Cantidades autorizadas para los códigos G de HCPCS del modelo ACCESS
Códigos G del HCPCS para pagos alineados con los resultados (OAP)
La información sobre precios ya está disponible para los códigos del Healthcare Common Procedure Coding System (HCPCS) pagados por Medicare cuando se prestan para el modelo Advancing Chronic Care with Effective, Scalable Solutions (ACCESS).
El modelo ACCESS es un modelo voluntario del Centro de Innovación con una duración de 10 años, diseñado para evaluar si una metodología de pago alternativa, Pagos Alineados con los Resultados (OAP) y destinada al cuidado de enfermedades crónicas mediante tecnología, reduce los gastos a la vez que mejora la calidad del cuidado para los beneficiarios de Medicare. Su implementación está programada para el 1 de julio de 2026. Comenzando en el 2027, estos códigos figurarán en un nuevo archivo de pagos del CMMI. Todos los códigos HCPCS del modelo ACCESS pueden facturarse utilizando los códigos de lugar de servicio (POS) 02 y 10 correspondientes a telesalud.
| HCPCS | Descripción corta | Descripción larga | Cantidad mensual permitida |
|---|---|---|---|
| G0669 | OAP CRM fase inic, peri inic | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones cardio-reno-metabólicas (CRM) en fase inicial (hipertensión, o dos o más de las siguientes: dislipidemia, obesidad/sobrepeso con marcador de obesidad central, prediabetes); periodo inicial de 12 meses; por mes | $30.00 |
| G0670 | OAP CRM fase inic, peri sig | Pago por resultados (OAP) para el manejo tecnológico de atención crónica de afecciones cardio-reno-metabólicas (CRM) en fase inicial (hipertensión, o dos o más de las siguientes: dislipidemia, obesidad/sobrepeso con marcador de obesidad central, prediabetes); periodo siguiente de 12 meses; por mes | $15.00 |
| G0671 | OAP CRM, periodo inicial | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones cardio-reno-metabólicas (CRM) (una o más de las siguientes: diabetes mellitus, enfermedad renal crónica en etapa 3a o 3b, enfermedad cardiovascular aterosclerótica); periodo inicial de 12 meses; por mes | $35.00 |
| G0672 | OAP CRM, periodo siguiente | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones cardio-reno-metabólicas (CRM) (una o más de las siguientes: diabetes mellitus, enfermedad renal crónica en etapa 3a o 3b, enfermedad cardiovascular aterosclerótica); periodo siguiente de 12 meses; por mes | $17.50 |
| G0673 | OAP musculoesque, peri inic | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones musculoesqueléticas (ME) (dolor musculoesquelético crónico); periodo de tratamiento inicial de 12 meses; por mes | $15.00 |
| G0674 | OAP salud conduc, peri inic | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones de salud conductual (BH) (una o más de las siguientes: depresión, ansiedad); periodo inicial de 12 meses; por mes | $15.00 |
| G0675 | OAP salud conduc, peri sig | Pago por resultados (OAP) para el manejo tecnológico de la atención crónica de afecciones de salud conductual (BH) (una o más de las siguientes: depresión, ansiedad); periodo siguiente de 12 meses; por mes | $7.50 |
Códigos HCPCS de ACCESS y descripciones de modificadores
Códigos HCPCS
| HCPCS | Descripción corta | Descripción larga | Cantidad permitida |
|---|---|---|---|
| G0676 | Comanejo estánd, CRM/fas in | Pago por servicio de comanejo estándar para la revisión documentada de actualizaciones clínicas por parte de un participante en ACCESS que gestiona afecciones cardio-reno-metabólicas (línea de participación cardio-reno-metabolíca [CRM] en fase inicial o cardio-reno-metabólica [CRM]); por revisión | $30.00 |
