State prevailing rates

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

Latest update: 09-14-2018
CPT code State Provider class Modifier Current pricing Effective date Past pricing Past effective date
0359T NH 01 00 $500.00 02/22/16
0359T NH 04 00 $500.00 02/22/16
0360T NH 01 00 $62.50 02/22/16
0360T NH 04 00 $62.50 02/22/16
0361T NH 04 00 $62.50 02/22/16
0361T NH 01 00 $62.50 02/22/16
0364T NH 04 00 $62.50 07/13/18
0364T NH 01 00 $62.50 07/13/18
0365T NH 01 00 $62.50 02/22/16
0365T NH 04 00 $62.50 02/22/16
0368T NH 01 00 $62.50 02/22/16
0368T NH 04 00 $62.50 02/22/16
0369T NH 01 00 $62.50 02/22/16
0369T NH 04 00 $62.50 02/22/16
0370T NH 01 00 $125.00 02/22/16
0370T NH 04 00 $125.00 02/22/16
15824 NH 04 00 $343.40 07/13/18
15824 NH 01 00 $343.40 07/13/18
15825 NH 04 00 $343.40 07/13/18
15825 NH 01 00 $343.40 07/13/18
15826 NH 04 00 $343.40 07/13/18
15826 NH 01 00 $343.40 07/13/18
15828 NH 01 00 $343.40 07/13/18
15828 NH 04 00 $343.40 07/13/18
15829 NH 04 00 $343.40 07/13/18
15829 NH 01 00 $343.40 07/13/18
15876 NH 04 00 $343.40 07/13/18
15876 NH 01 00 $343.40 07/13/18
15878 NH 04 00 $343.40 07/13/18
15878 NH 01 00 $343.40 07/13/18
15879 NH 04 00 $343.40 07/13/18
15879 NH 01 00 $343.40 07/13/18
17380 NH 01 00 $343.40 02/22/16
17380 NH 04 00 $343.40 02/22/16
21088 NH 04 00 $343.40 02/22/16
21088 NH 01 00 $343.40 02/22/16
21089 NH 04 00 $343.40 07/13/18
21089 NH 01 00 $343.40 07/13/18
22841 NH 01 00 $343.40 07/13/18
22841 NH 04 00 $343.40 07/13/18
24940 NH 01 00 $343.40 07/13/18
24940 NH 04 00 $343.40 07/13/18
26989 NH 04 00 $343.40 07/13/18
26989 NH 01 00 $343.40 07/13/18
32850 NH 01 00 $343.40 07/13/18
32850 NH 04 00 $343.40 07/13/18
33930 NH 01 00 $343.40 07/13/18
33930 NH 04 00 $343.40 07/13/18
33940 NH 04 00 $343.40 07/13/18
33940 NH 01 00 $343.40 07/13/18
41821 NH 04 00 $343.40 07/13/18
41821 NH 01 00 $343.40 07/13/18
41870 NH 04 00 $343.40 07/13/18
41870 NH 01 00 $343.40 07/13/18
43496 NH 04 00 $343.40 07/13/18
43496 NH 01 00 $343.40 07/13/18
47133 NH 04 00 $343.40 07/13/18
47133 NH 01 00 $343.40 07/13/18
48160 NH 01 00 $343.40 07/13/18
48160 NH 04 00 $343.40 07/13/18
48550 NH 01 00 $343.40 07/13/18
48550 NH 04 00 $343.40 07/13/18
49906 NH 01 00 $343.40 07/13/18
49906 NH 04 00 $343.40 07/13/18
50300 NH 04 00 $343.40 07/13/18
50300 NH 01 00 $343.40 07/13/18
55970 NH 01 00 $343.40 07/13/18
55970 NH 04 00 $343.40 07/13/18
55980 NH 04 00 $343.40 07/13/18
55980 NH 01 00 $343.40 07/13/18
58974 NH 04 00 $343.40 02/22/16
58974 NH 01 00 $343.40 02/22/16
65767 NH 04 00 $343.40 07/13/18
65767 NH 01 00 $343.40 07/13/18
65771 NH 01 00 $343.40 02/22/16
65771 NH 04 00 $343.40 02/22/16
