Medicaid Reimbursement Survey, 2015 - AAP.org · 96111 Developmental testing, extended Pediatric 9...

Medicaid Reimbursement Survey, 2015

Survey Summary

As part of its effort to monitor the impact of the Medicaid program on pediatrics, the American Academy of Pediatrics (AAP) conducts its Medicaid Reimbursement Survey periodically.

Copyright 2015 American Academy of Pediatrics.

2015 AAP Medicaid Reimbursement Survey

The Survey, which collects state-administered fee-for-service program payment rates for commonly reported pediatric Current Procedural Terminology/CPT® codes and dental codes, was most recently mailed to State Medicaid Directors in the 50 states and the District of Columbia between January 2015 and September 2015 to request payment rates effective July 1, 2015, the beginning of the 2010-11 fiscal year for most states. In addition, the survey requested ACA rates, in effect as of October 1, 2014.

As of publication of this report, 39 states have responded to the survey.

This and earlier AAP Medicaid Reimbursement Survey reports can be found at URL: http://www.aap.org/research/medreimintro.htm

In this Report...

This report provides state-reported fees paid for pediatric services represented by over 150 CPT and dental codes used by state-administered fee-for-service Medicaid programs to reimburse providers. Medicaid fees are compared to Medicare where available, or to other benchmark fees where Medicare comparisons are unavailable.

Codes are selected for inclusion in the survey based on (i) utilization, and (ii) importance to Academy priorities, such as Bright Futures and the pediatric medical home. Also included in this report are summary updates on Medicaid managed care (MMC) enrollment, state-monitoring of MMC physician reimbursement, coverage of Bright Futures benefits, and reimbursement of pediatricians for providing certain mental and preventive oral health services to children.

Caveats and Notes

CPT® is a trademark of the American Medical Association. Dental codes (CDT Codes) are copyright 2016 American Dental Association. Reprinted with permission.

Medicaid fees shown in this report represent fee-for-service payments reported by states for state-administered Medicaid programs at the time of the study (January, 2015 - September, 2015). The rates are subject to change.



Medicare rates in this report are (a) based on non-facility Medicare payment published by the Centers for Medicare and Medicaid Services for 2015, and (b) adjusted with Geographic Practice Cost Index (GPCIs) published by CMS.

Nationally, the majority of children enrolled in Medicaid programs are enrolled in managed care plans, which may or may not benchmark provider payment rates to fees shown in this report. Depending on managed care penetration levels, the impact of state-administered fee-for-service Medicaid payment rates varies by state.

Unless noted otherwise, non-facility rates and enhanced payment rates for pediatric services, where available and reported by the state, are included in this report.

Contact Kelly Loes, Division of Quality, for comments on this report. For Medicaid questions and advocacy advice, contact Dan Walter or Wendy Chill, Division of State Government Affairs at [email protected]. Contact Elizabeth Sobczyk, Division of Pediatric Practice, for pediatric immunization questions and advocacy advice. For coding or RBRVS questions, please contact the AAP Coding Hotline at [email protected].

Contact Information

2015 AAP Medicaid Reimbursement Survey. American Academy of Pediatrics. Elk Grove Village, Illinois. Available for download at the AAP Website, at URL: http://www.aap.org/research/medreimintro.htm

Suggested Citation

Abbreviations


AAP American Academy of Pediatrics

BC Billed amount / billed charges

BI/BR/IC/MP/PR

By invoice/ by report/ individual consideration/manually priced/per review, i.e., Carrier will establish payment amounts for these services on a case-by-case basis following review of documentation, such as an operative report

BO Bundled with other services, i.e., Payment for covered services is always bundled into payment for other services not specified. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident

CMS Centers for Medicare and Medicaid Services

C-NP Covered, rate not provided

DMS “Department of Medicaid Services/DMS system amount” paid to Public Health Departments in the state of Kentucky only.

FFS Discounted fee-for-service

IER

RVUs not published for this code in the Medicare RBRVS; values are based on the Ingenix Essential RBRVS. Ratio (percentage listed under “%Medicare” column) represents Medicaid payment as a percentage of the rate calculated using the RVUs published in the Ingenix Essential RBRVS.

LFS Amount per Clinical Diagnostic Lab Fee Schedule. Ratio (percentage listed under “%Medicare” column) represents Medicaid payment as a percentage of the mount listed for the state in the Clinical Diagnostic Lab Fee Schedule.

NA Not applicable

NC Not covered

NE-ACA Code non-eligible for Medicaid fee increase for Affordable Care Act

NIS Not priced by the current Physician Fee Schedule, or RVUs not included in RBRVS

NL

Payment information specific to procedure code not listed on state Medicaid website or physician fee schedule. Note: absence of such information from fee schedule often indicates that the service is either not covered, or covered under alternate code(s).

NP Information not provided by state in returned AAP survey

OM Other method used

QMB Qualified Medicare Beneficiary

RBRVS Resource-Based Relative Value Scale, the physician payment schedule for Medicare

RNE Rate not established

RVU(s) Relative Value Unit(s), the numeric value of the resources needed to provide services according to the Resource-Based Relative Value Scale

SE Data not available due to survey error.


List of CPT and Dental Codes Included in Report

Service Type Code Description Page # Preventive

Medicine

Services

99381 New patient, under 1 year 1

99382 New patient, 1 through 4 years 1



99391 Established patient, under 1 year 1

99392 Established patient, 1 through 4 years 1



99406 Smoking and tobacco use cessation

counseling; >3 -10 mins 2

99407 Smoking and tobacco use cessation

counseling: >10 mins 2

99408 Alcohol/substance abuse structured

screening/SBI srvc; 15-30 mins 2

99409 Alcohol/substance abuse structured

screening/SBI srvc; >10 mins 2

99420 Administration+interpretation of health

risk assessment instrument 2

Office and

Other

Outpatient

Services

99201 New patient, problem-focused 2

99202 New patient, expanded 2

99203 New patient, low complexity 2

99204 New patient, moderate complexity 2

99205 New patient, high complexity 3

99211 Established patient, nurse only 3

99212 Established patient, problem-focused 3

99213 Established patient, low complexity 3

99214 Established patient, moderate complexity 3

99215 Established patient, high complexity 3

92551 Screening test, hearing evaluation 3

92567 Tympanometry, hearing evaluation 3

99173 Screening test, visual acuity 4

99174 Ocular photoscreening 4

99188 Application of topical fluoride varnish by a

physician or other qualified health care

professional 4

96110 Developmental testing; limited 4

Newborn Care 99460 Initial newborn care 4

99462 Subsequent newborn care 4

99463 Admit and discharge on same day 4

99464 Physician attendance at delivery 4

99465 Newborn resuscitation 4

54150 Circumcision, using clamp or other device

with regional dorsal penile or ring block 5

Immunizations 90460 Immunization administration through 18

years of age via any route of

administration, with counseling by physician

or other qualified health care professional;

first vaccine/toxoid component 5

Service Type Code Description Page # Immunizations

Continued

90461 Immunization administration through 18

years of age via any route of

administration, with counseling by physician

or other qualified health care professional;

each additional vaccine/toxoid component 5

90471 One immunization administration 5

90472 Each additional immunization administration 5

90473 One immunization administration, oral or

intranasal 5

90474 Each additional administration,

oral or intranasal 5

Non-physician

Provider (NPP)

Services

96150 Health and Behavior assessment; by NPP 5

96151 Health and Behavior re-assessment; by NPP 5

96152 Health and Behavior intervention; by NPP 6

97802 Medical Nutrition Therapy, individual, initial 6

97803 Medical Nutrition Therapy, individual,

follow-up 6

Hospital Care 99222 Initial hospitalization, per day, moderate

complexity 6

99223 Initial hospitalization, per day, high

complexity 6

99232 Subsequent hospitalization, per day, mod

complexity 6

99233 Subsequent hospitalization, per day, high

complexity 6

99238 Hospital discharge, day management, ≤30

min 6

Evaluation and

Management

99339 Care plan oversight, supervision of patient

in home, 15-29 minutes per month

7

99354 Prolonged service outpatient, 1st hour, face-

to-face

7

99355 Same as 99354, each additional 30 minutes 7

99356 Prolonged service, inpatient, 1st hour, face-

to-face

7


99358 Prolonged service, inpatient, 1st hour, non-

face-to-face

7


99367 Medical team conference, patient/family

not present, ≥30 min

7

99442 Telephone evaluation and management – 11-

20 minutes

7

99447 Physician to physician tele/internet

consultation – 11-20 minutes

8

99448 Physician to physician tele/internet

consultation – 21-30 minutes

8

99490 Chronic care management services ≥20 mins

clinical staff time directed by a physician

or other qualified health care professional,

per calendar month

8

List of CPT and Dental Codes Included in Report

Service Type Code Description Page # Pathology and

Laboratory

81000 Urinalysis, non-automated with microscopy 8

81002 Urinalysis, non-automated without microscopy 8

86500 Tuberculosis, intradermal 8

87081 Throat culture 8

87880 Rapid Streptococcus screen 8

Mental Health 90791 Psychiatric diagnostic eval 8

90792 Psychiatric diagnostic eval w/ medical services 9

90832 Psychotherapy, 30 mins w/ patient/family 9

90837 Consultation w/ family 9

90889 Preparation of report 9

96111 Developmental testing, extended 9

90887 Interpretation of explanation of psychiatric

or other medical exams 9

90889 Preparation of reports on patient’s

psychiatric status, history, treatment or

progress. 9

96127 Brief emotional/behavioral assessment 9

Allergy and

Immunology

95004

Percutaneous tests with allergenic extracts

9

95017 Allergy testing, with venoms 10

95018 Allergy testing, with drugs or biologics 10

95024 Intracutaneous tests, with allergenic

extracts 10

95115 Allergen immunotherapy, single injection 10

95117 Allergen immunotherapy, two or more

injections 10

Cardiology 32551 Tube thoracostomy, includes water seal 10

92950 Cardiopulmonary resuscitation 10

93303 Transthoracic echocardiography 10

93307 Echocardiography, real-time w/ image

documentation 10

93320 Doppler echocardiograph 11

93451 Right heart catheterization 11

93452 Left heart catheterization 11

Critical Care 31500 Intubation, endotracheal 11

36555 Insertion of non-tunneled center venous

cathether; < 5 yrs 11

36568 Insertion of peripherally inserted CVC; under

5 years 11

36660 Arterial puncture, diagnostic 11

36620 Arterial line placement 11

99291 Critical care, first hour 11

Emergency

Care

10120 Simple surgical removal of foreign body

12

36400 Venipuncture necessitating physician skill; < 3

yrs

12

36410 Venipuncture necessitating physician skill; >=

3 yrs

12

36415 Routine venipuncture 12

62270 Lumbar puncture, diagnostic 12

99282 ED visit, problem focused 12

99283 ED visit, expanded 12

99284 ED visit, detailed 12

Service Type Code Description Page # Gastrointestinal 43239 Upper gastrointestinal endoscopy 13

