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 VT 04 00 $500.00 03/07/16
0359T VT 01 00 $500.00 03/07/16
0360T VT 01 00 $62.50 03/07/16
0360T VT 04 00 $62.50 03/07/16
0361T VT 04 00 $62.50 03/07/16
0361T VT 01 00 $62.50 03/07/16
0364T VT 01 00 $62.50 07/17/18
0364T VT 04 00 $62.50 07/17/18
0365T VT 01 00 $62.50 03/07/16
0365T VT 04 00 $62.50 03/07/16
0368T VT 01 00 $62.50 03/07/16
0368T VT 04 00 $62.50 03/07/16
0369T VT 01 00 $62.50 03/07/16
0369T VT 04 00 $62.50 03/07/16
0370T VT 04 00 $125.00 03/07/16
0370T VT 01 00 $125.00 03/07/16
15824 VT 01 00 $343.40 07/17/18
15824 VT 04 00 $343.40 07/17/18
15825 VT 01 00 $343.40 07/17/18
15825 VT 04 00 $343.40 07/17/18
15826 VT 01 00 $343.40 07/17/18
15826 VT 04 00 $343.40 07/17/18
15828 VT 01 00 $343.40 07/17/18
15828 VT 04 00 $343.40 07/17/18
15829 VT 01 00 $343.40 07/17/18
15829 VT 04 00 $343.40 07/17/18
15876 VT 04 00 $343.40 07/17/18
15876 VT 01 00 $343.40 07/17/18
15878 VT 04 00 $343.40 07/17/18
15878 VT 01 00 $343.40 07/17/18
15879 VT 04 00 $343.40 07/17/18
15879 VT 01 00 $343.40 07/17/18
17380 VT 04 00 $343.40 03/07/16
17380 VT 01 00 $343.40 03/07/16
21088 VT 04 00 $343.40 03/07/16
21088 VT 01 00 $343.40 03/07/16
21089 VT 04 00 $343.40 07/17/18
21089 VT 01 00 $343.40 07/17/18
22841 VT 04 00 $343.40 07/17/18
22841 VT 01 00 $343.40 07/17/18
24940 VT 04 00 $343.40 07/17/18
24940 VT 01 00 $343.40 07/17/18
26989 VT 04 00 $343.40 07/17/18
26989 VT 01 00 $343.40 07/17/18
32850 VT 01 00 $343.40 07/17/18
32850 VT 04 00 $343.40 07/17/18
33930 VT 01 00 $343.40 07/17/18
33930 VT 04 00 $343.40 07/17/18
33940 VT 04 00 $343.40 07/17/18
33940 VT 01 00 $343.40 07/17/18
41821 VT 01 00 $343.40 07/17/18
41821 VT 04 00 $343.40 07/17/18
41870 VT 01 00 $343.40 07/17/18
41870 VT 04 00 $343.40 07/17/18
43496 VT 04 00 $343.40 07/17/18
43496 VT 01 00 $343.40 07/17/18
47133 VT 04 00 $343.40 07/17/18
47133 VT 01 00 $343.40 07/17/18
48160 VT 04 00 $343.40 07/17/18
48160 VT 01 00 $343.40 07/17/18
48550 VT 04 00 $343.40 07/17/18
48550 VT 01 00 $343.40 07/17/18
49906 VT 01 00 $343.40 07/17/18
49906 VT 04 00 $343.40 07/17/18
50300 VT 01 00 $343.40 07/17/18
50300 VT 04 00 $343.40 07/17/18
55970 VT 01 00 $343.40 07/17/18
55970 VT 04 00 $343.40 07/17/18
55980 VT 04 00 $343.40 07/17/18
55980 VT 01 00 $343.40 07/17/18
58974 VT 04 00 $343.40 03/07/16
