| Jurisdiction A DME MAC | ||||||||||||||
| 2007 DMEPOS/PEN Fee Schedule Updates | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| Capped Rental | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| E0165 | RR | $18.58 | $15.79 | $16.00 | $15.79 | $15.79 | $15.79 | $15.79 | $18.22 | $18.58 | $15.79 | $18.58 | $15.79 | |
| E0170 | RR | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | $160.72 | |
| E0171 | RR | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | $28.92 | |
| E0181 | RR | $26.06 | $26.06 | $26.06 | $26.06 | $24.43 | $26.06 | $26.06 | $26.06 | $26.06 | $26.06 | $26.06 | $26.06 | |
| E0182 | RR | $22.25 | $26.18 | $26.18 | $22.25 | $26.18 | $22.25 | $22.25 | $26.18 | $22.42 | $26.18 | $22.25 | $22.25 | |
| E0186 | RR | $20.30 | $20.30 | $20.30 | $17.26 | $20.30 | $17.26 | $17.26 | $20.30 | $20.30 | $20.30 | $18.60 | $17.26 | |
| E0187 | RR | $23.21 | $23.21 | $23.21 | $19.73 | $23.21 | $19.73 | $19.73 | $22.57 | $23.21 | $23.21 | $19.73 | $19.73 | |
| E0193 | RR | $895.06 | $799.95 | $842.90 | $903.46 | $860.22 | $903.46 | $903.46 | $869.41 | $895.83 | $903.46 | $767.94 | $903.46 | |
| E0194 | RR | $3,254.34 | $3,254.34 | $3,254.34 | $3,254.34 | $2,802.47 | $3,254.34 | $3,254.34 | $3,149.86 | $2,766.19 | $3,216.94 | $3,040.96 | $3,254.34 | |
| E0196 | RR | $32.49 | $32.49 | $31.93 | $27.62 | $32.49 | $27.62 | $27.62 | $27.62 | $32.49 | $32.49 | $27.62 | $27.62 | |
| E0202 | RR | $54.22 | $62.61 | $62.61 | $60.28 | $62.61 | $62.32 | $57.22 | $62.61 | $62.61 | $62.61 | $53.22 | $59.79 | |
| E0235 | RR | $17.26 | $17.26 | $17.26 | $15.76 | $16.31 | $16.21 | $14.88 | $17.26 | $17.26 | $17.26 | $14.67 | $15.55 | |
| E0236 | RR | $39.23 | $41.29 | $39.85 | $44.25 | $39.33 | $44.25 | $44.25 | $38.28 | $38.52 | $39.11 | $37.61 | $44.25 | |
| E0250 | RR | $97.76 | $83.10 | $97.76 | $97.76 | $97.76 | $97.76 | $97.76 | $92.92 | $83.10 | $97.76 | $84.29 | $97.76 | |
| E0251 | RR | $74.08 | $74.08 | $74.08 | $74.08 | $74.08 | $74.08 | $74.08 | $67.67 | $67.61 | $74.08 | $74.08 | $74.08 | |
| E0255 | RR | $117.48 | $111.62 | $117.48 | $117.48 | $117.48 | $117.48 | $117.48 | $101.58 | $117.48 | $114.37 | $99.86 | $117.48 | |
| E0256 | RR | $83.35 | $79.55 | $78.46 | $83.35 | $82.09 | $83.35 | $83.35 | $70.85 | $83.35 | $78.09 | $83.35 | $83.35 | |
| E0260 | RR | $140.45 | $140.46 | $140.46 | $140.46 | $140.46 | $140.45 | $140.46 | $140.46 | $140.46 | $140.46 | $140.47 | $140.45 | |
| E0261 | RR | $136.94 | $120.34 | $136.94 | $136.94 | $119.77 | $136.94 | $136.94 | $116.40 | $136.94 | $128.65 | $116.40 | $136.94 | |
| E0265 | RR | $193.79 | $199.88 | $199.88 | $199.88 | $194.59 | $199.88 | $194.63 | $192.12 | $199.88 | $199.88 | $169.90 | $199.88 | |
| E0266 | RR | $153.96 | $177.59 | $150.95 | $177.59 | $176.74 | $177.59 | $177.59 | $177.59 | $177.59 | $177.59 | $150.95 | $177.59 | |
| E0277 | RR | $703.47 | $646.37 | $645.46 | $703.47 | $703.49 | $703.47 | $703.47 | $645.46 | $703.47 | $645.46 | $703.47 | $703.47 | |
| E0290 | RR | $74.74 | $63.53 | $74.74 | $74.74 | $74.74 | $74.74 | $74.74 | $63.53 | $73.63 | $74.74 | $74.74 | $74.74 | |
| E0291 | RR | $54.30 | $54.30 | $54.30 | $54.30 | $54.30 | $54.30 | $54.30 | $46.16 | $54.30 | $54.30 | $54.30 | $54.30 | |
| E0292 | RR | $84.04 | $79.16 | $77.88 | $84.04 | $80.46 | $84.04 | $84.04 | $71.43 | $84.04 | $81.07 | $74.71 | $84.04 | |
| E0293 | RR | $71.51 | $71.51 | $71.51 | $71.51 | $71.51 | $71.51 | $71.51 | $68.69 | $71.51 | $71.51 | $60.78 | $71.51 | |
| E0294 | RR | $130.65 | $119.99 | $130.65 | $130.65 | $118.15 | $130.65 | $130.65 | $111.47 | $130.65 | $130.65 | $111.05 | $130.65 | |
