|
CPT Codes and Fees, |
| Surgery, Part 1 (10000-29999) |
| Surgery, Part 2 (30000-49999) |
| Surgery, Part 3 (50000-69999) |
| Assistant Surgery Guide |
| Radiology |
| Pathology and Laboratory |
| Evaluation & Management, Medicine, Physical Therapy |
|
Commission Assigned Codes |
| N.C. Industrial Commission Assigned Codes |
Effective January 1, 2013ABBREVIATIONS: BR = by report (i.e., report is
needed to establish fee), CPT = Current Procedural Terminology, FAC
= services were performed in a facility setting, FUD = follow-up
days (i.e., number of days in global period), NA = no allowance, OFF
= services were performed in physician office setting, PC (26) =
professional component, PER AGM = per agreement, SC =
special consideration (see Guides or contact Industrial Commission), TBA
= to be assigned, TC (27) = technical component, Total =
total fee, and Units = requires time or number of units.
|
|
CPT Code |
Total |
OFF |
FAC |
TC (27) |
PC (26) |
|
80047 |
BR |
BR |
BR |
||
|
80048 |
$17.70 |
|
|
||
|
80050 |
$47.07 |
|
|
||
|
80051 |
$15.07 |
|
|
||
|
80053 |
$18.64 |
|
|
||
|
80055 |
$53.73 |
|
|
||
|
80061 |
$34.34 |
|
|
||
|
80069 |
BR |
BR |
BR |
||
|
80074 |
$102.87 |
|
|
||
|
80076 |
BR |
BR |
BR |
||
|
80100 |
$37.66 |
|
|
||
|
80101 |
$29.90 |
|
|
||
|
80102 |
$42.64 |
|
|
||
|
80103 |
$21.60 |
|
|
||
|
80104 |
BR |
BR |
BR |
||
|
80150 |
$38.77 |
|
|
||
|
80152 |
$42.64 |
|
|
||
|
80154 |
$42.64 |
|
|
||
|
80156 |
$34.34 |
|
|
||
|
80157 |
BR |
BR |
BR |
||
|
80158 |
$51.50 |
|
|
||
|
80160 |
$42.64 |
|
|
||
|
80162 |
$32.67 |
|
|
||
|
80164 |
$34.34 |
|
|
||
|
80166 |
$42.64 |
|
|
||
|
80168 |
$38.77 |
|
|
||
|
80170 |
$34.34 |
|
|
||
|
80172 |
$34.34 |
|
|
||
|
80173 |
BR |
BR |
BR |
||
|
80174 |
$42.64 |
|
|
||
|
80176 |
$34.34 |
|
|
||
|
80178 |
$19.94 |
|
|
||
|
80182 |
$42.64 |
|
|
||
|
80184 |
$34.34 |
|
|
||
|
80185 |
$32.67 |
|
|
||
|
80186 |
$34.34 |
|
|
||
|
80188 |
$38.77 |
|
|
||
|
80190 |
$38.77 |
|
|
||
|
80192 |
$51.50 |
|
|
||
|
80194 |
$34.34 |
|
|
||
|
80195 |
BR |
BR |
BR |
||
|
80196 |
$20.50 |
|
|
||
|
80197 |
BR |
BR |
BR |
||
|
80198 |
$32.67 |
|
|
||
|
80200 |
$38.77 |
|
|
||
|
80201 |
BR |
BR |
BR |
||
|
80202 |
$34.34 |
|
|
||
|
80299 |
BR |
BR |
BR |
||
|
80400 |
$80.30 |
|
|
||
|
80402 |
$148.43 |
|
|
||
|
80406 |
$137.90 |
|
|
||
|
80408 |
$184.99 |
|
|
||
|
80410 |
$165.60 |
|
|
||
|
80412 |
$411.52 |
|
|
||
|