44389 Colonoscopy with biopsy 13

45331 Sigmoidoscopy with biopsy 13

Ophthalmology 67311 Strabismus surgery, horizontal 13

67314 Strabismus surgery, vertical 13

68810 Nasolacrimal probing 13

Otolaryngology 42820 Tonsillectomy/adenoidectomy, < 12 years 13

42821 Tonsillectomy/adenoidectomy, > 12 years 13

69436 Tympanostomy and tubes 13

Neonatal and

Pediatric

Critical Care

36510 Umbilical vein catheterization 14

36660 Umbilical artery catheterization 14

99471 Initial pediatric critical care (29d-24m) 16

99472 Subsequent pediatric critical care (29d-

24m) 16

99475 Initial pediatric critical care (2-5 yrs) 16

99476 Subsequent pediatric critical care (2-5

yrs) 16

99468 Initial neonatal critical care 16

99469 Subsequent neonatal critical care 16

Initial and

Continuing

Intensive Care

Services

99477 Initial neonatal intensive care 17

99478 Subsq intensive care, < 1500 gm 17

99479 Subsq intensive care, 1500-2500 gm 17

99480 Subsq intensive care, 2501-5000 gm 17

Plastic Surgery 40700 Cleft lip repair 14

42200 Cleft palate repair 14

Pulmonology 31622 Bronchoscopy 14

32421 Thoracentesis for aspiration 14

94010 Spirometry, including graphic record 15

94640 Inhalation treatment 16

94644 Continuous inhalation treatment, first hour 16

94664 Demonstration/evaluation 16

Radiology 71010 Frontal chest x-ray 15

Surgery 28262 Extensive clubfoot release 14

44950 Appendectomy 14

49500 Bilateral inguinal hernia, 6 mos to < 5 years 14

49505 Bilateral inguinal hernia, 5 years or over 15

Urology and

Dialysis

50200 Renal biopsy; percutaneous, by trocar or

needle 15

90957 ESRD services; 12-19 yrs, 4+ physician

visits/mo 15

90959 Same as above, 1 physician visits/mo 15

90965 Same, home dialysis for full month 15

90945 Peritoneal dialysis 15

Dental Services D0120 Periodic exam 17

D0145 Caries Risk Assessment 17

D1206 Topical fluoride varnish 17

D1120 Prophylaxis, child 17

D2150 Amalgam – 2 surfaces, primary or perm 17

D2330 Resin-based composite –1 surface anterior 18

D1351 Sealant, per tooth 18

D2930 Stainless steel crown on a primary tooth 18

D3220 Pulpotomy 18

D7140 Extraction 18

State 99381 99382 99383

Payment for Commonly Reported Pediatric Services in State-administered FFS Medicaid Programs

% FFS~ 99384 99391 99392 99393 99394*Alabama $70.00 $70.00 $70.0066% $70.00 $70.00 $70.00 $70.00 $70.00

Alaska $185.81 $194.59 $203.51100% $231.46 $167.62 $179.67 $179.16 $197.37

Arizona $81.05 $84.47 $88.14NP $99.66 $72.95 $77.92 $77.66 $85.05

Arkansas $56.41 $56.41 $56.41NP $56.41 $56.41 $56.41 $56.41 $56.41

California

Colorado

Connecticut $93.60 $93.60 $93.60NP $93.60 $93.60 $93.60 $93.60 $93.60

Delaware

District of Columbia $95.25 $99.09 $103.2610% $122.54 $85.63 $91.32 $90.99 $104.56

Florida $81.91 $81.91 $81.91NP $81.91 $81.91 $81.91 $81.91 $81.91

Georgia $67.38 $67.38 $67.3813.65% $75.38 $67.38 $67.38 $67.38 $75.38

Hawaii

Idaho $108.25 $121.50 $120.72100% $134.65 $89.46 $102.99 $102.60 $116.24

Illinois $91.90 $98.65 $96.6046% $104.96 $69.52 $77.87 $76.84 $84.62

Indiana $79.11 $82.62 $86.2215.7% $97.58 $71.24 $76.14 $75.89 $83.25

Iowa $88.72 $95.22 $94.5719% $105.26 $72.40 $79.93 $79.60 $90.07

Kansas

Kentucky $78.58 $89.90 $89.907.5% $101.22 $67.57 $78.58 $78.58 $89.90

Louisiana $72.96 $79.61 $79.063.7% $86.25 $60.88 $68.05 $67.79 $74.70

Maine $62.06 $62.06 $62.06NP $62.06 $58.37 $58.37 $58.37 $58.37

Maryland $103.28 $107.85 $112.06NP $126.79 $92.63 $98.84 $98.50 $107.96

Massachusetts $81.74 $87.96 $86.5955% $93.71 $63.38 $70.50 $69.81 $76.71

Michigan $86.72 $93.36 $91.4644% $99.37 $65.83 $73.74 $72.79 $80.39

Minnesota $85.43 $89.62 $93.25NP $105.25 $77.05 $82.80 $81.80 $89.90

Mississippi $80.78 $87.40 $85.74NP $93.37 $61.58 $69.19 $68.54 $76.15

Missouri $23.00 $23.00 $23.0035% $23.00 $15.00 $15.00 $15.00 $15.00

Montana $111.78 $116.37 $121.46100% $137.34 $100.59 $107.47 $107.11 $117.15

Nebraska $95.16 $100.17 $110.18NP $120.20 $80.13 $85.14 $90.15 $95.16

Nevada $59.07 $59.07 $59.0749.65% $59.07 $59.07 $59.07 $59.07 $59.07

New Hampshire $44.80 $44.80 $44.805% $47.04 $62.07 $62.07 $62.07 $62.07

New Jersey $80.06 $86.53 $85.172% $92.67 $64.05 $71.54 $70.86 $77.68

New Mexico $150.55 $150.55 $150.5512.6% $150.55 $89.83 $89.83 $89.83 $89.83

New York $56.22 $60.68 $59.69NP $64.87 $44.89 $50.07 $49.57 $54.28

North Carolina

North Dakota $157.26 $164.48 $171.18NP $193.35 $141.79 $151.07 $150.56 $164.99

Ohio

Oklahoma $91.92 $95.97 $100.25100% $113.66 $82.62 $88.61 $88.83 $96.93

Oregon $84.89 $88.68 $92.2710% $104.46 $76.20 $81.36 $81.09 $89.02

Pennsylvania $20.00 $20.00 $20.009% $20.00 $20.00 $20.00 $20.00 $20.00

Rhode Island

South Carolina $79.43 $87.04 $85.359% $92.95 $62.53 $70.98 $70.14 $76.05

South Dakota

Tennessee NP NP NPNP NP NP NP NP NP

Texas $82.82 $90.62 $90.25NP $98.42 $76.20 $79.28 $83.03 $90.55

Utah

Vermont $88.35 $92.57 $96.50100% $108.77 $79.52 $84.89 $84.61 $93.05

Virginia $80.92 $24.32 $87.976% $99.46 $72.83 $77.79 $77.53 $84.84

Washington $91.31 $95.36 $99.4016% $112.12 $82.06 $87.84 $87.27 $95.65

West Virginia $55.17 $58.84 $62.52NP $73.29 $49.91 $55.17 $55.17 $62.52

Wisconsin

Wyoming $95.16 $104.17 $103.77NP $113.17 $81.84 $91.24 $95.85 $99.86

Page 1

*Tennessee does not have a fee-for-service program. CA, CO, DE, HI, NC, OH, RI, SD, UT, WI, and WY had not provided fee data as of compilation of this report. FL and MA provided URL links to fee schedules only. Fees for these 2 states, where shown, were compiled from fee data located through state-provided links. ~ State report of proportion of Medicaid-covered children enrolled in state-administered medical fee-for-service plan. Fees shown in this report apply to children in these (FFS) plans only. They do not apply to children enrolled in managed care plans.

99406 99407 99408 99409 99420 99201 99202 99203 99204State


*$8.60 $17.12 NA NA $30.00 $53.00 $100.52 $111.00NAAlabama

$24.42 $48.53 $62.51 $122.46 $70.46 $123.13 $179.60 $280.39NPAlaska$11.01 $21.74 NP NP $30.49 $52.45 $76.14 $117.03$8.41Arizona$20.00 $25.00 NA NC $29.70 $45.10 $64.90 $88.00NCArkansas

California

Colorado$7.56 $12.59 $22.40 $43.01 $33.48 $58.05 $85.69 $129.27$18.00Connecticut

Delaware$12.39 $24.35 $31.27 $60.82 $39.59 $67.61 $97.86 $149.27NPDistrict of Columbia

$8.41 $16.50 NP NP $35.76 $37.49 $55.79 $78.90NPFlorida$10.51 $20.71 NA NA $29.67 $40.70 $62.71 $110.51NAGeorgia

Hawaii$11.96 $23.59 $30.10 $58.62 $34.15 $59.02 $86.54 $133.19NPIdaho

$7.19 $15.29 NC NC $29.55 $33.60 $43.55 $69.65$14.60IllinoisNC NC $27.26 $53.20 $30.65 $52.90 $76.71 $118.22NPIndiana

Not Allowed $66.02 $33.78 $65.95 $36.82 $57.82 $81.37 $117.82$8.19Iowa

KansasNP $52.03 NP NP $29.66 $53.00 $79.04 $112.27NPKentuckyNP NP NP NA $29.52 $51.33 $74.62 $115.88NALouisiana

$8.67 $16.81 $21.04 $41.08 $23.91 $41.55 $60.20 $93.60$7.53Maine$13.15 $25.20 $32.39 $63.44 $40.97 $69.70 $101.20 $153.32NPMaryland

NSP $53.74 NSP NSP $31.59 $54.19 $77.94 $118.82NSPMassachusetts$7.92 $15.25 NA NA $44.86 - $41.72 $77.15 -$72.01 $80.46 $122.14NAMichigan

$10.60 $20.94 $26.80 $52.48 $33.50 $57.51 $82.92 $126.19$8.37Minnesota$11.66 $23.48 NC NC $35.06 $61.65 $89.66 $138.72NCMississippi

$8.00 $12.00 $22.00 $35.00 $25.30 $42.05 $62.62 $88.68Missouri$14.06 $27.79 $35.75 $69.68 $43.64 $75.02 $109.05 $167.68$10.83Montana$13.79 $23.64 NP NP $32.30 $47.21 $69.58 $104.21NPNebraska$12.46 $24.32 NP $25.68 $46.56 $69.84 $99.01NPNevada

$8.32 $16.33 $37.33 $71.64 $20.16 $33.60 $42.56 $63.84$5.36New Hampshire$10.42 $20.45 $24.34 $47.74 $31.74 $56.10 $83.37 $117.67New Jersey$13.19 $25.83 $13.59 $26.96 $35.18 $62.74 $93.52 $132.71$12.05New Mexico$10.00 $19.00 NA NA $22.74 $38.90 $56.93 $86.41NANew York

North Carolina$20.11 $39.13 NP NP $61.36 $105.70 $152.62 $234.08NPNorth Dakota

Ohio$11.79 $23.37 $30.08 NC $35.42 $61.34 $89.29 $138.22NCOklahoma$10.86 $21.00 $27.00 $52.84 $33.38 $57.06 $82.56 $125.86$8.33Oregon

NP $19.33 NP NP $20.00 $35.33 $54.25 $90.37NPPennsylvania

Rhode IslandNP $21.33 $26.78 $52.59 $27.83 $48.32 $69.96 $108.72$8.14South Carolina

South DakotaNP NP NP NP NP NP NP NPNPTennessee

$11.51 $22.45 Not Payable Not Payable $28.29 $44.65 $60.33 $88.27Not PayableTexas

Utah$11.32 $21.86 $28.09 $54.74 $34.74 $59.49 $86.37 $131.24$8.84Vermont

$9.43 $18.61 $25.84 $50.38 $33.42 $57.44 $83.40 $128.14$7.83VirginiaNC $16.41 $21.03 $40.80 $34.96 $59.81 $86.11 $131.48NCWashington

$9.19 $18.39 NC NC $18.91 $35.73 $55.43 $93.26NPWest Virginia

Wisconsin$13.53 $25.95 NP NP $40.33 $69.70 $99.86 $153.90NPWyoming

Page 2

*Tennessee does not have a fee-for-service program. CA, CO, DE, HI, NC, OH, RI, SD, UT, WI, and WY had not provided fee data as of compilation of this report. FL and MA provided URL links to fee schedules only. Fees for these 2 states, where shown, were compiled from fee data located through state-provided links.