| E0295 | RR | $109.20 | $119.99 | $127.35 | $127.35 | $109.20 | $127.35 | $127.35 | $111.47 | $127.35 | $127.35 | $108.25 | $127.35 | |
| E0296 | RR | $162.35 | $164.20 | $164.20 | $164.20 | $147.38 | $164.20 | $164.20 | $140.95 | $164.20 | $164.20 | $139.57 | $164.20 | |
| E0297 | RR | $122.51 | $140.67 | $119.57 | $140.67 | $133.28 | $140.67 | $138.79 | $140.67 | $140.67 | $140.67 | $119.57 | $140.67 | |
| E0301 | RR | $270.72 | $270.72 | $264.08 | $270.72 | $254.58 | $270.72 | $270.72 | $252.58 | $262.10 | $258.66 | $230.11 | $270.72 | |
| E0302 | RR | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | $715.44 | |
| E0303 | RR | $303.98 | $303.98 | $297.32 | $303.98 | $287.30 | $303.98 | $303.98 | $285.83 | $295.35 | $291.90 | $258.38 | $303.98 | |
| E0304 | RR | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | $770.67 | |
| E0305 | RR | $17.79 | $17.79 | $17.79 | $17.79 | $16.14 | $17.79 | $17.79 | $15.12 | $15.12 | $16.00 | $16.17 | $17.79 | |
| E0316 | RR | $211.28 | $211.28 | $211.28 | $211.28 | $206.17 | $211.28 | $211.28 | $211.28 | $211.28 | $211.28 | $211.28 | $211.28 | |
| E0371 | RR | $444.48 | $444.48 | $433.84 | $444.48 | $419.26 | $444.48 | $444.48 | $417.09 | $431.00 | $425.96 | $377.81 | $444.48 | |
| E0372 | RR | $539.34 | $539.34 | $526.47 | $539.34 | $508.74 | $539.34 | $539.34 | $506.09 | $522.98 | $516.87 | $458.44 | $539.34 | |
| E0373 | RR | $614.47 | $614.47 | $603.06 | $614.47 | $582.77 | $614.47 | $614.47 | $579.75 | $599.09 | $592.09 | $522.30 | $614.47 | |
| E0459 | RR | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | $50.89 | |
| E0462 | RR | $269.22 | $291.40 | $291.40 | $247.69 | $291.40 | $247.69 | $247.69 | $291.40 | $247.69 | $291.40 | $247.69 | $247.69 | |
| E0470 | RR | $239.78 | $218.11 | $218.11 | $231.77 | $218.11 | $238.54 | $229.82 | $218.11 | $256.60 | $218.11 | $237.89 | $230.98 | |
| E0471 | RR | $642.17 | $545.84 | $545.84 | $642.17 | $642.17 | $642.17 | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | |
| E0472 | RR | $642.17 | $545.84 | $545.84 | $642.17 | $642.17 | $642.17 | $642.17 | $545.84 | $642.17 | $545.84 | $642.17 | $642.17 | |
| E0480 | RR | $43.94 | $43.94 | $43.94 | $43.94 | $43.94 | $43.94 | $43.94 | $43.94 | $37.35 | $43.94 | $37.35 | $43.94 | |
| E0482 | RR | $430.02 | $430.02 | $419.73 | $430.02 | $405.63 | $430.02 | $430.02 | $403.53 | $416.98 | $412.10 | $365.52 | $430.02 | |
| E0483 | RR | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | $1,063.13 | |
| E0550 | RR | $42.61 | $50.13 | $50.13 | $42.61 | $42.61 | $42.61 | $42.61 | $50.13 | $50.13 | $50.13 | $42.61 | $42.61 | |
| E0565 | RR | $61.01 | $51.86 | $51.86 | $61.01 | $61.01 | $61.01 | $61.01 | $51.86 | $61.01 | $61.01 | $61.01 | $61.01 | |
| E0570 | RR | $16.10 | $16.10 | $16.10 | $16.11 | $16.10 | $16.11 | $16.11 | $16.10 | $16.10 | $16.10 | $16.10 | $16.11 | |
| E0571 | RR | $29.97 | $29.97 | $29.40 | $29.97 | $28.42 | $29.97 | $29.97 | $28.28 | $29.21 | $28.86 | $25.47 | $29.97 | |
| E0572 | RR | $38.09 | $38.09 | $37.38 | $38.09 | $36.13 | $38.09 | $38.09 | $35.93 | $37.13 | $36.71 | $32.38 | $38.09 | |
| E0574 | RR | $40.26 | $40.26 | $39.52 | $40.26 | $38.20 | $40.26 | $40.26 | $37.97 | $39.27 | $38.80 | $34.22 | $40.26 | |
| E0585 | RR | $35.07 | $35.07 | $35.07 | $29.81 | $35.07 | $29.81 | $29.81 | $35.07 | $35.07 | $35.07 | $35.07 | $29.81 | |
| E0600 | RR | $45.79 | $45.79 | $45.79 | $45.79 | $45.79 | $45.79 | $45.79 | $44.03 | $45.79 | $45.79 | $45.79 | $45.79 | |
| E0601 | RR | $102.24 | $107.85 | $104.09 | $96.99 | $111.71 | $99.82 | $96.18 | $100.10 | $111.71 | $102.23 | $111.71 | $96.64 | |