58974 VT 01 00 $343.40 03/07/16
65767 VT 01 00 $343.40 07/17/18
65767 VT 04 00 $343.40 07/17/18
65771 VT 04 00 $343.40 03/07/16
65771 VT 01 00 $343.40 03/07/16
69090 VT 04 00 $343.40 03/07/16
69090 VT 01 00 $343.40 03/07/16
69710 VT 01 00 $343.40 03/07/16
69710 VT 04 00 $343.40 03/07/16
69949 VT 01 00 $343.40 07/17/18
69949 VT 04 00 $343.40 07/17/18
69979 VT 04 00 $343.40 07/17/18
69979 VT 01 00 $343.40 07/17/18
76001 VT 01 TC $391.34 07/17/18
76001 VT 04 00 $423.31 07/17/18
76001 VT 04 TC $391.34 07/17/18
76001 VT 01 00 $423.31 07/17/18
78609 VT 01 00 $343.40 07/17/18
78609 VT 04 00 $343.40 07/17/18
79300 VT 01 00 $343.40 07/17/18
79300 VT 04 00 $343.40 07/17/18
80301 VT 01 00 $650.00 03/07/16
80301 VT 04 00 $650.00 03/07/16
80365 VT 04 00 $125.00 03/07/16
80365 VT 01 00 $125.00 03/07/16
86860 VT 04 00 $48.00 07/17/18
86860 VT 01 00 $48.00 07/17/18
86891 VT 04 00 $80.00 07/17/18
86891 VT 01 00 $80.00 07/17/18
86930 VT 01 00 $8.00 07/17/18
86930 VT 04 00 $8.00 07/17/18
86931 VT 04 00 $8.00 07/17/18
86931 VT 01 00 $8.00 07/17/18
86932 VT 01 00 $8.00 07/17/18
86932 VT 04 00 $8.00 07/17/18
86950 VT 04 00 $40.00 07/17/18
86950 VT 01 00 $40.00 07/17/18
86970 VT 04 00 $128.00 07/17/18
86970 VT 01 00 $128.00 07/17/18
86971 VT 01 00 $128.00 07/17/18
86971 VT 04 00 $128.00 07/17/18
86972 VT 01 00 $128.00 07/17/18
86972 VT 04 00 $128.00 07/17/18
86975 VT 04 00 $128.00 07/17/18
86975 VT 01 00 $128.00 07/17/18
86976 VT 04 00 $128.00 07/17/18
86976 VT 01 00 $128.00 07/17/18
86977 VT 04 00 $128.00 07/17/18
86977 VT 01 00 $128.00 07/17/18
86978 VT 04 00 $128.00 07/17/18
86978 VT 01 00 $128.00 07/17/18
90736 VT 01 NU $235.51 10/19/16 $208.09 05/07/15
90736 VT 04 NU $235.51 10/19/16 $208.09 05/07/15
90736 VT 01 00 $235.51 07/19/17
90736 VT 01 00 $254.35 07/20/17
90736 VT 04 00 $254.35 07/20/17
90736 VT 04 00 $235.51 07/19/17
90993 VT 01 00 $343.40 07/17/18
90993 VT 04 00 $343.40 07/17/18
92993 VT 01 00 $343.40 07/17/18
92993 VT 04 00 $343.40 07/17/18
93299 VT 04 00 $154.00 07/17/18
93299 VT 01 00 $154.00 07/17/18
99000 VT 01 00 $25.00 07/17/18 $25.00 02/27/17
99000 VT 01 00 $25.00 07/17/18 $25.00 04/19/17
99000 VT 04 00 $25.00 07/17/18 $25.00 02/27/17
99000 VT 04 00 $25.00 07/17/18 $25.00 04/19/17
99000 VT 01 00 $25.00 04/19/17
99000 VT 04 00 $25.00 04/19/17
