State prevailing rates

Please note that the CHAMPUS Maximum Allowable Charges (CMAC) take precedence over the state prevailing rates listed below.

Latest update: 08-01-2018
CPT code State Provider class Modifier Current pricing Effective date Past pricing Past effective date
0359T DE 01 00 $500.00 02/04/16
0359T DE 04 00 $500.00 02/04/16
0360T DE 01 00 $62.50 02/04/16
0360T DE 04 00 $62.50 02/04/16
0361T DE 01 00 $62.50 02/04/16
0361T DE 04 00 $62.50 02/04/16
0364T DE 01 00 $62.50 05/25/17
0364T DE 04 00 $62.50 05/25/17
0365T DE 01 00 $62.50 02/04/16
0365T DE 04 00 $62.50 02/04/16
0368T DE 01 00 $62.50 02/04/16
0368T DE 04 00 $62.50 02/04/16
0369T DE 01 00 $62.50 02/04/16
0369T DE 04 00 $62.50 02/04/16
0370T DE 01 00 $125.00 02/04/16
0370T DE 04 00 $125.00 02/04/16
15824 DE 01 00 $343.40 05/25/17
15824 DE 04 00 $343.40 05/25/17
15825 DE 01 00 $343.40 05/25/17
15825 DE 04 00 $343.40 05/25/17
15826 DE 01 00 $343.40 05/25/17
15826 DE 04 00 $343.40 05/25/17
15828 DE 01 00 $343.40 05/25/17
15828 DE 04 00 $343.40 05/25/17
15829 DE 01 00 $343.40 05/25/17
15829 DE 04 00 $343.40 05/25/17
15876 DE 01 00 $343.40 05/25/17
15876 DE 04 00 $343.40 05/25/17
15878 DE 01 00 $343.40 05/25/17
15878 DE 04 00 $343.40 05/25/17
15879 DE 01 00 $343.40 05/25/17
15879 DE 04 00 $343.40 05/25/17
17380 DE 01 00 $343.40 02/04/16
17380 DE 04 00 $343.40 02/04/16
21088 DE 01 00 $343.40 02/04/16
21088 DE 04 00 $343.40 02/04/16
21089 DE 01 00 $343.40 05/25/17
21089 DE 04 00 $343.40 05/25/17
22841 DE 01 00 $343.40 05/25/17
22841 DE 04 00 $343.40 05/25/17
24940 DE 01 00 $343.40 05/25/17
24940 DE 04 00 $343.40 05/25/17
26989 DE 01 00 $343.40 05/25/17
26989 DE 04 00 $343.40 05/25/17
32850 DE 01 00 $343.40 05/25/17
32850 DE 04 00 $343.40 05/25/17
33930 DE 01 00 $343.40 05/25/17
33930 DE 04 00 $343.40 05/25/17
33940 DE 01 00 $343.40 05/25/17
33940 DE 04 00 $343.40 05/25/17
41821 DE 01 00 $343.40 05/25/17
41821 DE 04 00 $343.40 05/25/17
41870 DE 01 00 $343.40 05/25/17
41870 DE 04 00 $343.40 05/25/17
43496 DE 01 00 $343.40 05/25/17
43496 DE 04 00 $343.40 05/25/17
47133 DE 01 00 $343.40 05/25/17
47133 DE 04 00 $343.40 05/25/17
48160 DE 01 00 $343.40 05/25/17
48160 DE 04 00 $343.40 05/25/17
48550 DE 01 00 $343.40 05/25/17
48550 DE 04 00 $343.40 05/25/17
49906 DE 01 00 $343.40 05/25/17
49906 DE 04 00 $343.40 05/25/17
50300 DE 01 00 $343.40 05/25/17
50300 DE 04 00 $343.40 05/25/17
55970 DE 01 00 $343.40 05/25/17
55970 DE 04 00 $343.40 05/25/17
55980 DE 01 00 $343.40 05/25/17
55980 DE 04 00 $343.40 05/25/17
58974 DE 01 00 $343.40 02/04/16
58974 DE 04 00 $343.40 02/04/16
65767 DE 01 00 $343.40 05/25/17
65767 DE 04 00 $343.40 05/25/17
65771 DE 01 00 $343.40 02/04/16
65771 DE 04 00 $343.40 02/04/16
69090 DE 01 00 $343.40 02/04/16
69090 DE 04 00 $343.40 02/04/16
69710 DE 01 00 $343.40 02/04/16
69710 DE 04 00 $343.40 02/04/16
69949 DE 01 00 $343.40 05/25/17
69949 DE 04 00 $343.40 05/25/17
69979 DE 01 00 $343.40 05/25/17
