ACCESS model HCPCS G-code allowed amounts

Outcome-aligned payment (OAP) HCPCS G-codes

Pricing information is now available for new Healthcare Common Procedure Coding System (HCPCS) codes payable under Medicare when furnished for the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. 

The ACCESS Model is a 10-year voluntary Innovation Center model that tests whether an alternative payment methodology, Outcome-Aligned Payments (OAPs), for technology-enabled chronic care reduces expenditures while enhancing quality of care for Medicare beneficiaries. It is scheduled for implementation on July 1, 2026. Beginning in 2027, these codes will be listed on a new CMMI payment file. All ACCESS model HCPCS codes can be billed with telehealth place of service (POS) codes 02 and 10.
 

HCPCS Short Descriptor Long Descriptor Monthly Allowed Amount
G0669 Eckm oap-initial period Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of early cardio-kidney-metabolic (eCKM) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); initial 12-month period; per month $30.00
G0670 Eckm oap-follow-on period(s) Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of early cardio-kidney-metabolic (eCKM) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); follow-on 12-month period; per month $15.00
G0671 Ckm oap-initial period Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of cardio-kidney-metabolic (CKM) conditions (one or more of: diabetes mellitus, chronic kidney disease Stage 3a or 3b, atherosclerotic cardiovascular disease); initial 12-month period; per month $35.00
G0672 Ckm oap-follow-on period(s) Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of cardio-kidney-metabolic (CKM) conditions (one or more of: diabetes mellitus, chronic kidney disease Stage 3a or 3b, atherosclerotic cardiovascular disease); follow-on 12-month period; per month $17.50
G0673 Msk oap-initial period Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of musculoskeletal (MSK) conditions (chronic musculoskeletal pain); initial 12-month treatment period; per month $15.00
G0674 Bh oap-initial period Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of behavioral health (BH) conditions (one or more of: depression, anxiety); initial 12-month period; per month  $15.00
G0675 Bh oap-follow-on period(s) Outcome-Aligned Payment (OAP) for technology-enabled chronic care management of behavioral health (BH) conditions (one or more of: depression, anxiety); follow-on 12-month period; per month  $7.50

ACCESS HCPCS codes and modifier descriptions

HCPCS codes

HCPCS Short Descriptor Long Descriptor Allowed Amount
G0676 Std co-mgmt-eckm, ckm Standard Co-Management service payment for documented review of clinical updates from ACCESS Participant managing cardio-kidney-metabolic conditions (early cardio-kidney-metabolic [eCKM] or cardio-kidney-metabolic [CKM]); per review $30.00
G0677 Std co-mgmt-msk Standard Co-Management service payment for documented review of clinical updates from ACCESS Participant managing musculoskeletal (MSK) conditions; per review $30.00
G0678 Std co-mgmt-bh Standard Co-Management service payment for documented review of clinical updates from ACCESS Participant managing behavioral health (BH) conditions (depression, anxiety); per review $30.00

Modifier descriptions

Modifier Short Descriptor Long Descriptor Allowed Amount
AC Co-mgmt mod – onboarding Initial onboarding support payment for access beneficiary enrollment, device/app setup, and care coordination activities; first month only; once per beneficiary per track. $10.00

 

ACCESS HCPCS codes that include GAF

HCPCS Code Carrier Locality Modifier Price
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