69090 NH 04 00 $343.40 02/22/16
69090 NH 01 00 $343.40 02/22/16
69710 NH 04 00 $343.40 02/22/16
69710 NH 01 00 $343.40 02/22/16
69949 NH 01 00 $343.40 07/13/18
69949 NH 04 00 $343.40 07/13/18
69979 NH 01 00 $343.40 07/13/18
69979 NH 04 00 $343.40 07/13/18
77386 NH 01 00 $4,352.00 02/22/16
77386 NH 04 00 $4,352.00 02/22/16
78609 NH 01 00 $343.40 07/13/18
78609 NH 04 00 $343.40 07/13/18
79300 NH 01 00 $343.40 07/13/18
79300 NH 04 00 $343.40 07/13/18
80301 NH 04 00 $250.00 02/22/16
80301 NH 01 00 $250.00 02/22/16
80302 NH 04 00 $500.00 02/22/16
80302 NH 01 00 $500.00 02/22/16
80320 NH 01 00 $179.00 02/22/16
80320 NH 04 00 $179.00 02/22/16
86860 NH 01 00 $54.00 07/13/18
86860 NH 04 00 $54.00 07/13/18
86891 NH 04 00 $90.00 07/13/18
86891 NH 01 00 $90.00 07/13/18
86930 NH 04 00 $9.00 07/13/18
86930 NH 01 00 $9.00 07/13/18
86931 NH 04 00 $9.00 07/13/18
86931 NH 01 00 $9.00 07/13/18
86932 NH 04 00 $9.00 07/13/18
86932 NH 01 00 $9.00 07/13/18
86950 NH 01 00 $45.00 07/13/18
86950 NH 04 00 $45.00 07/13/18
86970 NH 04 00 $144.00 07/13/18
86970 NH 01 00 $144.00 07/13/18
86971 NH 04 00 $144.00 07/13/18
86971 NH 01 00 $144.00 07/13/18
86972 NH 04 00 $144.00 07/13/18
86972 NH 01 00 $144.00 07/13/18
86975 NH 01 00 $144.00 07/13/18
86975 NH 04 00 $144.00 07/13/18
86976 NH 01 00 $144.00 07/13/18
86976 NH 04 00 $144.00 07/13/18
86977 NH 01 00 $144.00 07/13/18
86977 NH 04 00 $144.00 07/13/18
86978 NH 01 00 $144.00 07/13/18
86978 NH 04 00 $144.00 07/13/18
90736 NH 01 NU $235.51 10/19/16 $208.09 05/07/15
90736 NH 04 NU $235.51 10/19/16 $208.09 05/07/15
90736 NH 01 00 $235.51 07/19/17
90736 NH 01 00 $254.35 07/20/17
90736 NH 04 00 $235.51 07/19/17
90736 NH 04 00 $254.35 07/20/17
90993 NH 01 00 $343.40 07/13/18
90993 NH 04 00 $343.40 07/13/18
92993 NH 01 00 $343.40 07/13/18
92993 NH 04 00 $343.40 07/13/18
93299 NH 01 00 $73.00 07/13/18
93299 NH 04 00 $73.00 07/13/18
99000 NH 01 00 $15.00 07/13/18 $15.00 02/27/17
99000 NH 01 00 $15.00 07/13/18 $15.00 04/19/17
99000 NH 04 00 $15.00 04/19/17 $13.00 08/27/15
99000 NH 04 00 $15.00 07/13/18 $15.00 02/27/17
99000 NH 04 00 $15.00 07/13/18 $15.00 04/19/17
99000 NH 01 00 $15.00 04/19/17
99001 NH 01 00 $20.00 07/13/18
99001 NH 04 00 $20.00 07/13/18
99071 NH 04 00 $2.00 02/22/16
99071 NH 01 00 $2.00 02/22/16
99075 NH 01 00 $2.00 02/22/16
99075 NH 04 00 $2.00 02/22/16
99455 NH 01 00 $343.40 02/22/16
99455 NH 04 00 $343.40 02/22/16
A0225 NH 01 00 $235.00 07/13/18
A0225 NH 04 00 $235.00 07/13/18
A0435 NH 01 00 $3.16 04/09/18 $3.72 12/08/16
A0435 NH 04 00 $3.16 04/09/18 $3.72 12/08/16
A0435 NH 04 00 $4.38 12/10/15
A0435 NH 01 00 $4.38 12/10/15
A0436 NH 01 00 $41.24 04/09/18 $48.52 12/08/16
