
70140 TC $23.70
70150 $39.60
70150 26 $18.00
70150 TC $21.60
70160 $37.30
70160 26 $13.00
70160 TC $24.30
70170 $38.03
70170 26 $20.05
70190 $27.50
70190 26 $13.20
70190 TC $14.30
70200 $32.52
70200 26 $16.82
70200 TC $15.70
70210 $35.20
70210 26 $18.00
70210 TC $17.20
70220 $49.50
70220 26 $16.50
70220 TC $33.00
70240 $30.80
70240 26 $12.10
70240 TC $18.70
70250 $45.10
70250 26 $19.00
70250 TC $26.10
70260 $58.30
70260 26 $22.38
70260 TC $35.92
70300 $20.90
70300 26 $7.38
70300 TC $13.52
70310 $24.20
70310 26 $7.70
70310 TC $16.50
70320 $34.10
70320 26 $13.20
70320 TC $20.90
70328 $30.80
70328 26 $15.00
70328 TC $15.80
70330 $44.00
70330 26 $16.32
70330 TC $27.68
70332 $79.20
70332 26 $36.37
70336 $462.00
70336 26 $119.00
70336 TC $343.00
70350 $31.00
70350 26 $9.00
70350 TC $22.00
70355 $35.20
70355 26 $10.45
70355 TC $24.20
70360 $20.90
70360 26 $11.00
70360 TC $10.45
70370 $55.00
70370 26 $15.40
70370 TC $39.60
70371 $140.67
70371 26 $52.80
70371 TC $87.87
70380 $27.50
70380 26 $11.00
70380 TC $16.50
70390 $64.26
70390 26 $25.18
70450 $276.10
70450 26 $86.00
70450 TC $190.10
70460 $341.00
70460 26 $102.00
70460 TC $239.00
70470 $413.60
70470 26 $125.00
70470 TC $288.60
70480 $304.70
70480 26 $96.00
70480 TC $208.70
70481 $359.70
70481 26 $106.00
70481 TC $253.70
70482 $424.60
70482 26 $129.00
70482 TC $295.60
70486 $298.10
70486 26 $92.00
70486 TC $206.10
70487 $298.10
70487 26 $85.79
70487 TC $212.31
70488 $556.57
70488 26 $278.56
70488 TC $278.00
70490 $298.10
70490 26 $84.86
70490 TC $213.24
70491 $355.30
70491 26 $96.00
70491 TC $259.30
70492 $558.32
70492 26 $416.32
70492 TC $142.00
70496 $375.03
70496 26 $94.13
70496 TC $280.90
70498 $375.03
70498 26 $94.13
70498 TC $280.90
70540 $564.00
70540 26 $162.00
70540 TC $403.00
70542 $576.05
70542 26 $61.13
70542 TC $514.92
70543 $1,035.46
70543 26 $82.51
70543 TC $952.95
70544 $499.54
70544 26 $63.76
70544 TC $435.78
70545 $499.54
70545 26 $63.76
70545 TC $435.78
70546 $946.96
70546 26 $94.13
70546 TC $852.82
70547 $499.54
70547 26 $63.76
70547 TC $435.78
70548 $499.54
70548 26 $63.76
70548 TC $435.78
70549 $946.96
70549 26 $94.13
70549 TC $852.82
70551 $564.00
70551 26 $162.00
70551 TC $403.00
70552 $677.00
70552 26 $182.00
70552 TC $495.00
70553 $834.90
70553 26 $182.00
70553 TC $652.90
70557 $0.00
70557 26 $184.63
70558 $0.00
70558 26 $204.22
70559 $0.00
70559 26 $205.14
71045 $22.95
71045 26 $11.09
71045 TC $11.86
71046 $35.13
71046 26 $13.27
71046 TC $21.87
71047 $44.96
71047 26 $17.09
71047 TC $27.87
71048 $48.34
71048 26 $19.68
71048 TC $28.67
71100 $39.60
71100 26 $18.00
71100 TC $21.60
71101 $46.20
71101 26 $24.00
71101 TC $22.20
71110 $52.80
71110 26 $22.00
71110 TC $30.80
71111 $59.40
71111 26 $22.00
71111 TC $37.40
71120 $26.40
71120 26 $11.00
71120 TC $15.40
71130 $35.20
71130 26 $14.92
71130 TC $20.28
71250 $352.00
71250 26 $106.00
71250 TC $246.00
71260 $413.60
71260 26 $112.00
71260 TC $301.60
71270 $504.90
71270 26 $129.00
71270 TC $375.90
71275 $406.16
71275 26 $64.88
71275 TC $341.28
71550 $571.00
71550 26 $165.00
71550 TC $406.00
71551 $584.30
71551 26 $67.88
71551 TC $516.42
71552 $1,036.59
71552 26 $88.88
71552 TC $947.71
71555 $542.30
71555 26 $94.88
71555 TC $447.41
72020 $39.05
72020 26 $12.00
72020 TC $27.04
72040 $46.00
72040 26 $18.00
72040 TC $28.00
72050 $58.30
72050 26 $21.00
72050 TC $37.30
72052 $83.00
72052 26 $27.00
72052 TC $55.00
72070 $47.09
72070 26 $19.00
72070 TC $28.09
72072 $50.60
72072 26 $18.00
72072 TC $32.60
72074 $57.20
72074 26 $20.00
72074 TC $37.20
72080 $48.02
72080 26 $18.00
72080 TC $30.02