| E0606 | RR | $22.94 | $19.50 | $19.50 | $22.94 | $22.94 | $22.94 | $22.89 | $19.50 | $20.96 | $19.50 | $19.50 | $22.94 | |
| E0617 | RR | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | $304.05 | |
| E0617 | RR | KF | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 | $328.70 |
| E0618 | RR | $280.35 | $264.26 | $255.08 | $280.35 | $280.35 | $280.35 | $280.35 | $245.23 | $280.35 | $250.47 | $280.35 | $280.35 | |
| E0630 | RR | $87.68 | $86.61 | $101.89 | $101.89 | $99.30 | $101.89 | $92.09 | $96.83 | $101.89 | $101.89 | $97.45 | $96.27 | |
| E0635 | RR | $104.01 | $104.01 | $104.01 | $122.36 | $104.01 | $122.36 | $122.36 | $104.01 | $114.71 | $104.01 | $104.01 | $122.36 | |
| E0636 | RR | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | $1,054.56 | |
| E0675 | RR | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | $384.55 | |
| E0744 | RR | $85.25 | $91.57 | $91.57 | $91.57 | $77.83 | $91.57 | $91.57 | $91.57 | $91.57 | $91.57 | $77.83 | $91.57 | |
| E0745 | RR | $78.95 | $85.40 | $89.51 | $89.51 | $76.08 | $89.51 | $76.08 | $89.51 | $88.78 | $89.51 | $76.08 | $76.08 | |
| E0779 | RR | $16.73 | $16.73 | $16.43 | $16.73 | $15.87 | $16.73 | $16.73 | $16.73 | $16.32 | $16.13 | $14.70 | $16.73 | |
| E0781 | RR | $264.87 | $264.87 | $225.14 | $225.14 | $257.89 | $225.14 | $225.14 | $225.14 | $225.14 | $225.14 | $231.27 | $225.14 | |
| E0784 | RR | $417.57 | $417.49 | $417.57 | $417.57 | $417.49 | $417.57 | $417.57 | $417.57 | $417.57 | $417.57 | $417.57 | $417.57 | |
| E0791 | RR | $316.20 | $268.77 | $268.77 | $316.20 | $268.77 | $316.20 | $316.20 | $268.77 | $268.77 | $268.77 | $271.87 | $316.20 | |
| E0910 | RR | $20.00 | $20.00 | $20.00 | $20.00 | $20.00 | $20.00 | $20.00 | $19.56 | $20.00 | $20.00 | $20.00 | $20.00 | |
| E0911 | RR | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | $49.85 | |
| E0912 | RR | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | $114.47 | |
| E0920 | RR | $46.14 | $42.79 | $46.14 | $46.14 | $46.14 | $46.14 | $46.14 | $39.69 | $46.14 | $46.14 | $46.14 | $46.14 | |
| E0930 | RR | $45.69 | $42.79 | $41.31 | $45.69 | $45.69 | $45.69 | $45.69 | $39.69 | $40.46 | $45.69 | $45.69 | $45.69 | |
| E0940 | RR | $34.38 | $29.55 | $34.77 | $34.77 | $32.18 | $34.77 | $34.77 | $31.68 | $34.77 | $29.55 | $34.77 | $34.77 | |
| E0941 | RR | $43.41 | $41.73 | $40.30 | $36.90 | $43.41 | $36.90 | $36.90 | $38.73 | $43.41 | $43.41 | $43.41 | $36.90 | |
| E0946 | RR | $59.16 | $59.16 | $59.16 | $59.16 | $59.16 | $59.16 | $59.16 | $59.16 | $53.53 | $59.16 | $59.16 | $59.16 | |
| E0958 | RR | $43.63 | $43.63 | $43.63 | $37.09 | $37.09 | $37.41 | $37.09 | $42.41 | $43.35 | $43.40 | $37.09 | $37.09 | |
| E0968 | RR | $17.93 | $17.93 | $17.93 | $16.94 | $16.53 | $17.46 | $16.02 | $17.93 | $17.91 | $17.93 | $15.24 | $16.75 | |
| E0983 | RR | $249.93 | $249.93 | $244.47 | $249.93 | $236.25 | $249.93 | $249.93 | $235.02 | $242.86 | $240.02 | $212.44 | $249.93 | |
| E1031 | RR | $50.51 | $50.51 | $50.51 | $49.09 | $50.51 | $50.51 | $46.35 | $50.51 | $42.93 | $50.51 | $50.51 | $48.44 | |
| E1035 | RR | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | $613.20 | |
| E1037 | RR | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | $108.49 | |
| E1038 | RR | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | $18.03 | |
| E1039 | RR | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | $34.20 | |
| E1050 | RR | $101.84 | $101.84 | $101.84 | $86.56 | $86.56 | $86.56 | $86.56 | $101.84 | $101.54 | $94.75 | $86.56 | $86.56 | |
