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2024 Workers' Compensation Part B Fee Schedule

19105-21014

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CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
19105   002 0 2 X 3,115.22 306.69
19105   003 0 2 X 3,115.22 306.69
19105   004 0 2 X 3,115.22 306.69
19105   001 0 2 X 3,774.12 338.05
19110   002 90 2 X 797.35 X
19110   003 90 2 X 746.66 X
19110   001 90 2 X 870.06 X
19110   004 90 2 X 738.29 X
19112   004 90 2 X 641.93 X
19112   003 90 2 X 697.86 X
19112   002 90 2 X 750.30 X
19112   001 90 2 X 699.45 X
19120   004 90 2 X 798.41 X
19120   002 90 2 X 798.41 X
19120   003 90 2 X 798.41 X
19120   001 90 2 X 895.60 X
19125   001 90 2 X 1,058.31 X
19125   004 90 2 X 884.59 X
19125   002 90 2 X 1,043.16 X
19125   003 90 2 X 890.98 X
19126   003 ZZZ 0 X 729.39 X
19126   002 ZZZ 0 X 522.84 X
19126   004 ZZZ 0 X 724.78 X
19126   001 ZZZ 0 X 530.54 X
19281   002 0 2 X 374.09 165.82
19281   003 0 2 X 374.09 165.82
19281   004 0 2 X 374.09 165.82
19281   001 0 2 X 421.25 178.61
19282   001 ZZZ 0 X 291.34 83.91
19282   004 ZZZ 0 X 257.03 78.95
19282   002 ZZZ 0 X 257.03 78.95
19282   003 ZZZ 0 X 257.03 78.95
19283   004 0 2 X 423.37 167.41
19283   002 0 2 X 423.37 167.41
19283   003 0 2 X 423.37 167.41
19283   001 0 2 X 478.66 180.49
19284   004 ZZZ 0 X 307.35 79.48
19284   001 ZZZ 0 X 349.98 84.51
19284   003 ZZZ 0 X 307.35 79.48
19284   002 ZZZ 0 X 307.35 79.48
19285   002 0 2 X 707.37 141.97
19285   003 0 2 X 707.37 141.97
19285   004 0 2 X 707.37 141.97
19285   001 0 2 X 811.72 152.98
19286   002 ZZZ 0 X 589.64 68.21
19286   003 ZZZ 0 X 589.64 68.21
19286   004 ZZZ 0 X 589.64 68.21
19286   001 ZZZ 0 X 680.13 72.64
19287   004 0 2 X 1,309.86 232.04
19287   003 0 2 X 1,309.86 232.04
19287   002 0 2 X 1,309.86 232.04
19287   001 0 2 X 1,511.29 255.56
19288   001 ZZZ 0 X 1,196.98 108.54
19288   004 ZZZ 0 X 1,036.28 102.04
19288   003 ZZZ 0 X 1,036.28 102.04
19288   002 ZZZ 0 X 1,036.28 102.04
19294   001 ZZZ 0 X 267.36 X
19294   002 ZZZ 0 X 245.30 X
19294   003 ZZZ 0 X 245.30 X
19294   004 ZZZ 0 X 245.30 X
19296   001 0 2 X 11,245.01 466.13
19296   004 0 2 X 9,413.97 421.79
19296   003 0 2 X 9,413.97 421.79
19296   002 0 2 X 9,413.97 421.79
19297   004 ZZZ 0 X 193.64 X
19297   002 ZZZ 0 X 193.64 X
19297   001 ZZZ 0 X 213.43 X
19297   003 ZZZ 0 X 193.64 X
19298   002 0 2 X 3,563.84 677.96
19298   003 0 2 X 3,563.84 677.96
19298   004 0 2 X 3,563.84 677.96
19298   001 0 2 X 4,201.25 741.99
19300   001 90 2 X 955.19 661.54
19300   004 90 2 X 817.69 577.64
19300   003 90 2 X 817.69 577.64
19300   002 90 2 X 817.69 577.64
19301   003 90 2 X 632.00 X
19301   002 90 2 X 632.00 X
19301   004 90 2 X 632.00 X