72081 $37.23
72081 26 $13.72
72081 TC $23.51
72082 $59.46
72082 26 $16.64
72082 TC $42.82
72083 $64.66
72083 26 $18.18
72083 TC $46.48
72084 $76.95
72084 26 $21.15
72084 TC $55.80
72100 $46.20
72100 26 $14.92
72100 TC $31.28
72110 $66.00
72110 26 $20.51
72110 TC $45.49
72114 $71.50
72114 26 $22.00
72114 TC $49.50
72120 $58.30
72120 26 $20.00
72120 TC $38.30
72125 $352.00
72125 26 $106.00
72125 TC $246.00
72126 $410.30
72126 26 $112.00
72126 TC $298.30
72127 $497.20
72127 26 $129.00
72127 TC $368.20
72128 $352.00
72128 26 $106.00
72128 TC $246.00
72129 $410.30
72129 26 $112.00
72129 TC $298.30
72130 $497.20
72130 26 $129.00
72130 TC $368.20
72131 $352.00
72131 26 $106.00
72131 TC $246.00
72132 $410.30
72132 26 $112.00
72132 TC $298.30
72133 $497.20
72133 26 $129.00
72133 TC $368.20
72141 $571.00
72141 26 $165.00
72141 TC $406.00
72142 $693.00
72142 26 $182.00
72142 TC $512.00
72146 $627.00
72146 26 $182.00
72146 TC $446.00
72147 $693.00
72147 26 $182.00
72147 TC $512.00
72148 $614.00
72148 26 $182.00
72148 TC $432.00
72149 $677.00
72149 26 $182.00
72149 TC $495.00
72156 $834.90
72156 26 $182.00
72156 TC $652.90
72157 $834.90
72157 26 $182.00
72157 TC $652.90
72158 $834.90
72158 26 $182.00
72158 TC $652.90
72159 $447.06
72159 26 $243.85
72159 TC $203.21
72170 $35.20
72170 26 $11.66
72170 TC $23.54
72190 $46.20
72190 26 $13.20
72190 TC $33.00
72191 $393.03
72191 26 $64.88
72191 TC $328.15
72192 $348.70
72192 26 $89.00
72192 TC $259.70
72193 $396.00
72193 26 $106.00
72193 TC $290.00
72194 $479.60
72194 26 $128.00
72194 TC $351.60
72195 $488.67
72195 26 $57.38
72195 TC $431.29
72196 $502.00
72196 26 $132.00
72196 TC $370.00
72197 $1,044.84
72197 26 $89.63
72197 TC $955.20
72198 $545.30
72198 26 $97.88
72198 TC $447.41
72200 $30.80
72200 26 $15.00
72200 TC $15.80
72202 $35.20
72202 26 $12.10
72202 TC $23.10
72220 $35.20
72220 26 $15.00
72220 TC $20.20
72240 $166.54
72240 26 $60.14
72255 $154.60
72255 26 $60.14
72265 $144.77
72265 26 $55.02
72270 $220.04
72270 26 $88.12
72275 $125.00
72275 26 $113.64
72285 $275.37
72285 26 $58.30
72295 $250.72
72295 26 $58.30
73000 $27.50
73000 26 $10.72
73000 TC $16.78
73010 $33.00
73010 26 $12.00
73010 TC $21.00
73020 $27.50
73020 26 $12.00
73020 TC $15.50
73030 $38.50
73030 26 $15.00
73030 TC $23.50
73040 $78.94
73040 26 $36.00
73050 $45.10
73050 26 $15.00
73050 TC $30.10
73060 $37.40
73060 26 $12.00
73060 TC $25.40
73070 $33.00
73070 26 $12.00
73070 TC $21.00
73080 $35.20
73080 26 $12.00
73080 TC $23.20
73085 $79.20
73085 26 $36.37
73090 $33.00
73090 26 $12.00
73090 TC $21.00
73092 $44.29
73092 26 $13.40
73092 TC $30.89
73100 $33.00
73100 26 $12.00
73100 TC $21.00
73110 $37.77
73110 26 $12.00
73110 TC $25.77
73115 $64.78
73115 26 $36.37
73120 $30.80
73120 26 $12.00
73120 TC $18.80
73130 $40.00
73130 26 $15.00
73130 TC $25.00
73140 $27.50
73140 26 $9.33
73140 TC $18.17
73200 $301.40
73200 26 $89.00
73200 TC $212.40
73201 $370.66
73201 26 $204.00
73201 TC $166.66
73202 $443.30
73202 26 $242.00
73202 TC $201.30
73206 $353.28
73206 26 $64.88
73206 TC $288.40
73218 $480.79
73218 26 $51.38
73218 TC $429.41
73219 $576.05
73219 26 $61.13
73219 TC $514.92
73220 $564.00
73220 26 $162.00
73220 TC $403.00
73221 $577.19
73221 26 $98.20
73221 TC $380.00
73222 $576.05
73222 26 $61.13
73222 TC $514.92
73223 $1,035.46
73223 26 $82.51
73223 TC $952.95
73225 $426.39
73225 26 $93.39
73225 TC $333.00
73501 $28.63
73501 26 $9.78
73501 TC $18.85
73502 $39.49
73502 26 $11.65
73502 TC $27.84
73503 $55.16
73503 26 $16.54
73503 TC $38.63
73521 $38.16
73521 26 $11.98
73521 TC $26.17