State 99211 99212 99213 99214 99215 92551 9256799205


*$142.00 $17.00 $31.00Alabama $42.00 $98.00 $15.75 $14.00$67.00

$352.32 $31.95 $70.97Alaska $121.87 $244.66 $16.69 $24.67$181.21

$145.84 $14.11 $30.75Arizona $51.45 $101.71 $10.05 $15.56$75.94

$137.50 $14.30 $27.50Arkansas $36.30 $106.00 $9.90 $16.50$70.05

California

Colorado$161.96 $19.27 $34.62Connecticut $55.41 $113.06 $6.49 $14.19$83.87

Delaware$185.32 $18.50 $39.94District of Columbia $66.06 $129.64 $14.78 $13.26$97.16

$100.26 $14.30 $29.15Florida $35.88 $69.09 NP NP$53.19

$137.12 $17.46 $29.67Georgia $40.70 $93.46 $5.62 $18.46$62.71

Hawaii$167.67 $18.25 $35.15Idaho $57.45 $117.01 $14.59 $12.40$86.45

$74.10 $12.88 $25.65Illinois $46.56 $49.95 $15.20 $15.20$72.97

$147.68 $14.17 $30.90Indiana $51.99 $103.18 $8.09 $10.49$76.88

$146.89 $18.10 $31.36Iowa $43.23 $99.95 $14.11 $18.25$66.80

Kansas$143.29 $16.98 $31.08Kentucky $42.63 $98.39 $12.24 $14.87$67.10

$146.62 $14.82 $29.79Louisiana $49.84 $101.92 $8.27 $14.15$75.18

$118.41 $13.17 $24.14Maine $40.51 $82.60 $11.08 $10.99$61.05

$192.40 $18.72 $40.97Maryland $67.54 $135.13 $7.73 $16.15$100.21

$147.51 $15.41 $31.87Massachusetts $52.37 $103.84 $9.38 $11.72$77.46

$153.27 $14.77 $32.18Michigan $53.82 $107.63 $6.74 $8.12$79.40

$158.02 $15.63 $33.50Minnesota $56.11 $111.68 $8.33 $10.10$82.92

$173.50 $16.34 $35.88Mississippi $60.71 $120.83 $10.40 $12.25$89.90

$112.84 $16.15 $27.50Missouri $36.38 $77.69 $29.20 $13.13$54.74

$208.81 $20.15 $44.00Montana $73.58 $145.27 $11.91 $14.77$108.55

$131.18 $17.39 $29.82Nebraska $45.09 $46.91 $13.79 $13.23$67.78

$125.77 $15.52 $27.56Nevada $38.26 $87.77 $8.62 $17.85$59.67

$80.64 $15.43 $31.10New Hampshire $42.72 $75.04 $5.00 $8.00$65.79

$149.24 $18.90 $33.43New Jersey $45.48 $103.11 $16.10 $15.78$71.20

$169.19 $20.25 $36.89New Mexico $50.52 $116.27 $11.21 $19.88$79.45

$108.35 $12.56 $23.48New York $37.41 $75.80 $6.38 $6.38$56.18

North Carolina$291.83 $28.87 $61.87North Dakota $103.64 $204.69 $17.01 $21.14$152.62

Ohio$172.84 $16.23 $35.69Oklahoma $60.41 $120.19 $9.09 $12.17$89.43

$158.12 $15.23 $33.38Oregon $55.53 $111.17 $8.37 $10.24$82.45

$117.54 $20.00 $35.50Pennsylvania $35.00 $78.50 $8.00 $12.00$54.42

Rhode Island$137.51 $14.09 $28.09South Carolina $47.12 $95.99 $7.77 $6.36$70.99

South DakotaNP NP NPTennessee NP NP NP NPNP

$109.74 $14.66 $24.54Texas $36.89 $79.75 $10.38 $11.79$51.80

Utah$164.52 $16.05 $34.74Vermont $58.14 $115.88 $9.71 $11.70$85.76

$159.62 $15.46 $33.69Virginia $56.34 $111.29 $10.20 $12.68$83.12

$163.55 $16.47 $35.25Washington $58.37 $115.01 $7.15 $8.83$86.11

$121.63 $6.57 $18.39West Virginia $36.25 $80.12 $7.62 $7.62$55.96

Wisconsin$194.23 $19.58 $40.33Wyoming $67.36 $136.28 NP $14.66$95.57

Page 3


State 99174 99188 96110


99173 99460 99462 99463 99464 99465*Alabama NC NP $10.00$5.00 $50.00 $28.00 $68.00 $66.00 $123.00

Alaska $10.55 $28.50 $11.57$3.90 $171.33 $75.73 $203.49 $129.61 $264.72

Arizona $6.39 $18.58 $7.00$2.43 $67.04 $29.83 $81.13 $56.25 $116.89

Arkansas NC NA NC$22.10 $108.16 NC $108.16 NC $144.72

California

Colorado

Connecticut MP $20.00 $18.00$7.60 $51.09 $27.23 $68.79 $64.07 $132.82

Delaware

District of Columbia $9.40 $29.00 $10.30$3.59 $82.93 $36.99 $101.30 $62.05 $129.86

Florida NP NP NPNP $44.50 $23.84 $59.15 $43.04 $87.10

Georgia NA NA $11.77$5.62 $64.89 $34.66 $83.17 $82.53 $162.57

Hawaii

Idaho $5.96 $14.26 $6.80$26.32 $82.12 $36.36 $98.67 $61.75 $127.12

Illinois NP NP $16.07$7.45 $38.75 $16.40 $42.55 $83.70 $94.50

Indiana $5.15 NC $5.61$1.90 $69.01 $30.58 $83.07 $51.86 $106.96

Iowa Not Allowed Not Allowed $61.51$2.09 $69.24 $36.97 $88.75 $88.11 $173.54

Kansas

Kentucky $21.93 NA $32.19$60.00 $45.99 $24.63 $61.12 $57.26 $119.57

Louisiana NP $24.05 NP$2.00 $46.97 $24.98 $62.67 $59.13 $120.72

Maine $5.26 NC $8.99NP $54.04 $22.75 $63.80 $66.22 $97.34

Maryland NA NA $8.86$2.16 $91.41 $38.10 $110.83 $68.44 $138.73

Massachusetts $22.76 NP $9.73NP $63.30 $33.55 $86.19 $52.66 $158.05

Michigan NA $9.00 - $13.23 $9.20NA NA NA NA NA NA

Minnesota $5.05 $14.00 $6.56$2.02 $76.22 $31.82 $91.85 $56.95 $115.86

Mississippi NC NC $38.87$8.82 $81.80 $36.28 $98.16 $61.62 $127.01

Missouri NP $13.56 NPNP $60.00 $24.75 $66.80 $55.00 $128.61

Montana NP $19.52 $8.32$2.94 $106.96 $47.71 $129.65 $80.40 $167.69

Nebraska NC $15.76 $14.18NC $109.34 $49.70 $126.73 $100.47 $110.32

Nevada NP $12.30 $11.68NP $42.20 $22.44 $56.57 $53.00 $108.78

New Hampshire NC NC $5.00$5.00 $33.46 $17.89 $44.98 $42.05 $86.41

New Jersey BR NA $7.28$5.00 $51.37 $26.98 $69.22 $65.14 $127.74

New Mexico $20.64 NC $12.05$39.93 $65.60 $34.47 $87.80 $83.30 $163.28

New York NA $30.00 NANA $22.99 $12.26 $30.89 NA $59.36

North Carolina

North Dakota $10.83 NA $11.86$4.12 $134.57 $59.81 $162.93 $101.06 $208.30

Ohio

Oklahoma NC $14.53 $6.33$2.19 $81.36 $36.13 $97.68 $61.33 $126.61

Oregon NA $12.94 $6.63$2.17 $76.45 $32.01 $92.02 $57.32 $116.02

Pennsylvania NA$18.00 (after 8.1.15) $6.99$6.00 $35.63 $18.92 $47.98 $46.50 $90.98

Rhode Island

South Carolina NA $15.89 $7.11NA $43.83 $23.40 $58.63 $55.19 $112.83

South Dakota


Texas Not Payable Not Payable $7.58NC $78.75 Not Payable $107.36 $107.36 Not Payable

Utah

Vermont $5.95Percent of billed $7.69$2.50 $79.28 $33.26 $95.80 $59.33 $120.60

Virginia $6.49 $20.79 $7.11$2.47 $73.18 $32.59 $88.65 $54.96 $114.33

Washington $4.63 NC $5.05BO $77.44 $34.39 $93.62 $42.07 $87.29

West Virginia NC NC $6.04$2.10 $70.67 $29.69 $85.11 $53.33 $107.97

Wisconsin

Wyoming NP $35.00 $13.16NP $58.29 $31.21 $77.47 $72.58 $151.56

Page 4


54150 90460 90461 90471 90472 90473 90474 96150 96151State


*$172.00 $17.00 $8.00 $5.00 NA NA NA NA$7.00Alabama$255.77 $38.32 $20.63 $38.32 $38.32 $20.63 $34.18 $32.98$20.63Alaska

NP $21.40 $10.72 $21.40 $21.40 $10.72 $18.46 $17.84$10.72Arizona$761.71 NC NC NC NC NC NC NCNCArkansas

California

Colorado$80.07 $15.05 NC $12.52 $8.18 $5.43 $14.46 $14.01$6.45Connecticut

Delaware$141.94 $28.06 $13.68 $23.38 $23.38 $11.40 NC $17.89$11.40District of Columbia

NP $10.00 NP NP NP NP NP NPNPFlorida$154.82 $10.00 NA $10.00 $10.00 $10.00 $22.80 $22.19$10.00Georgia

HawaiiNC $22.98 $11.67 $22.98 $22.98 $11.67 $18.90 $18.25$11.67Idaho

$77.50 NA NA NA NA NA MOA MOANAIllinois$110.17 NC NC $17.61 $17.61 $8.90 $16.88 $16.31$8.90Indiana$161.47$19.68 (VFC Cap) $10.51 $5.09 $12.88 $6.86 $21.16 Not allowed$5.09Iowa

Kansas$76.27 $3.30 $3.30 $3.30 $3.30 $3.30 $15.75 $15.21$3.30Kentucky

$137.82 NA NA $14.70 $10.43 $9.13 NP NP$9.13Louisiana$92.08 NA NA $13.43 $8.93 $5.94 $15.46 $14.95$6.84Maine

$144.79 NA NA NA NA NA $26.91 $25.29NAMarylandNP $23.29 NC $18.23 $18.23 $8.83 NC NC$8.83Massachusetts

$86.57 $7.00 NC $7.00 $3.00 $3.00 NA NA$7.00Michigan$107.56 $19.82 $9.49 $19.82 $19.82 $9.49 $17.24 $16.37$9.49Minnesota

NC $10.00 NP $20.21 $10.00 $10.00 NC NC$10.36Mississippi$113.83 $12.84 $6.28 $12.34 $7.85 $5.36 $12.00 $12.00$6.25Missouri$157.64 $21.32 NC $21.32 $21.32 $12.69 $21.59 $20.87$12.69Montana

$90.49 NC NC $5.80 $5.80 $5.80 NC NC$5.80Nebraska$186.82 $7.80 NP $7.80 $7.80 $7.80 $22.77 $22.15$7.80Nevada

$80.00 $6.20 $3.50 $3.68 $3.00 $5.00 $15.76 $15.40$5.00New Hampshire$168.40 NA NA $16.18 $12.12 $8.43 $21.18 $20.49$11.50New Jersey$224.66 $20.80 $20.80 $20.80 $20.80 $20.81 $22.79 $22.79$20.80New Mexico$119.33 $17.85 NA $13.23 $8.57 $2.00 NA NA$2.00New York

North Carolina$219.65 NP NP $15.04 $15.04 $15.04 $23.20 $22.42$15.04North Dakota

Ohio$128.18 $17.48 NC $20.05 $20.05 $10.30 $14.98 $18.09$10.30Oklahoma$108.65 $19.29 NA $19.29 $19.29 $9.79 $15.33 $14.58$9.79Oregon