99001 VT 01 00 $7.00 07/17/18
99001 VT 04 00 $7.00 07/17/18
99071 VT 04 00 $1.80 03/07/16
99071 VT 01 00 $1.80 03/07/16
99075 VT 01 00 $1.80 03/07/16
99075 VT 04 00 $1.80 03/07/16
99455 VT 04 00 $343.40 03/07/16
99455 VT 01 00 $343.40 03/07/16
A0225 VT 01 00 $235.00 07/17/18
A0225 VT 04 00 $235.00 07/17/18
A4206 VT 04 00 $0.30 07/17/18
A4206 VT 01 00 $0.30 07/17/18
A4213 VT 04 00 $1.03 07/17/18
A4213 VT 01 00 $1.03 07/17/18
A4215 VT 04 00 $0.30 07/17/18
A4215 VT 01 00 $0.30 07/17/18
A4218 VT 04 00 $0.58 07/17/18
A4218 VT 01 00 $0.58 07/17/18
A4223 VT 01 00 $350.00 07/17/18 $190.00 04/19/17
A4223 VT 04 00 $350.00 07/17/18 $190.00 04/19/17
A4223 VT 04 00 $190.00 04/19/17
A4223 VT 01 00 $190.00 04/19/17
A4305 VT 04 00 $6.00 07/17/18
A4305 VT 01 00 $6.00 07/17/18
A4306 VT 04 00 $525.00 07/17/18
A4306 VT 01 00 $525.00 07/17/18
A4466 VT 04 00 $89.93 04/21/17
A4466 VT 01 00 $89.93 04/21/17
A4550 VT 01 00 $48.00 07/17/18 $48.00 02/27/17
A4550 VT 01 00 $48.00 07/17/18 $48.00 04/19/17
A4550 VT 04 00 $48.00 07/17/18 $48.00 04/19/17
A4550 VT 01 00 $48.00 04/19/17
A4550 VT 04 00 $48.00 04/19/17
A4570 VT 01 00 $44.00 07/17/18
A4570 VT 04 00 $44.00 07/17/18
A4580 VT 01 00 $48.00 07/17/18
A4580 VT 04 00 $48.00 07/17/18
A4590 VT 04 00 $28.00 07/17/18
A4590 VT 01 00 $28.00 07/17/18
A4606 VT 04 00 $25.00 07/17/18
A4606 VT 01 00 $25.00 07/17/18
A4627 VT 04 00 $63.00 07/17/18
A4627 VT 01 00 $63.00 07/17/18
A4648 VT 01 00 $292.50 07/17/18 $253.50 02/27/17
A4648 VT 01 00 $292.50 07/17/18 $292.50 04/19/17
A4648 VT 04 00 $292.50 07/17/18 $253.50 02/27/17
A4648 VT 04 00 $292.50 07/17/18 $292.50 04/19/17
A4648 VT 01 00 $292.50 04/19/17
A4648 VT 04 00 $292.50 04/19/17
A4770 VT 04 00 $160.00 07/17/18
A4770 VT 01 00 $160.00 07/17/18
A4927 VT 01 00 $9.05 04/19/17 $9.79 08/31/15
A4927 VT 01 00 $10.75 07/17/18 $9.05 04/19/17
A4927 VT 04 00 $9.05 04/19/17 $9.79 08/31/15
A4927 VT 04 00 $10.75 07/17/18 $9.05 04/19/17
A6208 VT 04 00 $67.11 07/17/18
A6208 VT 01 00 $67.11 07/17/18
A6213 VT 01 00 $9.80 07/17/18
A6213 VT 04 00 $9.80 07/17/18
A6451 VT 01 00 $1.99 07/17/18
A6451 VT 04 00 $1.99 07/17/18
A6530 VT 04 00 $73.50 07/17/18
A6530 VT 01 00 $73.50 07/17/18
A6533 VT 01 00 $120.00 07/17/18
A6533 VT 04 00 $120.00 07/17/18
A9282 VT 04 00 $2,000.00 07/17/18
A9282 VT 01 00 $2,000.00 07/17/18