80414 |
$60.93 |
|
|
||
|
80415 |
$60.93 |
|
|
||
|
80416 |
BR |
BR |
BR |
||
|
80417 |
BR |
BR |
BR |
||
|
80418 |
$1,145.38 |
|
|
||
|
80420 |
$145.66 |
|
|
||
|
80422 |
$90.83 |
|
|
||
|
80424 |
$88.06 |
|
|
||
|
80426 |
$214.34 |
|
|
||
|
80428 |
$106.90 |
|
|
||
|
80430 |
$130.16 |
|
|
||
|
80432 |
$232.06 |
|
|
||
|
80434 |
$153.97 |
|
|
||
|
80435 |
$163.39 |
|
|
||
|
80436 |
$150.66 |
|
|
||
|
80438 |
$76.99 |
|
|
||
|
80439 |
$96.93 |
|
|
||
|
80440 |
$85.84 |
|
|
||
|
80500 |
$29.90 |
|
|
||
|
80502 |
$88.62 |
|
|
||
|
81000 |
$9.97 |
|
|
||
|
81001 |
$7.76 |
|
|
||
|
81002 |
$7.76 |
|
|
||
|
81003 |
$7.76 |
|
|
||
|
81005 |
$6.64 |
|
|
||
|
81007 |
$10.53 |
|
|
||
|
81015 |
$7.76 |
|
|
||
|
81020 |
$7.76 |
|
|
||
|
81025 |
$14.40 |
|
|
||
|
81050 |
$6.64 |
|
|
||
|
81099 |
BR |
BR |
BR |
||
|
81200 |
BR |
BR |
BR |
||
| 81201 | BR | BR | BR | ||
| 81202 | BR | BR | BR | ||
| 81203 | BR | BR | BR | ||
| 81205 | BR |
BR |
BR |
||
| 81206 | BR |
BR |
BR |
||
| 81207 | BR |
BR |
BR |
||
| 81208 | BR |
BR |
BR |
||
| 81209 | BR |
BR |
BR |
||
| 81210 | BR |
BR |
BR |
||
| 81211 | BR |
BR |
BR |
||
| 81212 | BR |
BR |
BR |
||
| 81213 | BR |
BR |
BR |
||
| 81214 | BR |
BR |
BR |
||
| 81215 | BR |
BR |
BR |
||
| 81216 | BR |
BR |
BR |
||
| 81217 | BR |
BR |
BR |
||
| 81220 | BR |
BR |
BR |
||
| 81221 | BR |
BR |
BR |
||
| 81222 | BR |
BR |
BR |
||
| 81223 | BR |
BR |
BR |
||
| 81224 | BR |
BR |
BR |
||
| 81225 | BR |
BR |
BR |
||
| 81226 | BR |
BR |
BR |
||
| 81227 | BR |
BR |
BR |
||
| 81228 | BR |
BR |
BR |
||
| 81229 | BR |
BR |
BR |
||
| 81235 | BR | BR | BR | ||
| 81240 | BR |
BR |
BR |
||
| 81241 | BR |
BR |
BR |
||
| 81242 | BR |
BR |
BR |
||
| 81243 | BR |
BR |
BR |
||
| 81244 | BR |
BR |
BR |
||
| 81245 | BR |
BR |
BR |
||
| 81250 | BR |
BR |
BR |
||
| 81251 | BR |
BR |
BR |
||
| 81252 | BR | BR | BR | ||
| 81253 | BR | BR | BR | ||
| 81254 | BR | BR | BR | ||
| 81255 | BR |
BR |
BR |
||
| 81256 | BR |
BR |
BR |
||
| 81257 | BR |
BR |
BR |
||
| 81260 | BR |
BR |
BR |
||
| 81261 | BR |
BR |
BR |
||
| 81262 | BR |
BR |
BR |
||
| 81263 | BR |
BR |
BR |
||
| 81264 | BR |
BR |
BR |
||
| 81265 | BR |
BR |
BR |
||
| 81266 | BR |
BR |
BR |
||
| 81267 | BR |
BR |
BR |
||
| 81268 | BR |
BR |
BR |
||
| 81270 | BR |
BR |
BR |
||
| 81275 | BR |
BR |
BR |
||
| 81280 | BR |
BR |
BR |
||
| 81281 | BR |
BR |
BR |
||
| 81282 | BR |
BR |
BR |
||
| 81290 | BR |