69979 DE 04 00 $343.40 05/25/17
78609 DE 01 00 $343.40 05/25/17
78609 DE 04 00 $343.40 05/25/17
79300 DE 01 00 $343.40 05/25/17
79300 DE 04 00 $343.40 05/25/17
80300 DE 01 00 $30.00 02/04/16
80300 DE 04 00 $30.00 02/04/16
80301 DE 01 00 $356.00 02/04/16
80301 DE 04 00 $356.00 02/04/16
86860 DE 01 00 $54.00 05/25/17
86860 DE 04 00 $54.00 05/25/17
86891 DE 01 00 $90.00 05/25/17
86891 DE 04 00 $90.00 05/25/17
86921 DE 01 00 $421.00 05/25/17
86921 DE 04 00 $421.00 05/25/17
86930 DE 01 00 $9.00 05/25/17
86930 DE 04 00 $9.00 05/25/17
86931 DE 01 00 $9.00 05/25/17
86931 DE 04 00 $9.00 05/25/17
86932 DE 01 00 $9.00 05/25/17
86932 DE 04 00 $9.00 05/25/17
86950 DE 01 00 $45.00 05/25/17
86950 DE 04 00 $45.00 05/25/17
86970 DE 01 00 $144.00 05/25/17
86970 DE 04 00 $144.00 05/25/17
86971 DE 01 00 $144.00 05/25/17
86971 DE 04 00 $144.00 05/25/17
86972 DE 01 00 $144.00 05/25/17
86972 DE 04 00 $144.00 05/25/17
86975 DE 01 00 $144.00 05/25/17
86975 DE 04 00 $144.00 05/25/17
86976 DE 01 00 $144.00 05/25/17
86976 DE 04 00 $144.00 05/25/17
86977 DE 01 00 $144.00 05/25/17
86977 DE 04 00 $144.00 05/25/17
86978 DE 01 00 $144.00 05/25/17
86978 DE 04 00 $144.00 05/25/17
90736 DE 01 00 $254.35 07/20/17
90736 DE 04 00 $254.35 07/20/17
90993 DE 01 00 $343.40 05/25/17
90993 DE 04 00 $343.40 05/25/17
92594 DE 01 00 $138.00 04/20/17
92594 DE 04 00 $138.00 04/20/17
92993 DE 01 00 $343.40 05/25/17
92993 DE 04 00 $343.40 05/25/17
93010 DE 01 26 $34.00 05/25/17
93010 DE 04 26 $34.00 05/25/17
93299 DE 01 00 $113.00 04/20/17
93299 DE 04 00 $113.00 04/20/17
94772 DE 01 TC $212.50 05/25/17
94772 DE 04 TC $212.50 05/25/17
99000 DE 01 00 $37.50 04/20/17 $20.00 08/27/15
99000 DE 04 00 $25.00 05/25/17
99001 DE 01 00 $6.00 05/25/17
99001 DE 04 00 $6.00 05/25/17
99071 DE 01 00 $2.30 02/04/16
99071 DE 04 00 $2.30 02/04/16
99075 DE 01 00 $2.30 02/04/16
99075 DE 04 00 $2.30 02/04/16
99455 DE 01 00 $343.40 02/04/16
99455 DE 04 00 $343.40 02/04/16
A0225 DE 01 00 $155.00 05/25/17
A0225 DE 04 00 $155.00 05/25/17
A0422 DE 01 00 $15.00 05/25/17
A0422 DE 04 00 $15.00 05/25/17
A0431 DE 01 00 $3,129.62 04/09/18 $3,681.90 12/07/16
A0431 DE 01 00 $4,331.65 12/10/15
A0431 DE 04 00 $3,129.62 04/09/18 $3,681.90 12/07/16
A0431 DE 04 00 $4,331.65 12/10/15
A0436 DE 01 00 $44.32 04/09/18 $52.14 12/08/16
A0436 DE 01 00 $61.34 12/10/15
A0436 DE 04 00 $44.32 04/09/18 $52.14 12/08/16
A0436 DE 04 00 $61.34 12/10/15
A4206 DE 01 00 $10.00 04/20/17
A4206 DE 04 00 $10.00 04/20/17
A4207 DE 01 00 $3.00 05/25/17
A4207 DE 04 00 $3.00 05/25/17
A4208 DE 01 00 $10.00 04/20/17
A4208 DE 04 00 $10.00 04/20/17
A4209 DE 01 00 $25.00 05/25/17
A4209 DE 04 00 $25.00 05/25/17
A4212 DE 01 00 $31.25 05/25/17
A4212 DE 04 00 $31.25 05/25/17
A4213 DE 01 00 $1.00 05/25/17
A4213 DE 04 00 $1.00 05/25/17
A4215 DE 01 00 $10.00 05/25/17
A4215 DE 04 00 $10.00 05/25/17
A4218 DE 01 00 $.58 05/25/17
A4218 DE 04 00 $.58 05/25/17
A4223 DE 01 00 $500.00 04/20/17