A9500 VT 01 00 $567.32 07/17/18 $567.32 02/27/17
A9500 VT 01 00 $567.32 07/17/18 $567.32 04/19/17
A9500 VT 04 00 $338.00 07/17/18
A9500 VT 01 00 $567.32 04/19/17
A9502 VT 04 00 $561.44 07/17/18
A9502 VT 01 00 $561.44 07/17/18
A9503 VT 01 00 $132.42 04/19/17 $87.00 09/03/15
A9503 VT 01 00 $142.35 07/17/18 $132.42 02/27/17
A9503 VT 01 00 $142.35 07/17/18 $132.42 04/19/17
A9503 VT 04 00 $87.00 07/17/18 $87.00 02/27/17
A9505 VT 04 00 $31.74 07/17/18
A9505 VT 01 00 $31.74 07/17/18
A9507 VT 04 00 $3,244.35 07/17/18
A9507 VT 01 00 $3,244.35 07/17/18
A9516 VT 04 00 $68.45 07/17/18
A9516 VT 01 00 $68.45 07/17/18
A9517 VT 04 00 $33.31 07/17/18
A9517 VT 01 00 $33.31 07/17/18
A9521 VT 04 00 $567.61 07/17/18
A9521 VT 01 00 $567.61 07/17/18
A9530 VT 04 00 $28.91 07/17/18
A9530 VT 01 00 $28.91 07/17/18
A9537 VT 04 00 $59.54 07/17/18
A9537 VT 01 00 $247.50 07/17/18
A9538 VT 04 00 $24.70 07/17/18
A9538 VT 01 00 $24.70 07/17/18
A9539 VT 04 00 $16.25 07/17/18
A9539 VT 01 00 $16.25 07/17/18
A9541 VT 04 00 $75.35 07/17/18
A9541 VT 01 00 $132.16 07/17/18
A9542 VT 04 00 $2,769.63 07/17/18
A9542 VT 01 00 $2,769.63 07/17/18
A9551 VT 04 00 $126.63 07/17/18
A9551 VT 01 00 $126.63 07/17/18
A9552 VT 04 00 $1,159.00 07/17/18
A9552 VT 01 00 $1,159.00 07/17/18
A9556 VT 04 00 $32.04 07/17/18
A9556 VT 01 00 $32.04 07/17/18
A9558 VT 04 00 $38.96 07/17/18
A9558 VT 01 00 $38.96 07/17/18
A9560 VT 01 00 $114.00 07/17/18
A9560 VT 04 00 $114.00 07/17/18
A9561 VT 04 00 $34.56 07/17/18
A9561 VT 01 00 $34.56 07/17/18
A9562 VT 01 00 $445.51 07/17/18
A9562 VT 04 00 $445.51 07/17/18
A9600 VT 01 00 $1,014.13 07/17/18
A9600 VT 04 00 $1,014.13 07/17/18
B4172 VT 04 00 $195.00 07/17/18
B4172 VT 01 00 $195.00 07/17/18
B5200 VT 04 00 $4.94 07/17/18
B5200 VT 01 00 $4.94 07/17/18
C1713 VT 04 00 $926.10 07/17/18
C1713 VT 01 00 $926.10 07/17/18
C1726 VT 04 00 $3,028.20 07/17/18
C1726 VT 01 00 $3,028.20 07/17/18
C1729 VT 01 00 $72.62 07/17/18
C1729 VT 04 00 $72.62 07/17/18
C1730 VT 04 00 $1,497.60 07/17/18
C1730 VT 01 00 $1,497.60 07/17/18
C1758 VT 04 00 $57.71 07/17/18
C1758 VT 01 00 $57.71 07/17/18
C1760 VT 04 00 $721.50 07/17/18
C1760 VT 01 00 $721.50 07/17/18
C1769 VT 01 00 $241.00 07/17/18
C1769 VT 04 00 $241.00 07/17/18
C1771 VT 04 00 $3,965.00 07/17/18
C1771 VT 01 00 $3,965.00 07/17/18
C1781 VT 04 00 $1,224.98 07/17/18