| E1060 | RR | $114.36 | $126.07 | $126.07 | $126.07 | $123.95 | $126.07 | $125.01 | $113.30 | $110.27 | $126.07 | $118.92 | $126.07 | |
| E1070 | RR | $109.53 | $93.10 | $93.10 | $109.53 | $93.10 | $109.53 | $97.27 | $109.53 | $103.96 | $109.53 | $103.87 | $101.66 | |
| E1083 | RR | $78.74 | $78.74 | $78.74 | $72.72 | $78.74 | $74.79 | $68.65 | $72.17 | $78.74 | $78.74 | $66.93 | $71.75 | |
| E1084 | RR | $98.10 | $91.85 | $98.10 | $96.57 | $98.10 | $98.10 | $91.18 | $98.10 | $92.14 | $98.10 | $83.39 | $95.32 | |
| E1087 | RR | $107.53 | $126.51 | $126.51 | $126.51 | $126.51 | $126.51 | $107.53 | $116.00 | $126.51 | $109.10 | $126.51 | $107.53 | |
| E1088 | RR | $128.15 | $150.77 | $150.77 | $150.77 | $128.15 | $150.77 | $128.15 | $150.77 | $150.77 | $147.66 | $150.77 | $128.15 | |
| E1092 | RR | $128.51 | $128.51 | $128.51 | $109.23 | $109.23 | $109.23 | $109.23 | $128.51 | $128.51 | $128.51 | $109.23 | $109.23 | |
| E1093 | RR | $110.52 | $110.52 | $110.52 | $93.94 | $98.79 | $93.94 | $93.94 | $110.52 | $110.52 | $110.52 | $93.94 | $93.94 | |
| E1100 | RR | $103.81 | $103.81 | $103.81 | $103.81 | $103.81 | $103.81 | $97.27 | $103.81 | $97.48 | $103.81 | $99.85 | $101.66 | |
| E1110 | RR | $86.41 | $86.41 | $86.41 | $101.66 | $94.40 | $101.66 | $97.27 | $101.66 | $96.56 | $100.33 | $101.66 | $101.66 | |
| E1150 | RR | $69.92 | $81.58 | $81.58 | $81.58 | $81.54 | $75.12 | $81.58 | $78.16 | $81.58 | $81.58 | $69.34 | $81.58 | |
| E1160 | RR | $62.50 | $62.50 | $62.50 | $62.50 | $62.50 | $55.56 | $53.13 | $61.46 | $62.50 | $62.50 | $62.50 | $55.02 | |
| E1170 | RR | $89.31 | $89.31 | $89.31 | $89.31 | $75.91 | $89.31 | $89.31 | $86.31 | $82.62 | $75.91 | $75.91 | $89.31 | |
| E1171 | RR | $80.15 | $73.98 | $71.43 | $80.15 | $74.25 | $80.15 | $80.15 | $68.67 | $76.67 | $70.14 | $71.80 | $80.15 | |
| E1172 | RR | $97.95 | $97.95 | $91.85 | $97.95 | $97.95 | $97.95 | $97.27 | $88.30 | $97.95 | $88.95 | $83.26 | $97.95 | |
| E1180 | RR | $101.34 | $100.40 | $86.14 | $101.34 | $86.14 | $101.34 | $101.34 | $94.39 | $101.34 | $86.14 | $86.14 | $101.34 | |
| E1190 | RR | $117.07 | $105.09 | $117.07 | $107.92 | $99.51 | $105.76 | $101.91 | $109.06 | $117.07 | $101.97 | $99.51 | $106.53 | |
| E1195 | RR | $125.63 | $125.63 | $106.79 | $125.63 | $116.07 | $125.63 | $125.63 | $106.79 | $125.63 | $106.79 | $106.79 | $125.63 | |
| E1200 | RR | $73.96 | $79.25 | $76.51 | $87.01 | $87.01 | $87.01 | $74.36 | $81.21 | $87.01 | $87.01 | $73.96 | $77.73 | |
| E1221 | RR | $40.38 | $47.51 | $47.51 | $47.51 | $47.51 | $47.50 | $45.77 | $41.92 | $47.51 | $40.38 | $40.38 | $47.51 | |
| E1222 | RR | $67.79 | $67.79 | $67.79 | $67.79 | $67.79 | $67.68 | $65.19 | $67.79 | $67.79 | $67.79 | $57.62 | $67.79 | |
| E1223 | RR | $74.02 | $74.02 | $74.02 | $74.02 | $68.65 | $74.02 | $72.38 | $74.02 | $72.52 | $72.60 | $62.92 | $74.02 | |
| E1224 | RR | $81.15 | $81.15 | $81.15 | $81.15 | $80.98 | $81.15 | $81.15 | $81.15 | $68.98 | $81.15 | $68.98 | $81.15 | |
| E1225 | RR | $45.20 | $45.20 | $45.20 | $38.42 | $45.20 | $38.42 | $38.42 | $45.20 | $45.20 | $45.20 | $38.42 | $38.42 | |
| E1228 | RR | $28.02 | $23.82 | $23.82 | $28.02 | $23.82 | $28.02 | $28.02 | $23.82 | $23.82 | $23.82 | $23.82 | $28.02 | |
| E1240 | RR | $103.02 | $87.57 | $103.02 | $103.02 | $87.73 | $103.02 | $98.57 | $103.02 | $94.40 | $92.49 | $87.57 | $103.02 | |
| E1270 | RR | $78.94 | $78.94 | $67.10 | $78.94 | $75.72 | $78.94 | $78.94 | $76.84 | $70.38 | $78.94 | $67.10 | $78.94 | |
| E1280 | RR | $131.26 | $131.26 | $111.57 | $131.26 | $131.26 | $131.26 | $131.26 | $122.82 | $131.26 | $131.26 | $113.02 | $131.26 | |