A4223 DE 04 00 $500.00 04/20/17
A4244 DE 01 00 $1.80 05/25/17
A4244 DE 04 00 $1.80 05/25/17
A4245 DE 01 00 $7.05 05/25/17
A4245 DE 04 00 $7.05 05/25/17
A4246 DE 01 00 $8.00 05/25/17
A4246 DE 04 00 $8.00 05/25/17
A4247 DE 01 00 $5.00 05/25/17
A4247 DE 04 00 $5.00 05/25/17
A4250 DE 01 00 $41.30 05/25/17
A4250 DE 04 00 $41.30 05/25/17
A4284 DE 01 00 $14.07 05/25/17
A4284 DE 04 00 $14.07 05/25/17
A4285 DE 01 00 $18.29 05/25/17
A4285 DE 04 00 $18.29 05/25/17
A4300 DE 01 00 $10.00 05/25/17
A4300 DE 04 00 $10.00 05/25/17
A4305 DE 01 00 $80.00 04/20/17
A4305 DE 04 00 $80.00 04/20/17
A4470 DE 01 00 $4.95 05/25/17
A4470 DE 04 00 $4.95 05/25/17
A4483 DE 01 00 $5.25 05/25/17
A4483 DE 04 00 $5.25 05/25/17
A4490 DE 01 00 $24.20 05/25/17
A4490 DE 04 00 $24.20 05/25/17
A4495 DE 01 00 $36.90 05/25/17
A4495 DE 04 00 $36.90 05/25/17
A4500 DE 01 00 $35.00 05/25/17
A4500 DE 04 00 $35.00 05/25/17
A4510 DE 01 00 $80.00 05/25/17
A4510 DE 04 00 $80.00 05/25/17
A4550 DE 01 00 $126.00 04/20/17 $120.00 08/29/15
A4550 DE 04 00 $126.00 04/20/17 $120.00 08/29/15
A4554 DE 01 00 $92.00 02/04/16
A4554 DE 04 00 $92.00 02/04/16
A4570 DE 01 00 $50.00 05/25/17 $18.00 08/29/15
A4570 DE 04 00 $50.00 05/25/17 $18.00 08/29/15
A4580 DE 01 00 $58.00 05/25/17
A4580 DE 04 00 $58.00 05/25/17
A4590 DE 01 00 $74.00 04/20/17
A4590 DE 04 00 $74.00 04/20/17
A4606 DE 01 00 $58.50 05/25/17
A4606 DE 04 00 $58.50 05/25/17
A4627 DE 01 00 $25.00 05/25/17
A4627 DE 04 00 $25.00 05/25/17
A4648 DE 01 00 $39.00 05/25/17
A4648 DE 04 00 $39.00 05/25/17
A4657 DE 01 00 $67.33 05/25/17
A4657 DE 04 00 $67.33 05/25/17
A4750 DE 01 00 $6.00 05/25/17
A4750 DE 04 00 $6.00 05/25/17
A4770 DE 01 00 $160.00 05/25/17
A4770 DE 04 00 $160.00 05/25/17
A4772 DE 01 00 $59.50 05/25/17
A4772 DE 04 00 $59.50 05/25/17
A4773 DE 01 00 $59.50 05/25/17
A4773 DE 04 00 $59.50 05/25/17
A4927 DE 01 00 $7.74 05/25/17
A4927 DE 04 00 $7.74 05/25/17
A6208 DE 01 00 $67.11 05/25/17
A6208 DE 04 00 $67.11 05/25/17
A6213 DE 01 00 $9.80 05/25/17
A6213 DE 04 00 $9.80 05/25/17
A6450 DE 01 00 $5.00 05/25/17
A6450 DE 04 00 $5.00 05/25/17
A6451 DE 01 00 $1.99 05/25/17
A6451 DE 04 00 $1.99 05/25/17
A6530 DE 01 00 $55.00 05/25/17
A6530 DE 04 00 $55.00 05/25/17
A6533 DE 01 00 $125.00 05/25/17
A6533 DE 04 00 $125.00 05/25/17
A9282 DE 01 00 $2,000.00 05/25/17
A9282 DE 04 00 $2,000.00 05/25/17
A9500 DE 01 00 $315.50 04/20/17 $274.00 09/01/15
A9500 DE 04 00 $302.00 05/25/17 $274.00 09/01/15
A9502 DE 01 00 $250.00 04/20/17
A9502 DE 04 00 $250.00 04/20/17 $170.00 09/01/15
A9503 DE 01 00 $80.50 04/20/17
A9503 DE 04 00 $61.00 04/20/17
A9505 DE 01 00 $135.00 05/25/17
A9505 DE 04 00 $83.00 05/25/17
A9507 DE 01 00 $3,244.35 05/25/17
A9507 DE 04 00 $3,244.35 05/25/17
A9512 DE 01 00 $181.00 05/25/17
A9512 DE 04 00 $47.00 05/25/17
A9516 DE 01 00 $313.00 04/20/17
A9516 DE 04 00 $68.45 05/25/17
A9517 DE 01 00 $83.00 05/25/17
A9517 DE 04 00 $33.31 05/25/17
A9521 DE 01 00 $567.61 05/25/17
A9521 DE 04 00 $567.61 05/25/17