C1781 VT 01 00 $1,224.98 07/17/18
C1788 VT 01 00 $2,255.00 07/17/18
C1788 VT 04 00 $2,255.00 07/17/18
C1874 VT 04 00 $4,974.64 07/17/18
C1874 VT 01 00 $4,974.64 07/17/18
C1887 VT 01 00 $1,432.08 07/17/18
C1887 VT 04 00 $1,432.08 07/17/18
C1893 VT 01 00 $643.50 07/17/18
C1893 VT 04 00 $643.50 07/17/18
C1894 VT 01 00 $142.98 07/17/18
C1894 VT 04 00 $142.98 07/17/18
C2617 VT 04 00 $446.22 07/17/18
C2617 VT 01 00 $446.22 07/17/18
C9113 VT 01 00 $45.38 07/17/18
C9113 VT 04 00 $30.00 07/17/18
C9285 VT 01 00 $42.73 07/17/18
C9285 VT 04 00 $42.73 07/17/18
D0120 VT 04 00 $55.00 07/17/18
D0120 VT 01 00 $55.00 07/17/18
D0140 VT 04 00 $110.00 07/17/18
D0140 VT 01 00 $110.00 07/17/18
D0145 VT 04 00 $42.00 07/17/18
D0145 VT 01 00 $42.00 07/17/18
D0220 VT 01 00 $379.61 07/17/18
D0220 VT 04 00 $379.61 07/17/18
D1110 VT 04 00 $92.00 07/17/18
D1110 VT 01 00 $92.00 07/17/18
D1120 VT 01 00 $60.00 07/17/18
D1120 VT 04 00 $60.00 07/17/18
D1206 VT 04 00 $379.58 07/17/18
D1206 VT 01 00 $379.58 07/17/18
D7140 VT 01 00 $2,418.00 07/17/18
D7140 VT 04 00 $2,418.00 07/17/18
D7230 VT 04 00 $325.00 07/17/18
D7230 VT 01 00 $325.00 07/17/18
D7240 VT 04 00 $355.00 07/17/18
D7240 VT 01 00 $495.00 07/17/18
D7880 VT 04 00 $795.00 07/17/18
D7880 VT 01 00 $795.00 07/17/18
D9220 VT 04 00 $470.00 07/17/18
D9220 VT 01 00 $470.00 07/17/18
E0190 VT 01 NU $53.30 07/17/18
E0190 VT 04 00 $53.30 07/17/18
E0190 VT 04 NU $53.30 07/17/18
E0190 VT 01 00 $53.30 07/17/18
E0246 VT 04 00 $63.00 03/07/16
E0246 VT 01 RR $5.25 03/07/16
E0246 VT 04 RR $5.25 03/07/16
E0246 VT 01 00 $63.00 03/07/16
E0352 VT 04 00 $45.53 07/17/18
E0352 VT 01 00 $45.53 07/17/18
E0430 VT 04 RR $26.25 07/17/18
E0430 VT 01 00 $315.00 07/17/18
E0430 VT 04 00 $315.00 07/17/18
E0430 VT 01 RR $26.25 07/17/18
E0435 VT 01 00 $3,700.00 07/17/18
E0435 VT 01 NU $3,700.00 07/17/18
E0435 VT 04 NU $3,700.00 07/17/18
E0435 VT 01 RR $308.33 07/17/18
E0435 VT 04 00 $3,700.00 07/17/18
E0435 VT 04 RR $308.33 07/17/18
E0440 VT 01 00 $3,706.50 07/17/18
E0440 VT 01 NU $3,706.50 07/17/18
E0440 VT 04 RR $308.88 07/17/18
E0440 VT 04 00 $3,706.50 07/17/18
E0440 VT 01 RR $308.88 07/17/18
E0440 VT 04 NU $3,706.50 07/17/18
E0445 VT 01 RR $1,282.31 07/17/18 $1,282.31 04/20/17
E0445 VT 04 RR $1,282.31 07/17/18 $1,282.31 04/19/17
E0445 VT 04 RR $1,282.31 04/19/17