BR |
BR |
||
| 81291 | BR |
BR |
BR |
||
| 81292 | BR |
BR |
BR |
||
| 81293 | BR |
BR |
BR |
||
| 81294 | BR |
BR |
BR |
||
| 81295 | BR |
BR |
BR |
||
| 81296 | BR |
BR |
BR |
||
| 81297 | BR |
BR |
BR |
||
| 81298 | BR |
BR |
BR |
||
| 81299 | BR |
BR |
BR |
||
| 81300 | BR |
BR |
BR |
||
| 81301 | BR |
BR |
BR |
||
| 81302 | BR |
BR |
BR |
||
| 81303 | BR |
BR |
BR |
||
| 81304 | BR |
BR |
BR |
||
| 81310 | BR |
BR |
BR |
||
| 81315 | BR |
BR |
BR |
||
| 81316 | BR |
BR |
BR |
||
| 81317 | BR |
BR |
BR |
||
| 81318 | BR |
BR |
BR |
||
| 81319 | BR |
BR |
BR |
||
| 81321 | BR | BR | BR | ||
| 81322 | BR | BR | BR | ||
| 81323 | BR | BR | BR | ||
| 81324 | BR | BR | BR | ||
| 81325 | BR | BR | BR | ||
| 81326 | BR | BR | BR | ||
| 81330 | BR |
BR |
BR |
||
| 81331 | BR |
BR |
BR |
||
| 81332 | BR |
BR |
BR |
||
| 81340 | BR |
BR |
BR |
||
| 81341 | BR |
BR |
BR |
||
| 81342 | BR |
BR |
BR |
||
| 81350 | BR |
BR |
BR |
||
| 81355 | BR |
BR |
BR |
||
| 81370 | BR |
BR |
BR |
||
| 81371 | BR |
BR |
BR |
||
| 81372 | BR |
BR |
BR |
||
| 81373 | BR |
BR |
BR |
||
| 81374 | BR |
BR |
BR |
||
| 81375 | BR |
BR |
BR |
||
| 81376 | BR |
BR |
BR |
||
| 81377 | BR |
BR |
BR |
||
| 81378 | BR |
BR |
BR |
||
| 81379 | BR |
BR |
BR |
||
| 81380 | BR |
BR |
BR |
||
| 81381 | BR |
BR |
BR |
||
| 81382 | BR |
BR |
BR |
||
| 81383 | BR |
BR |
BR |
||
| 81400 | BR |
BR |
BR |
||
| 81401 | BR |
BR |
BR |
||
| 81402 | BR |
BR |
BR |
||
| 81403 | BR |
BR |
BR |
||
| 81404 | BR |
BR |
BR |
||
| 81405 | BR |
BR |
BR |
||
| 81406 | BR |
BR |
BR |
||
| 81407 | BR |
BR |
BR |
||
| 81408 | BR |
BR |
BR |
||
| 81479 | BR | BR | BR | ||
| 81500 | BR | BR | BR | ||
| 81503 | BR | BR | BR | ||
| 81506 | BR | BR | BR | ||
| 81508 | BR | BR | BR | ||
| 81509 | BR | BR | BR | ||
| 81510 | BR | BR | BR | ||
| 81511 | BR | BR | BR | ||
| 81512 | BR | BR | BR | ||
| 81599 | BR | BR | BR | ||
| 82777 | BR | BR | BR | ||
| 87389 | BR |
BR |
BR |
||
|
82000 |
$37.10 |
|
|
||
|
82003 |
$38.77 |
|
|
||
|
82009 |
$9.41 |
|
|
||
|
82010 |
$20.50 |
|
|
||
|
82013 |
$34.34 |
|
|
||
|
82016 |
BR |
BR |
BR |
||
|
82017 |
BR |
BR |
BR |
||
|
82024 |
$76.99 |
|
|
||
|
82030 |
$59.82 |
|
|
||
|
82040 |
$11.07 |
|
|
||
|
82042 |
$13.84 |
|
|
||
|
82043 |
$29.90 |
|
|
||
|
82044 |
$15.50 |
|
|
||
|
82045 |
BR |
BR |
BR |
||
|
82055 |
$25.47 |
|
|
||
|
82075 |
$24.93 |
|
|
||
|
82085 |
$25.47 |
|
|
||
|
82088 |
$68.67 |
|
|
||
|
82101 |
$42.64 |
|
|
||
|
82103 |
$34.34 |
|
|
||
|
82104 |
$47.07 |
|
|
||
|
82105 |
$40.43 |
|
|
||
|
82106 |
$40.43 |
|
|
||
| 82107 |
BR |
BR |
BR |
||
|
82108 |
$51.50 |
|
|
||
|
82120 |
BR |
BR |
BR |
||
|
82127 |
BR |
BR |
BR |
||
|
82128 |
$24.93 |
|
|
||
|
82131 |
$153.97 |
|
|
||
|
82135 |
$37.66 |
|
|
||
|
82136 |
BR |
BR |
BR |
||
|
82139 |
BR |
BR |
BR |
||
|
82140 |
$25.47 |
|
|
||
|
82143 |
$27.70 |
|
|
||
|
82145 |
$42.64 |
|
|
||
|
82150 |
$13.84 |
|
|
||
|
82154 |
$55.94 |
|
|
||
|
82157 |
$51.50 |
|
|
||
|
82160 |
$55.94 |
|
|
||
|
82163 |
$51.50 |
|
|
||
|
82164 |
$42.64 |
|
|
||
|
82172 |
$28.24 |
|
|
||
|
82175 |
$47.07 |
|
|
||
|
82180 |
$28.24 |
|
|
||
|
82190 |
$51.50 |
|
|
||
|
82205 |
$34.34 |
|
|
||
|
82232 |
$47.07 |
|
|
||
|
82239 |
$27.70 |
|
|
||
|
82240 |
$60.93 |
|
|
||
|
82247 |
BR |
BR |
BR |
||
|
82248 |
BR |
BR |
BR |
||
|
82252 |
$7.76 |
|
|
||
|
82261 |
BR |
BR |
BR |
||
|
82270 |
$8.30 |
$8.30 |
$0.00 |
||
|
82271 |
BR |
BR |
BR |
||
|
82272 |
BR |
BR |
BR |
||
|
82274 |
BR |
BR |
BR |
||
|
82286 |
$51.50 |
|
|
||
|
82300 |
$51.50 |
|
|
||
|
82306 |
$64.24 |
|
|
||
|
82308 |
$65.90 |
|
|
||
|
82310 |
$12.19 |
|
|
||
|
82330 |
$31.57 |
|
|
||
|
82331 |
$34.34 |
|
|
||
|
82340 |
$12.19 |
|
|
||
|
82355 |
$26.59 |
|
|
||
|
82360 |
$32.67 |
|
|
||
|
82365 |
$32.67 |
|
|
||
|
82370 |
$32.67 |
|
|
||
|
82373 |
BR |
BR |
BR |
||
|
82374 |
$11.07 |
|
|
||
|
82375 |
$29.36 |
|
|
||
|
82376 |
$10.53 |
|
|
||
|
82378 |
$44.30 |
|
|
||
|
82379 |
BR |
BR |
BR |
||
|
82380 |
$25.47 |
|
|
||
|
82382 |
$44.30 |
|
|
||
|
82383 |
$64.24 |
|
|
||
|
82384 |
$64.24 |
|
|
||
|
82387 |
$51.50 |
|
|
||
|
82390 |
$27.70 |
|
|
||
|
82397 |
$38.77 |
|
|
||
|
82415 |
$42.64 |
|
|
||
|
82435 |
$11.07 |
|
|
||
|
82436 |
$12.19 |
|
|
||
|
82438 |
$12.19 |
|
|
||
|
82441 |
$31.01 |
|
|
||
|
82465 |
$11.63 |
|
|
||
|
82480 |
$20.50 |
|
|
||
|
82482 |
$31.01 |
|
|
||
|
82485 |
$51.50 |
|
|
||
|
82486 |
$48.19 |
|
|
||
|
82487 |
$37.66 |
|
|
||
|
82488 |
$59.82 |
|
|
||
|
82489 |
$37.66 |
|
|
||
|
82491 |
$42.64 |
|
|
||
|
82492 |
BR |
BR |
BR |
||
|
82495 |
$51.50 |
|
|
||
|
82507 |
$64.24 |
|
|
||
|
82520 |
$42.64 |
|
|
||
|
82523 |
BR |
BR |
BR |
||
|
82525 |
$34.34 |
|
|
||
|
82528 |
$51.50 |
|
|
||
|
82530 |
$47.07 |
|
|
||
|
82533 |
$40.43 |
|
|
||
|
82540 |
$12.19 |
|
|
||
|
82541 |
BR |
BR |
BR |
||
|
82542 |
$39.86 |
|
|
||
|
82543 |
BR |
BR |
BR |
||
|
82544 |
BR |
BR |
BR |
||
|
82550 |
$12.74 |
|
|
||
|
82552 |
$34.34 |
|
|
||
|
82553 |
$16.06 |
|
|
||
|
82554 |
$29.90 |
|
|
||
|
82565 |
$11.07 |
|
|
||
|
82570 |
$12.19 |
|
|
||
|
82575 |
$23.26 |
|
|
||
|
82585 |
$29.36 |
|
|
||
|
82595 |
$15.50 |
|
|
||
|
82600 |
$34.34 |
|
|
||
|
82607 |
$34.34 |
|
|
||
|
82608 |
$39.33 |
|
|
||
|
82610 |
BR |
BR |
BR |
||
|
82615 |
$25.47 |
|
|
||
|
82626 |
$59.82 |
|
|
||
|
82627 |
$51.50 |
|
|
||
|
82633 |
$68.67 |
|
|
||
|
82634 |
$59.82 |
|
|
||
|
82638 |
$23.81 |
|
|
||
|
82646 |
$42.64 |
|
|
||
|
82649 |
$42.64 |
|
|
||
|
82651 |
$51.50 |
|
|
||
|
82652 |
$68.67 |
|
|
||
|
82654 |
$42.64 |
|
|
||
|
82656 |
BR |
BR |
BR |
||
|
82657 |
BR |
BR |
BR |
||
|
82658 |
BR |
BR |
BR |
||
|
82664 |
$31.57 |
|
|
||
|
82666 |
$51.50 |
|
|
||
|
82668 |
$55.94 |
|
|
||
|
82670 |
$40.43 |
|
|
||
|
82671 |
$72.00 |
|
|
||
|
82672 |
$51.50 |
|
|
||
|
82677 |
$37.10 |
|
|
||
|
82679 |
$55.94 |
|
|
||
|
82690 |
$28.24 |
|
|
||
|
82693 |
$31.01 |
|
|
||
|
82696 |
$59.82 |
|
|
||
|
82705 |
$12.74 |
|
|
||
|
82710 |
$48.19 |
|
|
||
|
82715 |
$20.50 |
|
|
||
|
82725 |
$20.50 |
|
|
||
|
82726 |
BR |
BR |
BR |
||
|
82728 |
$31.57 |
|
|
||
|
82731 |
BR |
BR |
BR |
||
|
82735 |
$45.97 |
|
|
||
|
82742 |
$42.64 |
|
|
||
|
82746 |
$34.90 |
|
|
||
|
82747 |
$42.10 |
|
|
||
|
82757 |
$22.16 |
|
|
||
|
82759 |
$27.70 |
|
|
||
|
82760 |
$28.24 |
|
|
||
|
82775 |
$36.00 |
|
|
||
|
82776 |
$11.63 |
|
|
||
|
82784 |
$29.36 |
|
|
||
|
82785 |
$37.10 |
|
|
||
|
82787 |
$91.94 |
|
|
||
|
82800 |
$25.47 |
|
|
||
|
82803 |
$46.53 |
|
|
||
|
82805 |
$54.83 |
|
|
||
|
82810 |
$25.47 |
|
|
||
|
82820 |
$29.90 |
|
|
||
|
82930 |
BR |
BR |
BR |
||
|
82938 |
$42.10 |
|
|
||
|
82941 |
$42.10 |
|
|
||
|
82943 |
$50.40 |
|
|
||
|
82945 |
BR |
BR |
BR |
||
|
82946 |
$28.24 |
|
|
||
|
82947 |
$11.07 |
|
|
||
|
82948 |
$8.30 |
|
|
||
|
82950 |
$14.40 |
|
|
||
|
82951 |
$31.57 |
|
|
||
|
82952 |
$8.30 |
|
|
||
|
82953 |
$37.10 |
|
|
||
|
82955 |
$32.67 |
|
|
||
|
82960 |
$17.17 |
|
|
||
|
82962 |
$8.30 |
|
|
||
|
82963 |
$42.64 |
|
|
||
|
82965 |
$12.19 |
|
|
||
|
82975 |
$29.36 |
|
|
||
|
82977 |
$12.74 |
|
|
||
|
82978 |
$29.90 |
|
|
||
|
82979 |
$21.60 |
|
|
||
|
82980 |
$42.64 |
|
|
||
|
82985 |
$20.50 |
|
|
||
|
83001 |
$42.64 |
|
|
||
|
83002 |
$42.64 |
|
|
||
|
83003 |
$42.64 |
|
|
||
|
83008 |
$51.50 |
|
|
||
|
83009 |
BR |
BR |
BR |
||
|
83010 |
$31.57 |
|
|
||
|
83012 |
$48.74 |
|
|
||
|
83013 |
BR |
BR |
BR |
||
|
83014 |
BR |
BR |
BR |
||
|
83015 |
$59.82 |
|
|
||
|
83018 |
$59.82 |
|
|
||
|
83020 |
$32.13 |
$22.49 |
$9.64 |
||
|
83021 |
BR |
BR |
BR |
||
|
83026 |
$7.76 |
|
|
||
|
83030 |
$22.16 |
|
|
||
|
83033 |
$12.74 |
|
|
||
|
83036 |
$24.93 |
|
|
||
|
83037 |
BR |
BR |
BR |
||
|
83045 |
$8.30 |
|
|
||
|
83050 |
$12.19 |
|
|
||
|
83051 |
$11.07 |
|
|
||
|
83055 |
$15.50 |
|
|
||
|
83060 |
$23.81 |
|
|
||
|
83065 |
$6.64 |
|
|
||
|
83068 |
$9.41 |
|
|
||
|
83069 |
$6.64 |
|
|
||
|
83070 |
$10.53 |
|
|
||
|
83071 |
$10.53 |
|
|
||
|
83080 |
BR |
BR |
BR |
||
|
83088 |
$65.90 |
|
|
||
|
83090 |
BR |
BR |
BR |
||
|
83150 |
$42.64 |
|
|
||
|
83491 |
$50.40 |
|
|
||
|
83497 |
$40.43 |
|
|
||
|
83498 |
$58.16 |
|
|
||
|
83499 |
$45.97 |
|
|
||
|
83500 |
$42.64 |
|
|
||
|
83505 |
$55.94 |
|
|
||
|
83516 |
$27.70 |
|
|
||
|
83518 |
$17.17 |
|
|
||
|
83519 |
$36.00 |
|
|
||
|
83520 |
$36.00 |
|
|
||
|
83525 |
$33.23 |
|
|
||
|
83527 |
$33.23 |
|
|
||
|
83528 |
$44.30 |
|
|
||
|
83540 |
$12.19 |
|
|
||
|
83550 |
$16.61 |
|
|
||
|
83570 |
$20.50 |
|
|
||
|
83582 |
$34.90 |
|
|
||
|
83586 |
$34.34 |
|
|
||
|
83593 |
$75.33 |
|
|
||
|
83605 |
$27.70 |
|
|
||
|
83615 |
$11.63 |
|
|
||
|
83625 |
$34.34 |
|
|
||
|
83630 |
BR |
BR |
BR |
||
|
83631 |
BR |
BR |
BR |
||
|
83632 |
$54.83 |
|
|
||
|
83633 |
$10.53 |
|
|
||
|
83634 |
$18.83 |
|
|
||
|
83655 |
$22.16 |
|
|
||
|
83661 |
$73.66 |
|
|
||
|
83662 |
$21.60 |
|
|
||
|
83663 |
BR |
BR |
BR |
||
|
83664 |
BR |
BR |
BR |
||
|
83670 |
$31.01 |
|
|
||
|
83690 |
$19.94 |
|
|
||
|
83695 |
BR |
BR |
BR |
||
| 83698 |
BR |
BR |
BR |
||
|
83700 |
BR |
BR |
BR |
||
|
83701 |
BR |
BR |
BR |
||
|
83704 |
BR |
BR |
BR |
||
|
83718 |
$17.17 |
|
|
||
|
83719 |
$17.73 |
|
|
||
|
83721 |
$17.17 |
|
|
||
|
83727 |
$47.07 |
|
|
||
|
83735 |
$12.74 |
|
|
||
|
83775 |
$19.94 |
|
|
||
|
83785 |
$51.50 |
|
|
||
|
83788 |
BR |
BR |
BR |
||
|
83789 |
BR |
BR |
BR |
||
|
83805 |
$42.64 |
|
|
||
|
83825 |
$44.30 |
|
|
||
|
83835 |
$44.30 |
|
|
||
|
83840 |
$36.04 |
|
|
||
|
83857 |
$25.47 |
|
|
||
|
83858 |
$42.64 |
|
|
||
|
83861 |
BR |
BR |
BR |
||
|
83864 |
$25.47 |
|
|
||
|
83866 |
$16.06 |
|
|
||
|
83872 |
$9.41 |
|
|
||
|
83873 |
$47.07 |
|
|
||
|
83874 |
$38.77 |
|
|
||
|
83876 |
BR |
BR |
BR |
||
|
83880 |
$74.94 |
|
|
||
|
83883 |
$31.57 |