A9530 DE 01 00 $28.91 05/25/17
A9530 DE 04 00 $28.91 05/25/17
A9537 DE 01 00 $185.75 04/20/17 $131.00 09/03/15
A9537 DE 04 00 $59.54 05/25/17
A9538 DE 01 00 $24.70 05/25/17
A9538 DE 04 00 $24.70 05/25/17
A9539 DE 01 00 $131.00 05/25/17
A9539 DE 04 00 $16.25 05/25/17
A9540 DE 01 00 $414.00 04/20/17
A9540 DE 04 00 $56.00 05/25/17
A9541 DE 01 00 $667.00 04/20/17
A9541 DE 04 00 $75.35 05/25/17
A9542 DE 01 00 $2,769.63 05/25/17
A9542 DE 04 00 $2,769.63 05/25/17
A9551 DE 01 00 $126.63 05/25/17
A9551 DE 04 00 $126.63 05/25/17
A9552 DE 01 00 $1,553.00 04/20/17 $1,273.00 09/16/15
A9552 DE 04 00 $881.00 05/25/17
A9556 DE 01 00 $32.04 05/25/17
A9556 DE 04 00 $32.04 05/25/17
A9558 DE 01 00 $38.96 05/25/17
A9558 DE 04 00 $38.96 05/25/17
A9560 DE 01 00 $283.50 05/25/17
A9560 DE 04 00 $114.00 05/25/17
A9561 DE 01 00 $34.56 05/25/17
A9561 DE 04 00 $34.56 05/25/17
A9562 DE 01 00 $448.00 05/25/17
A9562 DE 04 00 $403.00 05/25/17
A9572 DE 01 00 $3,230.00 05/25/17
A9572 DE 04 00 $3,230.00 05/25/17
A9600 DE 01 00 $1,014.13 05/25/17
A9600 DE 04 00 $1,014.13 05/25/17
B4100 DE 01 00 $3.18 02/04/16
B4100 DE 04 00 $3.18 02/04/16
B4158 DE 01 00 $34.00 05/25/17
B4158 DE 04 00 $34.00 05/25/17
B4160 DE 01 00 $4.86 05/25/17
B4160 DE 04 00 $4.86 05/25/17
B4161 DE 01 00 $11.08 05/25/17
B4161 DE 04 00 $11.08 05/25/17
B4162 DE 01 00 $5.40 05/25/17
B4162 DE 04 00 $5.40 05/25/17
B4172 DE 01 00 $143.00 05/25/17
B4172 DE 04 00 $143.00 05/25/17
B5200 DE 01 00 $4.94 05/25/17
B5200 DE 04 00 $4.94 05/25/17
C1713 DE 01 00 $1,955.00 05/25/17
C1713 DE 04 00 $1,955.00 05/25/17
C1725 DE 01 00 $914.00 05/25/17
C1725 DE 04 00 $914.00 05/25/17
C1726 DE 01 00 $822.50 05/25/17 $699.00 09/17/15
C1726 DE 04 00 $822.50 05/25/17 $699.00 09/17/15
C1729 DE 01 00 $402.50 05/25/17
C1729 DE 04 00 $402.50 05/25/17
C1730 DE 01 00 $772.50 05/25/17
C1730 DE 04 00 $772.50 05/25/17
C1732 DE 01 00 $10,649.50 05/25/17
C1732 DE 04 00 $10,649.50 05/25/17
C1733 DE 01 00 $16,236.00 05/25/17
C1733 DE 04 00 $16,236.00 05/25/17
C1751 DE 01 00 $478.00 05/25/17
C1751 DE 04 00 $478.00 05/25/17
C1758 DE 01 00 $242.25 05/25/17
C1758 DE 04 00 $242.25 05/25/17
C1760 DE 01 00 $725.00 05/25/17
C1760 DE 04 00 $725.00 05/25/17
C1762 DE 01 00 $3,808.00 05/25/17
C1762 DE 04 00 $3,808.00 05/25/17
C1763 DE 01 00 $6,383.00 05/25/17
C1763 DE 04 00 $6,383.00 05/25/17
C1765 DE 01 00 $1,202.25 05/25/17
C1765 DE 04 00 $1,202.25 05/25/17
C1769 DE 01 00 $193.50 05/25/17
C1769 DE 04 00 $193.50 05/25/17
C1771 DE 01 00 $3,363.00 05/25/17
C1771 DE 04 00 $3,363.00 05/25/17
C1773 DE 01 00 $854.00 05/25/17
C1773 DE 04 00 $854.00 05/25/17
C1778 DE 01 00 $17,505.00 05/25/17
C1778 DE 04 00 $17,505.00 05/25/17
C1781 DE 01 00 $2,751.00 05/25/17
C1781 DE 04 00 $2,751.00 05/25/17
C1785 DE 01 00 $14,145.50 05/25/17
C1785 DE 04 00 $14,145.50 05/25/17
C1788 DE 01 00 $1,593.50 05/25/17
C1788 DE 04 00 $1,593.50 05/25/17
C1789 DE 01 00 $1,871.50 05/25/17 $1,277.00 09/21/15