E0445 VT 01 RR $1,282.31 04/20/17
E0445 VT 04 00 $1,282.31 07/17/18
E0445 VT 04 NU $1,282.31 07/17/18
E0445 VT 01 00 $1,282.31 07/17/18
E0445 VT 01 NU $1,282.31 07/17/18
E0455 VT 04 00 $2,750.00 07/17/18
E0455 VT 01 RR $229.17 07/17/18
E0455 VT 01 00 $2,750.00 07/17/18
E0455 VT 04 RR $229.17 07/17/18
E0486 VT 01 00 $2,600.00 07/17/18
E0486 VT 01 NU $2,600.00 07/17/18
E0486 VT 04 00 $2,600.00 07/17/18
E0486 VT 04 NU $2,600.00 07/17/18
E0604 VT 01 00 $86.40 07/17/18
E0604 VT 04 NU $86.40 07/17/18
E0604 VT 04 00 $86.40 07/17/18
E0604 VT 01 NU $86.40 07/17/18
E0700 VT 04 RR $2.67 07/17/18
E0700 VT 01 00 $32.00 07/17/18
E0700 VT 01 RR $2.67 07/17/18
E0700 VT 04 00 $32.00 07/17/18
E0710 VT 04 00 $12.00 07/17/18
E0710 VT 01 RR $1.00 07/17/18
E0710 VT 01 00 $12.00 07/17/18
E0710 VT 04 RR $1.00 07/17/18
E0970 VT 01 00 $41.10 07/17/18
E0970 VT 04 RR $3.43 07/17/18
E0970 VT 01 RR $3.43 07/17/18
E0970 VT 04 00 $41.10 07/17/18
E1085 VT 01 00 $750.00 07/17/18
E1085 VT 01 NU $750.00 07/17/18
E1085 VT 04 RR $62.50 07/17/18
E1085 VT 04 00 $750.00 07/17/18
E1085 VT 01 RR $62.50 07/17/18
E1085 VT 04 NU $750.00 07/17/18
E1086 VT 01 00 $838.00 07/17/18
E1086 VT 01 NU $838.00 07/17/18
E1086 VT 04 RR $69.83 07/17/18
E1086 VT 01 RR $69.83 07/17/18
E1086 VT 04 00 $838.00 07/17/18
E1086 VT 04 NU $838.00 07/17/18
E1089 VT 01 00 $1,200.00 07/17/18
E1089 VT 04 RR $100.00 07/17/18
E1089 VT 01 RR $100.00 07/17/18
E1089 VT 04 00 $1,200.00 07/17/18
E1090 VT 01 NU $880.00 07/17/18
E1090 VT 04 RR $73.33 07/17/18
E1090 VT 01 00 $880.00 07/17/18
E1090 VT 04 00 $880.00 07/17/18
E1090 VT 01 RR $73.33 07/17/18
E1090 VT 04 NU $880.00 07/17/18
E1130 VT 04 00 $475.00 07/17/18
E1130 VT 01 RR $39.58 07/17/18
E1130 VT 01 00 $475.00 07/17/18
E1130 VT 04 NU $475.00 07/17/18
E1130 VT 04 RR $39.58 07/17/18
E1130 VT 01 NU $475.00 07/17/18
E1140 VT 04 00 $784.00 07/17/18
E1140 VT 01 RR $65.33 07/17/18
E1140 VT 04 NU $784.00 07/17/18
E1140 VT 01 00 $784.00 07/17/18
E1140 VT 01 NU $784.00 07/17/18
E1140 VT 04 RR $65.33 07/17/18
E1250 VT 04 NU $860.30 07/17/18
E1250 VT 01 RR $71.69 07/17/18
E1250 VT 04 00 $860.30 07/17/18
E1250 VT 01 00 $860.30 07/17/18
E1250 VT 04 RR $71.69 07/17/18
E1250 VT 01 NU $860.30 07/17/18
E1260 VT 01 RR $73.92 07/17/18
E1260 VT 04 00 $887.00 07/17/18
E1260 VT 04 NU $887.00 07/17/18
E1260 VT 01 00 $887.00 07/17/18