A0436 NH 04 00 $41.24 04/09/18 $48.52 12/08/16
A0436 NH 04 00 $57.08 12/10/15
A0436 NH 01 00 $57.08 12/10/15
A4206 NH 01 00 $1.20 07/13/18
A4206 NH 04 00 $1.20 07/13/18
A4208 NH 04 00 $0.97 07/13/18
A4208 NH 01 00 $0.97 07/13/18
A4209 NH 01 00 $0.26 07/13/18
A4209 NH 04 00 $0.26 07/13/18
A4210 NH 01 00 $3.50 07/13/18
A4210 NH 04 00 $3.50 07/13/18
A4212 NH 04 00 $25.00 07/13/18
A4212 NH 01 00 $25.00 07/13/18
A4213 NH 01 00 $1.42 07/13/18
A4213 NH 04 00 $1.42 07/13/18
A4215 NH 04 00 $0.30 07/13/18
A4215 NH 01 00 $0.30 07/13/18
A4218 NH 01 00 $0.58 07/13/18
A4218 NH 04 00 $0.58 07/13/18
A4223 NH 01 00 $525.00 07/13/18 $525.00 02/27/17
A4223 NH 01 00 $525.00 07/13/18 $525.00 04/19/17
A4223 NH 04 00 $525.00 07/13/18 $525.00 02/27/17
A4223 NH 04 00 $525.00 07/13/18 $525.00 04/19/17
A4223 NH 01 00 $525.00 04/19/17
A4223 NH 04 00 $525.00 04/19/17
A4245 NH 04 00 $3.00 07/13/18
A4245 NH 01 00 $3.00 07/13/18
A4250 NH 04 00 $0.76 07/13/18
A4250 NH 01 00 $0.76 07/13/18
A4263 NH 01 00 $100.00 07/13/18
A4263 NH 04 00 $100.00 07/13/18
A4305 NH 01 00 $100.70 07/13/18 $25.00 02/27/17
A4305 NH 04 00 $100.70 07/13/18 $25.00 02/27/17
A4466 NH 01 00 $79.95 04/20/17
A4466 NH 04 00 $79.95 04/20/17
A4550 NH 01 00 $68.00 04/19/17 $59.00 08/29/15
A4550 NH 01 00 $68.00 07/13/18 $68.00 02/27/17
A4550 NH 01 00 $68.00 07/13/18 $68.00 04/19/17
A4550 NH 04 00 $68.00 04/19/17 $59.00 08/29/15
A4550 NH 04 00 $68.00 07/13/18 $68.00 02/27/17
A4550 NH 04 00 $68.00 07/13/18 $68.00 04/19/17
A4570 NH 04 00 $24.50 07/13/18
A4570 NH 01 00 $24.50 07/13/18
A4580 NH 01 00 $10.00 07/13/18 $10.00 02/27/17
A4580 NH 01 00 $10.00 07/13/18 $10.00 04/19/17
A4580 NH 04 00 $10.00 07/13/18 $10.00 04/19/17
A4580 NH 01 00 $10.00 04/19/17
A4580 NH 04 00 $10.00 04/19/17
A4590 NH 01 00 $46.00 07/13/18
A4590 NH 04 00 $46.00 07/13/18
A4627 NH 01 00 $42.00 07/13/18 $42.00 02/27/17
A4627 NH 01 00 $42.00 07/13/18 $42.00 04/19/17
A4627 NH 04 00 $42.00 07/13/18 $42.00 04/19/17
A4627 NH 04 00 $42.00 04/19/17
A4627 NH 01 00 $42.00 04/19/17
A4648 NH 01 00 $343.25 07/13/18
A4648 NH 04 00 $343.25 07/13/18
A4657 NH 01 00 $67.33 07/13/18 $55.64 02/27/17
A4657 NH 04 00 $67.33 07/13/18 $55.64 02/27/17
A4770 NH 01 00 $160.00 07/13/18
A4770 NH 04 00 $160.00 07/13/18
A4927 NH 04 00 $9.10 07/13/18
A4927 NH 01 00 $9.10 07/13/18
A6208 NH 01 00 $67.11 07/13/18
A6208 NH 04 00 $67.11 07/13/18
A6213 NH 01 00 $9.80 07/13/18
A6213 NH 04 00 $9.80 07/13/18
A6260 NH 04 00 $22.00 07/13/18
A6260 NH 01 00 $22.00 07/13/18
A6451 NH 04 00 $1.99 07/13/18
A6451 NH 01 00 $1.99 07/13/18
A6530 NH 01 00 $80.00 07/13/18 $80.00 04/19/17
A6530 NH 04 00 $80.00 07/13/18 $80.00 04/19/17
A6530 NH 04 00 $80.00 04/19/17