$79.00 NA NA NA NA NA $20.38 $19.94NAPennsylvania

Rhode IslandNA $12.61 $12.61 $3.72 $3.72 $3.72 $21.01 $17.33$3.72South Carolina

South DakotaNP NA NA NA NA NA NP NPNATennessee

$127.71 $7.84 $3.92 $7.84 $7.84 $7.84 $16.84 $16.28$7.84Texas

Utah$123.71 $20.35 $9.98 $20.35 $20.35 $9.98 $17.34 $16.48$9.98Vermont$134.82 $11.00 NC NC NC NC $18.55 $17.93NCVirginia

$93.18 NC NC $15.35 NC NC $12.83 $12.41$7.57Washington$72.24 NP NP $16.29 $16.29 $8.41 NC NC$8.41West Virginia

Wisconsin$165.48 $21.72 NC $10.00 $10.00 $10.00 NP NP$10.00Wyoming

Page 5


State 97802 97803 99222 99223 99232 99233 9923896152


*NA $40.00 $38.00Alabama $81.00 $40.00 $57.00 $51.00$113.00

$31.35 $25.00 $17.50Alaska $244.69 $128.82 $185.62 $127.38$361.26

$16.92 $30.65 $26.35Arizona $109.21 $57.05 $82.19 $57.31$160.89

NC NC NCArkansas $92.40 $50.60 $68.20 $52.80$141.90

California

Colorado$3.25 NC NCConnecticut $73.37 $57.66 $82.29 $40.82$106.65

Delaware$16.94 $32.14 $27.66District of Columbia $36.00 $63.54 $91.54 NC$179.56

NP NP NPFlorida $79.32 $41.81 $60.25 $42.22$117.44

NA $14.89 $14.89Georgia $99.20 $48.02 $67.47 $57.11$132.67

Hawaii$17.33 NC NCIdaho $118.24 $62.14 $89.56 $62.16$174.50

MOA QMB only QMB onlyIllinois $51.40 $24.90 $35.05 $29.65$69.00

$15.47 $25.63 $22.00Indiana $99.60 $52.29 $75.37 $52.39$146.98

$19.08 $15.19 $15.19Iowa $107.01 $51.88 $72.99 $61.82$143.59

Kansas$15.21 $11.87 $11.87Kentucky $85.60 $42.24 $60.07 $53.11$119.25

NP NP NPLouisiana $102.41 $55.71 $79.83 $55.01$150.65

$14.22 $19.59 $17.12Maine $82.56 $445.06 $64.54 $44.44$121.62

$5.50 $30.03 $26.35Maryland $126.60 $66.65 $96.08 $67.58$187.43

NC $23.98 $20.93Massachusetts $96.80 $51.02 $73.22 $51.24$142.30

NA NA NAMichigan NA NA NA NANA

$15.78 $22.04 $19.08Minnesota $104.42 $55.28 $79.85 $55.56$154.67

NC NC NCMississippi $118.02 $61.93 $89.23 $61.79$174.16

$12.00 NC NCMissouri $72.11 $38.98 $55.89 $39.76$105.94

$19.79 $36.04 $31.02Montana $140.03 $72.90 $105.00 $73.23$206.05

NC NC NCNebraska $86.68 $47.28 $78.80 $70.92$112.29

$21.23 NP NPNevada $81.61 $40.40 $57.53 $49.77$113.73

$14.68 NC NCNew Hampshire $96.32 $33.60 $47.04 $53.28$112.00

$19.41 $16.24 $16.24New Jersey $95.73 $47.25 $67.16 $60.27$133.33

$22.20 $16.44 $16.44New Mexico $136.54 $71.84 $103.61 $72.17$202.05

NA NA NANew York $48.07 $26.01 $37.28 $26.74$70.62

North Carolina$21.27 NA NANorth Dakota NP NP NP NPNP

Ohio$13.75 $29.86 $25.64Oklahoma $117.76 $61.66 $88.82 $61.48$173.58

$13.89 $24.54 $21.08Oregon $105.20 $55.62 $80.07 $56.08$155.84

$19.60 NA NAPennsylvania $29.50 $17.00 $17.00 $17.00$42.00

Rhode Island$16.48 $22.76 NASouth Carolina $95.68 $52.25 $74.83 $51.54$140.97

South DakotaNP NP NPTennessee NP NP NP NPNP

$15.44 NP NPTexas Not Payable Not Payable Not Payable Not PayableNot Payable

Utah$15.71 $28.00 $24.07Vermont $109.31 $57.81 $83.42 $57.92$161.27

$17.01 $30.92 $26.59Virginia $106.87 $55.78 $80.36 $56.06$157.41

$11.57 $21.45 $18.30Washington $78.24 $42.91 $61.63 $43.12$115.47

NC $22.85 NCWest Virginia $98.78 $52.01 $75.13 $51.23$145.01

WisconsinNP NP NPWyoming $127.87 $70.33 $100.79 $68.82$188.80

Page 6


State 99354 99355 99356


99339 99357 99358 99359 99367 99442*Alabama $71.00 $70.00 $65.00$63.00 $66.00 NA NA NA NA

Alaska $175.53 $172.46 $163.11NC $162.09 NC NC NC NC

Arizona $79.03 $77.34 $72.83$61.78 $72.27 $86.97 $42.06 $44.90 $21.46

Arkansas $106.00 $55.64 $106.00NC $55.00 NC NC NC NC

California

Colorado

Connecticut $56.41 $55.96 $51.51$31.10 $51.70 NC NC NC NC

Delaware

District of Columbia $88.75 $86.69 $81.43NC $80.74 NC NC $49.98 NC

Florida $57.59 $55.95 $53.09$45.09 $52.47 NP NP NP NP

Georgia $90.61 $88.37 $79.12NA $79.72 NA NA NA NA

Hawaii

Idaho $85.62 $83.88 $79.06NC $78.48 NC NC NC NC

Illinois NP NP NPNP NP NA NA NP NP

Indiana $72.16 $70.68 $66.59NC $66.09 NC NC NC NC

Iowa $97.16 $94.89 $85.38Not allowed $85.94 Not allowed Not allowed Not allowed $35.70

Kansas

Kentucky $71.96 $70.67 $68.88NA $67.00 NA NA $163.38 NA

Louisiana NP NP NPNP NP NP NP NP NP

Maine $61.46 $60.89 $56.22NA $56.57 NA NA $34.82 NA

Maryland $92.12 $89.40 $84.73NA $83.69 NA NA NA NA

Massachusetts $70.81 $69.97 $64.34$57.10 $64.62 $79.35 $38.33 $41.03 $19.63

Michigan $55.47 $53.69 NANA NA NA NA NA NA

Minnesota $76.50 $73.98 $70.35NC $69.88 NC NC NC NC

Mississippi $85.16 $83.48 $78.76NC $78.20 NC NC NC NC

Missouri $81.40 $55.00 $74.27NC $55.00 NC NC NC NC

Montana $101.05 $98.90 $93.16NC $92.45 NC NC NC $27.59

Nebraska $78.80 $39.40 $86.68NC $43.34 NC NC NC NC

Nevada $90.18 $84.02 $64.75NP $65.56 NP NP $47.77 NP

New Hampshire $60.48 $58.24 $56.00NC $56.00 $33.74 $26.89 $16.80 $5.60

New Jersey $84.46 $83.48 $77.18NA $77.81 NA NA NA NA

New Mexico $97.45 $96.41 $91.01NP $89.94 NP NP NP NP

New York $55.42 $54.46 $33.56 NA $33.71 NA NA NA NA

North Carolina

North Dakota NP NP NPNP NP NP NP NP NP

Ohio

Oklahoma NC NC NC$65.74 NC NC NC $48.54 NC

Oregon $76.53 $74.37 $70.60$59.85 $69.86 NA NA NA $20.73

Pennsylvania NP NP NPNP NP NP NP NP NP

Rhode Island

South Carolina $71.28 $76.07 $65.16NA $71.15 NA NA NA NA

South Dakota


Texas $59.30 $26.93 NP$64.42 NP $92.02 $44.31 $39.30 NP

Utah

Vermont $79.49 $76.91 $13.25NP $72.47 NP NP $34.00 NP

Virginia $77.32 $75.67 $71.25NC $70.70 NC NC $43.91 NC

Washington $59.52 $58.26 $54.69$46.69 $54.27 BO BO $52.58 $16.20

West Virginia $65.94 $64.10 $65.15$54.38 $64.62 $78.55 $37.57 NC NC

Wisconsin

Wyoming $95.15 $93.64 $86.50NC $86.87 $110.19 $53.03 $57.16 $27.07

Page 7


99447 99448 99490 81000 81002 86580 87081 87880 90791State


*NA NA $28.01 $4.00 $6.00 $8.00 $14.00 $106.83$3.00AlabamaNC NC NC $4.32 $11.06 $9.05 $16.36 $247.50$3.49AlaskaNC NC NC $3.74 $6.70 $7.83 $14.15 $114.97$3.02ArizonaNC NC NC $4.52 $8.80 $9.47 $12.87 $182.31$3.66Arkansas

California

ColoradoNC NC NC $3.02 $3.57 $6.34 $11.45 $147.50$2.44Connecticut

Delaware$24.04 NC NC $2.20 $7.58 $4.00 $7.00 NP$2.00District of Columbia

NP NP $23.71 NP NP NP NP NPNPFloridaNA NA NA $3.99 $8.13 $8.38 $15.08 $128.24$3.21Georgia

HawaiiNC NC NC $3.89 $6.25 $6.05 $14.34 $116.89$3.14IdahoNP NP NP $2.62 $4.00 $5.80 $15.70 $121.11$2.60IllinoisNC NC NC $4.31 $5.37 $9.02 $16.32 $104.56$3.48Indiana

Not allowed Not allowed $38.25 $4.50 $9.12 $8.32 $17.04 $103.14$3.64Iowa

KansasNA NA NA NA $6.95 NA NA $122.40NAKentuckyNP NP NP $3.16 $5.83 $6.59 $13.13 $102.85$2.54LouisianaNA NA NA $3.84 $5.76 $5.40 $13.00 $72.58$3.42MaineNA NA NA $3.38 $6.52 $7.05 $12.76 $146.63$2.72MarylandNP NP NP $3.24 - $3.27 NP $6.78 - $6.84 $11.70 -$11.81 $117.42$2.62 -$2.64MassachusettsNA NA NA $2.64 $4.36 $4.74 $13.12 $72.31$1.10Michigan

By report By report NC $4.31 $7.77 $8.26 $16.32 $116.96$3.48MinnesotaNC NC NC $3.89 $6.08 $8.15 $14.72 $116.73$3.14MississippiNC NC $26.30 $3.30 $5.50 $8.69 $15.77 NR$1.83MissouriNC NC NC $4.30 $7.96 $7.72 $16.32 $134.76$3.48MontanaNC NC NC $4.31 $7.22 $9.02 $16.32 $171.40$3.48NebraskaNP NP $37.53 $2.22 $13.33 $4.64 $8.39 $139.46$1.79NevadaNC NC NC $2.72 $4.15 $4.96 $9.85 $87.82$2.20New HampshireNA NA $2.85 $1.20 $4.00 $9.00 $12.00 $130.00$1.00New JerseyNP NP $41.27 $4.31 $7.32 $9.02 $16.32 NR$3.48New MexicoNA NA NA $4.00 $5.00 $5.20 $3.75 $93.26$2.00New York

North CarolinaNP NP NA $4.32 NA $7.75 $16.36 $190.26$3.49North Dakota

OhioNC NC NC $3.65 $6.05 $7.65 $13.84 NR$2.70OklahomaNA NA $29.85 $3.02 $5.39 $6.31 $11.42 $92.39$2.44OregonNP NP NA $4.23 $4.00 $5.20 $6.30 NR$3.57Pennsylvania

Rhode Island$61.45 $86.56 NA $3.60 $5.02 $7.56 $13.67 $66.26$2.92South Carolina

South DakotaNP NP NP NP NP NP NPNPTennesseeNP NP NP Not Payable $6.74 NP NP $119.82Not PayableTexas