73522 $46.71
73522 26 $15.54
73522 TC $31.17
73523 $54.14
73523 26 $16.64
73523 TC $37.49
73525 $78.94
73525 26 $36.00
73551 $26.53
73551 26 $8.68
73551 TC $17.85
73552 $30.96
73552 26 $9.78
73552 TC $21.18
73560 $37.30
73560 26 $12.00
73560 TC $32.81
73562 $48.00
73562 26 $12.00
73562 TC $35.00
73564 $51.00
73564 26 $14.00
73564 TC $37.00
73565 $35.20
73565 26 $10.49
73565 TC $24.71
73580 $93.37
73580 26 $36.00
73590 $37.30
73590 26 $12.00
73590 TC $25.30
73592 $40.00
73592 26 $13.00
73592 TC $27.00
73600 $33.00
73600 26 $11.19
73600 TC $21.81
73610 $37.40
73610 26 $16.00
73610 TC $21.40
73615 $137.50
73615 26 $38.00
73615 TC $99.50
73620 $35.90
73620 26 $12.00
73620 TC $23.90
73630 $44.00
73630 26 $16.00
73630 TC $28.00
73650 $25.30
73650 26 $11.00
73650 TC $14.30
73660 $28.60
73660 26 $13.00
73660 TC $15.60
73700 $293.70
73700 26 $86.00
73700 TC $207.70
73701 $370.66
73701 26 $204.00
73701 TC $166.66
73702 $443.30
73702 26 $242.00
73702 TC $201.30
73706 $353.28
73706 26 $64.88
73706 TC $288.40
73718 $521.34
73718 26 $115.32
73718 TC $403.00
73719 $576.05
73719 26 $61.13
73719 TC $514.92
73720 $564.00
73720 26 $162.00
73720 TC $403.00
73721 $531.00
73721 26 $152.00
73721 TC $380.00
73722 $576.05
73722 26 $61.13
73722 TC $514.92
73723 $1,035.46
73723 26 $82.51
73723 TC $952.95
73725 $541.17
73725 26 $93.76
73725 TC $447.41
74018 $31.34
74018 26 $11.09
74018 TC $20.26
74019 $38.38
74019 26 $14.11
74019 TC $24.26
74021 $44.82
74021 26 $16.55
74021 TC $28.27
74022 $57.20
74022 26 $21.45
74022 TC $35.75
74150 $345.40
74150 26 $96.00
74150 TC $249.40
74160 $402.60
74160 26 $106.00
74160 TC $296.60
74170 $490.60
74170 26 $129.00
74170 TC $361.60
74174 $566.11
74174 26 $136.95
74174 TC $429.16
74175 $393.03
74175 26 $64.88
74175 TC $328.15
74176 $212.36
74176 26 $112.11
74176 TC $108.30
74177 $315.22
74177 26 $117.51
74177 TC $206.27
74178 $393.56
74178 26 $130.03
74178 TC $272.95
74181 $571.00
74181 26 $162.00
74181 TC $409.00
74182 $584.30
74182 26 $67.88
74182 TC $516.42
74183 $1,044.84
74183 26 $89.53
74183 TC $955.20
74185 $541.54
74185 26 $94.13
74185 TC $447.41
74190 $70.40
74190 26 $64.00
74210 $66.00
74210 26 $25.00
74210 TC $41.00
74220 $80.30
74220 26 $37.00
74220 TC $43.30
74221 $116.80
74221 26 $39.94
74221 TC $76.86
74230 $62.70
74230 26 $30.80
74230 TC $31.90
74235 $208.87
74235 26 $78.79
74240 $80.30
74240 26 $46.16
74240 TC $34.14
74246 $94.60
74246 26 $46.16
74246 TC $48.44
74248 $89.42
74248 26 $39.94
74248 TC $49.48
74250 $70.40
74250 26 $31.24
74250 TC $39.16
74251 $70.40
74251 26 $31.90
74251 TC $38.50
74261 $409.91
74261 26 $145.12
74261 TC $264.79
74262 $459.34
74262 26 $159.34
74262 TC $299.99
74263 $675.11
74263 26 $151.76
74263 TC $523.35
74270 $94.60
74270 26 $40.70
74270 TC $53.90
74280 $112.20
74280 26 $62.70
74280 TC $49.50
74283 $146.87
74283 26 $88.32
74283 TC $58.55
74290 $58.28
74290 26 $24.00
74290 TC $34.28
74300 $29.72
74300 26 $29.72
74300 TC $24.00
74301 $18.07
74301 26 $18.07
74301 TC $18.07
74328 $254.10
74328 26 $58.28
74329 $254.10
74329 26 $58.28
74330 $120.64
74330 26 $56.10
74340 $93.37
74340 26 $24.00
74340 TC $72.00
74355 $101.76
74355 26 $50.82
74360 $108.84
74360 26 $36.83
74363 $310.23
74363 26 $55.29
74363 TC $254.94
74400 $97.90
74400 26 $34.00
74400 TC $63.90
74410 $94.60
74410 26 $41.00
74410 TC $53.60
74415 $119.90
74415 26 $45.00
74415 TC $74.90
74420 $97.90
74420 26 $16.50
74420 TC $81.40
74425 $49.83
74425 26 $23.78
74430 $41.70
74430 26 $21.45
74440 $46.16
74440 26 $25.64
74445 $80.30
74445 26 $76.46
74450 $53.24
74450 26 $21.91
74455 $80.30