C1789 DE 04 00 $1,871.50 05/25/17 $1,277.00 09/21/15
C1830 DE 01 00 $390.00 05/25/17
C1830 DE 04 00 $390.00 05/25/17
C1874 DE 01 00 $5,000.00 05/25/17
C1874 DE 04 00 $5,000.00 05/25/17
C1876 DE 01 00 $4,025.00 05/25/17
C1876 DE 04 00 $4,025.00 05/25/17
C1884 DE 01 00 $547.00 05/25/17
C1884 DE 04 00 $547.00 05/25/17
C1887 DE 01 00 $439.00 05/25/17
C1887 DE 04 00 $439.00 05/25/17
C1892 DE 01 00 $135.00 05/25/17
C1892 DE 04 00 $135.00 05/25/17
C1893 DE 01 00 $641.50 05/25/17
C1893 DE 04 00 $641.50 05/25/17
C1894 DE 01 00 $84.00 05/25/17
C1894 DE 04 00 $84.00 05/25/17
C1898 DE 01 00 $2,500.00 05/25/17
C1898 DE 04 00 $2,500.00 05/25/17
C2617 DE 01 00 $473.00 05/25/17
C2617 DE 04 00 $473.00 05/25/17
C8908 DE 01 00 $1,355.00 05/25/17
C8908 DE 04 00 $1,355.00 05/25/17
C9113 DE 01 00 $58.75 05/25/17
C9113 DE 04 00 $30.00 05/25/17
C9600 DE 01 00 $32,851.00 04/20/17
C9600 DE 04 00 $32,851.00 05/25/17
D0120 DE 01 00 $60.00 05/25/17
D0120 DE 04 00 $60.00 05/25/17
D0150 DE 01 00 $101.00 05/25/17
D0150 DE 04 00 $101.00 05/25/17
D0220 DE 01 00 $33.00 05/25/17
D0220 DE 04 00 $33.00 05/25/17
D0272 DE 01 00 $52.00 05/25/17
D0272 DE 04 00 $52.00 05/25/17
D1120 DE 01 00 $78.00 05/25/17
D1120 DE 04 00 $78.00 05/25/17
D7140 DE 01 00 $199.00 05/25/17
D7140 DE 04 00 $130.00 05/25/17
D7230 DE 01 00 $515.00 04/20/17
D7230 DE 04 00 $450.00 04/20/17
D7240 DE 01 00 $615.00 04/20/17
D7240 DE 04 00 $300.00 05/25/17
D9940 DE 01 00 $883.00 04/20/17
D9940 DE 04 00 $883.00 04/20/17
E0118 DE 01 00 $60.00 05/25/17
E0118 DE 01 NU $60.00 05/25/17
E0118 DE 01 RR $60.00 04/20/17
E0118 DE 04 00 $60.00 05/25/17
E0118 DE 04 NU $60.00 05/25/17
E0118 DE 04 RR $60.00 04/20/17
E0246 DE 01 00 $123.19 02/04/16
E0246 DE 01 RR $10.27 02/04/16
E0246 DE 04 00 $123.19 02/04/16
E0246 DE 04 RR $10.27 02/04/16
E0352 DE 01 00 $45.53 05/25/17
E0352 DE 04 00 $45.53 05/25/17
E0430 DE 01 00 $300.00 05/25/17
E0430 DE 01 RR $40.00 05/25/17
E0430 DE 04 00 $300.00 05/25/17
E0430 DE 04 RR $40.00 05/25/17
E0435 DE 01 00 $4,417.00 05/25/17
E0435 DE 01 NU $4,417.00 05/25/17
E0435 DE 01 RR $118.70 05/25/17
E0435 DE 04 00 $4,417.00 05/25/17
E0435 DE 04 NU $4,417.00 05/25/17
E0435 DE 04 RR $118.70 05/25/17
E0440 DE 01 00 $4,500.00 05/25/17
E0440 DE 01 NU $4,500.00 05/25/17
E0440 DE 01 RR $375.00 05/25/17
E0440 DE 04 00 $4,500.00 05/25/17
E0440 DE 04 NU $4,500.00 05/25/17
E0440 DE 04 RR $375.00 05/25/17
E0445 DE 01 RR $1,282.31 04/20/17
E0445 DE 04 RR $1,282.31 04/20/17
E0486 DE 01 00 $3,000.00 05/25/17
E0486 DE 01 NU $3,000.00 05/25/17
E0486 DE 04 00 $3,000.00 05/25/17
E0486 DE 04 NU $3,000.00 05/25/17
E0555 DE 01 00 $40.00 05/25/17
E0555 DE 01 RR $3.33 05/25/17
E0555 DE 04 00 $40.00 05/25/17
E0555 DE 04 RR $3.33 05/25/17
E0604 DE 01 RR $60.00 05/25/17
E0604 DE 04 RR $60.00 05/25/17
E0619 DE 01 RR $776.16 05/25/17
E0619 DE 04 RR $776.16 05/25/17
E0830 DE 01 00 $110.00 05/25/17
E0830 DE 01 NU $110.00 05/25/17
E0830 DE 04 00 $110.00 05/25/17