| G0677 | Comanejo estánd, musculoesq | Pago por servicio de comanejo estándar para la revisión documentada de actualizaciones clínicas por parte de un participante en ACCESS que gestiona afecciones musculoesqueléticas (ME); por revisión | $30.00 |
| G0678 | Comanejo estánd, salud condu | Pago por servicio de comanejo estándar para la revisión documentada de actualizaciones clínicas por parte de un participante en ACCESS que gestiona afecciones de salud conductual (BH) (depresión, ansiedad); por revisión | $30.00 |
Descripciones de modificador
| Modificador | Descripción corta | Descripción larga | Cantidad permitida |
|---|---|---|---|
| AC | Co-mgmt mod – onboarding | Pago inicial de apoyo a la admisión para la inscripción del beneficiario en el acceso, configuración del dispositivo / aplicación y las actividades de coordinación de atención; solo durante el primer mes; una vez por beneficiario y por modalidad. | $10.00 |
Códigos HCPCS de ACCESS que incluyen GAF
| Código HCPCS | Portador | Localidad | Modificador | Precio |
|---|---|---|---|---|
| G0669 | $30.00 | |||
| G0670 | $15.00 | |||
| G0671 | $35.00 | |||
| G0672 | $17.50 | |||
| G0673 | $15.00 | |||
| G0674 | $15.00 | |||
| G0675 | $7.50 | |||
| G0676 | 01112 | 05 | $36.42 | |
| G0676 | 01112 | 05 | AC | $46.42 |
| G0676 | 01112 | 09 | $37.05 | |
| G0676 | 01112 | 09 | AC | $47.05 |
| G0676 | 01112 | 51 | $34.74 | |
| G0676 | 01112 | 51 | AC | $44.74 |
| G0676 | 01112 | 52 | $36.45 | |
| G0676 | 01112 | 52 | AC | $46.45 |
| G0676 | 01112 | 53 | $34.71 | |
| G0676 | 01112 | 53 | AC | $44.71 |
| G0676 | 01112 | 54 | $31.14 | |
| G0676 | 01112 | 54 | AC | $41.14 |
| G0676 | 01112 | 55 | $31.02 | |
| G0676 | 01112 | 55 | AC | $41.02 |
| G0676 | 01112 | 56 | $31.02 | |
| G0676 | 01112 | 56 | AC | $41.02 |
| G0676 | 01112 | 57 | $31.02 | |
| G0676 | 01112 | 57 | AC | $41.02 |
| G0676 | 01112 | 58 | $31.02 | |
| G0676 | 01112 | 58 | AC | $41.02 |
| G0676 | 01112 | 59 | $31.02 | |
| G0676 | 01112 | 59 | AC | $41.02 |
| G0676 | 01112 | 60 | $31.02 | |
| G0676 | 01112 | 60 | AC | $41.02 |
| G0676 | 01112 | 61 | $31.02 | |
| G0676 | 01112 | 61 | AC | $41.02 |
| G0676 | 01112 | 62 | $31.41 | |
| G0676 | 01112 | 62 | AC | $41.41 |
| G0676 | 01112 | 63 | $32.25 | |
| G0676 | 01112 | 63 | AC | $42.25 |
| G0676 | 01112 | 64 | $32.10 | |
| G0676 | 01112 | 64 | AC | $42.10 |
| G0676 | 01112 | 65 | $37.20 | |
| G0676 | 01112 | 65 | AC | $47.20 |
| G0676 | 01112 | 66 | $32.73 | |
| G0676 | 01112 | 66 | AC | $42.73 |
| G0676 | 01112 | 67 | $33.06 | |
| G0676 | 01112 | 67 | AC | $43.06 |
| G0676 | 01112 | 68 | $31.02 | |
| G0676 | 01112 | 68 | AC | $41.02 |
| G0676 | 01112 | 69 | $31.02 | |
| G0676 | 01112 | 69 | AC | $41.02 |
| G0676 | 01112 | 70 | $31.02 | |
| G0676 | 01112 | 70 | AC | $41.02 |
| G0676 | 01112 | 75 | $31.02 | |
| G0676 | 01112 | 75 | AC | $41.02 |
| G0676 | 01182 | 17 | $32.49 | |
| G0676 | 01182 | 17 | AC | $42.49 |
| G0676 | 01182 | 18 | $32.73 | |
| G0676 | 01182 | 18 | AC | $42.73 |
| G0676 | 01182 | 71 | $31.02 | |
| G0676 | 01182 | 71 | AC | $41.02 |
| G0676 | 01182 | 72 | $32.61 | |
| G0676 | 01182 | 72 | AC | $42.61 |
| G0676 | 01182 | 73 | $31.62 | |
| G0676 | 01182 | 73 | AC | $41.62 |
| G0676 | 01182 | 74 | $32.16 | |
| G0676 | 01182 | 74 | AC | $42.16 |
| G0676 | 01212 | 01 | $31.38 | |
| G0676 | 01212 | 01 | AC | $41.38 |
| G0676 | 01312 | 00 | $29.82 | |