A6530 NH 01 00 $80.00 04/19/17
A6533 NH 01 00 $49.20 07/13/18
A6533 NH 04 00 $49.20 07/13/18
A6534 NH 01 00 $100.00 07/13/18
A6534 NH 04 00 $100.00 07/13/18
A6539 NH 01 00 $150.00 07/13/18
A6539 NH 04 00 $150.00 07/13/18
A9270 NH 01 00 $28.00 02/22/16
A9270 NH 04 00 $28.00 02/22/16
A9282 NH 01 00 $2,000.00 07/13/18
A9282 NH 04 00 $2,000.00 07/13/18
A9500 NH 01 00 $741.00 04/19/17 $671.00 09/01/15
A9500 NH 01 00 $779.00 07/13/18 $679.06 02/27/17
A9500 NH 01 00 $779.00 07/13/18 $741.00 04/19/17
A9500 NH 04 00 $85.00 07/13/18
A9502 NH 04 00 $187.88 07/13/18
A9502 NH 01 00 $313.89 07/13/18
A9503 NH 01 00 $996.50 04/19/17 $201.00 09/03/15
A9503 NH 01 00 $996.50 07/13/18 $222.00 02/27/17
A9503 NH 01 00 $996.50 07/13/18 $996.50 04/19/17
A9503 NH 04 00 $132.00 07/13/18
A9505 NH 01 00 $31.74 07/13/18
A9505 NH 04 00 $31.74 07/13/18
A9507 NH 04 00 $3,244.35 07/13/18
A9507 NH 01 00 $3,244.35 07/13/18
A9516 NH 04 00 $68.45 07/13/18
A9516 NH 01 00 $68.45 07/13/18
A9517 NH 04 00 $33.31 07/13/18
A9517 NH 01 00 $33.31 07/13/18
A9521 NH 01 00 $567.61 07/13/18
A9521 NH 04 00 $567.61 07/13/18
A9530 NH 01 00 $28.91 07/13/18
A9530 NH 04 00 $28.91 07/13/18
A9537 NH 01 00 $482.00 07/13/18 $347.00 02/27/17
A9537 NH 04 00 $59.54 07/13/18
A9538 NH 04 00 $24.70 07/13/18
A9538 NH 01 00 $24.70 07/13/18
A9539 NH 01 00 $16.25 07/13/18
A9539 NH 04 00 $16.25 07/13/18
A9540 NH 01 00 $885.00 07/13/18
A9540 NH 04 00 $885.00 07/13/18
A9541 NH 01 00 $886.50 07/13/18 $886.50 02/27/17
A9541 NH 04 00 $75.35 07/13/18
A9542 NH 01 00 $2,769.63 07/13/18
A9542 NH 04 00 $2,769.63 07/13/18
A9551 NH 04 00 $126.63 07/13/18
A9551 NH 01 00 $126.63 07/13/18
A9552 NH 01 00 $1,759.42 07/13/18
A9552 NH 04 00 $1,485.00 07/13/18
A9556 NH 01 00 $32.04 07/13/18
A9556 NH 04 00 $32.04 07/13/18
A9558 NH 04 00 $38.96 07/13/18
A9558 NH 01 00 $38.96 07/13/18
A9560 NH 04 00 $114.00 07/13/18
A9560 NH 01 00 $114.00 07/13/18
A9561 NH 04 00 $34.56 07/13/18
A9561 NH 01 00 $34.56 07/13/18
A9562 NH 04 00 $445.51 07/13/18
A9562 NH 01 00 $445.51 07/13/18
A9600 NH 04 00 $1,014.13 07/13/18
A9600 NH 01 00 $1,014.13 07/13/18
B4100 NH 01 00 $2.00 02/22/16
B4100 NH 04 00 $2.00 02/22/16
B4160 NH 04 00 $2.06 07/13/18
B4160 NH 01 00 $2.06 07/13/18
B4161 NH 01 00 $141.50 07/13/18
B4161 NH 04 00 $141.50 07/13/18
B4172 NH 01 00 $195.00 07/13/18
B4172 NH 04 00 $195.00 07/13/18
B5200 NH 04 00 $4.94 07/13/18
B5200 NH 01 00 $4.94 07/13/18
C1713 NH 01 00 $3,032.00 07/13/18
C1713 NH 04 00 $3,032.00 07/13/18
C1717 NH 04 00 $1,631.00 07/13/18
C1717 NH 01 00 $1,631.00 07/13/18
C1725 NH 01 00 $1,358.00 07/13/18
C1725 NH 04 00 $1,358.00 07/13/18
C1726 NH 04 00 $1,938.00 07/13/18