E0830 DE 04 NU $110.00 05/25/17
E0970 DE 01 00 $185.00 05/25/17
E0970 DE 01 RR $15.42 05/25/17
E0970 DE 04 00 $185.00 05/25/17
E0970 DE 04 RR $15.42 05/25/17
E1085 DE 01 00 $932.00 05/25/17
E1085 DE 01 NU $932.00 05/25/17
E1085 DE 01 RR $77.67 05/25/17
E1085 DE 04 00 $932.00 05/25/17
E1085 DE 04 NU $932.00 05/25/17
E1085 DE 04 RR $77.67 05/25/17
E1086 DE 01 00 $1,133.00 05/25/17
E1086 DE 01 NU $1,133.00 05/25/17
E1086 DE 01 RR $94.42 05/25/17
E1086 DE 04 00 $1,133.00 05/25/17
E1086 DE 04 NU $1,133.00 05/25/17
E1086 DE 04 RR $94.42 05/25/17
E1089 DE 01 00 $1,305.00 05/25/17
E1089 DE 01 RR $108.75 05/25/17
E1089 DE 04 00 $1,305.00 05/25/17
E1089 DE 04 RR $108.75 05/25/17
E1090 DE 01 00 $1,705.00 05/25/17
E1090 DE 01 NU $1,705.00 05/25/17
E1090 DE 01 RR $142.08 05/25/17
E1090 DE 04 00 $1,705.00 05/25/17
E1090 DE 04 NU $1,705.00 05/25/17
E1090 DE 04 RR $142.08 05/25/17
E1130 DE 01 00 $560.00 05/25/17
E1130 DE 01 NU $560.00 05/25/17
E1130 DE 01 RR $46.67 05/25/17
E1130 DE 04 00 $560.00 05/25/17
E1130 DE 04 NU $560.00 05/25/17
E1130 DE 04 RR $46.67 05/25/17
E1140 DE 01 00 $1,215.00 05/25/17
E1140 DE 01 NU $1,215.00 05/25/17
E1140 DE 01 RR $101.25 05/25/17
E1140 DE 04 00 $1,215.00 05/25/17
E1140 DE 04 NU $1,215.00 05/25/17
E1140 DE 04 RR $101.25 05/25/17
E1250 DE 01 00 $580.00 05/25/17
E1250 DE 01 NU $580.00 05/25/17
E1250 DE 01 RR $48.33 05/25/17
E1250 DE 04 00 $580.00 05/25/17
E1250 DE 04 NU $580.00 05/25/17
E1250 DE 04 RR $48.33 05/25/17
E1260 DE 01 00 $1,570.00 05/25/17
E1260 DE 01 NU $1,570.00 05/25/17
E1260 DE 01 RR $130.83 05/25/17
E1260 DE 04 00 $1,570.00 05/25/17
E1260 DE 04 NU $1,570.00 05/25/17
E1260 DE 04 RR $130.83 05/25/17
E1290 DE 01 00 $1,265.00 05/25/17
E1290 DE 01 NU $1,265.00 05/25/17
E1290 DE 04 00 $1,265.00 05/25/17
E1290 DE 04 NU $1,265.00 05/25/17
E1353 DE 01 RR $10.46 05/25/17
E1353 DE 04 RR $10.46 05/25/17
E1355 DE 01 RR $1.40 05/25/17
E1355 DE 04 RR $1.40 05/25/17
G0175 DE 01 00 $64.00 05/25/17
G0175 DE 04 00 $64.00 05/25/17
G0177 DE 01 00 $118.75 04/20/17
G0177 DE 04 00 $118.75 04/20/17
G0260 DE 01 00 $2,388.00 05/25/17
G0260 DE 04 00 $2,388.00 05/25/17
G0340 DE 01 00 $19,417.50 05/25/17
G0340 DE 04 00 $19,417.50 05/25/17
G0378 DE 01 00 $247.23 04/20/17
G0378 DE 04 00 $247.23 04/20/17
G0379 DE 01 00 $153.27 04/20/17
G0379 DE 04 00 $153.27 04/20/17
G0390 DE 01 00 $2,311.00 05/25/17
G0390 DE 04 00 $1,950.00 05/25/17
G0410 DE 01 00 $118.75 04/20/17
G0410 DE 04 00 $118.75 04/20/17
G0463 DE 01 00 $332.00 04/20/17 $207.00 09/30/15
G0463 DE 04 00 $332.00 04/20/17 $207.00 09/30/15
G8539 DE 01 00 $31.25 05/25/17
G8539 DE 04 00 $31.25 05/25/17
G8542 DE 01 00 $31.25 05/25/17
G8542 DE 04 00 $31.25 05/25/17
H0015 DE 01 00 $282.00 09/18/17 $268.00 02/24/16
H0015 DE 01 00 $268.00 02/24/16
H0015 DE 04 00 $282.00 09/18/17 $268.00 02/24/16
H0015 DE 04 00 $268.00 02/24/16
H0035 DE 01 00 $268.00 09/22/15 $254.00 01/03/14
H0035 DE 01 00 $282.00 09/18/17 $268.00 09/22/15