UtahNP NP NP $4.36 $6.25 $5.69 $16.01 $104.13$2.49VermontNC NC NC $3.65 $6.80 $7.66 $13.86 $115.65$2.96VirginiaNC NC NC $3.46 $4.84 $7.26 $13.12 NR$2.80WashingtonNC NC NC $4.31 $4.99 $9.02 $16.32 $91.42$3.20West Virginia

WisconsinNC NC $42.12 $3.21 $6.39 $5.29 $15.08 $162.09$2.58Wyoming

Page 8


State 90832 90837 90887 90889 96111 96127 9500490792


*$89.85 $44.60 $85.41Alabama $36.00 $103.00 NA $2.48NA

NC $120.59 $239.83Alaska NC $233.35 SE $9.21NC

$123.90 $55.65 $110.39Arizona $76.64 $111.42 NC $5.48$52.56

$161.45 $77.22 $153.78Arkansas $12.96 $69.72 NC $2.88NC

California

Colorado$147.50 $61.51 $135.19Connecticut $82.29 $87.00 $18.00 $3.26NC

DelawareNC NC NCDistrict of Columbia NC NC $5.19 $6.16NC

NP NP NPFlorida NP NP NP NPNP

$105.37 $53.22 $111.16Georgia NR $62.10 NR $3.50NR

Hawaii$126.11 $56.66 $112.56Idaho $48.59 $111.93 $4.21 $5.12$48.55

$124.44 $29.48 $66.71Illinois QMB only $16.07 NP $1.70QMB only

$112.78 $50.65 $100.60Indiana C-NP $94.13 $3.88 $4.40C-NP

$85.86 $42.90 $81.59Iowa Not allowed $120.41 $61.51 $3.46Not allowed

Kansas$102.72 $51.08 $97.68Kentucky NR $49.92 NR $2.82NR

$86.64 $51.57 $98.87Louisiana NP NP SE $4.41NP

$60.42 $30.23 $57.43Maine NP $86.59 $3.37 $3.54NP

$146.63 $48.38 $97.83Maryland NA $95.52 $4.71 $4.44NA

$95.06 $48.53 $90.29Massachusetts $64.99 $91.83 SE $5.16IC

$80.23 $36.05 $70.13Michigan $49.33 $71.32 $2.97 $3.57NA

$129.96 $57.50 $113.39Minnesota $79.27 $89.38 SE $4.29NC

$125.90 $56.66 $112.55Mississippi NP $117.90 SE $5.00NP

NR NR NRMissouri NR NR NR $3.39NR

$145.16 $65.27 $129.38Montana NC $131.07 $5.45 $6.53NC

$239.69 $74.83 $154.39Nebraska $28.26 $143.81 $39.40 $2.75NC

$113.76 $57.78 $108.15Nevada NA $112.36 $4.82 $3.39NP

$65.00 $32.50 $72.00New Hampshire $45.00 $38.99 SE $1.63$45.00

$130.00 $55.77 $43.21New Jersey $69.84 $123.15 $203/$256 $3.75NA

NR NR NRNew Mexico NR $60.52 NR $3.77NR

$76.13 $38.64 $72.35New York NA $150.00 NC $3.65NA

North Carolina$205.21 $91.78 $182.52North Dakota $126.32 $183.55 NA $9.28NA

Ohio$125.20 NR NROklahoma NR NR NR $4.99NR

$103.45 $70.74 $166.31Oregon $90.14 $90.50 $3.65 $4.41NA

NR NR NRPennsylvania NR $20.00 NR $1.50NR

Rhode Island$70.34 $35.17 $66.85South Carolina $66.87 $100.27 $3.91 $4.13NA

South Dakota

Tennessee NANP

$119.82 $49.39 $100.78Texas NA $104.69 SE $5.61NA

Utah$115.63 $51.55 $100.96Vermont NP $102.45 $186.21 $5.09NP

$124.62 $55.97 $111.01Virginia NC $112.25 NP $5.57NC

NR NR NRWashington NR $76.77 SE $4.00NR

$101.40 $46.76 $91.16West Virginia $54.64 $87.48 NC $3.94Bundled

Wisconsin$172.62 $58.29 $113.95Wyoming NC $133.13 NC $6.39NC

Page 9


State 95018 95024 95115


95017 95117 32551 92950 93303 93307*Alabama $13.69 $4.00 $9.28$5.54 $11.78 $97.73 $216.00 $149.00 $134.00

Alaska $31.17 $11.26 $12.60$12.94 $14.64 $313.12 $507.64 $365.96 $206.36

Arizona $17.12 $6.70 $7.61$7.03 $8.83 $156.69 $260.87 $204.16 $113.14

Arkansas Not Payable $4.19 $11.02Not Payable $14.16 $231.46 $189.20 $261.91 $195.80

California

Colorado

Connecticut $13.57 $4.54 $9.33$40.14 $11.62 $104.67 $183.67 $144.30 $128.51

Delaware


Florida NP NP NPNP NP NP NP NP NP

Georgia $18.64 $5.11 $13.41$7.56 $17.25 $130.58 $189.40 $198.86 $185.42

Hawaii

Idaho $16.53 $6.28 $7.11$7.25 $8.27 $151.55 $256.13 $140.86 $109.53

Illinois $4.24 $2.50 $6.50$2.26 $8.30 $224.70 $112.50 $98.10 $91.00

Indiana $14.08 $5.39 $6.11$5.76 $7.10 $128.20 $216.88 $167.79 $93.25

Iowa $18.90 $5.07 $13.35$7.64 $17.22 $136.77 $202.93 $203.17 $277.87

Kansas

Kentucky $22.60 $4.10 $10.54$65.30 $13.37 $139.15 $176.52 $166.87 $157.16

Louisiana $16.91 $5.22 $7.91$6.89 $9.54 $144.84 $218.62 $169.94 $137.41

Maine $14.04 $4.21 $7.29$5.71 $9.28 $113.88 $155.21 $137.18 $110.55

Maryland $18.75 $5.32 $10.20$7.61 $12.67 $128.39 $212.81 $171.05 $148.36

Massachusetts $23.83 $6.00 $8.27$70.79 $10.22 $126.62 $213.80 $167.28 $117.77

Michigan $10.50 $4.36 $4.95$4.36 $5.74 NA $170.96 $132.53 $72.50

Minnesota $13.38 $5.30 $6.06$5.30 $7.07 $115.39 $213.61 $170.43 $92.92

Mississippi $16.17 $6.12 $6.91$6.66 $8.03 $153.37 $253.23 $191.66 $106.97

Missouri $13.25 $4.07 $7.44$5.41 $9.23 $118.80 $169.68 $132.56 $121.00

Montana $20.15 $7.96 $9.04$8.32 $10.47 $188.12 $307.36 $239.83 $132.93

Nebraska $7.88 $3.94 $12.50$3.94 $17.50 $159.69 $145.78 $216.71 $232.46

Nevada $27.78 $4.92 $12.62$81.95 $16.00 $214.89 $176.00 $181.85 $165.85

New Hampshire $3.15 $2.21 $7.00$1.64 $9.73 $88.76 $1.64 $128.89 $121.89

New Jersey $11.03 $5.50 $2.50$4.50 $2.50 $145.41 $270.95 $196.65 $145.69

New Mexico $20.37 $5.48 $14.05$8.33 $17.81 $141.27 $300.10 $208.43 $188.98

New York $13.76 $4.39 NA$5.58 NA $105.41 $175.24 $176.27 $152.90

North Carolina

North Dakota $28.87 $11.34 $12.89$11.86 $14.95 $248.00 $432.07 $343.39 $189.74

Ohio

Oklahoma $16.05 $6.10 $6.88$6.63 $7.99 $154.36 $252.02 $55.28 $39.29

Oregon $13.18 $5.40 $6.14NA $7.13 $120.80 $214.25 $166.48 $91.42

Pennsylvania $5.61 $5.00 $3.00$2.96 $7.00 $132.00 NA $62.25 $45.38

Rhode Island

South Carolina $15.94 $4.92 $7.40$46.40 $8.99 $65.82 $204.89 $160.07 $128.99

South Dakota

Tennessee

Texas $24.14 $6.74 $7.86$70.73 $8.98 Not Payable $254.01 $174.30 $100.80

Utah

Vermont $15.17 $6.25 $7.11$6.24 $8.27 $136.45 $244.88 $192.13 $105.02

Virginia $17.32 $6.80 $7.73$7.11 $8.97 $158.63 $263.46 $206.56 $114.41

Washington $12.20 $4.84 $5.47$5.05 $6.31 $104.95 $82.57 $146.60 $80.98

West Virginia $4.99 $0.79 $5.52$2.63 $6.30 $128.46 $138.71 $153.42 $84.85

Wisconsin

Wyoming $19.18 $7.14 $9.02$56.79 $11.28 $179.39 $271.16 $228.66 $178.27

Page10


93320 93451 93452 31500 36555 36568 36600 36620 99291State


*$71.00 $529.34 $586.39 $100.00 $257.00 $23.00 $48.00 $126.00$234.00Alabama$85.26 $1,168.96 $1,338.54 $202.27 $466.28 $50.66 $95.65 $473.51$419.43Alaska$46.78 $672.52 $755.29 $97.41 $258.21 $26.92 $45.10 $216.34$222.11Arizona

$129.00 $192.22 Not Payable $89.17 $319.76 $39.00 $99.66 $167.20$366.74Arkansas

California

Colorado$56.68 $504.65 $555.20 $64.06 $220.79 $19.46 $30.27 $159.51$193.02Connecticut

Delaware$51.05 $747.42 $831.97 $99.42 $282.73 $12.00 $45.64 $244.64$238.43District of Columbia

NP NP NP NP NP NP NP $150.29NPFlorida$81.11 $648.03 $718.21 $106.50 $341.47 $21.78 $53.60 $163.48$292.33Georgia

Hawaii$45.25 $639.33 $719.50 $96.39 $248.67 $26.16 $45.23 $233.04$216.41Idaho$39.80 $438.52 $491.73 $55.50 $55.01 QMB only $34.10 $140.10$74.38Illinois$38.53 $546.80 $614.47 $81.18 $211.94 $22.22 $38.00 $196.71$183.73Indiana$82.23 $680.11 $752.47 $114.50 $73.64 $22.93 $57.58 $176.58$279.52Iowa

Kansas$72.15 $666.68 $740.27 $102.35 $273.17 $17.39 $54.85 $215.12$237.45Kentucky$60.64 $463.81 $515.21 $144.81 $232.73 $23.56 $42.27 $209.02$208.61Louisiana$56.93 $720.24 $797.89 $71.31 $91.81 $22.50 $46.39 $168.75$120.19Maine$65.66 $646.25 $715.24 $76.86 $250.25 $23.05 $36.11 $255.83$211.96Maryland$49.70 $610.43 $667.72 $78.87 $237.37 $23.91 $36.66 $197.17$210.25Massachusetts$30.71 $440.18 $497.03 NA $171.36 $17.63 NA $153.33$143.23Michigan$39.13 $561.05 $626.95 $74.99 $218.41 $22.22 $35.35 $210.23$181.04Minnesota$44.21 $623.11 $703.89 $97.10 $243.04 $25.76 $45.42 $231.60$212.93Mississippi$67.04 $465.00 $581.31 $63.63 $201.04 $18.14 $33.33 $165.00$174.46Missouri$54.97 $793.83 $893.70 $115.83 $304.02 $31.74 $53.32 $276.98$261.60Montana

$110.32 $601.24 $667.83 $79.84 $53.23 $21.29 $58.55 $165.48$69.19Nebraska$72.92 $708.35 $786.80 $152.46 $103.86 $15.92 $53.93 $180.93$141.30Nevada$54.83 $354.95 $390.15 $70.00 $60.78 $5.00 $38.94 $80.64$83.11New Hampshire$59.53 $438.88 $489.32 $97.35 $320.10 $27.34 $46.23 $219.90$282.52New Jersey$82.84 $730.14 $815.30 $114.64 $336.40 $29.82 $54.68 $249.59$304.79New Mexico$67.67 $366.96 $405.06 $63.14 $206.53 $19.00 $29.65 $156.04$174.80New York