C1726 NH 01 00 $1,938.00 07/13/18
C1729 NH 01 00 $164.00 07/13/18
C1729 NH 04 00 $164.00 07/13/18
C1751 NH 04 00 $1,357.00 07/13/18
C1751 NH 01 00 $1,357.00 07/13/18
C1758 NH 04 00 $1,384.00 07/13/18
C1758 NH 01 00 $1,384.00 07/13/18
C1760 NH 04 00 $1,119.00 07/13/18
C1760 NH 01 00 $1,119.00 07/13/18
C1762 NH 04 00 $13,560.00 07/13/18
C1762 NH 01 00 $13,560.00 07/13/18
C1765 NH 01 00 $519.36 07/13/18
C1765 NH 04 00 $519.36 07/13/18
C1769 NH 01 00 $733.00 07/13/18
C1769 NH 04 00 $733.00 07/13/18
C1771 NH 01 00 $5,934.00 07/13/18
C1771 NH 04 00 $5,934.00 07/13/18
C1776 NH 01 00 $4,218.75 07/13/18
C1776 NH 04 00 $4,218.75 07/13/18
C1781 NH 01 00 $4,806.75 07/13/18
C1781 NH 04 00 $4,806.75 07/13/18
C1788 NH 01 00 $1,819.00 07/13/18
C1788 NH 04 00 $1,819.00 07/13/18
C1874 NH 01 00 $4,726.00 07/13/18
C1874 NH 04 00 $4,726.00 07/13/18
C1887 NH 04 00 $484.75 07/13/18
C1887 NH 01 00 $484.75 07/13/18
C1893 NH 01 00 $1,150.00 07/13/18
C1893 NH 04 00 $1,150.00 07/13/18
C1894 NH 01 00 $1,050.00 07/13/18
C1894 NH 04 00 $1,050.00 07/13/18
C2617 NH 04 00 $751.00 07/13/18
C2617 NH 01 00 $751.00 07/13/18
C8908 NH 04 00 $3,879.50 07/13/18
C8908 NH 01 00 $3,879.50 07/13/18
C8928 NH 04 00 $1,554.36 07/13/18
C8928 NH 01 00 $1,554.36 07/13/18
C8929 NH 04 00 $1,993.00 07/13/18
C8929 NH 01 00 $1,993.00 07/13/18
C9113 NH 04 00 $30.00 07/13/18
C9113 NH 01 00 $111.00 07/13/18
D0120 NH 01 00 $55.00 07/13/18
D0120 NH 04 00 $55.00 07/13/18
D0272 NH 01 00 $56.00 07/13/18
D0272 NH 04 00 $56.00 07/13/18
D1110 NH 01 00 $96.00 07/13/18
D1110 NH 04 00 $96.00 07/13/18
D1120 NH 01 00 $93.00 07/13/18
D1120 NH 04 00 $93.00 07/13/18
D1208 NH 04 00 $48.00 07/13/18
D1208 NH 01 00 $48.00 07/13/18
D7140 NH 01 00 $205.00 07/13/18
D7140 NH 04 00 $165.00 07/13/18
D7210 NH 04 00 $976.00 07/13/18
D7210 NH 01 00 $976.00 07/13/18
D7220 NH 04 00 $450.00 07/13/18
D7220 NH 01 00 $450.00 07/13/18
D7230 NH 04 00 $325.00 07/13/18
D7230 NH 01 00 $460.00 07/13/18
D7240 NH 01 00 $976.00 07/13/18 $976.00 02/27/17
D7240 NH 01 00 $976.00 07/13/18 $976.00 04/19/17
D7240 NH 01 00 $976.00 04/19/17
D7240 NH 04 00 $495.00 07/13/18
D9220 NH 01 00 $440.00 07/13/18
D9220 NH 04 00 $300.00 07/13/18
D9221 NH 01 00 $175.00 07/13/18
D9221 NH 04 00 $150.00 07/13/18
D9223 NH 01 00 $240.00 07/13/18
D9223 NH 04 00 $240.00 07/13/18
D9241 NH 04 00 $375.00 07/13/18
D9241 NH 01 00 $375.00 07/13/18
D9242 NH 04 00 $166.00 07/13/18
D9242 NH 01 00 $166.00 07/13/18
D9940 NH 04 00 $495.00 07/13/18
D9940 NH 01 00 $495.00 07/13/18
E0118 NH 04 00 $429.00 07/13/18
E0118 NH 01 00 $429.00 07/13/18
E0246 NH 01 00 $63.00 02/22/16
E0246 NH 04 RR $5.25 02/22/16
E0246 NH 01 RR $5.25 02/22/16