| E1295 | RR | $121.47 | $120.32 | $116.14 | $121.47 | $111.02 | $121.47 | $121.47 | $118.19 | $121.47 | $118.38 | $110.78 | $121.47 | |
| E1800 | RR | $104.13 | $122.50 | $104.13 | $104.13 | $122.50 | $104.29 | $104.13 | $104.13 | $104.13 | $104.13 | $104.13 | $104.13 | |
| E1801 | RR | $129.00 | $129.00 | $125.93 | $129.00 | $121.69 | $129.00 | $129.00 | $121.09 | $125.09 | $123.65 | $109.65 | $129.00 | |
| E1802 | RR | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | $326.80 | |
| E1805 | RR | $126.34 | $126.34 | $116.91 | $126.34 | $126.34 | $126.34 | $124.58 | $112.39 | $116.14 | $114.79 | $107.39 | $126.32 | |
| E1806 | RR | $105.91 | $105.91 | $103.37 | $105.91 | $99.90 | $105.91 | $105.91 | $99.37 | $102.69 | $101.49 | $90.02 | $105.91 | |
| E1810 | RR | $105.89 | $124.58 | $116.91 | $105.89 | $124.58 | $105.89 | $124.58 | $112.39 | $116.14 | $114.79 | $105.89 | $124.58 | |
| E1811 | RR | $134.12 | $134.12 | $130.94 | $134.12 | $126.55 | $134.12 | $134.12 | $125.87 | $130.08 | $128.55 | $114.00 | $134.12 | |
| E1812 | RR | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | $85.99 | |
| E1815 | RR | $126.34 | $126.34 | $116.91 | $126.34 | $126.34 | $126.34 | $124.58 | $112.39 | $116.14 | $114.79 | $107.39 | $126.32 | |
| E1816 | RR | $136.24 | $136.24 | $132.97 | $136.24 | $128.51 | $136.24 | $136.24 | $127.85 | $132.10 | $130.57 | $115.80 | $136.24 | |
| E1818 | RR | $139.09 | $139.09 | $135.77 | $139.09 | $131.21 | $139.09 | $139.09 | $130.52 | $134.86 | $133.29 | $118.23 | $139.09 | |
| E1825 | RR | $126.34 | $126.34 | $116.91 | $126.34 | $126.34 | $126.34 | $124.58 | $112.39 | $116.14 | $114.79 | $107.39 | $126.32 | |
| E1830 | RR | $126.34 | $126.34 | $116.91 | $126.34 | $126.34 | $126.34 | $124.58 | $112.39 | $116.14 | $114.79 | $107.39 | $126.32 | |
| E1840 | RR | $382.71 | $382.71 | $382.71 | $382.71 | $372.30 | $382.71 | $382.71 | $371.82 | $382.71 | $379.70 | $325.30 | $382.71 | |
| E1841 | RR | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | $453.00 | |
| E2000 | RR | $51.83 | $51.83 | $50.57 | $51.83 | $48.86 | $51.83 | $51.83 | $48.62 | $50.25 | $49.65 | $44.06 | $51.83 | |
| E2120 | RR | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | $283.52 | |
| E2402 | RR | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | $1,716.46 | |
| K0001 | RR | $48.33 | $53.27 | $53.27 | $53.27 | $53.27 | $53.27 | $51.28 | $52.48 | $51.56 | $53.27 | $53.27 | $46.43 | |
| K0002 | RR | $77.61 | $81.83 | $81.83 | $75.59 | $81.83 | $77.81 | $71.39 | $81.83 | $81.40 | $81.83 | $69.56 | $74.60 | |
| K0003 | RR | $89.59 | $88.63 | $76.15 | $89.59 | $80.67 | $89.59 | $88.76 | $89.59 | $80.22 | $89.59 | $76.15 | $89.59 | |
| K0004 | RR | $114.03 | $123.32 | $113.59 | $133.64 | $113.59 | $133.64 | $127.82 | $114.12 | $133.64 | $128.42 | $133.64 | $133.64 | |
| K0006 | RR | $125.41 | $125.41 | $106.60 | $125.41 | $106.60 | $125.41 | $125.41 | $122.39 | $125.41 | $125.41 | $106.60 | $125.41 | |
| K0007 | RR | $178.50 | $178.50 | $176.63 | $178.50 | $170.68 | $178.50 | $178.50 | $169.81 | $175.47 | $173.43 | $151.73 | $178.50 | |
| K0010 | RR | $425.99 | $425.99 | $365.46 | $425.99 | $409.37 | $425.99 | $425.99 | $362.09 | $362.09 | $362.41 | $362.09 | $425.99 | |
| K0011 | RR | $512.28 | $512.28 | $512.25 | $512.28 | $499.63 | $512.28 | $512.28 | $497.02 | $512.27 | $507.59 | $450.20 | $512.28 | |
| K0011 | RR | KF | $553.80 | $553.80 | $553.78 | $553.80 | $540.12 | $553.80 | $553.80 | $537.32 | $553.81 | $548.73 | $486.69 | $553.80 |