| G0676 | 01312 | 00 | AC | $39.82 |
| G0676 | 02102 | 01 | $37.83 | |
| G0676 | 02102 | 01 | AC | $47.83 |
| G0676 | 02202 | 00 | $28.26 | |
| G0676 | 02202 | 00 | AC | $38.26 |
| G0676 | 02302 | 01 | $31.47 | |
| G0676 | 02302 | 01 | AC | $41.47 |
| G0676 | 02302 | 99 | $29.58 | |
| G0676 | 02302 | 99 | AC | $39.58 |
| G0676 | 02402 | 02 | $33.66 | |
| G0676 | 02402 | 02 | AC | $43.66 |
| G0676 | 02402 | 99 | $30.63 | |
| G0676 | 02402 | 99 | AC | $40.63 |
| G0676 | 03102 | 00 | $29.40 | |
| G0676 | 03102 | 00 | AC | $39.40 |
| G0676 | 03202 | 01 | $30.00 | |
| G0676 | 03202 | 01 | AC | $40.00 |
| G0676 | 03302 | 01 | $29.28 | |
| G0676 | 03302 | 01 | AC | $39.28 |
| G0676 | 03402 | 02 | $29.19 | |
| G0676 | 03402 | 02 | AC | $39.19 |
| G0676 | 03502 | 09 | $29.04 | |
| G0676 | 03502 | 09 | AC | $39.04 |
| G0676 | 03602 | 21 | $29.70 | |
| G0676 | 03602 | 21 | AC | $39.70 |
| G0676 | 04112 | 01 | $30.81 | |
| G0676 | 04112 | 01 | AC | $40.81 |
| G0676 | 04212 | 05 | $29.10 | |
| G0676 | 04212 | 05 | AC | $39.10 |
| G0676 | 04312 | 00 | $28.26 | |
| G0676 | 04312 | 00 | AC | $38.26 |
| G0676 | 04412 | 09 | $29.73 | |
| G0676 | 04412 | 09 | AC | $39.73 |
| G0676 | 04412 | 11 | $29.91 | |
| G0676 | 04412 | 11 | AC | $39.91 |
| G0676 | 04412 | 15 | $29.82 | |
| G0676 | 04412 | 15 | AC | $39.82 |
| G0676 | 04412 | 18 | $30.48 | |
| G0676 | 04412 | 18 | AC | $40.48 |
| G0676 | 04412 | 20 | $28.68 | |
| G0676 | 04412 | 20 | AC | $38.68 |
| G0676 | 04412 | 28 | $29.79 | |
| G0676 | 04412 | 28 | AC | $39.79 |
| G0676 | 04412 | 31 | $30.69 | |
| G0676 | 04412 | 31 | AC | $40.69 |
| G0676 | 04412 | 99 | $29.19 | |
| G0676 | 04412 | 99 | AC | $39.19 |
| G0676 | 05102 | 00 | $28.08 | |
| G0676 | 05102 | 00 | AC | $38.08 |
| G0676 | 05202 | 00 | $28.08 | |
| G0676 | 05202 | 00 | AC | $38.08 |
| G0676 | 05302 | 01 | $29.34 | |
| G0676 | 05302 | 01 | AC | $39.34 |
| G0676 | 05302 | 02 | $29.13 | |
| G0676 | 05302 | 02 | AC | $39.13 |
| G0676 | 05302 | 99 | $28.05 | |
| G0676 | 05302 | 99 | AC | $38.05 |
| G0676 | 05402 | 00 | $28.17 | |
| G0676 | 05402 | 00 | AC | $38.17 |
| G0676 | 06102 | 12 | $30.12 | |
| G0676 | 06102 | 12 | AC | $40.12 |
| G0676 | 06102 | 15 | $31.41 | |
| G0676 | 06102 | 15 | AC | $41.41 |
| G0676 | 06102 | 16 | $31.74 | |
| G0676 | 06102 | 16 | AC | $41.74 |
| G0676 | 06102 | 99 | $29.49 | |
| G0676 | 06102 | 99 | AC | $39.49 |
| G0676 | 06202 | 00 | $29.55 | |
| G0676 | 06202 | 00 | AC | $39.55 |
| G0676 | 06302 | 00 | $28.59 | |
| G0676 | 06302 | 00 | AC | $38.59 |
| G0676 | 07102 | 13 | $27.45 | |
| G0676 | 07102 | 13 | AC | $37.45 |
| G0676 | 07202 | 01 | $29.34 | |
| G0676 | 07202 | 01 | AC | $39.34 |
| G0676 | 07202 | 99 | $28.35 | |
| G0676 | 07202 | 99 | AC | $38.35 |
| G0676 | 07302 | 00 | $27.75 | |
| G0676 | 07302 | 00 | AC | $37.75 |
| G0676 | 08102 | 00 | $28.38 | |
| G0676 | 08102 | 00 | AC | $38.38 |
| G0676 | 08202 | 01 | $30.36 | |
| G0676 | 08202 | 01 | AC | $40.36 |
| G0676 | 08202 | 99 | $28.95 | |
| G0676 | 08202 | 99 | AC | $38.95 |
| G0676 | 09102 | 03 | $31.17 | |
| G0676 | 09102 | 03 | AC | $41.17 |
| G0676 | 09102 | 04 | $32.43 | |
| G0676 | 09102 | 04 | AC | $42.43 |
| G0676 | 09102 | 99 | $30.00 | |
| G0676 | 09102 | 99 | AC | $40.00 |
| G0676 | 09202 | 20 | $30.12 | |
| G0676 | 09202 | 20 | AC | $40.12 |
| G0676 | 09202 | 50 | $30.12 | |
| G0676 | 09202 | 50 | AC | $40.12 |
| G0676 | 10112 | 00 | $27.75 | |
| G0676 | 10112 | 00 | AC | $37.75 |
| G0676 | 10212 | 01 | $30.51 | |
| G0676 | 10212 | 01 | AC | $40.51 |