E0246 NH 04 00 $63.00 02/22/16
E0352 NH 01 00 $45.53 07/13/18
E0352 NH 04 00 $45.53 07/13/18
E0430 NH 04 00 $315.00 07/13/18
E0430 NH 01 00 $315.00 07/13/18
E0435 NH 01 00 $3,700.00 07/13/18
E0435 NH 01 NU $3,700.00 07/13/18
E0435 NH 04 NU $3,700.00 07/13/18
E0435 NH 04 00 $3,700.00 07/13/18
E0440 NH 04 NU $3,706.50 07/13/18
E0440 NH 04 00 $3,706.50 07/13/18
E0440 NH 01 NU $3,706.50 07/13/18
E0440 NH 01 00 $3,706.50 07/13/18
E0445 NH 04 NU $584.28 07/13/18
E0445 NH 04 00 $584.28 07/13/18
E0445 NH 01 00 $584.28 07/13/18
E0445 NH 01 NU $584.28 07/13/18
E0455 NH 01 00 $2,750.00 07/13/18
E0455 NH 01 RR $229.17 07/13/18
E0455 NH 04 00 $2,750.00 07/13/18
E0455 NH 04 RR $229.17 07/13/18
E0555 NH 01 00 $3.30 07/13/18
E0555 NH 01 NU $3.30 07/13/18
E0555 NH 04 00 $3.30 07/13/18
E0555 NH 04 NU $3.30 07/13/18
E0604 NH 01 RR $86.40 07/13/18
E0604 NH 04 RR $86.40 07/13/18
E0700 NH 04 00 $32.00 07/13/18
E0700 NH 01 00 $32.00 07/13/18
E0700 NH 04 RR $2.67 07/13/18
E0700 NH 01 RR $2.67 07/13/18
E0710 NH 04 00 $12.00 07/13/18
E0710 NH 01 RR $1.00 07/13/18
E0710 NH 01 00 $12.00 07/13/18
E0710 NH 04 RR $1.00 07/13/18
E0766 NH 01 RR $21,000.00 07/13/18 $21,000.00 04/19/17
E0766 NH 04 RR $21,000.00 07/13/18 $21,000.00 04/19/17
E0766 NH 04 RR $21,000.00 04/19/17
E0766 NH 01 RR $21,000.00 04/19/17
E0936 NH 01 RR $215.00 07/13/18
E0936 NH 04 RR $215.00 07/13/18
E0970 NH 04 RR $3.43 07/13/18
E0970 NH 01 RR $3.43 07/13/18
E0970 NH 04 00 $41.10 07/13/18
E0970 NH 01 00 $41.10 07/13/18
E1085 NH 04 RR $62.50 07/13/18
E1085 NH 01 NU $750.00 07/13/18
E1085 NH 04 00 $750.00 07/13/18
E1085 NH 01 RR $62.50 07/13/18
E1085 NH 01 00 $750.00 07/13/18
E1085 NH 04 NU $750.00 07/13/18
E1086 NH 04 NU $838.00 07/13/18
E1086 NH 01 NU $838.00 07/13/18
E1086 NH 01 00 $838.00 07/13/18
E1086 NH 04 RR $69.83 07/13/18
E1086 NH 04 00 $838.00 07/13/18
E1086 NH 01 RR $69.83 07/13/18
E1089 NH 01 00 $1,200.00 07/13/18
E1089 NH 04 RR $100.00 07/13/18
E1089 NH 01 RR $100.00 07/13/18
E1089 NH 04 00 $1,200.00 07/13/18
E1090 NH 01 RR $73.33 07/13/18
E1090 NH 04 00 $880.00 07/13/18
E1090 NH 04 NU $880.00 07/13/18
E1090 NH 01 00 $880.00 07/13/18
E1090 NH 01 NU $880.00 07/13/18
E1090 NH 04 RR $73.33 07/13/18
E1130 NH 04 RR $39.58 07/13/18
E1130 NH 01 RR $39.58 07/13/18
E1130 NH 01 NU $475.00 07/13/18
E1130 NH 04 NU $475.00 07/13/18
E1130 NH 04 00 $475.00 07/13/18
E1130 NH 01 00 $475.00 07/13/18
E1140 NH 04 RR $174.72 07/13/18
E1140 NH 01 NU $784.00 07/13/18
E1140 NH 04 NU $784.00 07/13/18
E1140 NH 01 RR $174.72 07/13/18
E1140 NH 04 00 $784.00 07/13/18
E1140 NH 01 00 $784.00 07/13/18
E1250 NH 01 00 $860.30 07/13/18
E1250 NH 04 00 $860.30 07/13/18
E1250 NH 04 NU $860.30 07/13/18