| K0012 | RR | $324.92 | $324.92 | $317.16 | $324.92 | $306.48 | $324.92 | $324.92 | $304.88 | $315.04 | $311.39 | $276.18 | $324.92 | |
| K0195 | RR | $17.91 | $21.07 | $21.07 | $17.91 | $20.34 | $17.91 | $17.91 | $17.91 | $17.91 | $21.07 | $17.91 | $20.19 | |
| K0606 | RR | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | $2,268.20 | |
| K0606 | RR | KF | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 | $2,452.06 |
| K0730 | RR | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | $172.40 | |
| K0813 | NU | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | $2,412.40 | |
| K0813 | RR | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | $241.24 | |
| K0813 | UE | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | $1,809.30 | |
| K0814 | NU | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | $3,087.80 | |
| K0814 | RR | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | $308.78 | |
| K0814 | UE | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | $2,315.85 | |
| K0815 | NU | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | $3,516.30 | |
| K0815 | RR | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | $351.63 | |
| K0815 | UE | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | $2,637.23 | |
| K0816 | NU | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | $3,367.40 | |
| K0816 | RR | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | $336.74 | |
| K0816 | UE | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | $2,525.55 | |
| K0820 | NU | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | $2,576.60 | |
| K0820 | RR | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | $257.66 | |
| K0820 | UE | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | $1,932.45 | |
| K0821 | NU | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | $3,307.70 | |
| K0821 | RR | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | $330.77 | |
| K0821 | UE | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | $2,480.78 | |
| K0822 | NU | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | $3,997.50 | |
| K0822 | RR | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | $399.75 | |
| K0822 | UE | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | $2,998.13 | |
| K0823 | NU | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | $4,023.70 | |
| K0823 | RR | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | $402.37 | |
| K0823 | UE | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | $3,017.78 | |
| K0824 | NU | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | |
| K0824 | RR | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | |
| K0824 | UE | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | |
| K0825 | NU | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | $4,433.20 | |
| K0825 | RR | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | $443.32 | |
| K0825 | UE | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | $3,324.90 | |
| K0826 | NU | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | |
| K0826 | RR | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | |
| K0826 | UE | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | |
| K0827 | NU | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | |
| K0827 | RR | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | |
| K0827 | UE | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | |
| K0828 | NU | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | $6,908.20 | |
| K0828 | RR | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | $690.82 | |
| K0828 | UE | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | $5,181.15 | |
| K0829 | NU | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | |
| K0829 | RR | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | |
| K0829 | UE | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | |
| K0830 | NU | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | |
| K0830 | RR | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | |
| K0830 | UE | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | |
| K0831 | NU | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | $3,914.10 | |
| K0831 | RR | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | $391.41 | |
| K0831 | UE | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | $2,935.58 | |
| K0835 | NU | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | $4,057.40 | |
| K0835 | RR | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | $405.74 | |
| K0835 | UE | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | $3,043.05 | |
| K0836 | NU | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | $4,207.50 | |
| K0836 | RR | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | $420.75 | |
| K0836 | UE | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | $3,155.63 | |
| K0837 | NU | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | $4,842.70 | |
| K0837 | RR | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | $484.27 | |
| K0837 | UE | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | $3,632.03 | |
| K0838 | NU | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | $4,332.30 | |
| K0838 | RR | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | $433.23 | |
| K0838 | UE | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | $3,249.23 | |
| K0839 | NU | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | $6,269.30 | |
| K0839 | RR | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | $626.93 | |
| K0839 | UE | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | $4,701.98 | |
| K0840 | NU | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | $9,498.30 | |
| K0840 | RR | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | $949.83 | |
| K0840 | UE | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | $7,123.73 | |
| K0841 | NU | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | |
| K0841 | RR | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | |
| K0841 | UE | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | |
| K0842 | NU | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | $4,318.60 | |
| K0842 | RR | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | $431.86 | |
| K0842 | UE | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | $3,238.95 | |
| K0843 | NU | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | $5,199.60 | |
| K0843 | RR | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | $519.96 | |
| K0843 | UE | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | $3,899.70 | |
| K0848 | NU | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | $5,284.40 | |
| K0848 | RR | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | $528.44 | |
| K0848 | UE | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | $3,963.30 | |
| K0849 | NU | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | $5,080.70 | |
| K0849 | RR | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | $508.07 | |
| K0849 | UE | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | $3,810.53 | |
| K0850 | NU | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | $6,129.80 | |
| K0850 | RR | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | $612.98 | |
| K0850 | UE | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | $4,597.35 | |