| G0676 | 10212 | 99 | $28.74 | |
| G0676 | 10212 | 99 | AC | $38.74 |
| G0676 | 10312 | 35 | $28.17 | |
| G0676 | 10312 | 35 | AC | $38.17 |
| G0676 | 11202 | 01 | $28.77 | |
| G0676 | 11202 | 01 | AC | $38.77 |
| G0676 | 11302 | 00 | $29.40 | |
| G0676 | 11302 | 00 | AC | $39.40 |
| G0676 | 11402 | 16 | $28.71 | |
| G0676 | 11402 | 16 | AC | $38.71 |
| G0676 | 11502 | 00 | $28.62 | |
| G0676 | 11502 | 00 | AC | $38.62 |
| G0676 | 12102 | 01 | $29.79 | |
| G0676 | 12102 | 01 | AC | $39.79 |
| G0676 | 12202 | 01 | $33.42 | |
| G0676 | 12202 | 01 | AC | $43.42 |
| G0676 | 12302 | 01 | $31.53 | |
| G0676 | 12302 | 01 | AC | $41.53 |
| G0676 | 12302 | 99 | $30.21 | |
| G0676 | 12302 | 99 | AC | $40.21 |
| G0676 | 12402 | 01 | $33.24 | |
| G0676 | 12402 | 01 | AC | $43.24 |
| G0676 | 12402 | 99 | $31.98 | |
| G0676 | 12402 | 99 | AC | $41.98 |
| G0676 | 12502 | 01 | $31.08 | |
| G0676 | 12502 | 01 | AC | $41.08 |
| G0676 | 12502 | 99 | $28.80 | |
| G0676 | 12502 | 99 | AC | $38.80 |
| G0676 | 13102 | 00 | $31.62 | |
| G0676 | 13102 | 00 | AC | $41.62 |
| G0676 | 13202 | 01 | $33.90 | |
| G0676 | 13202 | 01 | AC | $43.90 |
| G0676 | 13202 | 02 | $34.62 | |
| G0676 | 13202 | 02 | AC | $44.62 |
| G0676 | 13202 | 03 | $32.25 | |
| G0676 | 13202 | 03 | AC | $42.25 |
| G0676 | 13282 | 99 | $28.95 | |
| G0676 | 13282 | 99 | AC | $38.95 |
| G0676 | 13292 | 04 | $34.02 | |
| G0676 | 13292 | 04 | AC | $44.02 |
| G0676 | 14112 | 03 | $29.43 | |
| G0676 | 14112 | 03 | AC | $39.43 |
| G0676 | 14112 | 99 | $28.44 | |
| G0676 | 14112 | 99 | AC | $38.44 |
| G0676 | 14212 | 01 | $33.18 | |
| G0676 | 14212 | 01 | AC | $43.18 |
| G0676 | 14212 | 99 | $30.72 | |
| G0676 | 14212 | 99 | AC | $40.72 |
| G0676 | 14312 | 40 | $30.42 | |
| G0676 | 14312 | 40 | AC | $40.42 |
| G0676 | 14412 | 01 | $30.60 | |
| G0676 | 14412 | 01 | AC | $40.60 |
| G0676 | 14512 | 50 | $29.25 | |
| G0676 | 14512 | 50 | AC | $39.25 |
| G0676 | 15102 | 00 | $28.35 | |
| G0676 | 15102 | 00 | AC | $38.35 |
| G0676 | 15202 | 00 | $28.80 | |
| G0676 | 15202 | 00 | AC | $38.80 |
| G0677 | 01112 | 05 | $36.42 | |
| G0677 | 01112 | 05 | AC | $46.42 |
| G0677 | 01112 | 09 | $37.05 | |
| G0677 | 01112 | 09 | AC | $47.05 |
| G0677 | 01112 | 51 | $34.74 | |
| G0677 | 01112 | 51 | AC | $44.74 |
| G0677 | 01112 | 52 | $36.45 | |
| G0677 | 01112 | 52 | AC | $46.45 |
| G0677 | 01112 | 53 | $34.71 | |
| G0677 | 01112 | 53 | AC | $44.71 |
| G0677 | 01112 | 54 | $31.14 | |
| G0677 | 01112 | 54 | AC | $41.14 |
| G0677 | 01112 | 55 | $31.02 | |
| G0677 | 01112 | 55 | AC | $41.02 |
| G0677 | 01112 | 56 | $31.02 | |
| G0677 | 01112 | 56 | AC | $41.02 |
| G0677 | 01112 | 57 | $31.02 | |
| G0677 | 01112 | 57 | AC | $41.02 |
| G0677 | 01112 | 58 | $31.02 | |
| G0677 | 01112 | 58 | AC | $41.02 |
| G0677 | 01112 | 59 | $31.02 | |
| G0677 | 01112 | 59 | AC | $41.02 |
| G0677 | 01112 | 60 | $31.02 | |
| G0677 | 01112 | 60 | AC | $41.02 |
| G0677 | 01112 | 61 | $31.02 | |
| G0677 | 01112 | 61 | AC | $41.02 |
| G0677 | 01112 | 62 | $31.41 | |
| G0677 | 01112 | 62 | AC | $41.41 |
| G0677 | 01112 | 63 | $32.25 | |
| G0677 | 01112 | 63 | AC | $42.25 |
| G0677 | 01112 | 64 | $32.10 | |
| G0677 | 01112 | 64 | AC | $42.10 |
| G0677 | 01112 | 65 | $37.20 | |
| G0677 | 01112 | 65 | AC | $47.20 |
| G0677 | 01112 | 66 | $32.73 | |
| G0677 | 01112 | 66 | AC | $42.73 |
| G0677 | 01112 | 67 | $33.06 | |
| G0677 | 01112 | 67 | AC | $43.06 |
| G0677 | 01112 | 68 | $31.02 | |
| G0677 | 01112 | 68 | AC | $41.02 |
| G0677 | 01112 | 69 | $31.02 | |