E1260 VT 01 NU $887.00 07/17/18
E1260 VT 04 RR $73.92 07/17/18
E1285 VT 04 RR $125.00 07/17/18
E1285 VT 01 NU $1,500.00 07/17/18
E1285 VT 04 NU $1,500.00 07/17/18
E1285 VT 01 RR $125.00 07/17/18
E1285 VT 04 00 $1,500.00 07/17/18
E1285 VT 01 00 $1,500.00 07/17/18
E1290 VT 04 NU $1,500.00 07/17/18
E1290 VT 01 00 $1,500.00 07/17/18
E1290 VT 01 NU $1,500.00 07/17/18
E1290 VT 04 00 $1,500.00 07/17/18
E1353 VT 04 RR $12.50 07/17/18
E1353 VT 01 RR $12.50 07/17/18
E1355 VT 04 RR $3.67 07/17/18
E1355 VT 01 RR $3.67 07/17/18
G0176 VT 01 00 $218.00 07/17/18 $170.00 04/19/17
G0176 VT 04 00 $170.00 07/17/18
G0176 VT 01 00 $170.00 04/19/17
G0177 VT 01 00 $210.00 04/19/17 $185.00 09/29/15
G0177 VT 01 00 $218.00 07/17/18 $200.00 02/27/17
G0177 VT 01 00 $218.00 07/17/18 $210.00 04/19/17
G0177 VT 04 00 $200.00 04/19/17 $170.00 09/29/15
G0177 VT 04 00 $210.00 07/17/18 $200.00 04/19/17
G0378 VT 01 00 $84.00 07/17/18 $72.00 02/27/17
G0378 VT 01 00 $84.00 07/17/18 $72.00 04/19/17
G0378 VT 04 00 $72.00 07/17/18 $72.00 02/27/17
G0378 VT 01 00 $72.00 04/19/17
G0379 VT 04 00 $165.00 07/17/18
G0379 VT 01 00 $165.00 07/17/18
G0410 VT 01 00 $210.00 04/19/17 $185.00 09/30/15
G0410 VT 01 00 $218.00 07/17/18 $200.00 02/27/17
G0410 VT 01 00 $218.00 07/17/18 $210.00 04/19/17
G0410 VT 04 00 $200.00 04/19/17 $150.00 09/30/15
G0410 VT 04 00 $218.00 07/17/18 $200.00 02/27/17
G0410 VT 04 00 $218.00 07/17/18 $200.00 04/19/17
G0463 VT 01 00 $162.00 04/19/17 $79.00 09/30/15
G0463 VT 01 00 $162.00 07/17/18 $102.00 02/27/17
G0463 VT 01 00 $162.00 07/17/18 $162.00 04/19/17
G0463 VT 04 00 $162.00 04/19/17 $79.00 09/30/15
G0463 VT 04 00 $162.00 07/17/18 $102.00 02/27/17
G0463 VT 04 00 $162.00 07/17/18 $162.00 04/19/17
G0467 VT 01 00 $160.00 07/17/18 $160.00 02/27/17
G0467 VT 04 00 $160.00 07/17/18
G8539 VT 04 00 $31.25 07/17/18
G8539 VT 01 00 $31.25 07/17/18
G8542 VT 04 00 $31.25 07/17/18
G8542 VT 01 00 $31.25 07/17/18
G9001 VT 04 00 $54.00 03/07/16
G9001 VT 01 00 $54.00 03/07/16
H0015 VT 01 00 $276.00 09/18/17 $262.00 02/24/16
H0015 VT 04 00 $276.00 09/18/17 $262.00 02/24/16
H0015 VT 04 00 $262.00 02/24/16
H0015 VT 01 00 $262.00 02/24/16
H0035 VT 01 00 $262.00 09/22/15 $248.00 01/03/14
H0035 VT 01 00 $276.00 09/18/17 $262.00 09/22/15
H0035 VT 04 00 $262.00 09/22/15 $248.00 01/03/14
H0035 VT 04 00 $276.00 09/18/17 $262.00 09/22/15
H0037 VT 01 00 $349.00 09/22/15 $331.00 01/03/14
H0037 VT 01 00 $368.00 09/18/17 $349.00 09/22/15
H0037 VT 04 00 $349.00 09/22/15 $331.00 01/03/14
H0037 VT 04 00 $368.00 09/18/17 $349.00 09/22/15
H0043 VT 04 00 $500.00 02/28/17
H0043 VT 01 00 $500.00 02/28/17
H2000 VT 04 00 $47.00 07/17/18
H2000 VT 01 00 $47.00 07/17/18
H2019 VT 01 00 $18.75 07/17/18
H2019 VT 04 00 $12.50 07/17/18
K0462 VT 04 00 $305.64 07/17/18
K0462 VT 01 00 $305.64 07/17/18
K0739 VT 01 00 $15.97 12/01/15 $15.62 12/19/13
K0739 VT 01 00 $16.39 01/24/18 $16.13 12/29/16
K0739 VT 04 00 $15.97 12/01/15 $15.62 12/19/13
K0739 VT 04 00 $16.39 01/24/18 $16.13 12/29/16
L3260 VT 01 00 $33.35 07/17/18
L3260 VT 04 00 $33.35 07/17/18
L3485 VT 04 00 $42.00 07/17/18
L3485 VT 01 00 $42.00 07/17/18
L4205 VT 01 00 $22.13 12/01/15 $21.66 12/19/13
L4205 VT 01 00 $22.71 01/24/18 $22.35 12/29/16
L4205 VT 04 00 $22.13 12/01/15 $21.66 12/19/13
L4205 VT 04 00 $22.71 01/24/18 $22.35 12/29/16
L7520 VT 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 VT 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 VT 04 00 $30.08 12/01/15 $29.43 12/19/13
L7520 VT 04 00 $30.87 01/24/18 $30.38 12/29/16
P9016 VT 01 00 $497.75 07/17/18
P9016 VT 04 00 $497.75 07/17/18
P9040 VT 04 00 $577.46 07/17/18
P9040 VT 01 00 $577.46 07/17/18
P9053 VT 01 00 $1,658.06 07/17/18 $1,658.06 04/19/17
P9053 VT 04 00 $1,658.06 07/17/18
P9053 VT 01 00 $1,658.06 04/19/17
P9058 VT 01 00 $614.56 07/17/18 $614.56 04/19/17
P9058 VT 04 00 $614.56 07/17/18
Q9964 VT 01 00 $5.00 07/17/18 $4.00 02/27/17
Q9964 VT 04 00 $3.00 07/17/18
S5108 VT 01 00 $31.25 07/17/18
S5108 VT 04 00 $31.25 07/17/18
S5110 VT 04 00 $31.25 07/17/18
S5110 VT 01 00 $31.25 07/17/18
S5115 VT 04 00 $31.25 07/17/18
S5115 VT 01 00 $31.25 07/17/18
S9088 VT 04 00 $75.00 03/07/16
S9088 VT 01 00 $100.00 03/07/16
S9480 VT 01 00 $276.00 09/18/17 $262.00 02/24/16
S9480 VT 04 00 $276.00 09/18/17 $262.00 02/24/16
S9480 VT 01 00 $262.00 02/24/16
S9480 VT 04 00 $262.00 02/24/16
T1015 VT 01 00 $158.73 07/17/18 $158.73 02/27/17
T1015 VT 04 00 $158.73 07/17/18 $158.73 02/27/17
T1023 VT 01 00 $95.00 07/17/18
T1023 VT 04 00 $95.00 07/17/18
V2781 VT 01 00 $240.00 07/17/18
V2781 VT 04 00 $240.00 07/17/18
V5264 VT 04 00 $50.00 07/17/18
V5264 VT 01 00 $50.00 07/17/18