MHCP Fee Schedule - MinnesotaDEPARTMENT OF HUMAN SERVICES PURCHASING AND DELIVERY SYSTEMS 540 CEDAR...

DEPARTMENT OF HUMAN SERVICES

PURCHASING AND DELIVERY SYSTEMS

540 CEDAR STREET

ST. PAUL, MINNESOTA 55155

SUBJECT - Minnesota Health Care Programs Fee Schedule

DENTAL SERVICES - For dental services provided on or after 7/1/97, an additional 9.52% must be added to the fee

schedule amount, to determine the total Minnesota Care dental reimbursement amount.

The fee schedule amount for dental exam and dental x-ray services provided on or after 01/01/02 to children under the age

of 21, is based on 85% of the 1999 median charge. The fee schedule amounts for those services can be found under factor

code Q.

Listed below is an explanation of each of the data elements that appear on the CURRENT FEE SCHEDULE.

SVC CODE - HCPCS level I (CPT), level II and level III procedure codes.

***Inclusion on this report does not imply coverage. See ‘FACT CODE’ below.

PA IND – indicates whether the procedure code requires prior authorization:

A = always requires prior authorization

B = sometimes requires prior authorization

(only after limits are exceeded or other conditions have been met; see the Provider Manual for details)

C = always requires service agreement

D = sometimes requires service agreement

EFF DATE - the effective date of the current TOTAL ALLOWABLE

FACT CODE - indicates the current coverage/price factor for the procedure

A prof comp fee schedule

B RBRVS professional

C prof comp price by report

D prof comp price not covered

E tech comp fee schedule

F RBRVS technical

G tech comp price by report

H tech comp price not covered

I anesthesia “base value”

J anesthesia relative value

K anesthesia price by report

L anesthesia price not covered

M rental fee schedule

N rental relative value

O rental price by report

P rental price not covered

Q other fee schedule

R other tech comp

S other by report

T other tech comp by report

V ACA enhanced general fee

W general DME comp bid fee

X rental DME comp bid fee

Z information/for reporting

1 general fee schedule

2 RBRVS non-fac & global radiology

3 general price by report

4 general price not covered

5 repair fee schedule

6 RBRVS facility

7 repair price by report

8 repair price not covered

9 discontinued procedure code

DEFINITIONS CLARIFYING THE FACTOR CODES AFFECTED BY RBRVS:

Factor Code 2: This is the professional fee for services provided in a non-facility setting and for global radiology.

Factor Code 6: This is the professional fee for services provided in a facility setting.

Factor Code B: This is professional fee (modifier 26) on codes where appropriate, for supervision and interpretation

services, primarily for diagnostics and radiology.

Factor Code F: This is the technical fee (modifier TC) on codes where appropriate, primarily for diagnostics and

radiology.

Factor Code E: This is the Facility’s fee.

ANESTHESIA BASE VALUE - the current anesthesia base value

TOTAL ALLOWABLE - the current maximum allowable for the procedure based on the code description.

TECH COMPONENT - the technical component or facility fee, if applicable, for the procedure.

PROF COMPONENT - the professional component, if applicable, for the procedure.

RENTAL ALLOWANCE - the current rental allowance for the medical equipment.

APC/ASC DATE - the effective date of the Ambulatory Payment Classification allowable and/or the effective date of the

Ambulatory Surgery Center allowable.

APC/ASC GRPR - the current Ambulatory Payment Classification number and/or the current Ambulatory Surgery

Center grouper number as assigned by CMS.

APC/ASC ALLOWABLE - the current allowable for the Ambulatory Payment Classification and/or the current

allowable for the Ambulatory Surgery Center. If none assigned, see TECH COMPONENT.

PSI - indicates the current Payment Status Indicator, if applicable, for the procedure.

PSI - specific to Outpatient Ambulatory Payment Classification (APC)

A fee schedule

B not paid under OPPS

E not covered

F acquisition of corneal tissue

G current drug or biological pass through

H device pass through

J1 packaged in presence of primary or highest ranked code with PSI = J1

J2 priced as composite APC in presence of observation services

K non-pass through drugs and non-implantable biologicals, including therapeutic

radiopharmaceuticals

L influenza or pneumococcal vaccine

N incidental, with payment packaged into another service or APC group

P partial hospitalization

Q1 packaged in the presence of codes with PSI S, T, V, or X

Q2 packaged in the presence of codes with PSI T

Q3 codes that may be paid through a composite APC

Q4 conditionally packaged laboratory tests

S significant procedure-multiple procedure reduction does NOT apply

T significant procedure-multiple procedure payment reduction applies

U brachytherapy sources

V visit to clinic or emergency department

X ancillary service

Y non implantable durable medical equipment

1 ASC grouper

2 significant fee schedule procedure-multiple procedure reduction does NOT apply

3 significant fee schedule procedure-multiple procedure payment reduction applies

PSI - specific to Ambulatory Surgery Center (ASC)

A2 surgical procedure

B5 alternative code may be available

F4 corneal tissue acquisition

G2 ASC non office surgery added to ASC list

H2 brachytherapy

J7 pass thru device paid separately when provided integral to surgical procedure on ASC list

J8 device intensive procedure on ASC list

K2 drugs and biologicals paid separately

K7 unclassified drugs

L1 influenza or pneumococcal vaccine, packaged

L6 new technology

N1 packaged item

P2 office based surgical procedure added to ASC list

P3 office based surgical procedure added to ASC list

R2 office based surgical procedure added to ASC list

Z2 radiology service paid separately when provided integral to a surgical procedure on ASC

list; payment based on OPPS relative payment weight

Z3 radiology service paid separately when provided integral to a surgical procedure on ASC

list; payment based on MPFS non-facility PE RVUs

Facility Component Pricing Hierarchy - Specifically for outpatient hospital facility component and ambulatory surgical

center services, payment is:

1) the APC/ASC rate. If no APC/ASC rate, the system looks for

2) the TC rate. If no TC rate (factor code E) then

3) the system calculates a facility charge allowable.

The APC rate may exceed the line item charge. Neither the TC nor system calculated rate can exceed the line item

charge.