E1250 NH 01 RR $71.69 07/13/18
E1250 NH 01 NU $860.30 07/13/18
E1250 NH 04 RR $71.69 07/13/18
E1260 NH 01 00 $887.00 07/13/18
E1260 NH 04 NU $887.00 07/13/18
E1260 NH 01 NU $887.00 07/13/18
E1260 NH 04 RR $73.92 07/13/18
E1260 NH 04 00 $887.00 07/13/18
E1260 NH 01 RR $73.92 07/13/18
E1285 NH 01 RR $125.00 07/13/18
E1285 NH 04 00 $1,500.00 07/13/18
E1285 NH 04 NU $1,500.00 07/13/18
E1285 NH 01 00 $1,500.00 07/13/18
E1285 NH 01 NU $1,500.00 07/13/18
E1285 NH 04 RR $125.00 07/13/18
E1290 NH 01 NU $1,500.00 07/13/18
E1290 NH 01 00 $1,500.00 07/13/18
E1290 NH 04 00 $1,500.00 07/13/18
E1290 NH 04 NU $1,500.00 07/13/18
E1353 NH 04 RR $12.50 07/13/18
E1353 NH 01 RR $12.50 07/13/18
E1355 NH 04 RR $3.67 07/13/18
E1355 NH 01 RR $3.67 07/13/18
G0177 NH 01 00 $266.00 07/13/18 $176.10 02/27/17
G0177 NH 01 00 $266.00 07/13/18 $201.91 04/19/17
G0177 NH 01 00 $201.91 04/19/17
G0177 NH 04 00 $169.00 07/13/18
G0295 NH 04 00 $22.00 07/13/18
G0295 NH 01 00 $22.00 07/13/18
G0378 NH 01 00 $113.00 07/13/18 $113.00 02/27/17
G0378 NH 01 00 $113.00 07/13/18 $113.00 04/19/17
G0378 NH 04 00 $100.00 04/19/17 $80.00 09/29/15
G0378 NH 04 00 $112.00 07/13/18 $94.00 02/27/17
G0378 NH 04 00 $112.00 07/13/18 $100.00 04/19/17
G0378 NH 01 00 $113.00 04/19/17
G0379 NH 01 00 $158.00 07/13/18
G0379 NH 04 00 $158.00 07/13/18
G0380 NH 01 00 $168.00 07/13/18
G0380 NH 04 00 $100.00 07/13/18
G0381 NH 01 00 $283.00 07/13/18
G0381 NH 04 00 $171.14 07/13/18
G0382 NH 01 00 $309.51 07/13/18
G0382 NH 04 00 $309.51 07/13/18
G0383 NH 04 00 $538.92 07/13/18
G0383 NH 01 00 $749.00 07/13/18
G0410 NH 01 00 $465.00 07/13/18 $176.10 02/27/17
G0410 NH 01 00 $465.00 07/13/18 $201.92 04/19/17
G0410 NH 04 00 $176.10 07/13/18
G0410 NH 01 00 $201.92 04/19/17
G0411 NH 01 00 $508.00 07/13/18
G0411 NH 04 00 $508.00 07/13/18
G0463 NH 01 00 $235.44 07/13/18 $235.44 02/27/17
G0463 NH 01 00 $235.44 07/13/18 $235.44 04/19/17
G0463 NH 04 00 $235.44 07/13/18 $235.44 02/27/17
G0463 NH 04 00 $235.44 07/13/18 $235.44 04/19/17
G0463 NH 04 00 $235.44 04/19/17
G0463 NH 01 00 $235.44 04/19/17
G0472 NH 04 00 $213.00 07/13/18
G0472 NH 01 00 $213.00 07/13/18
G8539 NH 04 00 $31.25 07/13/18
G8539 NH 01 00 $31.25 07/13/18
G8542 NH 04 00 $31.25 07/13/18
G8542 NH 01 00 $31.25 07/13/18
H0015 NH 01 00 $276.00 09/18/17 $262.00 02/24/16
H0015 NH 04 00 $276.00 09/18/17 $262.00 02/24/16
H0015 NH 01 00 $262.00 02/24/16
H0015 NH 04 00 $262.00 02/24/16
H0035 NH 01 00 $262.00 09/22/15 $248.00 01/03/14
H0035 NH 01 00 $276.00 09/18/17 $262.00 09/22/15
H0035 NH 04 00 $262.00 09/22/15 $248.00 01/03/14
H0035 NH 04 00 $276.00 09/18/17 $262.00 09/22/15
H0037 NH 01 00 $349.00 09/22/15 $331.00 01/03/14