North Carolina$78.37 $1,122.46 $1,251.36 $156.74 $1,130.20 $44.86 $73.22 $387.73$369.17North Dakota

Ohio$15.99 $127.08 $222.68 $97.27 $241.37 $25.63 $45.37 $230.66$211.71Oklahoma$38.34 $549.20 $619.67 $78.25 $214.41 $22.41 $36.57 $210.84$179.72Oregon$19.14 $119.19 $209.01 $72.00 $88.40 $13.00 $47.58 $151.63$117.84Pennsylvania

Rhode Island$56.73 $452.14 $498.83 $82.46 $222.69 $22.32 $39.01 $198.87$198.56South Carolina

South Dakota

Tennessee$37.05 $675.30 $747.71 $90.66 $237.17 $24.70 $41.26 Not PayableNot PayableTexas

Utah$44.45 $635.09 $713.98 $87.94 $247.36 $25.43 $41.12 $219.07$206.15Vermont$47.31 $681.53 $765.33 $98.33 $687.71 $27.21 $45.46 $211.81$224.50Virginia$33.44 $481.66 $536.13 $65.83 $184.25 $18.93 $30.71 $163.01$156.70Washington$35.99 $506.22 $390.90 $82.49 $73.56 $11.30 $38.09 $162.61$88.00West Virginia

Wisconsin$78.98 $515.63 $572.04 $110.19 $294.11 $30.84 $51.52 $261.38$110.19Wyoming

Page 11


State 36400 36410 36415 62270 99282 99283 9928410120


*$96.00 $19.00 $14.00Alabama $2.00 $21.00 $42.00 $66.00$114.00

$238.76 $50.43 $27.48Alaska $3.00 $75.11 $112.64 $214.57$254.16

$130.18 $26.30 $14.66Arizona $2.60 $32.76 $48.87 $93.19$138.37

$63.73 $14.16 $19.80Arkansas $3.00 $35.00 $53.90 $71.50$108.90

California


Delaware$141.44 $27.98 $15.75District of Columbia $1.10 $36.13 $53.77 $102.54$150.10

NP NP NPFlorida NP $23.84 $43.93 $67.28NP

$76.56 $17.10 $16.80Georgia NA $27.00 $54.80 $84.21$107.29

Hawaii$152.51 $25.57 $14.14Idaho $2.70 $35.69 $53.37 $101.61$133.04

$39.05 $16.65 NPIllinois $4.10 $24.20 $32.20 $44.00$53.70

$106.85 $21.69 $12.02Indiana $3.00 $30.00 $44.84 $85.38$113.27

$80.78 $17.72 $17.48Iowa $3.17 $28.97 $59.12 $91.03$111.12

Kansas$48.47 $7.94 $11.67Kentucky $8.45 $24.71 $47.40 $74.05$53.66

$95.48 $20.27 $14.32Louisiana $2.58 $33.06 $51.44 $96.16$113.70

$77.00 $16.81 $16.46Maine $2.70 $26.54 $41.03 $76.97$92.62

$99.11 $18.48 $13.73Maryland $2.19 $37.74 $56.95 $108.37$149.59

$104.01 $22.11 $14.11Massachusetts IC $29.29 $44.33 $83.33$120.19

$85.38 $15.85 NAMichigan $2.70 NA NA NA$89.94

$107.56 $19.94 $11.86Minnesota $3.00 $30.99 $46.62 $88.50$112.61

$123.26 $25.35 $14.00Mississippi $2.70 $35.78 $53.51 $101.97$131.03

$74.81 $14.86 $10.78Missouri NC $22.65 $36.52 $67.44$91.09

$153.66 $31.13 $17.39Montana $3.00 $42.03 $62.65 $119.59$163.74

$69.19 $21.29 $15.96Nebraska $3.00 $35.46 $53.19 $63.04$106.46

$80.93 $18.10 $8.68Nevada $3.98 $22.77 $51.69 $80.31$61.90

$12.50 $10.00 $10.00New Hampshire $4.00 $24.64 $40.32 $60.48$37.00

$116.08 $22.40 $18.00New Jersey $1.80 $23.50 $52.38 $81.74$139.87

$125.88 $25.29 $17.23New Mexico $3.00 $27.41 $61.59 $96.19$149.09

$78.42 $15.21 NANew York NA NA NA NA$96.04


Ohio$122.63 $25.29 NCOklahoma $2.54 $35.70 $53.38 $101.79NC

NP $19.97 $11.90Oregon $2.10 $31.55 $47.50 $90.31$112.65

$30.50 NA NAPennsylvania NA $26.85 $35.00 $50.00$42.00


South Dakota

Tennessee$119.57 $24.14 $13.47Texas Not Payable Not Payable Not Payable Not Payable$127.14

Utah$122.71 $22.83 $13.63Vermont $8.00 $32.69 $48.98 $93.47$128.86

$131.73 $26.59 $14.84Virginia $3.34 $29.19 $43.54 $83.05$140.08

$92.12 $18.30 $10.31Washington $2.41 $24.40 $36.18 $68.99$97.38

$71.72 $14.19 $7.09West Virginia NC $30.21 $45.18 $86.95$58.06

Wisconsin$122.60 $26.32 $18.80Wyoming $2.70 $41.37 $63.18 $119.59$143.67

Page 12


State 44389 45331 67311


43239 67314 68810 42820 42821 69436*Alabama $273.00 $117.00 $412.00$241.00 $458.00 $135.00 $225.00 $248.00 $123.00

Alaska $625.30 $255.43 $1,029.24$620.55 $1,159.29 $393.85 $502.52 $521.56 $270.64

Arizona $342.43 $141.11 $539.13$345.73 $606.67 $214.40 $257.32 $267.40 $141.29

Arkansas $268.40 $130.90 $652.74$373.00 $444.40 $172.57 $365.21 $422.20 $211.00

California

Colorado

Connecticut $240.88 $104.46 $313.59$210.48 $348.89 $147.99 $170.23 $179.06 $98.84

Delaware


Florida NP NP NPNP NP NP NP NP NP

Georgia $257.56 $102.19 $442.17$210.98 $493.57 $209.01 $240.77 $271.07 $130.29

Hawaii

Idaho $329.18 $135.45 $521.93$331.56 $587.32 $205.95 $251.51 $261.18 $137.46

Illinois $192.85 $142.70 $511.90$249.70 $511.90 $103.50 $194.20 $202.50 $80.50

Indiana $280.37 $115.45 $442.94$282.78 $498.42 $175.35 $212.97 $221.19 $116.59

Iowa $268.95 $106.74 $467.02$220.82 $521.67 $216.50 $254.67 $286.21 $137.26

Kansas

Kentucky $210.07 $83.80 $412.47$179.22 $467.63 $51.50 $209.24 $236.90 $122.45

Louisiana $291.61 $124.59 $404.49$255.17 $453.53 $157.32 $220.08 $229.89 $121.50

Maine $166.96 $101.62 $238.24$207.53 $384.55 $65.89 $176.99 $189.00 $110.20

Maryland $301.98 $130.91 $370.24$263.37 $413.18 $173.32 $212.03 $222.60 $148.82

Massachusetts $311.69 $134.84 $437.53$268.71 $491.28 $178.54 $222.33 $231.57 $124.82

Michigan $223.26 $92.12 NA$226.82 NA $135.30 NA NA NA

Minnesota $280.27 $116.51 $422.43$287.34 $475.20 $171.95 $203.76 $211.34 $112.36

Mississippi $323.55 $132.88 $518.59$324.50 $583.69 $203.01 $249.98 $259.62 $136.16

Missouri $226.35 $136.27 $297.13$197.68 $331.79 $136.85 $211.75 $237.05 $131.64

Montana $404.79 $166.68 $639.96$407.94 $720.21 $253.92 $304.59 $316.61 $167.14

Nebraska $260.82 $95.81 $958.14$228.88 $958.14 $106.46 $324.70 $351.31 $212.92

Nevada $179.91 $65.16 $493.04$158.19 $547.70 $106.79 $305.52 $330.86 $154.57

New Hampshire $75.00 $85.00 $335.00$126.00 $424.00 $42.93 $179.00 $215.00 $100.00

New Jersey $332.21 $143.51 $425.79$291.64 $471.88 $187.54 $244.42 $264.74 $145.62

New Mexico $357.47 $152.95 $475.86$314.55 $528.28 $202.44 $274.22 $297.46 $160.96

New York $239.11 $103.69 $304.87$208.53 $340.23 $142.88 $167.56 $175.90 $100.00

North Carolina

North Dakota $566.64 $234.08 $879.61$575.41 $989.44 $353.19 $421.25 $437.74 $232.02

Ohio

Oklahoma $322.17 $132.22 $518.12$322.64 $583.20 $202.40 $249.46 $259.12 $135.77

Oregon $278.51 $114.76 $421.33$284.11 $474.01 $169.41 $207.06 $214.96 $114.20

Pennsylvania $161.24 $63.67 $468.58$148.58 $483.50 NA $184.00 $199.00 $98.50

Rhode Island

South Carolina $276.53 $118.67 $380.59$242.08 $427.10 $149.44 $205.53 $214.37 $113.52

South Dakota

Tennessee

Texas $314.63 $129.67 $666.02$317.72 $731.77 $147.03 Not Payable Not Payable Not Payable

Utah

Vermont $320.15 $132.33 $482.12$326.53 $242.46 $195.15 $236.19 $245.21 $129.77

Virginia $346.64 $142.86 $545.47$350.04 $613.81 $170.38 $260.06 $270.26 $142.86

Washington $241.88 $100.12 $373.76$246.09 $420.45 $150.60 $178.36 $185.30 $98.43

West Virginia $135.03 $54.38 $411.65$108.23 $463.40 $127.93 $209.63 $217.52 $112.96

Wisconsin

Wyoming $388.13 $166.61 $514.88$338.11 $578.81 $201.21 $277.93 $290.34 $153.44

Page 13


28262 31622 32421 36510 36660 40700 42200 44950 49500State


*$890.00 $236.00 NP $137.00 $645.00 $658.00 $445.00 $285.00$58.00Alabama

$2,412.92 $499.41 $319.27 $161.08 $1,579.50 $1,475.71 $1,100.29 $643.44$121.75Alaska$1,274.17 $269.88 NC $86.10 $799.96 $754.52 $558.14 $329.88$60.14Arizona

$871.20 $282.70 Not Payable $89.00 $853.60 $1188.00 $536.80 $492.00$114.32Arkansas

California

Colorado$755.81 $201.77 NC $105.57 $535.61 $525.19 $347.81 $213.62$40.91Connecticut

Delaware$1,361.73 $292.09 NA $92.42 $838.87 $795.02 $583.36 $346.70$61.79District of Columbia

NP NP NP NP NP NP NP NPNPFlorida$974.90 $196.25 NA $48.22 $721.51 $675.92 $458.73 $294.45$61.41Georgia

Hawaii$1,230.74 $260.78 NC $82.59 $783.56 $737.50 $539.96 $318.52$57.99Idaho

$524.40 $235.20 Obsolete $25.20 $718.70 $718.70 $374.55 $362.00$37.40Illinois$1,045.28 $221.84 -- $70.24 $662.87 $624.42 $457.22 $269.95$49.01Indiana$1,028.68 $206.59 126.46 $52.02 $765.90 $716.90 $487.63 $310.42$66.41Iowa

Kansas$712.14 $186.18 -- $41.59 $611.31 $491.68 $443.78 $286.06$55.20Kentucky

$1,005.33 $234.37 NA $83.75 $696.82 $667.61 $478.41 $288.41$55.79Louisiana$689.22 $190.79 $97.82 $67.77 $560.41 $340.20 $377.46 $228.64$44.07Maine