H0035 DE 04 00 $268.00 09/22/15 $254.00 01/03/14
H0035 DE 04 00 $282.00 09/18/17 $268.00 09/22/15
H0037 DE 01 00 $357.00 09/22/15 $339.00 01/03/14
H0037 DE 01 00 $377.00 09/18/17 $357.00 09/22/15
H0037 DE 04 00 $357.00 09/22/15 $339.00 01/03/14
H0037 DE 04 00 $377.00 09/18/17 $357.00 09/22/15
H2016 DE 01 00 $1,344.78 02/04/16
H2016 DE 04 00 $1,344.78 02/04/16
H2019 DE 01 00 $18.75 05/25/17
H2019 DE 04 00 $12.50 05/25/17
H2024 DE 01 00 $222.04 02/04/16
H2024 DE 04 00 $222.04 02/04/16
K0739 DE 01 00 $27.38 12/01/15 $26.79 12/19/13
K0739 DE 01 00 $28.09 01/24/18 $27.65 12/29/16
K0739 DE 04 00 $27.38 12/01/15 $26.79 12/19/13
K0739 DE 04 00 $28.09 01/24/18 $27.65 12/29/16
L3201 DE 01 00 $38.00 05/25/17
L3201 DE 01 RR $3.16 05/25/17
L3201 DE 04 00 $38.00 05/25/17
L3201 DE 04 RR $3.16 05/25/17
L3202 DE 01 00 $45.00 05/25/17
L3202 DE 01 RR $3.75 05/25/17
L3202 DE 04 00 $45.00 05/25/17
L3202 DE 04 RR $3.75 05/25/17
L3204 DE 01 00 $34.50 05/25/17
L3204 DE 01 RR $2.88 05/25/17
L3204 DE 04 00 $34.50 05/25/17
L3204 DE 04 RR $2.88 05/25/17
L3206 DE 01 00 $47.00 05/25/17
L3206 DE 01 RR $3.92 05/25/17
L3206 DE 04 00 $47.00 05/25/17
L3206 DE 04 RR $3.92 05/25/17
L3215 DE 01 00 $88.00 02/04/16
L3215 DE 01 RR $7.33 02/04/16
L3215 DE 04 00 $88.00 02/04/16
L3215 DE 04 RR $7.33 02/04/16
L3222 DE 01 00 $127.40 02/04/16
L3222 DE 01 RR $10.62 02/04/16
L3222 DE 04 00 $127.40 02/04/16
L3222 DE 04 RR $10.62 02/04/16
L3230 DE 01 00 $497.00 02/04/16
L3230 DE 01 RR $41.42 02/04/16
L3230 DE 04 00 $497.00 02/04/16
L3230 DE 04 RR $41.42 02/04/16
L3250 DE 01 00 $210.00 02/04/16
L3250 DE 01 RR $17.50 02/04/16
L3250 DE 04 00 $210.00 02/04/16
L3250 DE 04 RR $17.50 02/04/16
L3252 DE 01 00 $170.00 02/04/16
L3252 DE 01 RR $14.16 02/04/16
L3252 DE 04 00 $170.00 02/04/16
L3252 DE 04 RR $14.16 02/04/16
L3260 DE 01 00 $35.00 05/25/17
L3260 DE 01 RR $7.63 05/25/17
L3260 DE 04 00 $35.00 05/25/17
L3260 DE 04 RR $7.63 05/25/17
L3265 DE 01 00 $98.00 02/04/16
L3265 DE 01 RR $8.16 02/04/16
L3265 DE 04 00 $98.00 02/04/16
L3265 DE 04 RR $8.16 02/04/16
L3320 DE 01 00 $90.00 05/25/17
L3320 DE 01 RR $7.50 05/25/17
L3320 DE 04 00 $90.00 05/25/17
L3320 DE 04 RR $7.50 05/25/17
L3485 DE 01 00 $39.00 05/25/17
L3485 DE 01 RR $3.25 05/25/17
L3485 DE 04 00 $39.00 05/25/17
L3485 DE 04 RR $3.25 05/25/17
L4205 DE 01 00 $22.13 12/01/15 $21.66 12/19/13
L4205 DE 01 00 $22.71 01/24/18 $22.35 12/29/16
L4205 DE 04 00 $22.13 12/01/15 $21.66 12/19/13
L4205 DE 04 00 $22.71 01/24/18 $22.35 12/29/16
L7520 DE 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 DE 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 DE 04 00 $30.08 12/01/15 $29.43 12/19/13
L7520 DE 04 00 $30.87 01/24/18 $30.38 12/29/16
L8010 DE 01 00 $41.95 05/25/17
L8010 DE 04 00 $41.95 05/25/17
L8680 DE 01 00 $1,200.00 05/25/17
L8680 DE 04 00 $1,200.00 05/25/17
P9016 DE 01 00 $344.00 04/20/17
P9016 DE 04 00 $287.00 05/25/17
P9037 DE 01 00 $1,987.00 05/25/17
P9037 DE 04 00 $1,987.00 05/25/17