| G0677 | 01112 | 69 | AC | $41.02 |
| G0677 | 01112 | 70 | $31.02 | |
| G0677 | 01112 | 70 | AC | $41.02 |
| G0677 | 01112 | 75 | $31.02 | |
| G0677 | 01112 | 75 | AC | $41.02 |
| G0677 | 01182 | 17 | $32.49 | |
| G0677 | 01182 | 17 | AC | $42.49 |
| G0677 | 01182 | 18 | $32.73 | |
| G0677 | 01182 | 18 | AC | $42.73 |
| G0677 | 01182 | 71 | $31.02 | |
| G0677 | 01182 | 71 | AC | $41.02 |
| G0677 | 01182 | 72 | $32.61 | |
| G0677 | 01182 | 72 | AC | $42.61 |
| G0677 | 01182 | 73 | $31.62 | |
| G0677 | 01182 | 73 | AC | $41.62 |
| G0677 | 01182 | 74 | $32.16 | |
| G0677 | 01182 | 74 | AC | $42.16 |
| G0677 | 01212 | 01 | $31.38 | |
| G0677 | 01212 | 01 | AC | $41.38 |
| G0677 | 01312 | 00 | $29.82 | |
| G0677 | 01312 | 00 | AC | $39.82 |
| G0677 | 02102 | 01 | $37.83 | |
| G0677 | 02102 | 01 | AC | $47.83 |
| G0677 | 02202 | 00 | $28.26 | |
| G0677 | 02202 | 00 | AC | $38.26 |
| G0677 | 02302 | 01 | $31.47 | |
| G0677 | 02302 | 01 | AC | $41.47 |
| G0677 | 02302 | 99 | $29.58 | |
| G0677 | 02302 | 99 | AC | $39.58 |
| G0677 | 02402 | 02 | $33.66 | |
| G0677 | 02402 | 02 | AC | $43.66 |
| G0677 | 02402 | 99 | $30.63 | |
| G0677 | 02402 | 99 | AC | $40.63 |
| G0677 | 03102 | 00 | $29.40 | |
| G0677 | 03102 | 00 | AC | $39.40 |
| G0677 | 03202 | 01 | $30.00 | |
| G0677 | 03202 | 01 | AC | $40.00 |
| G0677 | 03302 | 01 | $29.28 | |
| G0677 | 03302 | 01 | AC | $39.28 |
| G0677 | 03402 | 02 | $29.19 | |
| G0677 | 03402 | 02 | AC | $39.19 |
| G0677 | 03502 | 09 | $29.04 | |
| G0677 | 03502 | 09 | AC | $39.04 |
| G0677 | 03602 | 21 | $29.70 | |
| G0677 | 03602 | 21 | AC | $39.70 |
| G0677 | 04112 | 01 | $30.81 | |
| G0677 | 04112 | 01 | AC | $40.81 |
| G0677 | 04212 | 05 | $29.10 | |
| G0677 | 04212 | 05 | AC | $39.10 |
| G0677 | 04312 | 00 | $28.26 | |
| G0677 | 04312 | 00 | AC | $38.26 |
| G0677 | 04412 | 09 | $29.73 | |
| G0677 | 04412 | 09 | AC | $39.73 |
| G0677 | 04412 | 11 | $29.91 | |
| G0677 | 04412 | 11 | AC | $39.91 |
| G0677 | 04412 | 15 | $29.82 | |
| G0677 | 04412 | 15 | AC | $39.82 |
| G0677 | 04412 | 18 | $30.48 | |
| G0677 | 04412 | 18 | AC | $40.48 |
| G0677 | 04412 | 20 | $28.68 | |
| G0677 | 04412 | 20 | AC | $38.68 |
| G0677 | 04412 | 28 | $29.79 | |
| G0677 | 04412 | 28 | AC | $39.79 |
| G0677 | 04412 | 31 | $30.69 | |
| G0677 | 04412 | 31 | AC | $40.69 |
| G0677 | 04412 | 99 | $29.19 | |
| G0677 | 04412 | 99 | AC | $39.19 |
| G0677 | 05102 | 00 | $28.08 | |
| G0677 | 05102 | 00 | AC | $38.08 |
| G0677 | 05202 | 00 | $28.08 | |
| G0677 | 05202 | 00 | AC | $38.08 |
| G0677 | 05302 | 01 | $29.34 | |
| G0677 | 05302 | 01 | AC | $39.34 |
| G0677 | 05302 | 02 | $29.13 | |
| G0677 | 05302 | 02 | AC | $39.13 |
| G0677 | 05302 | 99 | $28.05 | |
| G0677 | 05302 | 99 | AC | $38.05 |
| G0677 | 05402 | 00 | $28.17 | |
| G0677 | 05402 | 00 | AC | $38.17 |
| G0677 | 06102 | 12 | $30.12 | |
| G0677 | 06102 | 12 | AC | $40.12 |
| G0677 | 06102 | 15 | $31.41 | |
| G0677 | 06102 | 15 | AC | $41.41 |
| G0677 | 06102 | 16 | $31.74 | |
| G0677 | 06102 | 16 | AC | $41.74 |
| G0677 | 06102 | 99 | $29.49 | |
| G0677 | 06102 | 99 | AC | $39.49 |
| G0677 | 06202 | 00 | $29.55 | |
| G0677 | 06202 | 00 | AC | $39.55 |
| G0677 | 06302 | 00 | $28.59 | |
| G0677 | 06302 | 00 | AC | $38.59 |
| G0677 | 07102 | 13 | $27.45 | |
| G0677 | 07102 | 13 | AC | $37.45 |
| G0677 | 07202 | 01 | $29.34 | |
| G0677 | 07202 | 01 | AC | $39.34 |
| G0677 | 07202 | 99 | $28.35 | |
| G0677 | 07202 | 99 | AC | $38.35 |
| G0677 | 07302 | 00 | $27.75 | |