$1,269.81 $236.42 NA $103.72 $664 $650.22 $439.85 $272.11$51.12Maryland$1,019.12 NP NP $81.27 $725.37 $658.37 $458.40 $275.52$54.95Massachusetts

$840.74 $176.21 NA $52.30 NA NA NA NANAMichigan$1,022.87 $222.95 Discontinued $64.64 $699.93 $596.15 $428.99 $278.00$42.16Minnesota$1,221.31 $256.46 Discontinued $82.07 $780.69 $733.42 $543.43 $319.78$59.14Mississippi

$745.16 $184.95 NC $85.92 $515.54 $501.90 $345.00 $242.00$52.80Missouri$1,512.40 $318.58 -- $102.49 $947.67 $893.42 $667.75 $394.32$72.58Montana$1,064.60 $250.18 -- $53.23 $851.68 $862.32 $612.14 $553.59$74.52Nebraska$1,612.74 $198.12 -- $69.86 $915.13 $846.71 $602.00 $350.41$68.78Nevada

$300.00 $138.00 38.35 $15.00 $400.00 $500.00 $284.00 $225.00$25.00New Hampshire$1,037.39 $258.58 61.81 $109.25 $740.56 $763.70 $501.10 $299.76$63.33New Jersey$1,165.00 $307.65 126.44 $179.05 $837.27 $856.88 $578.76 $342.48$73.94New Mexico

$763.63 $194.95 NA $85.53 NA $513.64 $346.88 $216.62$41.98New York

North Carolina$2,080.96 $447.54 -- $139.73 $1,306.01 $1,234.86 $890.96 $528.49$93.84North Dakota

Ohio$1,219.95 $255.23 -- $82.10 $779.60 $732.05 $545.75 $320.92$59.73Oklahoma$1,042.67 $221.11 NA $65.22 $714.70 $607.33 $451.03 $288.54$43.61Oregon

$569.50 $133.86 NA $42.50 $568.50 $531.00 $301.50 $318.50$49.51Pennsylvania

Rhode Island$924.38 $222.52 -- $68.28 $650.50 $619.16 $436.62 $264.84$50.92South Carolina

South Dakota

TennesseeNot Payable $269.45 Not Payable $79.15 $733.68 Not Payable Not Payable Not Payable$55.29Texas

Utah$1,189.27 $254.02 NP $74.59 $813.99 $691.58 $509.94 $328.14$49.07Vermont$1,289.46 $273.04 Code Ended $87.20 $808.31 $762.54 $564.95 $333.96$60.92Virginia

$885.28 $190.56 NC $59.73 $552.12 $522.46 $377.96 $224.42$39.75Washington$864.55 $107.44 -- $43.08 $725.58 $615.24 $479.43 $301.05$45.45West Virginia

Wisconsin$1,311.46 $303.13 -- $82.36 $882.33 $839.83 $602.88 $369.33$68.07Wyoming

Page 14


State 50200 71010 90945 90957 90959 90965 9401049505


*$356.00 $132.00 $20.00Alabama $54.00 $258.00 $258.00 $24.00$258.00

$880.15 $892.91 $37.39Alaska $152.58 $526.75 $811.08 $54.58$1,159.59

$451.18 $506.00 $20.47Arizona $74.25 $255.29 $390.68 $30.84$557.65

$539.90 $210.10 $28.60Arkansas $81.40 Not Payable Not Payable $37.77Not Payable

California


Delaware$559.39 $559.36 $22.30District of Columbia $76.58 $262.67 NC $34.06$571.42

NP NP NPFlorida NP NP NP NPNP

$363.81 $144.45 $24.44Georgia $52.92 $226.83 $348.09 $25.73$521.18

Hawaii$435.93 $484.20 $19.74Idaho $74.26 $255.50 $391.93 $29.53$559.31

$387.05 $112.40 $17.00Illinois $36.50 $213.65 $213.65 $37.40$213.65

$369.44 $413.50 $16.81Indiana $62.56 $215.15 $329.68 $25.21$470.64

$385.47 $153.93 $25.04Iowa $75.64 $256.10 $393.88 $26.30$578.51

Kansas$350.04 $152.52 $20.47Kentucky $73.57 $221.93 $346.55 $24.44$522.49

$380.25 $120.69 $16.68Louisiana $56.93 $232.69 $358.19 $25.45$525.93

$300.34 $97.02 $15.06Maine $64.88 $188.31 $289.51 $28.44$425.34

$352.07 $106.82 $19.65Maryland $51.45 $210.28 $257.97 $26.21$329.23

$371.40 $462.35 $18.66Massachusetts $61.27 $214.14 $326.20 $28.17$473.35

NA $346.28 $12.48Michigan NA $165.02 $253.57 $20.21$360.34

$349.71 $443.89 $15.65Minnesota $59.84 $206.29 $316.38 $25.75$449.19

$437.43 $471.83 $19.35Mississippi $73.82 $254.25 $390.14 $28.79$557.26

$275.27 $86.88 $15.30Missouri $41.77 $172.17 $264.83 $20.23$389.11

$539.05 $595.99 $24.13Montana $87.25 $300.15 $459.29 $36.33$655.66

$521.65 $149.04 $24.09Nebraska $182.81 $169.42 $263.98 $41.37$394.00

$460.10 $137.19 $27.15Nevada $69.54 $241.53 $370.71 $32.62$545.52

$273.00 $60.00 $10.00New Hampshire $30.00 $167.93 $257.28 $18.00$378.91

$397.62 $131.65 $10.00New Jersey $65.06 $279.65 $349.82 $28.99$420.08

$456.93 $151.20 $26.13New Mexico $74.41 $264.32 $406.99 $30.54$597.58

$277.72 $87.87 $15.05New York $42.34 $172.66 $264.59 $27.03$389.69


Ohio$438.86 $468.46 $7.94Oklahoma $73.44 $253.04 $388.33 $7.35$554.74

$365.25 $433.77 $15.62Oregon $60.48 $208.70 $319.72 $25.29$454.82

$317.50 $137.11 $7.50Pennsylvania $35.00 NA NA $3.00NA


South Dakota

TennesseeNot Payable $465.07 $19.65Texas $69.89 $241.10 $367.40 $30.87$522.61

Utah$413.58 $500.97 $17.95Vermont $68.55 $236.71 $363.34 $29.20$576.14

$456.72 $512.38 $20.72Virginia $74.83 $257.27 $393.64 $31.23$561.86

$307.08 $362.61 $14.51Washington $51.53 $176.68 $270.06 $22.08$385.32

$383.54 $105.34 $14.97West Virginia $60.42 $210.16 $324.43 $23.38$462.09

Wisconsin$484.41 $152.69 $18.16Wyoming $70.77 $281.32 $439.28 $34.60$662.31

Page 15


State 94644 94664 99468


94640 99469 99471 99472 99475 99476*Alabama $23.00 $10.00 $225.00$9.00 $132.00 $196.00 $131.00 $196.00 $131.00

Alaska $62.72 $24.36 $1,669.35$25.90 $714.92 $1,519.29 $722.99 $1,029.66 $621.43

Arizona $37.51 $14.63 $738.44$15.55 $313.36 $676.10 $318.34 $456.21 $275.79

Arkansas $46.65 $13.90 $869.04$14.16 $378.72 $776.32 $383.40 $535.32 $317.88

California

Colorado

Connecticut $23.88 $9.20 $786.48$8.56 $344.16 $704.55 $348.06 $484.53 $287.97

Delaware


Florida NP NP $500.39NP $216.82 $475.81 $222.63 $314.30 $189.36

Georgia NA $16.90 $683.12$17.25 $341.09 $690.72 $342.03 $454.31 $270.25

Hawaii

Idaho $35.42 $13.75 $801.70$14.63 $342.77 $736.05 $347.31 $495.56 $299.39

Illinois $17.87 $15.20 $566.70$14.50 $251.69 $510.67 $249.50 $84.90 $42.35

Indiana $30.39 $11.87 $674.75$12.55 $288.16 $619.67 $292.12 $417.12 $252.04

Iowa $29.79 $16.80 $741.17$17.22 $370.53 $741.17 $370.53 $486.37 $290.47

Kansas

Kentucky $23.85 $14.38 $707.33$11.19 $308.57 $636.72 $313.91 $441.19 $261.99

Louisiana $25.63 $11.19 $728.36$10.10 $317.14 $648.92 $320.73 $448.23 $266.40

Maine $20.99 $8.84 $582.37$11.63 $255.52 $518.13 $257.14 $357.64 $213.47

Maryland $29.15 $11.84 $843.20$10.69 $365.39 $806.56 $375.89 $530.76 $319.81

Massachusetts $32.79 $13.00 $655.37$13.00 $287.89 $568.54 $285.94 $399.76 $242.44

Michigan $24.37 NA NA$10.30 NA NA NA NA NA

Minnesota $31.31 $12.27 $704.70$13.13 $305.16 $662.54 $311.58 $440.85 $265.24

Mississippi $34.25 $13.33 $801.58$14.17 $341.76 $732.43 $346.44 $494.93 $298.98

Missouri $22.03 $12.57 $79.61$11.28 $337.31 $457.47 $223.88 $332.13 $197.04

Montana $44.18 $17.28 $1,060.27$18.36 $448.06 $863.40 $406.87 $584.34 $353.33

Nebraska $23.64 $33.49 $650.10$17.73 $346.10 $563.42 $281.71 $374.30 $228.52

Nevada $30.23 $18.15 $750.49$24.31 $326.77 $671.11 $331.10 $462.51 $274.44

New Hampshire NC $6.00 $512.70$10.00 $225.79 $457.51 $227.09 $314.98 $188.00

New Jersey $31.85 $11.70 $800.82NA $348.61 $699.84 $347.70 $284.76 $169.01

New Mexico $29.15 $12.00 $1,026.40$10.96 $445.50 $896.42 $445.17 $511.99 $303.65

New York $24.08 $9.76 NA$8.82 NA NA NA NA NA

North Carolina

North Dakota NA $24.75 $1,314.26$26.30 NA $1,214.24 $570.25 $813.62 $491.88

Ohio

Oklahoma $33.95 $13.24 $799.49$14.06 $340.15 $728.85 $344.98 $493.39 $298.06

Oregon $30.46 $12.09 $646.74$12.94 $280.24 $611.00 $287.01 $405.18 $244.11

Pennsylvania $25.70 $11.82 $548.82NA $239.59 $480.03 $240.22 $331.12 $198.82

Rhode Island

South Carolina $24.61 $10.31 $674.04$9.53 $296.08 $599.74 $297.78 $413.85 $247.14

South Dakota

Tennessee

Texas $38.23 Not Payable Not Payable$16.00 Not Payable Not Payable Not Payable Not Payable Not Payable

Utah

Vermont $35.36 $14.03 $733.11$14.90 $317.58 $692.98 $325.10 $459.81 $276.69

Virginia $38.03 $14.84 $722.43$15.77 $306.26 $661.12 $311.23 $446.27 $269.81

Washington NC $10.52 $550.64$11.15 $234.94 $508.79 $238.51 $340.94 $206.12

West Virginia $27.06 $10.77 $659.64$11.56 $285.82 $624.96 $293.44 $414.54 $249.57

Wisconsin

Wyoming $36.35 $16.17 $896.62$14.66 $391.14 $807.11 $397.91 $559.26 $332.09

Page 16


99477 99478 99479 99480 D0120 D0145 D1206 D1120 D2150State


*$113.00 $57.00 $40.00 $24.00 $22.00 $18.00 $28.00 $60.00$18.00Alabama$626.88 $247.65 $224.76 $216.17 $52.72 $28.50 $64.95 $135.39$48.86Alaska$274.92 $109.02 $98.86 $95.18 $32.65 $18.58 $40.19 $82.10$26.13Arizona$418.50 $137.88 $121.32 $116.64 $80.75 $19.95 $36.10 $80.75$26.00Arkansas