P9040 DE 01 00 $764.00 05/25/17
P9040 DE 04 00 $578.00 05/25/17
P9053 DE 01 00 $1,441.50 05/25/17
P9053 DE 04 00 $1,441.50 05/25/17
P9058 DE 01 00 $460.00 05/25/17
P9058 DE 04 00 $460.00 05/25/17
P9059 DE 01 00 $137.00 05/25/17
P9059 DE 04 00 $137.00 05/25/17
Q9959 DE 01 00 $4.00 05/25/17
Q9959 DE 04 00 $4.00 05/25/17
Q9962 DE 01 00 $35.00 05/25/17
Q9962 DE 04 00 $35.00 05/25/17
S0630 DE 01 00 $135.00 02/04/16
S0630 DE 04 00 $135.00 02/04/16
S1040 DE 01 00 $3,984.42 04/20/17
S1040 DE 04 00 $3,984.42 04/20/17
S2900 DE 01 00 $8,745.00 02/04/16
S2900 DE 04 00 $8,745.00 02/04/16
S5108 DE 01 00 $31.25 05/25/17
S5108 DE 04 00 $31.25 05/25/17
S5110 DE 01 00 $31.25 05/25/17
S5110 DE 04 00 $31.25 05/25/17
S5115 DE 01 00 $31.25 05/25/17
S5115 DE 04 00 $31.25 05/25/17
S9083 DE 01 00 $175.00 02/04/16
S9083 DE 04 00 $150.00 02/04/16 $175.00 08/06/14
S9430 DE 01 00 $35.00 05/25/17
S9430 DE 04 00 $35.00 05/25/17
S9480 DE 01 00 $282.00 09/18/17 $268.00 02/24/16
S9480 DE 01 00 $268.00 02/24/16
S9480 DE 04 00 $282.00 09/18/17 $268.00 02/24/16
S9480 DE 04 00 $268.00 02/24/16
T1015 DE 01 00 $162.14 05/25/17 $133.00 10/03/15
T1015 DE 04 00 $133.00 05/25/17
T2014 DE 01 00 $105.89 02/04/16
T2014 DE 04 00 $105.89 02/04/16
T4542 DE 01 00 $1.25 02/04/16
T4542 DE 04 00 $1.25 02/04/16
V2781 DE 01 00 $199.50 05/25/17
V2781 DE 04 00 $199.50 05/25/17
V2787 DE 01 00 $1,100.00 02/04/16
V2787 DE 04 00 $1,100.00 02/04/16
V5030 DE 01 00 $550.00 05/25/17
V5030 DE 04 00 $550.00 05/25/17
V5040 DE 01 00 $550.00 05/25/17
V5040 DE 04 00 $550.00 05/25/17
V5050 DE 01 00 $597.00 05/25/17
V5050 DE 04 00 $597.00 05/25/17
V5060 DE 01 00 $615.00 05/25/17
V5060 DE 04 00 $615.00 05/25/17
V5070 DE 01 00 $550.00 05/25/17
V5070 DE 04 00 $550.00 05/25/17
V5080 DE 01 00 $550.00 05/25/17
V5080 DE 04 00 $550.00 05/25/17
V5100 DE 01 00 $500.00 05/25/17
V5100 DE 04 00 $500.00 05/25/17
V5120 DE 01 00 $1,100.00 05/25/17
V5120 DE 04 00 $1,100.00 05/25/17
V5130 DE 01 00 $1,000.00 05/25/17
V5130 DE 04 00 $1,000.00 05/25/17
V5140 DE 01 00 $1,000.00 05/25/17
V5140 DE 04 00 $1,000.00 05/25/17
V5150 DE 01 00 $1,100.00 05/25/17
V5150 DE 04 00 $1,100.00 05/25/17
V5160 DE 01 00 $1,073.00 05/25/17
V5160 DE 04 00 $1,073.00 05/25/17
V5170 DE 01 00 $650.00 05/25/17
V5170 DE 04 00 $650.00 05/25/17
V5180 DE 01 00 $650.00 05/25/17
V5180 DE 04 00 $650.00 05/25/17
V5190 DE 01 00 $650.00 05/25/17
V5190 DE 04 00 $650.00 05/25/17
V5210 DE 01 00 $1,180.00 05/25/17
V5210 DE 04 00 $1,180.00 05/25/17
V5220 DE 01 00 $1,180.00 05/25/17
V5220 DE 04 00 $1,180.00 05/25/17
V5230 DE 01 00 $1,180.00 05/25/17
V5230 DE 04 00 $1,180.00 05/25/17
V5257 DE 01 00 $4,800.00 05/25/17
V5257 DE 04 00 $4,800.00 05/25/17
V5261 DE 01 00 $9,600.00 05/25/17
V5261 DE 04 00 $9,600.00 05/25/17
V5264 DE 01 00 $150.00 05/25/17
V5264 DE 04 00 $150.00 05/25/17
V5266 DE 01 00 $10.00 04/20/17
V5266 DE 04 00 $10.00 04/20/17
V5267 DE 01 00 $400.00 05/25/17
V5267 DE 04 00 $400.00 05/25/17