MINNESOTA DEPARTMENT OF HUMAN SERVICES

MINNESOTA HEALTH CARE PROGRAMS - ANESTHESIA FORMULAS

AS OF 01/01/20

AA Anesthesiologist Personally Performed

((Base Units + (Time Units / 15)) X 18.00

AA GC Anesthesiologist Directing One Anesthesia Resident or SRNA


QY Anesthesiologist Directing One CRNA

((Base Units + (Time Units / 15)) X 21.37 X 0.632

QK Anesthesiologist Directing 2 - 4 CRNA


QK GC Anesthesiologist Directing 2 – 4 Anesthesia Residents or SRNA


AD Anesthesiologist Supervising More Than Four CRNA

4 Base Units X 18.00

QX CRNA Directed by an Anesthesiologist


QZ CRNA Without Direction by an Anesthesiologist


Time Units equal the number of minutes from preparation of the patient to the time when the anesthetist is no longer in

personal attendance or continues to be required. Time Units / 15 is truncated at one decimal place. Example: 62 / 15 = 4.1.

CRNA - Certified Registered Nurse Anesthetist

Minnesota Health Care Programs follows Medicare coverage standards for direction and supervision of CRNA and

anesthesia residents.

Revised 01/01/20

CURRENT FEE SCHEDULE

AS OF 03/12/2020

SVC PA EFF FACT ANESTH TOTAL TECH PROF RENTAL APC/ASC APC/ASC APC/ASC

CODE IND DATE CODE BASE VALUE ALLOW COMPONENT COMPONENT ALLOW DATE GRPR ALLOW PSI

1

A0010 04/01/95 9 1 A0020 04/01/95 9 2 A0021 B 01/01/20 1 7.7200 08/01/00 A 3 A0030 04/11/01 9 4 A0040 04/11/01 9 5 A0050 04/11/01 9 6 A0060 04/01/95 9 7 A0070 04/01/95 9 8 A0080 01/01/20 1 .5700 9 A0090 07/01/16 1 .2200 10 A0100 07/01/16 1 11.0000 11 A0110 07/01/11 1 200.0000 12 A0120 01/01/16 1 200.0000 13 A0130 B 07/01/16 1 18.0000 08/01/00 E 14 A0140 04/01/13 3 15 A0150 04/01/95 9 16 A0160 06/01/13 1 17 A0170 07/01/11 1 50.0000 18 A0180 07/01/16 1 200.0000 19 A0190 07/01/11 1 8.0000 20 A0200 06/01/13 1 21 A0210 06/01/13 1 22 A0215 04/01/95 9 23 A0220 04/01/95 9 24 A0221 04/01/95 9 25 A0222 04/01/95 9 26 A0223 04/01/95 9 27 A0225 B 01/01/20 1 282.9100 04/01/15 E 28 A0300 04/11/01 9 29 A0302 04/11/01 9 30 A0304 04/11/01 9 31 A0306 04/11/01 9 32 A0308 04/11/01 9 33 A0310 04/11/01 9 34 A0320 04/11/01 9 35 A0322 04/11/01 9 36 A0324 04/11/01 9 37 A0326 04/11/01 9 38 A0328 04/11/01 9 39 A0330 04/11/01 9 40 A0340 04/11/01 9 41 A0342 04/11/01 9 42 A0344 04/11/01 9 43 A0346 04/11/01 9 44 A0348 04/11/01 9 45 A0350 04/11/01 9 46 A0360 04/11/01 9 47 A0362 04/11/01 9 48 A0364 04/11/01 9 49


AS OF 03/12/2020



2

A0366 04/11/01 9 1 A0368 04/01/01 9 2 A0370 04/11/01 9 3 A0380 01/13/04 4 4 A0382 05/01/03 4 5 A0384 05/01/03 4 6 A0390 01/13/04 4 7 A0392 05/01/03 4 8 A0394 05/01/03 4 9 A0396 05/01/03 4 10 A0398 05/01/03 4 11 A0420 02/01/15 4 12 A0422 05/01/03 4 13 A0424 B 01/01/20 1 11.6900 08/01/00 A 14 A0425 B 01/01/20 1 7.4000 01/01/01 A 15 A0426 B 01/01/20 1 278.2700 01/01/01 A 16 A0427 07/01/01 1 430.0300 01/01/01 A 17 A0428 B 01/01/20 1 231.8700 01/01/01 A 18 A0429 07/01/01 1 430.0300 01/01/01 A 19 A0430 B 01/01/20 1 3147.8700 01/01/01 A 20 A0431 B 01/01/20 1 3659.8800 01/01/01 A 21 A0432 01/01/20 1 405.8500 01/01/01 A 22 A0433 01/01/20 1 637.8100 01/01/01 A 23 A0434 B 01/01/20 1 753.7700 01/01/01 A 24 A0435 B 01/01/20 1 8.8400 01/01/01 A 25 A0436 B 01/01/20 1 23.7700 01/01/01 A 26 A0800 01/01/07 9 27 A0888 04/01/02 Z 28 A0998 01/01/20 1 222.0500 07/15/09 A 29 A0999 04/01/15 4 30 A2000 04/01/98 9 31 A4190 04/01/97 9 32 A4200 04/01/97 9 33 A4201 04/01/90 9 34 A4202 04/01/97 9 35 A4203 04/01/97 9 36 A4204 04/01/97 9 37 A4205 04/01/97 9 38 A4206 B 07/01/85 1 .3000 01/01/15 N 39 A4207 B 07/01/85 1 .3000 01/01/15 N 40 A4208 B 07/01/85 1 .3000 01/01/15 N 41 A4209 B 07/01/85 1 .7500 01/01/15 N 42 A4210 A 03/01/06 3 08/01/00 E 43 A4211 B 01/01/04 1 .2800 01/01/15 N 44 A4212 B 06/16/95 1 7.5000 01/01/15 N 45 A4213 B 04/01/00 1 .4000 01/01/15 N 46 A4214 04/01/04 9 47 A4215 B 11/01/02 1 .2700 01/01/15 N 48 A4216 B 01/01/19 1 .5100 01/01/17 N1 49


AS OF 03/12/2020



3

01/01/14 N 1 A4217 B 01/01/20 1 3.6400 01/01/17 N1 2 01/01/14 N 3 A4218 B 01/01/06 1 .1500 07/01/15 N1 4 01/01/06 N 5 A4220 B 02/01/99 1 33.6000 07/01/15 N1 6 01/01/11 N 7 A4221 B 01/01/20 1 20.6000 01/01/15 N 8 A4222 B 01/01/20 1 39.0700 01/01/15 N 9 A4223 B 01/01/18 1 58.2400 01/01/15 N 10 A4224 B 01/01/20 1 20.6000 01/01/17 N 11 A4225 B 01/01/20 1 2.7600 01/01/17 N 12 A4226 01/01/20 3 01/01/20 N 13 A4230 B 10/01/18 1 10.3500 01/01/11 N 14 A4231 B 10/01/18 1 6.7500 01/01/11 N 15 A4232 B 01/01/09 1 2.6500 08/01/00 E 16 A4233 B 07/01/16 1 .5100 08/01/09 E 17 W .5100 18 A4234 B 01/01/18 1 2.3600 08/01/09 E 19 W 2.3600 20 A4235 B 07/01/16 1 1.0000 08/01/09 E 21 W 1.0000 22 A4236 B 07/01/16 1 1.1600 08/01/09 E 23 W 1.1600 24 A4244 B 02/01/09 1 1.2000 01/01/17 N1 25 01/01/15 N 26 A4245 B 01/01/01 1 4.5000 01/01/17 N1 27 01/01/15 N 28 A4246 B 11/01/07 3 01/01/17 N1 29 01/01/15 N 30 A4247 B 11/01/07 3 01/01/17 N1 31 01/01/15 N 32 A4248 B 05/01/10 1 .0300 07/01/15 N1 33 01/01/11 N 34 A4250 B 01/01/08 1 14.6000 08/01/00 E 35 A4252 A 10/01/08 1 4.0200 07/15/09 E 36 A4253 B 07/01/16 1 8.3200 01/01/15 N 37 W 8.3200 38 A4254 01/01/06 9 39 A4255 B 01/01/20 1 4.7800 01/01/15 N 40 A4256 B 07/01/16 1 3.3800 01/01/15 N 41 W 3.3800 42 A4257 B 01/01/20 1 14.8200 08/01/09 E 43 A4258 B 07/01/16 1 2.1200 01/01/15 N 44 W 2.5200 45 A4259 B 07/01/16 1 1.4200 01/01/15 N 46 W 1.4200 47 A4260 01/01/06 9 48 A4261 B 01/01/99 1 60.0000 01/01/15 E 49


AS OF 03/12/2020



4

A4262 01/01/94 3 07/01/15 N1 1 08/01/00 N 2 A4263 01/01/94 3 07/01/15 N1 3 08/01/00 N 4 A4264 01/01/11 Z 5 A4265 B 01/01/20 1 3.9600 01/01/15 N 6 A4266 B 07/01/15 1 72.9000 01/01/03 E 7 A4267 B 01/01/05 1 .3200 01/01/03 E 8 A4268 B 01/01/05 1 2.4400 01/01/03 E 9 A4269 B 07/01/06 1 9.2800 01/01/03 E 10 A4270 07/03/97 1 16.7600 07/01/15 N1 11 08/01/00 N 12 A4280 B 01/01/20 1 6.1900 01/01/14 N 13 A4281 B 04/01/06 3 01/01/03 E 14 A4282 B 04/01/06 3 01/01/03 E 15 A4283 B 04/01/06 3 01/01/03 E 16 A4284 B 05/01/07 3 01/01/03 E 17 A4285 01/01/03 4 18 A4286 B 04/01/06 3 01/01/03 E 19 A4290 10/01/14 1 139.8100 01/01/15 N 20 A4300 01/01/97 3 07/01/15 N1 21 01/01/11 N 22 A4301 01/01/96 3 07/01/15 N1 23 01/01/11 N 24 A4305 B 04/18/01 1 24.6900 07/01/15 N1 25 08/01/00 N 26 A4306 B 04/18/01 1 33.1300 07/01/15 N1 27 08/01/00 N 28 A4310 B 01/01/20 1 8.9700 01/01/15 N 29 A4311 B 01/01/20 1 17.2100 01/01/15 N 30 A4312 B 01/01/20 1 20.9600 01/01/15 N 31 A4313 B 01/01/20 1 21.5200 01/01/15 N 32 A4314 B 01/01/20 1 29.3700 01/01/15 N 33 A4315 B 01/01/20 1 30.6400 01/01/15 N 34 A4316 B 01/01/20 1 32.9900 01/01/15 N 35 A4319 04/01/04 9 36 A4320 B 01/01/20 1 6.2100 01/01/15 N 37 A4321 B 01/01/97 3 01/01/15 N 38 A4322 B 01/01/20 1 3.5200 01/01/15 N 39 A4323 04/01/04 9 40 A4324 01/01/05 9 41 A4325 01/01/05 9 42 A4326 B 01/01/20 1 12.5300 01/01/15 N 43 A4327 B 01/01/20 1 51.8200 01/01/15 N 44 A4328 B 01/01/20 1 11.7600 01/01/15 N 45 A4329 04/01/02 9 46 A4330 B 01/01/20 1 7.9100 01/01/15 N 47 A4331 B 01/01/20 1 3.6900 01/01/15 N 48 A4332 B 12/01/09 1 .1300 01/01/15 N 49


AS OF 03/12/2020



5

A4333 B 01/01/20 1 2.5700 01/01/15 N 1 A4334 B 01/01/20 1 5.7200 01/01/15 N 2 A4335 B 03/01/90 3 01/01/15 N 3 A4336 B 01/01/20 1 1.6700 01/01/15 N 4 A4337 01/01/16 4 5 A4338 B 01/01/20 1 14.2500 01/01/15 N 6 A4340 B 01/01/20 1 31.3600 01/01/15 N 7 A4341 04/01/90 9 8 A4342 04/01/90 9 9 A4343 04/01/90 9 10 A4344 B 01/01/20 1 17.8100 01/01/15 N 11 A4345 04/01/90 9 12 A4346 B 01/01/20 1 22.7500 01/01/15 N 13 A4347 01/01/05 9 14 A4348 01/01/07 9 15 A4349 B 01/01/20 1 2.3400 01/01/15 N 16 A4350 04/01/90 9 17 A4351 B 01/01/20 1 2.1100 01/01/15 N 18 A4352 B 01/01/20 1 6.3500 01/01/15 N 19 A4353 B 01/01/20 1 8.1300 01/01/15 N 20 A4354 B 01/01/20 1 13.7100 01/01/15 N 21 A4355 B 01/01/20 1 10.3600 01/01/15 N 22 A4356 B 01/01/20 1 53.0000 01/01/15 N 23 A4357 B 01/01/20 1 11.2800 01/01/15 N 24 A4358 B 01/01/20 1 7.5900 01/01/15 N 25 A4359 01/01/07 9 26 A4360 B 01/01/20 1 .5700 01/01/15 N 27 A4361 B 01/01/20 1 21.3400 01/01/15 N 28 A4362 B 01/01/20 1 3.9500 01/01/15 N 29 A4363 B 01/01/20 1 2.7500 01/01/15 E 30 A4364 B 01/01/20 1 3.4200 01/01/15 N 31 A4365 01/01/10 9 32 A4366 B 01/01/20 1 1.5000 01/01/15 N 33 A4367 B 01/01/20 1 8.5500 01/01/15 N 34 A4368 B 01/01/19 1 .2900 01/01/15 N 35 A4369 B 01/01/20 1 2.8200 01/01/15 N 36 A4370 04/01/03 9 37 A4371 B 01/01/20 1 4.2300 01/01/15 N 38 A4372 B 01/01/20 1 4.8700 01/01/15 N 39 A4373 B 01/01/20 1 7.2800 01/01/15 N 40 A4374 04/01/03 9 41 A4375 B 01/01/20 1 19.9500 01/01/15 N 42 A4376 B 01/01/20 1 55.2800 01/01/15 N 43 A4377 B 01/01/20 1 4.9800 01/01/15 N 44 A4378 B 01/01/20 1 35.7200 01/01/15 N 45 A4379 B 01/01/20 1 17.4500 01/01/15 N 46 A4380 B 01/01/20 1 43.3700 01/01/15 N 47 A4381 B 01/01/20 1 5.3800 01/01/15 N 48 A4382 B 01/01/20 1 28.6000 01/01/15 N 49


AS OF 03/12/2020



6

A4383 B 01/01/20 1 32.7500 01/01/15 N 1 A4384 B 01/01/20 1 11.1700 01/01/15 N 2 A4385 B 01/01/20 1 5.9200 01/01/15 N 3 A4386 04/01/03 9 4 A4387 B 01/01/20 1 2.6100 01/01/15 N 5 A4388 B 01/01/20 1 5.0700 01/01/15 N 6 A4389 B 01/01/20 1 7.2200 01/01/15 N 7 A4390 B 01/01/20 1 11.1600 01/01/15 N 8 A4391 B 01/01/20 1 8.2100 01/01/15 N 9 A4392 B 01/01/20 1 9.4900 01/01/15 N 10 A4393 B 01/01/20 1 10.5000 01/01/15 N 11 A4394 B 01/01/20 1 3.0100 01/01/15 N 12 A4395 B 05/01/06 1 .0500 01/01/15 N 13 A4396 B 01/01/20 1 47.0300 01/01/15 N 14 A4397 B 01/01/20 1 5.5600 01/01/15 N 15 A4398 B 01/01/20 1 16.0600 01/01/15 N 16 A4399 B 01/01/20 1 14.2500 01/01/15 N 17 A4400 B 01/01/20 1 56.7800 01/01/15 N 18 A4402 B 01/01/20 1 1.8600 01/01/15 N 19 A4404 B 01/01/20 1 1.9500 01/01/15 N 20 A4405 B 01/01/20 1 3.9700 01/01/15 N 21 A4406 B 01/01/20 1 6.6500 01/01/15 N 22 A4407 B 01/01/20 1 10.1800 01/01/15 N 23 A4408 B 01/01/20 1 11.4700 01/01/15 N 24 A4409 B 01/01/20 1 7.2200 01/01/15 N 25 A4410 B 01/01/20 1 10.5000 01/01/15 N 26 A4411 B 01/01/20 1 5.9200 01/01/15 N 27 A4412 B 01/01/20 1 3.1400 01/01/15 N 28 A4413 B 01/01/20 1 6.4000 01/01/15 N 29 A4414 B 01/01/20 1 5.7200 01/01/15 N 30 A4415 B 01/01/20 1 6.9600 01/01/15 N 31 A4416 B 01/01/20 1 3.2000 01/01/15 N 32 A4417 B 01/01/20 1 4.3300 01/01/15 N 33 A4418 B 01/01/20 1 2.1100 01/01/15 N 34 A4419 B 01/01/20 1 2.0100 01/01/15 N 35 A4420 B 01/01/18 3 01/01/15 N 36 A4421 B 06/25/97 3 01/01/15 N 37 A4422 B 01/01/09 1 .1300 01/01/15 N 38 A4423 B 01/01/20 1 2.1600 01/01/15 N 39 A4424 B 01/01/20 1 5.5300 01/01/15 N 40 A4425 B 01/01/20 1 4.1600 01/01/15 N 41 A4426 B 01/01/20 1 3.1700 01/01/15 N 42 A4427 B 01/01/20 1 3.2300 01/01/15 N 43 A4428 B 01/01/20 1 7.5700 01/01/15 N 44 A4429 B 01/01/20 1 9.5800 01/01/15 N 45 A4430 B 01/01/20 1 9.8900 01/01/15 N 46 A4431 B 01/01/20 1 7.2200 01/01/15 N 47 A4432 B 01/01/20 1 4.1700 01/01/15 N 48 A4433 B 01/01/20 1 3.8900 01/01/15 N 49


AS OF 03/12/2020



7

A4434 B 01/01/20 1 4.3700 01/01/15 N 1 A4435 B 01/01/20 1 6.7000 01/01/15 N 2 A4440 04/01/90 9 3 A4450 B 01/01/04 1 .0900 4 A4452 B 01/01/20 1 .4100 5 A4453 04/01/89 9 6 A4454 04/01/03 9 7 A4455 B 01/01/20 1 1.4700 01/01/14 N 8 A4456 B 01/01/19 1 .2800 01/01/14 N 9 A4458 B 10/01/08 3 01/01/15 N 10 A4459 A 01/01/15 3 01/01/15 N1 11 01/01/15 N 12 A4460 04/01/03 9 13 A4461 B 01/01/20 1 3.8300 01/01/14 N 14 A4462 01/01/07 9 15 A4463 B 01/01/20 1 15.4600 01/01/14 N 16 A4464 04/01/03 9 17 A4465 B 02/01/09 3 01/01/11 N 18 A4466 01/01/17 9 19 A4467 B 03/01/18 3 01/01/17 E 20 A4470 10/01/10 3 01/01/11 N 21 A4480 01/01/96 1 78.0000 01/01/11 N 22 A4481 B 01/01/19 1 .4300 01/01/14 N 23 A4483 B 01/01/20 1 4.8000 01/01/14 N 24 A4490 B 01/01/95 1 22.7500 08/01/00 E 25 A4495 B 01/01/95 1 29.7500 08/01/00 E 26 A4500 B 09/01/06 1 24.9000 08/01/00 E 27 A4510 B 01/01/95 1 56.5000 08/01/00 E 28 A4520 04/01/85 9 29 A4521 01/01/05 9 30 A4522 01/01/05 9 31 A4523 01/01/05 9 32 A4524 01/01/05 9 33 A4525 01/01/05 9 34 A4526 01/01/05 9 35 A4527 01/01/05 9 36 A4528 01/01/05 9 37 A4529 01/01/05 9 38 A4530 01/01/05 9 39 A4531 01/01/05 9 40 A4532 01/01/05 9 41 A4533 01/01/05 9 42 A4534 01/01/05 9 43 A4535 01/01/05 9 44 A4536 01/01/05 9 45 A4537 01/01/05 9 46 A4538 01/01/05 9 47 A4540 10/01/83 9 48 A4550 10/01/83 1 10.0000 01/01/15 B 49


AS OF 03/12/2020



8

A4553 01/01/17 4 1 A4554 01/15/05 4 2 A4555 01/01/14 4 3 A4556 B 01/01/20 1 11.9900 01/01/15 N 4 A4557 B 01/01/15 1 19.9200 01/01/15 N 5 A4558 B 01/01/20 1 6.2200 01/01/15 N 6 A4559 B 01/01/09 1 .1100 01/01/15 N 7 A4560 04/11/01 9 8 A4561 B 01/01/20 1 23.8100 01/01/01 N 9 A4562 B 01/01/20 1 59.1600 01/01/01 N 10 A4563 01/01/19 4 11 A4565 B 01/01/20 1 8.9400 01/01/11 N 12 A4566 B 01/01/11 3 07/01/11 E 13 7 14 A4570 B 02/01/09 3 01/01/15 E 15 A4572 04/01/03 9 16 A4575 06/01/07 4 17 A4580 03/01/02 4 18 A4581 04/01/97 9 19 A4590 03/01/02 4 20 A4595 B 01/01/15 1 31.9800 01/01/15 N 21 A4600 B 01/01/07 3 08/01/09 E 22 7 23 A4601 B 10/01/17 3 08/01/09 E 24 A4602 01/01/20 1 4.3300 01/01/15 N1 25 01/01/15 N 26 A4604 B 01/01/15 1 63.9000 01/01/15 N 27 W 44.5300 28 A4605 B 01/01/20 1 19.0500 01/01/15 N 29 A4606 B 02/01/09 1 23.4000 01/01/14 N 30 A4608 B 01/01/20 1 58.2300 01/01/14 N 31 A4609 01/01/05 9 32 A4610 01/01/05 9 33 A4611 B 01/01/19 3 08/01/00 E 34 A4612 B 01/01/19 3 08/01/00 E 35 A4613 B 01/01/19 3 08/01/00 E 36 A4614 B 01/01/20 1 27.6300 01/01/15 N 37 A4615 B 01/01/20 1 .8500 01/01/15 N 38 A4616 B 01/01/09 1 .0700 01/01/15 N 39 A4617 B 01/01/20 1 3.6000 01/01/15 N 40 A4618 B 01/01/20 1 8.9300 01/01/15 N 41 A4619 B 01/01/20 1 2.0400 01/01/15 N 42 A4620 B 01/01/20 1 .7400 01/01/15 N 43 A4621 04/01/04 9 44 A4622 04/01/04 9 45 A4623 B 01/01/20 1 7.6100 01/01/14 N 46 A4624 B 01/01/20 1 3.0600 01/01/15 N 47 A4625 B 01/01/20 1 8.0400 01/01/14 N 48 A4626 B 01/01/20 1 3.6100 01/01/14 N 49


AS OF 03/12/2020



9

A4627 B 02/01/09 1 28.6400 07/15/09 E 1 A4628 B 01/01/20 1 4.3500 01/01/15 N 2 A4629 B 01/01/20 1 5.4000 01/01/14 N 3 A4630 B 01/01/20 1 6.1600 08/01/00 E 4 A4631 04/01/04 9 5 A4632 01/01/07 9 6 A4633 B 01/01/20 1 47.6700 01/01/03 E 7 A4634 B 01/01/03 3 01/01/14 N 8 A4635 B 01/01/20 1 5.0500 01/01/15 E 9 A4636 B 01/01/20 1 3.1500 01/01/15 E 10 A4637 B 01/01/20 1 1.7500 01/01/15 E 11 A4638 03/01/09 4 12 A4639 05/01/07 4 13 A4640 B 01/01/15 1 59.7400 08/01/09 E 14 A4641 05/19/97 3 07/01/15 N1 15 01/01/11 N 16 A4642 10/01/10 1 831.2500 07/01/15 N1 17 01/01/11 N 18 A4643 01/01/06 9 19 A4644 01/01/06 9 20 A4645 01/01/06 9 21 A4646 01/01/06 9 22 A4647 01/01/06 9 23 A4648 01/01/08 3 07/01/15 N1 24 01/01/10 N 25 A4649 B 07/01/02 3 01/01/11 N 26 A4650 01/01/11 3 07/01/15 N1 27 08/01/00 N 28 A4651 B 01/01/02 3 01/01/14 N 29 A4652 B 01/01/02 3 01/01/14 N 30 A4653 B 01/01/03 3 01/01/14 N 31 A4655 04/01/02 9 32 A4656 01/01/06 9 33 A4657 B 02/01/09 1 .1700 01/01/11 N 34 A4660 B 01/01/95 1 59.7200 08/01/00 N 35 A4663 B 02/28/94 1 22.8800 08/01/00 N 36 A4670 B 07/01/00 1 82.4800 08/01/00 E 37 A4671 01/01/08 1 29.2400 01/01/15 B 38 A4672 01/01/08 1 5.2000 01/01/15 B 39 A4673 01/01/08 1 7.5100 01/01/15 B 40 A4674 01/01/08 1 2.6500 01/01/15 B 41 A4680 01/01/08 1 1.6100 08/01/00 N 42 A4690 01/01/08 1 43.3800 08/01/00 N 43 A4700 04/01/02 9 44 A4705 04/01/02 9 45 A4706 01/01/08 1 14.0300 01/01/11 N 46 A4707 01/01/08 1 5.0000 01/01/11 N 47 A4708 01/01/02 3 01/01/11 N 48 A4709 01/01/08 1 10.8000 01/01/11 N 49


AS OF 03/12/2020



10

A4710 04/01/85 9 1 A4712 04/01/04 9 2 A4714 01/01/08 1 1.7900 08/01/00 N 3 A4719 01/01/08 1 38.5600 01/01/11 N 4 A4720 01/01/08 1 16.6900 01/01/11 N 5 A4721 01/01/08 1 30.9400 01/01/11 N 6 A4722 01/01/08 1 33.2000 01/01/11 N 7 A4723 01/01/08 1 37.0200 01/01/11 N 8 A4724 01/01/08 1 33.3100 01/01/11 N 9 A4725 01/01/08 1 31.6400 01/01/11 N 10 A4726 01/01/08 1 39.0500 01/01/11 N 11 A4728 01/01/04 3 01/01/15 B 12 A4730 01/01/08 1 1.9100 08/01/00 N 13 A4735 04/01/02 9 14 A4736 01/01/02 3 01/01/11 N 15 A4737 01/01/08 1 10.0700 01/01/11 N 16 A4740 07/01/83 3 08/01/00 N 17 A4750 05/16/91 1 3.0000 08/01/00 N 18 A4755 01/01/08 1 17.3900 08/01/00 N 19 A4760 07/01/83 3 08/01/00 N 20 A4765 01/01/08 1 5.2500 08/01/00 N 21 A4766 01/01/02 3 01/01/11 N 22 A4770 01/01/08 1 .4400 11/01/07 N 23 A4771 01/01/08 1 83.9400 08/01/00 N 24 A4772 01/01/98 1 77.2000 08/01/00 N 25 A4773 01/01/08 1 31.2300 08/01/00 N 26 A4774 07/01/85 3 08/01/00 N 27 A4780 04/01/02 9 28 A4790 04/01/02 9 29 A4800 04/01/02 9 30 A4801 04/01/03 9 31 A4802 01/01/08 1 6.5900 01/01/11 N 32 A4810 04/01/87 9 33 A4820 04/01/02 9 34 A4830 04/01/85 9 35 A4840 04/01/85 9 36 A4850 04/01/02 9 37 A4860 01/01/08 1 5.4300 08/01/00 N 38 A4870 07/01/83 3 08/01/00 N 39 A4880 04/01/02 9 40 A4890 07/01/83 3 08/01/00 N 41 A4900 04/01/02 9 42 A4901 04/01/02 9 43 A4905 04/01/02 9 44 A4910 04/01/02 9 45 A4911 01/01/08 1 13.7000 01/01/11 N 46 A4912 04/01/02 9 47 A4913 07/01/85 3 08/01/00 N 48 A4914 04/01/02 9 49


AS OF 03/12/2020



11

A4918 01/01/08 1 4.9400 08/01/00 N 1 A4919 04/01/02 9 2 A4920 04/01/02 9 3 A4921 04/01/02 9 4 A4927 B 01/01/03 1 9.0000 08/01/00 N 5 A4928 01/01/08 1 .5300 01/01/11 N 6 A4929 01/01/08 1 .2300 01/01/11 N 7 A4930 B 01/01/03 1 .3400 01/01/11 N 8 A4931 B 01/01/08 1 6.2500 01/01/11 N 9 A4932 B 01/01/03 3 01/01/15 N 10 A5051 B 01/01/20 1 2.4000 01/01/15 N 11 A5052 B 01/01/20 1 1.7300 01/01/15 N 12 A5053 B 01/01/20 1 2.0100 01/01/15 N 13 A5054 B 01/01/20 1 2.0900 01/01/15 N 14 A5055 B 01/01/20 1 1.6700 01/01/15 N 15 A5056 B 01/01/20 1 5.4300 01/01/15 N 16 A5057 B 01/01/20 1 11.1600 01/01/15 N 17 A5061 B 01/01/20 1 4.1000 01/01/15 N 18 A5062 B 01/01/20 1 2.5900 01/01/15 N 19 A5063 B 01/01/20 1 3.1400 01/01/15 N 20 A5064 04/01/02 9 21 A5065 04/11/01 9 22 A5071 B 01/01/20 1 6.9800 01/01/15 N 23 A5072 B 01/01/20 1 4.1000 01/01/15 N 24 A5073 B 01/01/20 1 3.6900 01/01/15 N 25 A5074 04/01/02 9 26 A5075 04/01/02 9 27 A5081 B 01/01/20 1 3.8500 01/01/15 N 28 A5082 B 01/01/20 1 13.1200 01/01/15 N 29 A5083 B 01/01/20 1 .7500 01/01/15 N 30 A5093 01/01/20 1 2.2700 01/01/15 N 31 A5102 B 01/01/20 1 26.2200 01/01/15 N 32 A5105 B 01/01/20 1 47.3700 01/01/15 N 33 A5112 B 01/01/20 1 39.5000 01/01/15 N 34 A5113 B 01/01/20 1 5.4800 01/01/15 E 35 A5114 B 01/01/20 1 10.2800 01/01/15 E 36 A5119 01/01/06 9 37 A5120 B 01/01/20 1 .2800 01/01/15 N 38 A5121 B 01/01/20 1 8.1300 01/01/15 N 39 A5122 B 01/01/20 1 14.3900 01/01/15 N 40 A5123 04/01/03 9 41 A5126 B 01/01/20 1 1.2900 01/01/15 N 42 A5131 B 01/01/20 1 15.6500 01/01/15 N 43 A5149 04/11/01 9 44 A5200 B 01/01/20 1 13.1400 01/01/15 N 45 A5500 B 01/01/20 1 73.8700 01/01/15 Y 46 A5501 B 01/01/20 1 221.5700 01/01/15 Y 47 7 48 A5502 04/01/02 9 49


AS OF 03/12/2020



12

A5503 01/01/20 1 35.5300 01/01/15 Y 1 A5504 01/01/20 1 35.5300 01/01/15 Y 2 A5505 01/01/20 1 35.5300 01/01/15 Y 3 A5506 01/01/20 1 35.5300 01/01/15 Y 4 A5507 01/01/20 1 35.5300 01/01/15 Y 5 A5508 07/01/03 4 6 A5509 01/01/06 9 7 A5510 B 05/01/18 3 01/01/15 N 8 A5511 01/01/06 9 9 A5512 B 01/01/20 1 30.1300 01/01/15 Y 10 A5513 B 01/01/20 1 44.9600 01/01/15 Y 11 A5514 B 01/01/20 1 44.9600 01/01/19 Y 12 A6000 01/29/04 4 13 A6010 B 01/01/20 1 35.9800 01/01/14 N 14 A6011 B 01/01/20 1 2.6500 01/01/14 N 15 A6020 04/01/02 9 16 A6021 B 01/01/20 1 24.4200 01/01/14 N 17 A6022 B 01/01/20 1 24.4200 01/01/14 N 18 A6023 B 01/01/20 1 221.0900 01/01/14 N 19 A6024 B 01/01/20 1 7.1900 01/01/14 N 20 A6025 B 01/01/97 3 01/01/15 N 21 A6154 B 01/01/20 1 16.7100 01/01/14 N 22 A6196 B 01/01/20 1 8.5500 01/01/14 N 23 A6197 B 01/01/20 1 19.1000 01/01/14 N 24 A6198 B 02/01/09 3 01/01/14 N 25 A6199 B 01/01/20 1 6.1400 01/01/14 N 26 A6200 01/01/10 9 27 A6201 01/01/10 9 28 A6202 01/01/10 9 29 A6203 B 01/01/20 1 3.9100 01/01/14 N 30 A6204 B 01/01/20 1 7.2300 01/01/14 N 31 A6205 B 03/01/18 3 01/01/14 N 32 A6206 B 02/01/09 1 .3000 01/01/14 N 33 A6207 B 01/01/20 1 8.5300 01/01/14 N 34 A6208 B 02/01/09 3 01/01/14 N 35 A6209 01/01/20 1 8.6800 01/01/14 N 36 A6210 B 01/01/20 1 23.1500 01/01/14 N 37 A6211 B 01/01/20 1 34.1200 01/01/14 N 38 A6212 B 01/01/20 1 11.2800 01/01/14 N 39 A6213 B 03/01/18 1 16.4600 01/01/14 N 40 A6214 B 01/01/20 1 11.9600 01/01/14 N 41 A6215 B 02/01/09 3 01/01/14 N 42 A6216 B 01/01/04 1 .0500 01/01/14 N 43 A6217 B 02/01/09 3 01/01/14 N 44 A6218 B 02/01/09 3 01/01/14 N 45 A6219 B 01/01/20 1 1.1100 01/01/14 N 46 A6220 B 01/01/20 1 3.0100 01/01/14 N 47 A6221 B 02/01/09 3 01/01/14 N 48 A6222 B 01/01/20 1 2.4800 01/01/14 N 49


AS OF 03/12/2020



13

A6223 B 01/01/20 1 2.8200 01/01/14 N 1 A6224 B 01/01/20 1 4.1900 01/01/14 N 2 A6228 B 02/01/09 3 01/01/14 N 3 A6229 B 01/01/20 1 4.1900 01/01/14 N 4 A6230 B 02/01/09 3 01/01/14 N 5 A6231 B 01/01/20 1 5.4500 01/01/14 N 6 A6232 B 01/01/20 1 7.9700 01/01/14 N 7 A6233 B 01/01/20 1 22.2800 01/01/14 N 8 A6234 B 01/01/20 1 7.6000 01/01/14 N 9 A6235 B 01/01/20 1 19.5400 01/01/14 N 10 A6236 B 01/01/20 1 31.6600 01/01/14 N 11 A6237 B 01/01/20 1 9.1900 01/01/14 N 12 A6238 B 01/01/20 1 26.4900 01/01/14 N 13 A6239 B 02/01/09 3 01/01/14 N 14 A6240 B 01/01/20 1 14.2300 01/01/14 N 15 A6241 B 01/01/20 1 2.9900 01/01/14 N 16 A6242 B 01/01/20 1 7.0400 01/01/14 N 17 A6243 B 01/01/20 1 14.3200 01/01/14 N 18 A6244 B 01/01/20 1 45.6400 01/01/14 N 19 A6245 B 01/01/20 1 8.4500 01/01/14 N 20 A6246 B 01/01/20 1 11.5400 01/01/14 N 21 A6247 B 01/01/20 1 27.6300 01/01/14 N 22 A6248 B 01/01/20 1 18.8800 01/01/14 N 23 A6250 08/16/17 4 24 A6251 B 01/01/20 1 2.3100 01/01/14 N 25 A6252 B 01/01/20 1 3.7800 01/01/14 N 26 A6253 B 01/01/20 1 7.3600 01/01/14 N 27 A6254 B 01/01/20 1 1.3900 01/01/14 N 28 A6255 B 01/01/20 1 3.5300 01/01/14 N 29 A6256 B 02/01/09 3 01/01/14 N 30 A6257 B 01/01/20 1 1.7900 01/01/14 N 31 A6258 B 01/01/20 1 5.0000 01/01/14 N 32 A6259 B 01/01/20 1 12.7000 01/01/14 N 33 A6260 B 06/15/09 1 7.8000 01/01/14 N 34 A6261 B 02/01/09 1 30.2800 01/01/14 N 35 A6262 B 02/01/09 1 .8900 01/01/14 N 36 A6263 04/01/03 9 37 A6264 04/01/03 9 38 A6265 04/01/03 9 39 A6266 B 01/01/20 1 2.2300 01/01/14 N 40 A6402 B 01/01/20 1 .1300 01/01/14 N 41 A6403 B 01/01/19 1 .4900 01/01/14 N 42 A6404 B 02/01/09 1 .6100 01/01/14 N 43 A6405 04/01/03 9 44 A6406 04/01/03 9 45 A6407 B 01/01/20 1 2.1800 01/01/14 N 46 A6410 B 01/01/19 1 .4400 01/01/14 N 47 A6411 B 01/01/18 3 01/01/14 N 48 A6412 B 01/01/03 1 2.9600 01/01/14 N 49


AS OF 03/12/2020



14

A6413 01/01/08 4 1 A6421 04/01/04 9 2 A6422 04/01/04 9 3 A6424 04/01/04 9 4 A6426 04/01/04 9 5 A6428 04/01/04 9 6 A6430 04/01/04 9 7 A6432 04/01/04 9 8 A6434 04/01/04 9 9 A6436 04/01/04 9 10 A6438 04/01/04 9 11 A6440 04/01/04 9 12 A6441 B 01/01/20 1 .8000 01/01/14 N 13 A6442 B 02/01/09 1 .1800 01/01/14 N 14 A6443 B 01/01/19 1 .3200 01/01/14 N 15 A6444 B 01/01/20 1 .6500 01/01/14 N 16 A6445 B 01/01/19 1 .3700 01/01/14 N 17 A6446 B 01/01/19 1 .4600 01/01/14 N 18 A6447 B 01/01/20 1 .8000 01/01/14 N 19 A6448 B 01/01/20 1 1.3400 01/01/14 N 20 A6449 B 01/01/20 1 2.0400 01/01/14 N 21 A6450 B 01/01/20 1 2.0400 01/01/14 N 22 A6451 B 01/01/20 1 2.0400 01/01/14 N 23 A6452 B 01/01/20 1 6.8600 01/01/14 N 24 A6453 B 01/01/20 1 .7300 01/01/14 N 25 A6454 B 01/01/20 1 .9100 01/01/14 N 26 A6455 B 01/01/20 1 1.6200 01/01/14 N 27 A6456 B 01/01/20 1 1.4700 01/01/14 N 28 A6457 B 01/01/20 1 1.3200 01/01/14 N 29 A6460 B 01/01/19 3 01/01/19 N 30 A6461 B 01/01/19 3 01/01/19 N 31 A6501 B 01/01/03 3 01/01/14 N 32 A6502 B 01/01/03 3 01/01/14 N 33 A6503 B 01/01/03 3 01/01/14 N 34 A6504 B 01/01/03 3 01/01/14 N 35 A6505 B 01/01/03 3 01/01/14 N 36 A6506 B 01/01/03 3 01/01/14 N 37 A6507 B 01/01/03 3 01/01/14 N 38 A6508 B 01/01/03 3 01/01/14 N 39 A6509 B 01/01/03 3 01/01/14 N 40 A6510 B 01/01/03 3 01/01/14 N 41 A6511 B 01/01/03 3 01/01/14 N 42 A6512 B 01/01/03 3 01/01/14 N 43 A6513 B 01/01/06 3 01/01/15 B 44 A6530 B 01/01/06 1 20.0000 01/01/15 E 45 A6531 B 01/01/20 1 50.2600 01/01/14 N 46 A6532 B 01/01/20 1 70.8200 01/01/14 N 47 A6533 B 01/01/13 1 40.9500 01/01/15 E 48 A6534 B 01/01/13 1 39.6900 01/01/15 E 49


AS OF 03/12/2020



15

A6535 B 01/01/06 3 01/01/15 E 1 A6536 B 02/01/09 3 01/01/15 E 2 A6537 B 02/01/09 3 01/01/15 E 3 A6538 B 02/01/09 3 01/01/15 E 4 A6539 B 01/01/06 3 01/01/15 E 5 A6540 B 01/01/06 3 01/01/15 E 6 A6541 B 01/01/06 3 01/01/15 E 7 A6542 01/01/10 9 8 A6543 01/01/10 9 9 A6544 B 02/01/09 3 01/01/15 E 10 A6545 B 01/01/20 1 98.9600 01/01/14 N 11 A6549 B 01/01/06 3 01/01/15 E 12 A6550 B 01/01/15 1 26.2500 01/01/15 N 13 W 24.1200 14 A6551 01/01/06 9 15 A7000 B 01/01/15 1 8.1300 01/01/15 Y 16 W 7.6800 17 A7001 B 01/01/20 1 38.4300 01/01/15 Y 18 A7002 B 01/01/20 1 4.4500 01/01/15 Y 19 A7003 B 01/01/15 1 2.6600 01/01/15 Y 20 A7004 B 01/01/15 1 2.0100 01/01/15 Y 21 A7005 B 01/01/15 1 34.2200 01/01/15 Y 22 A7006 B 01/01/15 1 10.5900 01/01/15 Y 23 A7007 B 01/01/20 1 2.9700 01/01/15 Y 24 W 2.4800 25 A7008 B 01/01/20 1 12.7700 01/01/15 Y 26 A7009 B 01/01/20 1 48.8500 01/01/15 Y 27 A7010 B 01/01/15 1 26.1900 01/01/15 Y 28 A7011 01/01/16 9 29 A7012 B 01/01/15 1 3.6100 01/01/15 Y 30 A7013 B 01/01/15 1 .9200 01/01/15 Y 31 A7014 B 01/01/15 1 4.9800 01/01/15 Y 32 A7015 B 01/01/15 1 1.9100 01/01/15 Y 33 A7016 B 01/01/20 1 8.4300 01/01/15 Y 34 A7017 B 01/01/20 1 105.6000 01/01/15 Y 35 7 36 M 10.5600 37 W 96.9400 38 X 9.7000 39 A7018 B 01/01/15 1 .4200 01/01/15 Y 40 A7019 04/01/04 9 41 A7020 B 01/01/20 1 16.8200 01/01/15 Y 42 7 43 A7025 A 01/01/20 1 505.4000 01/01/15 N 44 A7026 B 01/01/20 1 33.3900 01/01/15 Y 45 A7027 B 01/01/15 1 207.0300 01/01/15 Y 46 W 144.2500 47 A7028 B 01/01/15 1 55.0000 01/01/15 Y 48 W 40.0000 49


AS OF 03/12/2020


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