California

Colorado$261.37 $125.67 $110.15 $105.94 $29.00 $46.00 $114.00$35.00Connecticut

Delaware$304.71 $121.00 $109.69 $105.65 $40.00 $29.00 $47.00 $115.00$35.00District of Columbia$196.71 $77.17 $67.89 $65.18Florida$247.49 $118.51 $113.54 $111.75 $17.59 $32.08 $77.62$22.77Georgia

Hawaii$300.60 $118.86 $107.85 $103.75Idaho$220.73 $88.85 $81.22 $79.04 $26.00 $41.00 $48.15$28.00Illinois$252.73 $99.98 $90.70 $87.27 $35.50 $22.25 $34.50 $71.93$22.58Indiana$263.22 $134.19 $122.56 $118.05 $23.54 $14.33 $24.57 $58.34$16.37Iowa

Kansas$275.93 $113.34 $98.50 $94.65 $15.00 $48.10 $65.00Kentucky$282.03 $114.88 $101.40 $97.47 $38.49 $24.29 $35.02 $82.14$27.24Louisiana$226.92 $92.06 $81.11 $78.01 $20.00 $12.00 $30.00 $48.00$30.00Maine$332.21 $130.32 $114.41 $109.86 $40.00 $24.92 $42.37 $88.00$29.08Maryland$254.27 $100.85 $92.75 $86.15 IC $26.00 $36.00 $72.00$20.00Massachusetts

NA NA NA NA $14.89 $13.23 $19.53 $48.41$14.89Michigan$275.84 $108.32 $95.48 $91.57 $26.67 $14.00 $18.34 $41.65$18.70Minnesota$299.75 $118.64 $107.63 $103.57 $37.83 $25.05 $30.11 $90.05Mississippi$174.86 $79.61 $72.34 $71.09 $28.75 $13.56 $21.31 $53.48$24.00Missouri$393.15 $156.15 $141.58 $136.35 $32.53 $19.52 $32.53 $71.57$22.77Montana$264.78 $138.72 $95.34 $95.34 $34.14 $17.15 $22.00 $59.00$21.20Nebraska$263.54 $119.18 $104.82 $100.78 $20.50 $53.30 $57.28 $86.04$33.24Nevada$169.97 $81.67 $71.66 $68.95 NC $18.00 $38.00 $111.00$30.50New Hampshire$273.50 $123.53 $112.95 $108.82 $50.00 $33.00 $50.00 $126.00$37.00New Jersey$304.23 $157.57 $143.99 $138.63 $31.19 $72.42$22.28New Mexico

NA NA NA NA $30.00 $30.00 $43.00 $67.00$25.00New York

North Carolina$492.91 $194.90 $176.85 $170.15 $39.67 $25.07 $37.70 $91.27$29.32North Dakota

Ohio$298.37 $118.19 $107.20 $103.17 $29.07 $14.53 $29.07 $90.10$20.35Oklahoma$253.71 $99.56 $87.75 $84.21 $23.66 $12.97 $28.59 $46.60$23.66Oregon$251.98 $85.83 $76.17 $73.04 $20.00 $18.00 $30.00 $55.00$20.00Pennsylvania

Rhode Island$262.93 $106.64 $93.91 $90.33 $22.00 $15.89 $28.11 $79.42$22.00South Carolina

South Dakota$24.16 $20.30 $33.79 $75.37$24.16Tennessee

Not Payable Not Payable Not Payable Not Payable $142.07 $14.70 $36.75 $85.71$28.85Texas

Utah$287.42 $112.94 $99.50 $95.48 $39.00 $18.00 $34.00 $80.00$25.00Vermont$268.70 $106.60 $96.66 $93.07 $20.15 $20.79 $33.52 $75.53$20.15Virginia$206.12 $81.61 $74.04 $71.30 $23.41 $22.98 $69.97$29.46Washington$258.50 $101.66 $89.58 $86.17 $25.00 $20.00 $40.00 $89.00$25.00West Virginia

Wisconsin$352.40 $143.67 $124.86 $119.97 $40.00 $35.00 $35.00 $96.00$32.00Wyoming

Page 17


State D1351 D2930 D3220 D7140D2330


*$59.00 $26.00 $90.00Alabama $82.00 $53.00

$127.56 $49.68 $199.53Alaska $131.83 $141.71

$81.22 $25.24 $126.02Arizona $75.68 $77.86

$76.95 $28.50 $140.60Arkansas $86.45 $72.20

California

Colorado$100.00 $40.00 $230.00Connecticut $133.00 $115.00

Delaware$106.00 $38.00 $300.00District of Columbia $134.00 $110.00

Florida$71.41 $27.94 $143.86Georgia $90.04 $64.17

Hawaii

Idaho$34.60 $36 $73.40Illinois $52.70 $39.12

$79.18 $29.35 $155.86Indiana $105.11 $77.24

$52.19 $20.47 $102.35Iowa $59.36 $51.17

Kansas$57.20 $19.50 $119.60Kentucky $67.60 $49.40

$76.01 $25.51 $127.54Louisiana $94.38 $79.07

$68.00 $16.00 $120.00Maine $50.00 $91.00

$84.00 $33.23 $154.00Maryland $60.00 $103.01

$67.00 $28.00 $143.00Massachusetts $82.00 $70.00

$25.62 $15.12 $84.00Michigan $66.15 $44.47

$36.70 $17.30 $76.51Minnesota $40.80 $44.70

$72.89 $28.39 $134.79Mississippi $92.28 $82.91

$49.99 $19.00 $86.80Missouri $60.06 $50.76

$65.06 $26.02 $130.12Montana $97.59 $71.57

$58.00 $23.00 $116.00Nebraska $70.00 $59.00

$56.38 $23.57 $92.24Nevada $61.50 $45.09

$89.00 $33.50 $225.00New Hampshire $100.00 $82.00

$119.00 $41.00 $207.00New Jersey $149.00 $63.88

$69.06 $23.59 $116.51New Mexico $79.10 $65.73

$50.00 $35.00 $116.00New York $87.00 $50.00

North Carolina$92.70 $30.08 $153.37North Dakota $95.52 $82.01

Ohio$58.13 $23.26 $116.25Oklahoma $87.19 $63.94

$39.28 $19.31 $73.12Oregon $49.23 $76.60

$50.00 $25.00 $99.00Pennsylvania $75.00 $65.00

Rhode Island$68.42 $22.61 $126.46South Carolina $81.86 $69.03

South Dakota$62.82 $29.01 $113.90Tennessee $82.05 $65.64

$77.75 $28.24 $152.94Texas $86.20 $65.70

Utah$80.00 $35.00 $160.00Vermont $90.00 $98.00

$74.28 $32.28 $136.93Virginia $83.19 $69.00

$63.61 $21.98 $155.00Washington $95.41 $57.65

$85.00 $30.00 $147.00West Virginia $92.00 $80.00

Wisconsin$82.00 $28.00 $136.00Wyoming $86.00 $70.00

Page 18


State* Supplemental Data: State Report on Preventive Care Coverage

Alabama Alabama covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Alaska Alaska reports that only some of the AAP recommended preventive services are coverred. The does not reimburse for preventive prenatal visits for members 21 and older. The state did not indicate what other preventive services are covered in accordance with the Periodicity Schedule published by the AAP/Bright Futures. Alaska does not offer any finanical incentives for providers to achieve Bright Futures benchmarks.

Arizona Arizona uses the AHCCS EPSDT periodicity schedule and does not offer any financial incentives for providers to achieve Bright Futures benchmarks.

Arkansas NP

Connecticut Connecticut covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

District of Columbia The District of Columbia covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Georgia Georgia covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Idaho Idaho covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Illinois Illinois covers all AAP recommended preventive services. Th state pays an annual incentive payment of $3c per patient to enrolled PCPs, Maternal and Child Health Physicians, [APNs and FANCS] who render all recommended well child visits during each year of patient's life from birth to five. MCOs also offer additional incentive payments to providers to meet BF benchmarks, HFS's PCCM program offers bonus payments to PCSs who meet specific childhoold HEDIS measures in hitting the 50th or 75th percentile benchmarks.

Indiana Indiana covers all AAP recommended preventive services. Indiana does not pay providers directly. The state does not pay providers directly, however Indiana's Managed Care Organizations may offer financial incentives to providers for meeting the periodicity guidelines.

Iowa Iowa reports they uses a different periodicity schedule, but did not report which schedule they used. The state does not offer incentives for providers to achieve Bright Futures benchmarks.

Kentucky Kentucky covers all AAP recommended preventive services. Information about incentives to providers for achieving Bright Futures benchmarks was not provided.

*Supplemental information on State-reported care coverage does not include placeholders for non-responder states.

Copyright 2015 American Academy of Pediatrics. 2015 AAP Medicaid Reimbursement Survey Report - Supplemental Data Report


Louisiana Louisiana covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Maryland Maryland covers all AAP recommended preventive services. Information about incentives to providers for achieving Bright Futures benchmarks was not provided.

Massachusetts Massachusetts covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Michigan Michigan covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Minnesota Minnesota covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Mississippi Mississippi reports that only some of the AAP recommended preventive services are covered. There is a separate payment for 96110 for routine developmental screening at 9, 18 and 24 months as well as for standardize autism screening without prior authorization through eQHealth for payment to Medicaid. There is a separate payment for Hemoglobin or hematocrit testing performed at 12-month visit in accordance with AAP/Bright Futures guidelines --included in EPSDT visit. Ant the AAP/ Bright Futures periodicity schedule call for an EPSDDT screening visit at 3-5 days, along with a separate visit before 1 month of age, which is not defined on the current State's periodicity schedule and is used only as a guide for EPSDT providers. As Medicaid payment system already allows payment for both visits cited above. The Division of Medicaid has adopted and are making system changes to adhere to all of the AAP/Bright Futures evidenced-based principals of preventative health care services periodicity schedule.

Missouri Missouri follows a periodicity schedule published by the Missouri Department of Health and Human Services: http://health.mo.gov/living/families/healthychildren/schedule.php. The state does not offer any financial incentives for providers to achieve Bright Futures benchmarks.

Montana Montana covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Nebraska Nevada covers preventive services in accordance with state rules and regulations, the FDA, and the AAP.

Nevada Nevada covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

New Hampshire New Hampshire covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

New Jersey New Jersey covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.




New Mexico New Mexico covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

New York New York state reports that only some of the AAP recommended preventive services are coverred. NYS recommends that all preventive services listed on the Periodicity Schedule be provided to children. Certain screening services (i.e., visual acuity screening, developmental screening, etc.) are consider part of the E/M visit and are not reimbursed separately.

North Dakota Montana covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Oklahoma Oklahoma covers all AAP recommended preventive services. All PCPs that meet or exceed the appropriate EPSDT compliance rate for medical home members for the age group will receive up to an additional 25% of the rate for the age appropriate procedure codes according to the current fee schedule (unenhanced). This percent increase is contigent on available funds and may be less.

Oregon Oregon covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Pennsylvania Pennsylvania covers all AAP recommended preventive services. Providers may receive an enhanced payment for submission of evidence-based screening; however, in order ro redieve the payment all components for EPSDT must be included on the claim. In addition, through the Provider Pay for Performance Program outlined in the HealthChoices Agreement, the HealthChoices Managed Care Organizations (MCOs) are permitted to develop incentive programs to pay providers for meeting certain benchmarks or be paid on a per service basis based upon HEDIS measures. These programs must receive prior Department approval. The HEDIS measures that align with Bright Fgures are the Adolescent Well Child Measure and the Annual Dental Visit Measure.

South Carolina South Carolina covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Tennessee Tennessee covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Texas Texas did not provide any information on preventive services covered.

Vermont Vermont covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Virginia Virginia covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Washington Washington uses the periodicity schedule provided by the CDC: http://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Washington provides an enhanced rate for EPSDT screenings.




West Virginia West Virginia covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.

Wyoming Wyoming covers all AAP recommended preventive services, but does not offer incentives for providers to achieve Bright Futures benchmarks.



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