| K0851 | NU | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | $5,893.70 | |
| K0851 | RR | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | $589.37 | |
| K0851 | UE | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | $4,420.28 | |
| K0852 | NU | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | $7,082.60 | |
| K0852 | RR | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | $708.26 | |
| K0852 | UE | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | $5,311.95 | |
| K0853 | NU | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | $7,275.60 | |
| K0853 | RR | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | $727.56 | |
| K0853 | UE | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | $5,456.70 | |
| K0854 | NU | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | $9,638.60 | |
| K0854 | RR | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | $963.86 | |
| K0854 | UE | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | $7,228.95 | |
| K0855 | NU | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | $9,105.10 | |
| K0855 | RR | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | $910.51 | |
| K0855 | UE | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | $6,828.83 | |
| K0856 | NU | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | $5,672.30 | |
| K0856 | RR | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | $567.23 | |
| K0856 | UE | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | $4,254.23 | |
| K0857 | NU | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | $5,786.00 | |
| K0857 | RR | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | $578.60 | |
| K0857 | UE | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | $4,339.50 | |
| K0858 | NU | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | |
| K0858 | RR | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | |
| K0858 | UE | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | |
| K0859 | NU | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | $6,711.70 | |
| K0859 | RR | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | $671.17 | |
| K0859 | UE | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | $5,033.78 | |
| K0860 | NU | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | |
| K0860 | RR | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | |
| K0860 | UE | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | |
| K0861 | KF | NU | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 | $6,141.90 |
| K0861 | KF | RR | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 | $614.19 |
| K0861 | KF | UE | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 | $4,606.43 |
| K0861 | NU | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | $5,681.40 | |
| K0861 | RR | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | $568.14 | |
| K0861 | UE | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | $4,261.05 | |
| K0862 | NU | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | $7,037.60 | |
| K0862 | RR | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | $703.76 | |
| K0862 | UE | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | $5,278.20 | |
| K0863 | NU | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | $10,054.10 | |
| K0863 | RR | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | $1,005.41 | |
| K0863 | UE | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | $7,540.58 | |
| K0864 | NU | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | |
| K0864 | RR | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | |
| K0864 | UE | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | |