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, 2015ABBREVIATIONS: 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) |
Units Required |
90281 |
BR |
|
|
|
|
|
90283 |
BR |
|
|
|
|
|
90284 |
BR |
|
|
|
|
|
90287 |
BR |
|
|
|
|
|
90288 |
BR |
|
|
|
|
|
90291 |
BR |
|
|
|
|
|
90296 |
BR |
|
|
|
|
|
90371 |
BR |
|
|
|
|
|
90375 |
BR |
|
|
|
|
|
90376 |
BR |
|
|
|
|
|
90378 |
BR |
|
|
|
|
|
90384 |
BR |
|
|
|
|
|
90385 |
BR |
|
|
|
|
|
90386 |
BR |
|
|
|
|
|
90389 |
BR |
|
|
|
|
|
90393 |
BR |
|
|
|
|
|
90396 |
BR |
|
|
|
|
|
90399 |
BR |
|
|
|
|
|
90460 |
|
$45.96 |
|
|
|
|
90461 |
|
$23.05 |
|
|
|
|
90471 |
BR |
|
|
|
|
|
90472 |
BR |
|
|
|
|
|
90473 |
BR |
|
|
|
|
|
90474 |
BR |
|
|
|
|
|
90476 |
BR |
|
|
|
|
|
90477 |
BR |
|
|
|
|
|
90581 |
BR |
|
|
|
|
|
90585 |
BR |
|
|
|
|
|
90586 |
BR |
|
|
|
|
|
90630 |
BR |
|
|
|
|
|
90632 |
BR |
|
|
|
|
|
90633 |
BR |
|
|
|
|
|
90634 |
BR |
|
|
|
|
|
90636 |
BR |
|
|
|
|
|
90644 |
BR |
|
|
|
|
|
90645 |
BR |
|
|
|
|
|
90646 |
BR |
|
|
|
|
|
90647 |
BR |
|
|
|
|
|
90648 |
BR |
|
|
|
|
|
90649 |
BR |
|
|
|
|
|
90650 |
BR |
|
|
|
|
|
90651 |
BR |
|
|
|
|
|
90653 |
BR |
|
|
|
|
|
90654 | BR | |||||
90655 |
BR |
|
|
|
|
|
90656 |
BR |
|
|
|
|
|
90657 |
BR |
|
|
|
|
|
90658 |
BR |
|
|
|
|
|
90659 |
BR |
|
|
|
|
|
90660 |
BR |
|
|
|
|
|
90661 |
BR |
|
|
|
|
|
90662 |
BR |
|
|
|
|
|
90664 |
BR |
|
|
|
|
|
90666 |
BR |
|
|
|
|
|
90667 |
BR |
|
|
|
|
|
90668 |
BR |
|
|
|
|
|
90669 |
BR |
|
|
|
|
|
90670 |
BR |
|
|
|
|
|
90672 |
BR |
|
|
|
|
|
90673 |
BR |
|
|
|
|
|
90675 |
BR |
|
|
|
|
|
90676 |
BR |
|
|
|
|
|
90680 |
BR |
|
|
|
|
|
90681 |
BR |
|
|
|
|
|
90685 |
BR |
|
|
|
|
|
90686 |
BR |
|
|
|
|
|
90687 |
BR |
|
|
|
|
|
90688 |
BR |
|
|
|
|
|
90690 |
BR |
|
|
|
|
|
90691 |
BR |
|
|
|
|
|
90692 |
BR |
|
|
|
|
|
90693 |
BR |
|
|
|
|
|
90696 |
BR |
|
|
|
|
|
90698 |
BR |
|
|
|
|
|
90700 |
$25.15 |
|
|
|
|
|
90702 |
$13.67 |
|
|
|
|
|
90703 |
$12.58 |
|
|
|
|
|
90704 |
$22.97 |
|
|
|
|
|
90705 |
$20.78 |
|
|
|
|
|
90706 |
$21.88 |
|
|
|
|
|
90707 |
$28.44 |
|
|
|
|
|
90708 |
$25.15 |
|
|
|
|
|
90710 |
$34.46 |
|
|
|
|
|
90712 |
$13.67 |
|
|
|
|
|
90713 |
$26.26 |
|
|
|
|
|
90714 |
$24.19 |
|
|
|
|
|
90715 |
BR |
|
|
|
|
|
90716 |
$34.46 |
|
|
|
|
|
90717 |
$33.37 |
|
|
|
|
|
90719 |
$20.78 |
|
|
|
|
|
90720 |
$37.75 |
|
|
|
|
|
90721 |
BR |
|
|
|
|
|
90723 |
BR |
|
|
|
|
|
90725 |
$14.77 |
|
|
|
|
|
90727 |
$20.78 |
|
|
|
|
|
90732 |
$18.04 |
|
|
|
|
|
90733 |
$39.93 |
|
|
|
|
|
90734 |
BR |
|
|
|
|
|
90735 |
$16.40 |
|
|
|
|
|
90736 |
BR |
|
|
|
|
|
90738 |
BR |
|
|
|
|
|
90739 |
BR |
|
|
|
|
|
90740 |
BR |
|
|
|
|
|
90743 |
BR |
|
|
|
|
|
90744 |
BR |
|
|
|
|
|
90746 |
BR |
|
|
|
|
|
90747 |
BR |
|
|
|
|
|
90748 |
BR |
|
|
|
|
|
90749 |
BR |
|
|
|
|
|
90780 |
$54.70 |
|
|
|
|
|
90781 |
$27.35 |
|
|
|
|
|
90782 |
$5.47 |
|
|
|
|
|
90783 |
$20.24 |
|
|
|
|
|
90784 |
$23.51 |
|
|
|
|
|
90785 |
|
$7.28 | $7.28 |
|
|
|
90788 |
$5.47 |
|
|
|
|
|
90791 |
|
$230.38 | $181.04 |
|
|
|
90792 |
|
$192.13 | $187.15 |
|
|
|
90799 |
BR |
|
|
|
|
|
90832 |
$95.97 | $76.05 | ||||
90833 | $64.15 | $63.64 | ||||
90834 | $124.65 | $114.19 | ||||
90836 | $104.20 | $104.20 | ||||
90837 | $182.65 | $172.19 | ||||
90838 | $168.25 | $167.26 | ||||
90839 | BR | |||||
90840 | BR | |||||
90845 |
$115.96 |
|
|
|
|
|
90846 |
$129.07 |
|
|
|
|
|
90847 |
$146.58 |
|
|
|
|
|
90849 |
$44.86 |
|
|
|
|
|
90853 |
$36.64 |
|
|
|
|
|
90863 |
BR |
|
|
|
|
|
90865 |
$175.16 |
|
|
|
|
|
90867 |
BR |
|
|
|
|
|
90868 |
BR |
|
|
|
|
|
90869 | $899.83 | $234.24 | ||||
90870 |
$129.07 |
|
|
|
|
|
90871 |
$188.70 |
|
|
|
|
|
90875 |
$71.19 |
|
|
|
|
YES |
90876 |
$110.74 |
|
|
|
|
YES |
90880 |
$149.86 |
|
|
|
|
|
90882 |
$98.45 |
|
|
|
|
|
90885 |
BR |
|
|
|
|
|
90887 |
$95.72 |
|
|
|
|
|
90889 |
$80.41 |
|
|
|
|
|
90899 |
BR |
|
|
|
|
|
90901 |
$78.00 |
|
|
|
|
|
90911 |
$124.00 |
|
|
|
|
|
90935 |
$141.11 |
|
|
|
|
|
90937 |
$247.76 |
|
|
|
|
|
90939 |
BR |
|
|
|
|
|
90940 |
BR |
|
|
|
|
|
90945 |
$132.91 |
|
|
|
|
|
90947 |
$221.50 |
|
|
|
|
|
90951 |
$1,922.58 |
|
|
|
|
|
90952 |
BR |
|
|
|
|
|
90953 |
BR |
|
|
|
|
|
90954 |
$1,578.58 |
|
|
|
|
|
90955 |
$893.77 |
|
|
|
|
|
90956 |
$605.43 |
|
|
|
|
|
90957 |
$1,267.02 |
|
|
|
|
|
90958 |
$854.82 |
|
|
|
|
|
90959 |
$560.96 |
|
|
|
|
|
90960 |
$561.93 |
|
|
|
|
|
90961 |
$453.67 |
|
|
|
|
|
90962 |
$328.10 |
|
|
|
|
|
90963 |
$1,086.05 |
|
|
|
|
|
90964 |
$906.30 |
|
|
|
|
|
90965 |
$862.05 |
|
|
|
|
|
90966 |
$448.87 |
|
|
|
|
|
90967 | $38.85 | |||||
90968 |
$30.32 |
|
|
|
|
|
90969 |
$29.58 |
|
|
|
|
|
90970 |
$15.68 |
|
|
|
|
|
90989 |
$526.69 |
|
|
|
|
|
90993 |
$88.05 |
|
|
|
|
|
90997 |
$218.23 |
|
|
|
|
|
90999 |
PA |
|
|
|
|
|
91010 |
$204.55 |
|
|
$40.91 |
$163.64 |
|
91013 |
$45.77 |
|
|
$26.00 |
$19.78 |
|
91020 |
$228.61 |
|
|
$45.72 |
$182.89 |
|
91022 |
$334.14 |
|
|
$217.14 |
$117.00 |
|
91030 |
$92.43 |
|
|
$9.24 |
$83.19 |
|
91034 |
$352.90 |
|
|
$273.70 |
$79.20 |
|
91035 |
$697.98 |
|
|
$569.46 |
$128.51 |
|
91037 |
$224.96 |
|
|
$145.75 |
$79.20 |
|
91038 |
$193.42 |
|
|
$103.66 |
$89.75 |
|
91040 |
$679.14 |
|
|
$599.92 |
$79.20 |
|
91065 |
$66.19 |
|
|
$13.24 |
$52.95 |
|
91110 |
$1,378.53 |
|
|
|
|
|
91111 | $1,085.40 | $1,004.97 | $80.42 | |||
91112 | $1,745.63 | $1,574.56 | $171.07 | |||
91117 |
|
$280.51 |
$298.66 |
|
|
|
91120 |
$670.44 |
|
|
$590.85 |
$79.60 |
|
91122 |
$210.66 |
|
|
$42.13 |
$168.53 |
|
91132 |
BR |
|
|
|
|
|
91133 |
BR |
|
|
|
|
|
91200 |
$67.07 |
|
|
$38.98 |
$28.09 |
|
91299 |
BR |
|
|
|
|
|
92002 |
$82.21 |
|
|
|
|
|
92004 |
$120.14 |
|
|
|
|
|
92012 |
$65.63 |
|
|
|
|
|
92014 |
$83.68 |
|
|
|
|
|
92015 |
$36.64 |
|
|
|
|
|
92018 |
$103.92 |
|
|
|
|
|
92019 |
$93.52 |
|
|
|
|
|
92020 |
$34.46 |
|
|
|
|
|
92025 |
$43.61 |
|
|
$18.04 |
$25.56 |
|
92060 |
$56.98 |
|
|
$9.88 |
$47.10 |
|
92065 |
$38.60 |
|
|
$8.55 |
$30.05 |
|
92071 | $74.14 | $66.33 | ||||
92072 | $236.45 | $190.94 | ||||
92081 |
$35.94 |
|
|
$8.01 |
$27.93 |
|
92082 |
$49.40 |
|
|
$10.41 |
$38.99 |
|
92083 |
$71.20 |
|
|
$15.22 |
$55.98 |
|
92100 |
$61.26 |
|
|
|
|
|
92132 |
$72.06 |
|
|
$30.03 |
$42.02 |
|
92133 |
$88.60 |
|
|
$30.03 |
$58.57 |
|
92134 |
$88.60 |
|
|
$30.03 |
$58.57 |
|
92136 |
$113.27 |
|
|
$71.26 |
$42.01 |
|
92140 |
$41.57 |
|
|
|
|
|
92145 |
$29.28 |
|
|
$12.27 |
$17.01 |
|
92225 |
$53.59 |
|
|
|
|
|
92226 |
$47.04 |
|
|
|
|
|
92227 |
|
$22.64 |
|
|
|
|
92228 |
$59.55 |
|
|
$24.66 |
$34.90 |
|
92230 |
$67.28 |
|
|
|
|
|
92235 |
$128.60 |
|
|
$54.48 |
$74.12 |
|
92240 |
$132.02 |
|
|
$49.99 |
$82.03 |
|
92250 |
$45.67 |
|
|
$9.35 |
$36.32 |
|
92260 |
$54.15 |
|
|
|
|
|
92265 |
$57.84 |
|
|
$12.29 |
$45.55 |
|
92270 |
$78.92 |
|
|
$16.56 |
$62.36 |
|
92275 |
$101.53 |
|
|
$21.36 |
$80.17 |
|
92283 |
$24.52 |
|
|
$6.40 |
$18.12 |
|
92284 |
$36.95 |
|
|
$9.35 |
$27.60 |
|
92285 |
$26.09 |
|
|
$5.88 |
$20.21 |
|
92286 |
$101.09 |
|
|
$21.36 |
$79.73 |
|
92287 |
$120.33 |
|
|
|
|
|
92310 |
$127.98 |
|
|
|
|
|
92311 |
$102.83 |
|
|
|
|
|
92312 |
$125.25 |
|
|
|
|
|
92313 |
$93.52 |
|
|
|
|
|
92314 |
$75.48 |
|
|
|
|
|
92315 |
$57.43 |
|
|
|
|
|
92316 |
$84.23 |
|
|
|
|
|
92317 |
$43.75 |
|
|
|
|
|
92325 |
$19.15 |
|
|
|
|
|
92326 |
$78.76 |
|
|
|
|
|
92341 |
$51.41 |
|
|
|
|
|
92342 |
$57.97 |
|
|
|
|
|
92352 |
$35.00 |
|
|
|
|
|
92353 |
$46.48 |
|
|
|
|
|
92354 |
$422.24 |
|
|
|
|
|
92355 |
$205.65 |
|
|
|
|
|
92358 |
$47.04 |
|
|
|
|
|
92370 |
$35.00 |
|
|
|
|
|
92371 |
$30.08 |
|
|
|
|
|
92499 |
BR |
|
|
|
|
|
92502 |
$138.38 |
|
|
|
|
|
92504 |
$22.97 |
|
|
|
|
|
92507 |
$44.86 |
|
|
|
|
|
92508 |
$22.97 |
|
|
|
|
|
92511 |
$100.96 |
|
|
|
|
|
92512 |
$53.59 |
|
|
|
|
|
92516 |
$43.21 |
|
|
|
|
|
92520 |
$67.81 |
|
|
|
|
|
92521 |
|
$174.32 |
$174.32 |
|
|
|
92522 |
|
$141.88 |
$141.88 |
|
|
|
92523 |
|
$294.16 |
$294.16 |
|
|
|
92524 |
|
$147.10 |
$147.10 |
|
|
|
92526 |
$52.43 |
|
|
|
|
|
92531 |
$25.15 |
|
|
|
|
|
92532 |
$36.64 |
|
|
|
|
|
92533 |
$57.43 |
|
|
|
|
|
92534 |
$28.44 |
|
|
|
|
|
92540 |
$185.21 |
|
|
$31.42 |
$153.80 |
|
92541 |
$56.33 |
|
|
$11.27 |
$45.06 |
|
92542 |
$49.22 |
|
|
$9.84 |
$39.38 |
|
92543 |
$62.90 |
|
|
$12.58 |
$50.32 |
|
92544 |
$38.28 |
|
|
$7.66 |
$30.62 |
|
92545 |
$32.82 |
|
|
$6.56 |
$26.26 |
|
92546 |
$42.66 |
|
|
$8.53 |
$34.13 |
|
92547 |
$27.89 |
|
|
$5.58 |
$22.31 |
|
92548 |
$119.05 |
|
|
$71.98 |
$47.07 |
|
92551 |
$16.40 |
|
|
|
|
|
92552 |
$21.88 |
|
|
|
|
|
92553 |
$32.82 |
|
|
|
|
|
92555 |
$18.60 |
|
|
|
|
|
92556 |
$28.44 |
|
|
|
|
|
92557 |
$59.08 |
|
|
|
|
|
92558 | BR | |||||
92559 |
$48.13 |
|
|
|
|
|
92560 |
$28.44 |
|
|
|
|
|
92561 |
$35.55 |
|
|
|
|
|
92562 |
$20.24 |
|
|
|
|
|
92563 |
$18.60 |
|
|
|
|
|
92564 |
$23.51 |
|
|
|
|
|
92565 |
$19.69 |
|
|
|
|
|
92567 |
$26.26 |
|
|
|
|
|
92568 |
$18.60 |
|
|
|
|
|
92570 |
$61.31 |
$57.87 |
|
|
|
|
92571 |
$19.15 |
|
|
|
|
|
92572 |
$4.38 |
|
|
|
|
|
92575 |
$15.31 |
|
|
|
|
|
92576 |
$21.88 |
|
|
|
|
|
92577 |
$35.55 |
|
|
|
|
|
92579 |
$36.33 |
|
|
|
|
|
92582 |
$36.10 |
|
|
|
|
|
92583 |
$44.30 |
|
|
|
|
|
92584 |
$123.07 |
|
|
|
|
|
92585 |
$195.26 |
|
|
$97.63 |
$97.63 |
|
92586 |
$107.06 |
|
|
|
|
|
92587 |
$82.29 |
|
|
$69.44 |
$12.85 |
|
92588 |
$113.67 |
|
|
$78.53 |
$35.14 |
|
92589 |
$26.80 |
|
|
|
|
|
92590 |
$74.39 |
|
|
|
|
|
92591 |
$97.36 |
|
|
|
|
|
92592 |
$27.35 |
|
|
|
|
|
92593 |
$51.41 |
|
|
|
|
|
92594 |
$27.35 |
|
|
|
|
|
92595 |
$51.41 |
|
|
|
|
|
92596 |
$28.99 |
|
|
|
|
|
92597 |
$112.33 |
|
|
|
|
|
92601 |
$191.46 |
|
|
|
|
|
92602 |
$134.11 |
|
|
|
|
|
92603 |
$128.69 |
|
|
|
|
|
92604 |
$87.56 |
|
|
|
|
|
92605 |
BR |
|
|
|
|
|
92606 |
BR |
|
|
|
|
|
92607 |
$159.93 |
|
|
|
|
|
92608 |
$31.14 |
|
|
|
|
|
92609 |
$86.54 |
|
|
|
|
|
92610 |
$60.86 |
|
|
|
|
|
92611 |
$66.27 |
|
|
|
|
|
92612 |
|
$255.83 |
$101.07 |
|
|
YES |
92613 |
BR |
|
|
|
|
|
92614 |
|
$197.93 |
$101.07 |
|
|
YES |
92615 |
BR |
|
|
|
|
|
92616 |
|
$271.82 |
$147.90 |
|
|
YES |
92617 |
BR |
|
|
|
|
|
92618 | BR | |||||
92620 |
$65.44 |
|
|
|
|
|
92621 |
$16.14 |
|
|
|
|
|
92625 |
$64.33 |
|
|
|
|
|
92626 |
$123.49 |
|
|
|
|
|
92627 |
$31.06 |
|
|
|
|
|
92630 |
BR |
|
|
|
|
|
92633 |
BR |
|
|
|
|
|
92640 | $77.67 | |||||
92700 |
BR |
|
|
|
|
|
92920 |
|
$809.13 | $809.13 |
|
|
|
92921 |
BR |
|
|
|
|
|
92924 |
|
$961.81 | $961.81 |
|
|
|
92925 |
BR |
|
|
|
|
|
92928 |
|
$898.45 | $898.45 |
|
|
|
92929 |
BR |
|
|
|
|
|
92933 |
|
$1,004.71 | $1,004.71 |
|
|
|
92934 |
BR |
|
|
|
|
|
92937 |
|
$897.42 | $897.42 |
|
|
|
92938 |
BR |
|
|
|
|
|
92941 |
|
$1,006.65 | $1,006.65 |
|
|
|
92943 |
|
$1,006.65 | $1,006.65 |
|
|
|
92944 |
BR |
|
|
|
|
|
92950 |
$318.32 |
|
|
|
|
|
92953 |
$70.55 |
|
|
|
|
|
92960 |
$216.59 |
|
|
|
|
|
92961 |
$349.35 |
|
|
|
|
|
92970 |
$368.63 |
|
|
|
|
|
92971 |
$150.95 |
|
|
|
|
|
92973 |
$260.70 |
|
|
|
|
|
92974 |
$273.69 |
|
|
|
|
|
92975 |
$678.20 |
|
|
|
|
|
92977 |
$394.34 |
|
|
|
|
|
92978 |
$359.67 |
|
|
$220.06 |
$139.61 |
|
92979 |
$221.96 |
|
|
$110.27 |
$111.69 |
|
92986 |
$1,698.23 |
|
|
|
|
|
92987 |
$1,733.64 |
|
|
|
|
|
92990 |
$1,353.67 |
|
|
|
|
|
92992 |
$3,429.18 |
|
|
|
|
|
92993 |
$2,402.67 |
|
|
|
|
|
92997 |
$1,357.01 |
|
|
|
|
|
92998 |
$524.43 |
|
|
|
|
|
93000 |
$39.37 |
|
|
$23.62 |
$15.75 |
|
93005 |
$21.88 |
|
|
|
|
|
93010 |
$16.95 |
|
|
$0.00 |
$16.95 |
|
93015 |
$161.89 |
|
|
$80.94 |
$80.95 |
|
93016 |
$43.75 |
|
|
|
|
|
93017 |
$82.03 |
|
|
|
|
|
93018 |
$35.55 |
|
|
|
|
|
93024 |
$194.70 |
|
|
$77.88 |
$116.82 |
|
93025 |
$387.21 |
|
|
|
|
|
93040 |
$21.88 |
|
|
$7.66 |
$14.22 |
|
93041 |
$7.11 |
|
|
|
|
|
93042 |
$14.77 |
|
|
|
|
|
93224 |
$230.81 |
|
|
$138.49 |
$92.32 |
|
93225 |
$60.70 |
|
|
$60.70 |
$0.00 |
|
93226 |
$107.20 |
|
|
|
|
|
93227 |
$63.44 |
|
|
|
|
|
93228 |
$51.25 |
|
|
|
|
|
93229 |
BR |
|
|
|
|
|
93260 |
$126.89 |
|
|
$40.94 |
$85.95 |
|
93261 |
$226.43 |
|
|
$135.86 |
$90.57 |
|
93268 |
$226.43 |
|
|
$135.86 |
$90.57 |
|
93270 |
$60.70 |
|
|
|
|
|
93271 |
$117.05 |
|
|
|
|
|
93272 |
$48.68 |
|
|
$0.00 |
$48.68 |
|
93278 |
$104.47 |
|
|
$62.68 |
$41.79 |
|
93279 |
$108.85 |
|
|
$36.94 |
$71.91 |
|
93280 |
$128.98 |
|
|
$42.64 |
$86.33 |
|
93281 |
$150.79 |
|
|
$50.00 |
$100.80 |
|
93282 |
$139.30 |
|
|
$45.18 |
$94.12 |
|
93283 |
$169.76 |
|
|
$51.38 |
$118.39 |
|
93284 |
$199.04 |
|
|
$58.24 |
$140.80 |
|
93285 |
$93.69 |
|
|
$34.88 |
$58.81 |
|
93286 |
$53.02 |
|
|
$22.93 |
$30.10 |
|
93287 |
$70.14 |
|
|
$25.94 |
$44.21 |
|
93288 |
$83.78 |
|
|
$35.56 |
$48.22 |
|
93289 |
$129.72 |
|
|
$42.64 |
$87.08 |
|
93290 |
$62.27 |
|
|
$19.76 |
$42.52 |
|
93291 |
$80.36 |
|
|
$31.66 |
$48.70 |
|
93292 |
$72.78 |
|
|
$24.56 |
$48.22 |
|
93293 |
$113.07 |
|
|
$79.41 |
$33.66 |
|
93294 |
$73.07 |
|
|
|
|
|
93295 |
$132.11 |
|
|
|
|
|
93296 |
$69.20 |
|
|
|
|
|
93297 |
$51.25 |
|
|
|
|
|
93298 |
$58.81 |
|
|
|
|
|
93299 |
BR |
|
|
|
|
|
93303 |
$300.01 |
|
|
$186.93 |
$113.08 |
|
93304 |
$164.33 |
|
|
$94.07 |
$70.26 |
|
93306 |
$509.19 |
|
|
$366.04 |
$143.15 |
|
93307 |
$336.93 |
|
|
$237.62 |
$99.31 |
|
93308 |
$162.22 |
|
|
$102.54 |
$59.68 |
|
93312 |
$339.65 |
|
|
$186.81 |
$152.84 |
|
93313 |
$85.32 |
|
|
$0.00 |
$85.32 |
|
93314 |
$271.82 |
|
|
$163.09 |
$108.73 |
|
93315 |
$385.83 |
|
|
$184.40 |
$201.43 |
|
93316 |
$79.52 |
|
|
|
|
|
93317 |
$305.82 |
|
|
$184.40 |
$121.42 |
|
93318 |
BR |
|
|
|
|
|
93320 |
$131.80 |
|
|
$79.08 |
$52.72 |
|
93321 |