H0037 NH 01 00 $368.00 09/18/17 $349.00 09/22/15
H0037 NH 04 00 $349.00 09/22/15 $331.00 01/03/14
H0037 NH 04 00 $368.00 09/18/17 $349.00 09/22/15
H2019 NH 01 00 $18.75 07/13/18
H2019 NH 04 00 $12.50 07/13/18
K0739 NH 01 00 $15.97 12/01/15 $15.62 12/19/13
K0739 NH 01 00 $16.39 01/24/18 $16.13 12/29/16
K0739 NH 04 00 $15.97 12/01/15 $15.62 12/19/13
K0739 NH 04 00 $16.39 01/24/18 $16.13 12/29/16
L3260 NH 01 00 $37.00 07/13/18 $37.00 02/27/17
L3260 NH 04 00 $37.00 07/13/18 $37.00 02/27/17
L3485 NH 01 00 $65.00 07/13/18
L3485 NH 04 00 $65.00 07/13/18
L4205 NH 01 00 $22.13 12/01/15 $21.66 12/19/13
L4205 NH 01 00 $22.71 01/24/18 $22.35 12/29/16
L4205 NH 04 00 $22.13 12/01/15 $21.66 12/19/13
L4205 NH 04 00 $22.71 01/24/18 $22.35 12/29/16
L7520 NH 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 NH 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 NH 04 00 $30.08 12/01/15 $29.43 12/19/13
L7520 NH 04 00 $30.87 01/24/18 $30.38 12/29/16
P9016 NH 04 00 $800.00 07/13/18
P9016 NH 01 00 $800.00 07/13/18
P9040 NH 04 00 $1,159.13 07/13/18
P9040 NH 01 00 $1,159.13 07/13/18
Q0084 NH 04 00 $414.00 07/13/18
Q0084 NH 01 00 $414.00 07/13/18
S5108 NH 01 00 $31.25 07/13/18
S5108 NH 04 00 $31.25 07/13/18
S5110 NH 01 00 $31.25 07/13/18
S5110 NH 04 00 $31.25 07/13/18
S5115 NH 04 00 $31.25 07/13/18
S5115 NH 01 00 $31.25 07/13/18
S9430 NH 04 00 $100.00 07/13/18
S9430 NH 01 00 $100.00 07/13/18
S9480 NH 01 00 $276.00 09/18/17 $262.00 02/24/16
S9480 NH 04 00 $276.00 09/18/17 $262.00 02/24/16
S9480 NH 04 00 $262.00 02/24/16
S9480 NH 01 00 $262.00 02/24/16
T1001 NH 01 00 $30.00 07/13/18
T1001 NH 04 00 $30.00 07/13/18
T1002 NH 01 00 $25.74 07/13/18
T1002 NH 04 00 $25.74 07/13/18
T1016 NH 01 00 $358.14 07/13/18 $358.14 02/27/17
T1016 NH 01 00 $358.14 07/13/18 $358.14 04/19/17
T1016 NH 04 00 $358.14 07/13/18 $358.14 02/27/17
T1016 NH 04 00 $358.14 07/13/18 $358.14 04/19/17
T1016 NH 04 00 $358.14 04/19/17
T1016 NH 01 00 $358.14 04/19/17
T1023 NH 04 00 $157.32 07/13/18
T1023 NH 01 00 $157.32 07/13/18
T1024 NH 04 00 $29.96 07/13/18
T1024 NH 01 00 $29.96 07/13/18
T1027 NH 01 00 $93.84 07/13/18 $93.84 04/19/17
T1027 NH 04 00 $93.84 07/13/18 $93.84 04/19/17
T1027 NH 04 00 $93.84 04/19/17
T1027 NH 01 00 $93.84 04/19/17
V2781 NH 01 00 $155.00 07/13/18
V2781 NH 04 00 $155.00 07/13/18
V5257 NH 04 00 $3,348.00 07/13/18
V5257 NH 01 00 $3,348.00 07/13/18
V5261 NH 01 00 $5,400.00 07/13/18
V5261 NH 04 00 $5,400.00 07/13/18
V5264 NH 01 00 $100.00 07/13/18 $85.00 02/27/17
V5264 NH 04 00 $100.00 07/13/18 $85.00 02/27/17
V5266 NH 01 00 $6.00 07/13/18
V5266 NH 04 00 $6.00 07/13/18
V5267 NH 01 00 $80.00 07/13/18
V5267 NH 04 00 $80.00 07/13/18