| G0677 | 07302 | 00 | AC | $37.75 |
| G0677 | 08102 | 00 | $28.38 | |
| G0677 | 08102 | 00 | AC | $38.38 |
| G0677 | 08202 | 01 | $30.36 | |
| G0677 | 08202 | 01 | AC | $40.36 |
| G0677 | 08202 | 99 | $28.95 | |
| G0677 | 08202 | 99 | AC | $38.95 |
| G0677 | 09102 | 03 | $31.17 | |
| G0677 | 09102 | 03 | AC | $41.17 |
| G0677 | 09102 | 04 | $32.43 | |
| G0677 | 09102 | 04 | AC | $42.43 |
| G0677 | 09102 | 99 | $30.00 | |
| G0677 | 09102 | 99 | AC | $40.00 |
| G0677 | 09202 | 20 | $30.12 | |
| G0677 | 09202 | 20 | AC | $40.12 |
| G0677 | 09202 | 50 | $30.12 | |
| G0677 | 09202 | 50 | AC | $40.12 |
| G0677 | 10112 | 00 | $27.75 | |
| G0677 | 10112 | 00 | AC | $37.75 |
| G0677 | 10212 | 01 | $30.51 | |
| G0677 | 10212 | 01 | AC | $40.51 |
| G0677 | 10212 | 99 | $28.74 | |
| G0677 | 10212 | 99 | AC | $38.74 |
| G0677 | 10312 | 35 | $28.17 | |
| G0677 | 10312 | 35 | AC | $38.17 |
| G0677 | 11202 | 01 | $28.77 | |
| G0677 | 11202 | 01 | AC | $38.77 |
| G0677 | 11302 | 00 | $29.40 | |
| G0677 | 11302 | 00 | AC | $39.40 |
| G0677 | 11402 | 16 | $28.71 | |
| G0677 | 11402 | 16 | AC | $38.71 |
| G0677 | 11502 | 00 | $28.62 | |
| G0677 | 11502 | 00 | AC | $38.62 |
| G0677 | 12102 | 01 | $29.79 | |
| G0677 | 12102 | 01 | AC | $39.79 |
| G0677 | 12202 | 01 | $33.42 | |
| G0677 | 12202 | 01 | AC | $43.42 |
| G0677 | 12302 | 01 | $31.53 | |
| G0677 | 12302 | 01 | AC | $41.53 |
| G0677 | 12302 | 99 | $30.21 | |
| G0677 | 12302 | 99 | AC | $40.21 |
| G0677 | 12402 | 01 | $33.24 | |
| G0677 | 12402 | 01 | AC | $43.24 |
| G0677 | 12402 | 99 | $31.98 | |
| G0677 | 12402 | 99 | AC | $41.98 |
| G0677 | 12502 | 01 | $31.08 | |
| G0677 | 12502 | 01 | AC | $41.08 |
| G0677 | 12502 | 99 | $28.80 | |
| G0677 | 12502 | 99 | AC | $38.80 |
| G0677 | 13102 | 00 | $31.62 | |
| G0677 | 13102 | 00 | AC | $41.62 |
| G0677 | 13202 | 01 | $33.90 | |
| G0677 | 13202 | 01 | AC | $43.90 |
| G0677 | 13202 | 02 | $34.62 | |
| G0677 | 13202 | 02 | AC | $44.62 |
| G0677 | 13202 | 03 | $32.25 | |
| G0677 | 13202 | 03 | AC | $42.25 |
| G0677 | 13282 | 99 | $28.95 | |
| G0677 | 13282 | 99 | AC | $38.95 |
| G0677 | 13292 | 04 | $34.02 | |
| G0677 | 13292 | 04 | AC | $44.02 |
| G0677 | 14112 | 03 | $29.43 | |
| G0677 | 14112 | 03 | AC | $39.43 |
| G0677 | 14112 | 99 | $28.44 | |
| G0677 | 14112 | 99 | AC | $38.44 |
| G0677 | 14212 | 01 | $33.18 | |
| G0677 | 14212 | 01 | AC | $43.18 |
| G0677 | 14212 | 99 | $30.72 | |
| G0677 | 14212 | 99 | AC | $40.72 |
| G0677 | 14312 | 40 | $30.42 | |
| G0677 | 14312 | 40 | AC | $40.42 |
| G0677 | 14412 | 01 | $30.60 | |
| G0677 | 14412 | 01 | AC | $40.60 |
| G0677 | 14512 | 50 | $29.25 | |
| G0677 | 14512 | 50 | AC | $39.25 |
| G0677 | 15102 | 00 | $28.35 | |
| G0677 | 15102 | 00 | AC | $38.35 |
| G0677 | 15202 | 00 | $28.80 | |
| G0677 | 15202 | 00 | AC | $38.80 |
| G0678 | 01112 | 05 | $36.42 | |
| G0678 | 01112 | 05 | AC | $46.42 |
| G0678 | 01112 | 09 | $37.05 | |
| G0678 | 01112 | 09 | AC | $47.05 |
| G0678 | 01112 | 51 | $34.74 | |
| G0678 | 01112 | 51 | AC | $44.74 |
| G0678 | 01112 | 52 | $36.45 | |
| G0678 | 01112 | 52 | AC | $46.45 |
| G0678 | 01112 | 53 | $34.71 | |
| G0678 | 01112 | 53 | AC | $44.71 |
| G0678 | 01112 | 54 | $31.14 | |
| G0678 | 01112 | 54 | AC | $41.14 |
| G0678 | 01112 | 55 | $31.02 | |
| G0678 | 01112 | 55 | AC | $41.02 |
| G0678 | 01112 | 56 | $31.02 | |
| G0678 | 01112 | 56 | AC | $41.02 |
| G0678 | 01112 | 57 | $31.02 | |
| G0678 | 01112 | 57 | AC | $41.02 |
| G0678 | 01112 | 58 | $31.02 | |
| G0678 | 01112 | 58 | AC | $41.02 |
| G0678 | 01112 | 59 | $31.02 | |
| G0678 | 01112 | 59 | AC | $41.02 |
| G0678 | 01112 | 60 | $31.02 | |
| G0678 | 01112 | 60 | AC | $41.02 |
| G0678 | 01112 | 61 | $31.02 | |
| G0678 | 01112 | 61 | AC | $41.02 |
| G0678 | 01112 | 62 | $31.41 | |
| G0678 | 01112 | 62 | AC | $41.41 |
| G0678 | 01112 | 63 | $32.25 | |
| G0678 | 01112 | 63 | AC | $42.25 |
| G0678 | 01112 | 64 | $32.10 | |
| G0678 | 01112 | 64 | AC | $42.10 |
| G0678 | 01112 | 65 | $37.20 | |
| G0678 | 01112 | 65 | AC | $47.20 |
| G0678 | 01112 | 66 | $32.73 | |
| G0678 | 01112 | 66 | AC | $42.73 |
| G0678 | 01112 | 67 | $33.06 | |
| G0678 | 01112 | 67 | AC | $43.06 |
| G0678 | 01112 | 68 | $31.02 | |
| G0678 | 01112 | 68 | AC | $41.02 |
| G0678 | 01112 | 69 | $31.02 | |
| G0678 | 01112 | 69 | AC | $41.02 |
| G0678 | 01112 | 70 | $31.02 | |
| G0678 | 01112 | 70 | AC | $41.02 |
| G0678 | 01112 | 75 | $31.02 | |
| G0678 | 01112 | 75 | AC | $41.02 |
| G0678 | 01182 | 17 | $32.49 | |
| G0678 | 01182 | 17 | AC | $42.49 |
| G0678 | 01182 | 18 | $32.73 | |
| G0678 | 01182 | 18 | AC | $42.73 |
| G0678 | 01182 | 71 | $31.02 | |
| G0678 | 01182 | 71 | AC | $41.02 |
| G0678 | 01182 | 72 | $32.61 | |
| G0678 | 01182 | 72 | AC | $42.61 |
| G0678 | 01182 | 73 | $31.62 | |
| G0678 | 01182 | 73 | AC | $41.62 |
| G0678 | 01182 | 74 | $32.16 | |
| G0678 | 01182 | 74 | AC | $42.16 |
| G0678 | 01212 | 01 | $31.38 | |
| G0678 | 01212 | 01 | AC | $41.38 |
| G0678 | 01312 | 00 | $29.82 | |
| G0678 | 01312 | 00 | AC | $39.82 |
| G0678 | 02102 | 01 | $37.83 | |
| G0678 | 02102 | 01 | AC | $47.83 |
| G0678 | 02202 | 00 | $28.26 | |
| G0678 | 02202 | 00 | AC | $38.26 |
| G0678 | 02302 | 01 | $31.47 | |
| G0678 | 02302 | 01 | AC | $41.47 |
| G0678 | 02302 | 99 | $29.58 | |
| G0678 | 02302 | 99 | AC | $39.58 |
| G0678 | 02402 | 02 | $33.66 | |
| G0678 | 02402 | 02 | AC | $43.66 |
| G0678 | 02402 | 99 | $30.63 | |
| G0678 | 02402 | 99 | AC | $40.63 |
| G0678 | 03102 | 00 | $29.40 | |
| G0678 | 03102 | 00 | AC | $39.40 |
| G0678 | 03202 | 01 | $30.00 | |
| G0678 | 03202 | 01 | AC | $40.00 |
| G0678 | 03302 | 01 | $29.28 | |
| G0678 | 03302 | 01 | AC | $39.28 |
| G0678 | 03402 | 02 | $29.19 | |
| G0678 | 03402 | 02 | AC | $39.19 |
| G0678 | 03502 | 09 | $29.04 | |
| G0678 | 03502 | 09 | AC | $39.04 |
| G0678 | 03602 | 21 | $29.70 | |
| G0678 | 03602 | 21 | AC | $39.70 |
| G0678 | 04112 | 01 | $30.81 | |
| G0678 | 04112 | 01 | AC | $40.81 |
| G0678 | 04212 | 05 | $29.10 | |
| G0678 | 04212 | 05 | AC | $39.10 |
| G0678 | 04312 | 00 | $28.26 | |
| G0678 | 04312 | 00 | AC | $38.26 |
| G0678 | 04412 | 09 | $29.73 | |
| G0678 | 04412 | 09 | AC | $39.73 |
| G0678 | 04412 | 11 | $29.91 | |
| G0678 | 04412 | 11 | AC | $39.91 |
| G0678 | 04412 | 15 | $29.82 | |
| G0678 | 04412 | 15 | AC | $39.82 |
| G0678 | 04412 | 18 | $30.48 | |
| G0678 | 04412 | 18 | AC | $40.48 |
| G0678 | 04412 | 20 | $28.68 | |
| G0678 | 04412 | 20 | AC | $38.68 |
| G0678 | 04412 | 28 | $29.79 | |
| G0678 | 04412 | 28 | AC | $39.79 |
| G0678 | 04412 | 31 | $30.69 | |
| G0678 | 04412 | 31 | AC | $40.69 |
| G0678 | 04412 | 99 | $29.19 | |
| G0678 | 04412 | 99 | AC | $39.19 |
| G0678 | 05102 | 00 | $28.08 | |
| G0678 | 05102 | 00 | AC | $38.08 |
| G0678 | 05202 | 00 | $28.08 | |
| G0678 | 05202 | 00 | AC | $38.08 |
| G0678 | 05302 | 01 | $29.34 | |
| G0678 | 05302 | 01 | AC | $39.34 |
| G0678 | 05302 | 02 | $29.13 | |
| G0678 | 05302 | 02 | AC | $39.13 |
| G0678 | 05302 | 99 | $28.05 | |
| G0678 | 05302 | 99 | AC | $38.05 |
| G0678 | 05402 | 00 | $28.17 | |
| G0678 | 05402 | 00 | AC | $38.17 |
| G0678 | 06102 | 12 | $30.12 | |
| G0678 | 06102 | 12 | AC | $40.12 |
| G0678 | 06102 | 15 | $31.41 | |
| G0678 | 06102 | 15 | AC | $41.41 |
| G0678 | 06102 | 16 | $31.74 | |
| G0678 | 06102 | 16 | AC | $41.74 |
| G0678 | 06102 | 99 | $29.49 | |
| G0678 | 06102 | 99 | AC | $39.49 |
| G0678 | 06202 | 00 | $29.55 | |
| G0678 | 06202 | 00 | AC | $39.55 |
| G0678 | 06302 | 00 | $28.59 | |
| G0678 | 06302 | 00 | AC | $38.59 |
| G0678 | 07102 | 13 | $27.45 | |
| G0678 | 07102 | 13 | AC | $37.45 |
| G0678 | 07202 | 01 | $29.34 | |
| G0678 | 07202 | 01 | AC | $39.34 |
| G0678 | 07202 | 99 | $28.35 | |
| G0678 | 07202 | 99 | AC | $38.35 |
| G0678 | 07302 | 00 | $27.75 | |
| G0678 | 07302 | 00 | AC | $37.75 |
| G0678 | 08102 | 00 | $28.38 | |
| G0678 | 08102 | 00 | AC | $38.38 |
| G0678 | 08202 | 01 | $30.36 | |
| G0678 | 08202 | 01 | AC | $40.36 |
| G0678 | 08202 | 99 | $28.95 | |
| G0678 | 08202 | 99 | AC | $38.95 |
| G0678 | 09102 | 03 | $31.17 | |
| G0678 | 09102 | 03 | AC | $41.17 |
| G0678 | 09102 | 04 | $32.43 | |
| G0678 | 09102 | 04 | AC | $42.43 |
| G0678 | 09102 | 99 | $30.00 | |
| G0678 | 09102 | 99 | AC | $40.00 |
| G0678 | 09202 | 20 | $30.12 | |
| G0678 | 09202 | 20 | AC | $40.12 |
| G0678 | 09202 | 50 | $30.12 | |
| G0678 | 09202 | 50 | AC | $40.12 |
| G0678 | 10112 | 00 | $27.75 | |
| G0678 | 10112 | 00 | AC | $37.75 |
| G0678 | 10212 | 01 | $30.51 | |
| G0678 | 10212 | 01 | AC | $40.51 |
| G0678 | 10212 | 99 | $28.74 | |
| G0678 | 10212 | 99 | AC | $38.74 |
| G0678 | 10312 | 35 | $28.17 | |
| G0678 | 10312 | 35 | AC | $38.17 |
| G0678 | 11202 | 01 | $28.77 | |
| G0678 | 11202 | 01 | AC | $38.77 |
| G0678 | 11302 | 00 | $29.40 | |
| G0678 | 11302 | 00 | AC | $39.40 |
| G0678 | 11402 | 16 | $28.71 | |
| G0678 | 11402 | 16 | AC | $38.71 |
| G0678 | 11502 | 00 | $28.62 | |
| G0678 | 11502 | 00 | AC | $38.62 |
| G0678 | 12102 | 01 | $29.79 | |
| G0678 | 12102 | 01 | AC | $39.79 |
| G0678 | 12202 | 01 | $33.42 | |
| G0678 | 12202 | 01 | AC | $43.42 |
| G0678 | 12302 | 01 | $31.53 | |
| G0678 | 12302 | 01 | AC | $41.53 |
| G0678 | 12302 | 99 | $30.21 | |
| G0678 | 12302 | 99 | AC | $40.21 |
| G0678 | 12402 | 01 | $33.24 | |
| G0678 | 12402 | 01 | AC | $43.24 |
| G0678 | 12402 | 99 | $31.98 | |
| G0678 | 12402 | 99 | AC | $41.98 |
| G0678 | 12502 | 01 | $31.08 | |
| G0678 | 12502 | 01 | AC | $41.08 |
| G0678 | 12502 | 99 | $28.80 | |
| G0678 | 12502 | 99 | AC | $38.80 |
| G0678 | 13102 | 00 | $31.62 | |
| G0678 | 13102 | 00 | AC | $41.62 |
| G0678 | 13202 | 01 | $33.90 | |
| G0678 | 13202 | 01 | AC | $43.90 |
| G0678 | 13202 | 02 | $34.62 | |
| G0678 | 13202 | 02 | AC | $44.62 |
| G0678 | 13202 | 03 | $32.25 | |
| G0678 | 13202 | 03 | AC | $42.25 |
| G0678 | 13282 | 99 | $28.95 | |
| G0678 | 13282 | 99 | AC | $38.95 |
| G0678 | 13292 | 04 | $34.02 | |
| G0678 | 13292 | 04 | AC | $44.02 |
| G0678 | 14112 | 03 | $29.43 | |
| G0678 | 14112 | 03 | AC | $39.43 |
| G0678 | 14112 | 99 | $28.44 | |
| G0678 | 14112 | 99 | AC | $38.44 |
| G0678 | 14212 | 01 | $33.18 | |
| G0678 | 14212 | 01 | AC | $43.18 |
| G0678 | 14212 | 99 | $30.72 | |
| G0678 | 14212 | 99 | AC | $40.72 |
| G0678 | 14312 | 40 | $30.42 | |
| G0678 | 14312 | 40 | AC | $40.42 |
| G0678 | 14412 | 01 | $30.60 | |
| G0678 | 14412 | 01 | AC | $40.60 |
| G0678 | 14512 | 50 | $29.25 | |
| G0678 | 14512 | 50 | AC | $39.25 |
| G0678 | 15102 | 00 | $28.35 | |
| G0678 | 15102 | 00 | AC | $38.35 |
| G0678 | 15202 | 00 | $28.80 | |
| G0678 | 15202 | 00 | AC | $38.80 |