74455 26 $73.00
74470 $55.08
74470 26 $36.00
74485 $108.32
74485 26 $35.90
74710 $45.10
74710 26 $24.00
74710 TC $21.10
74712 $463.34
74712 26 $155.97
74712 TC $307.37
74713 $224.09
74713 26 $92.38
74713 TC $131.71
74740 $50.88
74740 26 $25.64
74740 FP Family Planning $50.88
74742 $110.41
74742 26 $39.63
74742 FP Family Planning $110.41
74775 $100.24
74775 26 $39.19
74775 TC $61.05
75557 $435.58
75557 26 $160.77
75557 TC $274.82
75559 $479.69
75559 26 $204.87
75559 TC $274.82
75561 $598.03
75561 26 $177.84
75561 TC $420.19
75563 $633.13
75563 26 $212.94
75563 TC $420.19
75565 $86.83
75565 26 $16.60
75565 TC $70.23
75571 $79.35
75571 26 $24.48
75571 TC $54.87
75572 $247.55
75572 26 $89.63
75572 TC $157.91
75573 $313.15
75573 26 $89.63
75573 TC $223.51
75574 $501.31
75574 26 $89.63
75574 TC $411.67
75600 $370.84
75600 26 $34.03
75605 $394.70
75605 26 $76.46
75625 $394.44
75625 26 $76.00
75630 $430.89
75630 26 $91.30
75635 $429.41
75635 26 $101.26
75635 TC $328.15
75705 $433.26
75705 26 $145.00
75710 $394.70
75710 26 $76.46
75716 $400.47
75716 26 $86.72
75726 $394.18
75726 26 $75.53
75731 $394.18
75731 26 $75.53
75733 $400.73
75733 26 $87.18
75736 $394.18
75736 26 $75.53
75741 $400.47
75741 26 $86.72
75743 $413.59
75743 26 $110.03
75746 $393.92
75746 26 $75.06
75756 $396.01
75756 26 $78.79
75774 $365.07
75774 26 $23.78
75801 $182.01
75801 26 $54.55
75803 $194.86
75803 26 $77.39
75805 $200.89
75805 26 $54.08
75807 $214.00
75807 26 $77.39
75809 $69.94
75809 26 $65.00
75810 $394.18
75810 26 $75.53
75820 $52.98
75820 26 $35.20
75822 $80.78
75822 26 $69.94
75825 $394.18
75825 26 $75.53
75827 $394.18
75827 26 $75.53
75831 $394.18
75831 26 $75.53
75833 $407.29
75833 26 $98.84
75840 $394.18
75840 26 $75.53
75842 $407.29
75842 26 $98.84
75860 $394.44
75860 26 $76.00
75870 $394.18
75870 26 $75.53
75872 $394.18
75872 26 $75.53
75880 $52.98
75880 26 $46.62
75885 $697.40
75885 26 $95.11
75885 TC $602.29
75887 $697.40
75887 26 $95.11
75887 TC $602.29
75889 $672.10
75889 26 $76.00
75889 TC $596.10
75891 $394.18
75891 26 $75.53
75893 $371.88
75893 26 $104.00
75894 $722.52
75894 26 $86.72
75898 $203.40
75898 26 $120.44
75898 TC $79.96
75901 $110.14
75901 26 $28.05
75902 $104.37
75902 26 $22.28
75970 $353.79
75970 26 $55.95
75984 $141.90
75984 26 $48.02
75984 TC $93.88
75989 $232.10
75989 26 $78.79
75989 TC $153.31
76000 $43.01
76000 26 $18.00
76010 $21.24
76010 26 $12.55
76010 TC $8.69
76080 $49.83
76080 26 $36.00
76098 $40.21
76098 26 $26.20
76098 TC $14.00
76100 $91.30
76100 26 $37.81
76100 TC $53.49
76101 $136.96
76101 26 $66.96
76101 TC $70.00
76102 $112.20
76102 26 $49.50
76102 TC $62.70
76120 $66.00
76120 26 $24.20
76120 TC $41.80
76125 $32.26
76125 26 $18.18
76125 TC $14.08
76140 $6.60
76140 26 $6.60
76376 $33.75
76376 26 $13.75
76376 TC $20.00
76377 $33.75
76377 26 $13.75
76377 TC $20.00
76380 $134.28
76380 26 $65.27
76380 TC $69.01
76496 $0.00
76496 26 $0.00
76496 TC $0.00
76497 $0.00
76497 26 $0.00
76497 TC $0.00
76498 $0.00
76498 26 $0.00
76498 TC $0.00
76499 $0.00
76499 26 $0.00
76499 TC $0.00
76506 $63.99
76506 26 $46.00
76506 TC $17.99
76510 $210.27
76510 26 $105.37
76510 TC $104.90
76511 $105.60
76511 26 $52.80
76511 TC $52.80
76512 $105.60
76512 26 $51.00
76512 TC $54.60
76513 $74.80
76513 26 $45.10
76513 TC $29.70
76514 $13.62
76514 26 $10.73
76514 TC $2.96
76516 $102.00
76516 26 $41.00
76516 TC $61.00
76519 $109.00
76519 26 $44.00
76519 TC $65.00
76529 $116.00
76529 26 $70.00
76529 TC $46.00
76536 $94.60
76536 26 $35.20
76536 TC $59.40
76604 $57.17
76604 26 $29.19
76604 TC $27.98
76641 $108.89
76641 26 $45.49
76641 TC $63.40
76642 $90.88
76642 26 $42.37
76642 TC $48.50
76700 $141.90
76700 26 $73.00
76700 TC $68.90
76705 $80.30
76705 26 $53.00
76705 TC $27.30
76706 $105.27
76706 26 $33.27
76706 TC $72.03
76770 $108.90
76770 26 $55.00
76770 TC $53.90
76775 $61.63
76775 26 $41.96
76775 TC $19.67
76776 $124.63
76776 26 $48.37
76776 TC $76.26
76800 $88.00
76800 26 $52.80
76800 TC $35.20
76801 $104.37
76801 26 $57.34
76801 TC $47.03
76802 $81.68
76802 26 $48.27
76802 TC $33.41
76805 $145.20
76805 26 $76.00
76805 TC $69.20
76810 $191.19
76810 26 $112.57
76810 TC $78.62
76811 $272.27
76811 26 $112.62
76811 TC $159.65
76812 $162.13
76812 26 $105.20
76812 TC $56.93
76813 $162.66
76813 26 $73.98
76813 TC $88.68
76814 $95.64
76814 26 $62.13
76814 TC $33.52
76815 $92.40
76815 26 $58.00
76815 TC $34.40
76816 $92.40
76816 26 $58.00
76816 TC $34.40
76817 $107.67
76817 26 $43.32
76817 TC $64.35
76818 $95.37
76818 26 $52.22
76818 TC $43.15
76819 $106.44
76819 26 $37.13
76819 TC $69.31
76820 $87.90
76820 26 $33.57
76820 TC $57.11
76821 $99.79
76821 26 $46.62
76821 TC $57.11
76825 $166.98
76825 26 $100.19
76825 TC $66.79
76826 $124.72
76826 26 $80.43
76826 TC $44.29
76827 $143.00
76827 26 $85.00
76827 TC $58.00
76828 $119.47
76828 26 $68.48
76828 TC $49.00
76830 $172.00
76830 26 $104.00
76830 TC $74.80
76831 $108.91
76831 26 $44.97
76831 TC $63.94
76856 $116.60
76856 26 $62.00
76856 TC $54.50
76857 $71.50
76857 26 $39.00
76857 TC $32.50
76870 $101.20
76870 26 $58.00
76870 TC $43.20
76872 $122.62
76872 26 $76.00
76872 TC $46.62
76873 $169.96
76873 26 $154.51
76873 TC $84.01
76881 $140.55
76881 26 $38.21
76881 TC $102.34
76882 $38.50
76882 26 $26.51
76882 TC $11.99
76885 $109.74
76885 26 $45.79
76885 TC $63.95
76886 $97.77
76886 26 $38.37
76886 TC $59.40
76932 $68.98
76932 26 $46.62
76936 $256.75
76936 26 $143.60
76936 TC $113.51
76937 $37.96
76937 26 $18.57
76937 TC $19.39
76940 $189.35
76940 26 $114.68
76940 TC $74.67
76941 $94.68
76941 26 $46.72
76942 $68.19
76942 26 $45.22
76942 TC $24.13
76945 26 $46.72
76946 $57.17
76946 26 $25.64
76965 $343.31
76965 26 $121.62
76970 $44.85
76970 26 $32.00
76975 $73.17
76975 26 $26.40
76977 $45.75
76977 26 $3.85
76977 TC $41.90
76998 $135.95
76998 26 $81.57
76998 TC $54.38
76999 $0.00
76999 26 $0.00
76999 TC $0.00
77001 $91.53
77001 26 $24.66
77001 TC $66.86
77002 $100.06
77002 26 $34.62
77002 TC $65.45
77003 $102.43
77003 26 $36.99
77003 TC $65.45
77011 $354.39
77011 26 $78.72
77011 TC $275.67
77012 $75.41
77012 26 $75.41
77013 $584.41
77013 26 $259.41
77013 TC $324.99
77014 26 $55.49
77021 $99.12
77021 26 $99.12
77022 $699.23
77022 26 $277.90
77022 TC $421.33
77046 $271.61
77046 26 $84.69
77046 TC $186.92
77047 $279.48
77047 26 $93.69
77047 TC $185.79
77048 $430.31
77048 26 $122.47
77048 TC $307.84
77049 $440.34
77049 26 $134.01
77049 TC $306.34
77053 $23.71
77053 26 $23.71
77054 $29.40
77054 26 $29.40
77061 $109.69
77061 26 $46.87
77061 TC $62.82
77062 $140.81
77062 26 $58.14
77062 TC $82.67
77063 $60.95
77063 26 $38.12
77063 TC $22.83
77065 $147.36
77065 26 $42.92
77065 TC $104.44
77066 $182.79
77066 26 $56.31
77066 TC $126.48
77067 $144.14
77067 26 $45.30
77067 TC $98.84
77071 $30.82
77071 26 $30.82
77072 $37.94
77072 26 $12.33
77072 TC $25.61
77073 $56.91
77073 26 $17.54
77073 TC $39.36
77074 $79.67
77074 26 $29.40
77074 TC $50.27
77075 $107.18
77075 26 $35.10
77075 TC $72.09
77076 $82.52
77076 26 $45.53
77076 TC $36.99
77077 $75.88
77077 26 $20.39
77077 TC $55.49
77078 $115.14
77078 26 $16.13
77078 TC $99.02
77080 $174.52
77080 26 $19.44
77080 TC $155.08
77081 $52.64
77081 26 $14.70
77081 TC $37.94
77084 $478.71
77084 26 $103.86
77084 TC $374.86
77085 $55.50
77085 26 $19.04
77085 TC $36.46
77086 $34.78
77086 26 $11.00
77086 TC $23.78
77261 $98.00
77261 26 $98.00
77262 $149.00
77262 26 $149.00
77263 $221.00
77263 26 $221.00
77293 26 $133.07
77295 26 $203.91
77301 26 $428.16
77306 26 $91.47
77307 26 $189.76
77316 26 $91.81
77317 26 $120.66
77318 26 $190.43
77338 26 $295.93
77385 26 $0.00
77386 26 $0.00
77387 26 $24.62
77419 26 $167.20
77424 26 $0.00
77425 26 $0.00
77427 $185.64
77427 26 $185.64
77432 26 $620.00
77469 $0.00
77469 26 $0.00
78012 $77.42
78012 26 $11.45
78012 TC $65.98
78013 $193.71
78013 26 $22.10
78013 TC $171.61
78014 $225.63
78014 26 $29.82
78014 TC $195.81
78015 $97.30
78015 26 $37.84
78015 TC $59.46
78016 $145.20
78016 26 $45.10
78016 TC $100.10
78018 $184.37
78018 26 $70.00
78018 TC $114.37
78020 $35.07
78020 26 $22.32
78020 TC $12.75
78070 $79.73
78070 26 $48.36
78070 TC $31.37
78071 $343.90
78071 26 $70.94
78071 TC $272.82
78072 $97.15
78072 26 $97.15
78072 TC $38.86
78075 $179.65
78075 26 $55.00
78075 TC $124.65
78099 $0.00
78099 26 $0.00
78099 TC $0.00
78102 $128.70
78102 26 $51.00
78102 TC $77.70
78103 $178.20
78103 26 $97.00
78103 TC $81.20
78104 $203.50
78104 26 $111.00
78104 TC $92.50
78110 $35.20
78110 26 $15.00
78110 TC $20.20
78111 $86.90
78111 26 $11.00
78111 TC $75.90
78120 $67.10
78120 26 $13.20
78120 TC $53.90
78121 $93.10
78121 26 $24.00
78121 TC $69.10
78122 $228.95
78122 26 $26.82
78122 TC $202.13
78130 $116.60
78130 26 $26.40
78130 TC $90.20
78135 $191.40
78135 26 $104.00
78135 TC $87.40
78140 $145.20
78140 26 $26.40
78140 TC $118.80
78185 $94.60
78185 26 $48.00
78185 TC $46.60
78191 $227.38
78191 26 $83.00
78191 TC $144.38
78195 $155.78
78195 26 $74.60
78195 TC $81.18
78199 $0.00
78199 26 $0.00
78199 TC $0.00
78201 $146.86
78201 26 $43.00
78201 TC $103.86
78202 $110.00
78202 26 $60.00
78202 TC $50.00
78215 $116.60
78215 26 $76.00
78215 TC $40.60
78216 $157.30
78216 26 $86.00
78216 TC $71.30
78226 $357.99
78226 26 $45.60
78226 TC $312.39
78227 $488.80
78227 26 $55.00
78227 TC $433.79
78230 $78.42
78230 26 $30.77
78230 TC $47.65
78231 $108.32
78231 26 $34.97
78231 TC $73.35
78232 $127.60
78232 26 $70.00
78232 TC $57.60
78258 $169.15
78258 26 $47.20
78258 TC $121.95
78261 $140.83
78261 26 $55.00
78261 TC $85.83
78262 $176.00
78262 26 $96.00
78262 TC $80.00
78264 $144.77
78264 26 $52.22
78264 TC $92.55
78267 $10.48
78267 TC $16.29
78268 $38.61
78268 26 $42.47
78278 $173.35
78278 26 $83.00
78278 TC $90.35
78282 $77.00
78282 26 $42.00
78282 TC $35.00
78290 $148.50
78290 26 $56.00
78290 TC $92.50
78291 $186.05
78291 26 $51.57
78291 TC $134.48
78299 $0.00
78299 26 $0.00
78299 TC $0.00
78300 $105.60
78300 26 $73.00
78300 TC $32.60
78305 $133.23
78305 26 $60.00
78305 TC $73.23
78306 $170.50
78306 26 $96.00
78306 TC $74.50
78315 $184.80
78315 26 $47.30
78315 TC $137.50
78350 26 $13.07
78350 TC $33.55
78351 26 $17.25
78351 TC $25.88
78399 $0.00
78399 26 $0.00
78399 TC $0.00
78414 $30.77
78414 26 $30.77
78414 TC $30.77
78428 $127.60
78428 26 $70.00
78428 TC $57.60
78429 $99.42
78429 26 $59.65
78429 TC $23.86
78430 $94.33
78430 26 $56.60
78430 TC $22.64
78431 $109.46
78431 26 $65.68
78431 TC $26.27
78432 $116.88
78432 26 $70.13
78432 TC $28.05
78433 $127.72
78433 26 $76.63
78433 TC $30.65
78434 $35.64
78434 26 $21.38
78434 TC $8.55
78445 $79.20
78445 26 $43.00
78445 TC $36.20
78451 $225.81
78451 26 $87.73
78451 TC $138.07
78452 $370.57
78452 26 $103.86
78452 TC $266.71
78453 $192.34
78453 26 $63.55
78453 TC $128.79
78454 $192.73
78454 26 $84.41
78454 TC $108.31
78456 $231.02
78456 26 $55.69
78456 TC $175.33
78457 $134.20
78457 26 $73.00
78457 TC $61.20
78458 $203.50
78458 26 $111.00
78458 TC $92.50
78459 $138.24
78459 26 $82.94
78466 $105.60
78466 26 $58.00
78466 TC $47.60
78468 $132.18
78468 26 $58.00
78468 TC $74.18
78469 $180.70
78469 26 $108.42
78469 TC $72.28
78472 $276.10
78472 26 $99.00
78472 TC $177.10
78473 $285.60
78473 26 $98.38
78473 TC $187.22
78481 $183.22
78481 26 $70.00
78481 TC $113.32
78483 $276.16
78483 26 $100.24
78483 TC $175.92
78491 $176.69
78491 26 $106.01
78491 TC $70.68
78492 $208.34
78492 26 $125.00
78492 TC $83.34
78494 $312.70
78494 26 $74.60
78494 TC $238.10
78496 $108.09
78496 26 $33.10
78496 TC $74.99
78499 $0.00
78499 26 $0.00
78499 TC $0.00
78579 $191.91
78579 26 $30.65
78579 TC $161.27
78580 $127.60
78580 26 $53.00
78580 TC $74.60
78582 $355.58
78582 26 $66.38
78582 TC $289.19
78597 $218.64
78597 26 $45.78
78597 TC $172.86
78598 $332.20
78598 26 $46.69
78598 TC $149.23
78599 $0.00
78599 26 $0.00
78599 TC $0.00
78600 $116.60
78600 26 $64.00
78600 TC $52.60
78601 $141.90
78601 26 $83.00
78601 TC $58.90
78605 $130.90
78605 26 $76.00
78605 TC $54.90
78606 $163.90
78606 26 $92.00
78606 TC $71.90
78608 $119.00
78608 26 $76.00
78608 TC $43.00
78609 $119.00
78609 26 $76.00
78609 TC $43.00
78610 $55.60
78610 26 $30.00
78610 TC $25.60
78630 $173.80
78630 26 $66.00
78630 TC $107.80
78635 $169.25
78635 26 $66.00
78635 TC $103.25
78645 $173.80
78645 26 $89.00
78645 TC $84.80
78650 $152.37
78650 26 $60.00
78650 TC $92.37
78660 $127.60
78660 26 $70.00
78660 TC $57.60
78699 $0.00
78699 26 $0.00
78699 TC $0.00
78700 $101.76
78700 26 $48.00
78700 TC $53.76
78701 $117.49
78701 26 $60.00
78701 TC $57.49
78707 $160.77
78707 26 $73.00
78707 TC $87.77
78708 $256.60
78708 26 $69.72
78708 TC $186.88
78709 $264.85
78709 26 $77.97
78709 TC $186.88
78715 $124.14
78715 26 $64.12
78715 TC $60.00
78725 $77.00
78725 26 $42.00
78725 TC $35.00
78730 $104.00
78730 26 $62.00
78730 TC $42.00
78740 $80.51
78740 26 $37.77
78740 TC $42.74
78760 $102.30
78760 26 $55.00
78760 TC $47.30
78761 $116.18
78761 26 $64.00
78761 TC $52.18
78799 $0.00
78799 26 $0.00
78799 TC $0.00
78800 $119.85
78800 26 $45.00
78800 TC $74.85
78801 $147.65
78801 26 $63.00
78801 TC $84.65
78802 $186.99
78802 26 $69.00
78802 TC $117.99
78803 $224.23
78803 26 $72.74
78803 TC $151.49
78804 $250.42
78804 26 $61.05
78804 TC $189.37
78810 $1,366.79
78810 26 $79.79
78811 $1,558.25
78811 26 $97.81
78811 TC $1,850.00
78812 $1,576.74
78812 26 $96.74
78812 TC $1,480.00
78813 $1,580.06
78813 26 $100.06
78813 TC $1,480.00
78814 $1,558.25
78814 26 $78.25
78814 TC $1,480.00
78815 $1,576.74
78815 26 $86.74
78815 TC $1,480.00
78816 $1,580.86
78816 26 $100.06
78816 TC $1,480.00
78830 $0.00
78830 26 $0.00
78830 TC $0.00
78831 $0.00
78831 26 $0.00
78831 TC $0.00
78832 $0.00
78832 26 $0.00
78832 TC $0.00
78835 $0.00
78835 26 $0.00
78835 TC $0.00
78886 $97.77
78999 $0.00
78999 26 $0.00
78999 TC $0.00
79005 $244.31
79005 26 $115.62
79005 TC $128.68
79101 $255.03
79101 26 $126.35
79101 TC $128.68
79200 $195.80
79200 26 $178.00
79300 $116.00
79300 26 $116.00
79403 $316.82
79403 26 $134.07
79403 TC $182.75
79440 $195.80
79440 26 $178.00
79445 $285.34
79445 26 $155.73
79445 TC $129.62
79900 $99.00
79900 TC $99.00
91110 TC $672.12
92611 TC $51.56
92612 TC $193.90
92614 TC $149.75
92616 TC $205.03
93313 26 $59.48
93980 26 $92.28
93980 TC $60.62
93981 26 $58.00
93981 TC $55.30
95717 26 $125.60
95718 26 $164.26
95719 26 $193.49
95720 26 $254.18
95721 26 $240.15
95722 26 $310.80
95723 26 $297.29
95724 26 $396.98
95725 26 $339.28
95726 26 $501.66
95957 26 $73.52
95958 26 $324.26
95958 TC $74.25
A4641 $0.00
A4642 $1,340.00
A4648 $24.00
A9500 $70.66
A9502 $160.00
A9503 $64.00
A9504 $400.00
A9505 $16.88
A9507 $1,647.18
A9508 $14.30
A9510 $48.00
A9512 $0.20
A9515 $5,700.00
A9516 $20.45
A9517 $28.60
A9520 $258.12
A9521 $347.61
A9524 $44.96
A9526 $0.00
A9527 $0.00
A9528 $12.04
A9529 $7.32
A9530 $7.32
A9531 $7.32
A9532 $2,102.40
A9536 $640.00
A9537 $38.20
A9538 $20.80
A9539 $13.68
A9540 $18.14
A9541 $52.88
A9542 $1,808.00
A9543 $0.00
A9547 $409.28
A9548 $191.04
A9550 $0.00
A9551 $88.87
A9552 $0.00
A9553 $451.20
A9554 $414.00
A9555 $0.00
A9556 $14.68
A9557 $32.00
A9558 $25.60
A9559 $0.00
A9560 $53.92
A9561 $23.04
A9562 $31.27
A9563 $80.77
A9564 $181.98
A9567 $13.68
A9572 $128.00
A9575 $0.54
A9576 $2.46
A9577 $2.85
A9578 $2.68
A9579 $2.55
A9580 $0.00
A9582 $0.00
A9585 $0.00
A9586 $0.00
A9587 $71.78
A9588 $418.95
A9590 $344.28
A9597 $0.00
A9598 $0.00
A9600 $811.30
A9604 $0.00
A9699 $0.00
C8931 $0.00
C8931 26 $0.00
C8931 TC $0.00
C8932 $0.00
C8932 26 $0.00
C8932 TC $0.00
C8934 $0.00
C8934 26 $0.00
C8934 TC $0.00
C8935 $0.00
C8935 26 $0.00
C8935 TC $0.00
C8936 $0.00
C8936 26 $0.00
C8936 TC $0.00
C9734 $0.00
C9734 26 $0.00
C9734 TC $0.00
C9747 $0.00
C9747 26 $0.00
C9747 TC $0.00
G0130 $54.08
G0130 26 $13.98
G0130 TC $40.10
G0166 $170.64
G0166 26 $102.38
G0166 TC $68.26
G0255 $0.00
G0255 26 $0.00
G0255 TC $0.00
G0278 $12.82
G0278 26 $12.82
Q3014 $2.54
Q9969 $0.00
R0070 TC $53.00
S3904 $0.00
S3904 26 $0.00
S3904 TC $0.00
S8037 $0.00
S8037 26 $0.00
S8037 TC $0.00
S8110 $0.00
S8110 26 $0.00
S8110 TC $0.00
S9024 $0.00
S9024 26 $0.00
S9024 TC $0.00
77014 $154.50
77280 $219.60
77285 $347.35
77290 $428.94
77293 $481.10
77295 $953.58
77299 $0.00
77300 $111.00
77301 $1,234.32
77306 $169.24
77307 $332.06
77316 $212.46
77317 $278.15
77318 $404.09
77321 $306.00
77331 $84.00
77332 $103.04
77333 $150.59
77334 $249.00
77336 $101.20
77338 $519.76
77370 $89.10
77371 $974.17
77372 $739.93
77373 $1,378.11
77385 $382.34
77386 $382.34
77387 $83.65
77399 $0.00
77401 $49.83
77402 $64.90
77407 $72.60
77412 $83.60
77417 $28.60
77423 $78.49
77431 $94.60
77432 $620.00
77435 $796.45
77470 $490.60
77499 $0.00
77520 $0.00
77522 $0.00
77523 $0.00
77525 $0.00
77600 $181.50
77605 $246.40
77610 $181.50
77615 $246.40
77620 $181.50
77750 $355.30
77761 $469.74
77762 $702.27
77763 $993.67
77770 $309.72
77771 $577.78
77772 $879.39
77778 $562.55
77789 $69.30
77790 $100.00
77799 $0.00
78808 $58.33
G6015 $0.00
77014 TC $99.02
77280 TC $169.60
77285 TC $273.35
77290 TC $317.94
77293 TC $348.00
77295 TC $749.67
77299 TC $0.00
77300 TC $67.00
77301 TC $806.16
77306 TC $77.77
77307 TC $142.30
77316 TC $120.66
77317 TC $157.48
77318 TC $213.66
77321 TC $239.00
77331 TC $22.00
77332 TC $64.04
77333 TC $91.59
77334 TC $162.00
77336 TC $101.20
77338 TC $223.83
77370 TC $109.00
77371 TC $974.17
77372 TC $739.93
77373 TC $1,378.11
77385 TC $0.00
77386 TC $382.34
77387 TC $59.03
77399 TC $0.00
77401 TC $39.60
77402 TC $64.90
77407 TC $72.60
77412 TC $83.60
77417 TC $28.60
77423 TC $78.49
77424 TC $0.00
77425 TC $0.00
77435 TC $796.45
77470 TC $223.00
77499 TC $0.00
77520 TC $0.00
77522 TC $0.00
77523 TC $0.00
77525 TC $0.00
77600 TC $165.00
77605 TC $224.00
77610 TC $165.00
77615 TC $224.00
77620 TC $165.00
77761 TC $218.72
77762 TC $324.28
77763 TC $428.68
77770 TC $206.24
77771 TC $375.65
77772 TC $592.74
77778 TC $165.74
77789 TC $15.40
77790 TC $17.00
77799 TC $0.00
78808 TC $23.33
C2698 TC $0.00
C2699 TC $0.00
G6015 TC $0.00