19301   001 90 2 X 720.69 X
19302   001 90 2 X 1,527.57 X
19302   003 90 2 X 1,347.94 X
19302   002 90 2 X 1,347.94 X
19302   004 90 2 X 1,347.94 X
19303   003 90 2 X 1,376.25 X
19303   002 90 2 X 1,376.25 X
19303   004 90 2 X 1,376.25 X
19303   001 90 2 X 1,523.33 X
19305   004 90 2 X 1,669.72 X
19305   001 90 2 X 1,883.56 X
19305   003 90 2 X 1,669.72 X
19305   002 90 2 X 1,669.72 X
19306   001 90 2 X 1,960.80 X
19306   002 90 2 X 1,735.71 X
19306   003 90 2 X 1,735.71 X
19306   004 90 2 X 1,735.71 X
19307   003 90 2 X 1,745.24 X
19307   002 90 2 X 1,745.24 X
19307   004 90 2 X 1,745.24 X
19307   001 90 2 X 1,972.60 X
19316     90 2 X * X
19318   001 90 2 X 4,108.80 X
19318   004 90 2 X 3,945.84 X
19318   002 90 2 X 4,080.12 X
19318   003 90 2 X 3,926.23 X
19325   002 90 2 X 1,684.76 X
19325   003 90 2 X 2,204.70 X
19325   004 90 2 X 1,555.16 X
19325   001 90 2 X 1,711.79 X
19328   002 90 2 X 953.28 X
19328   003 90 2 X 891.83 X
19328   001 90 2 X 1,115.52 X
19328   004 90 2 X 1,013.98 X
19330   003 90 2 X 1,237.19 X
19330   002 90 2 X 1,315.98 X
19330   004 90 2 X 1,223.53 X
19330   001 90 2 X 1,335.17 X
19340   001 90 2 X 3,316.93 X
19340   003 90 2 X 3,224.38 X
19340   002 90 2 X 3,298.89 X
19340   004 90 2 X 1,861.59 X
19342   001 90 2 X 2,944.44 X
19342   003 90 2 X 2,446.93 X
19342   002 90 2 X 2,924.86 X
19342   004 90 2 X 2,417.98 X
19350   004 90 2 X 1,720.17 X
19350   002 90 2 X 1,934.75 X
19350   003 90 2 X 1,879.39 X
19350   001 90 2 X 1,904.09 X
19355   001 90 2 X 1,500.99 X
19355   004 90 2 X 1,364.32 X
19355   002 90 2 X 1,477.25 X
19355   003 90 2 X 1,379.80 X
19357   004 90 2 X 3,229.19 X
19357   001 90 2 X 3,555.93 X
19357   003 90 2 X 3,266.41 X
19357   002 90 2 X 3,499.39 X
19361   001 90 2 X 4,799.49 X
19361   003 90 2 X 3,563.84 X
19361   002 90 2 X 3,792.33 X
19361   004 90 2 X 4,303.33 X
19364   003 90 2 X 5,011.15 X
19364   002 90 2 X 5,358.66 X
19364   004 90 2 X 4,955.57 X
19364   001 90 2 X 5,443.17 X
19367   002 90 2 X 4,911.55 X
19367   003 90 2 X 4,628.86 X
19367   001 90 2 X 4,964.34 X
19367   004 90 2 X 5,225.93 X
19368   001 90 2 X 4,964.34 X
19368   004 90 2 X 5,225.93 X
19368   003 90 2 X 4,628.86 X
19368   002 90 2 X 4,911.55 X
19369   003 90 2 X 4,628.86 X
19369   002 90 2 X 4,911.55 X
19369   001 90 2 X 4,964.34 X
19369   004 90 2 X 5,225.93 X
19370   002 90 2 X 2,082.01 X
19370   003 90 2 X 2,033.70 X
19370   004 90 2 X 1,542.38 X
19370   001 90 2 X 2,093.70 X
19371   001 90 2 X 2,256.28 X
19371   004 90 2 X 1,886.78 X
19371   003 90 2 X 2,180.09 X
19371   002 90 2 X 2,241.45 X
19380   004 90 2 X 1,887.90 X
19380   002 90 2 X 2,058.60 X
19380   003 90 2 X 1,910.30 X
19380   001 90 2 X 2,094.58 X
19396     0 2 X * X
19499     YYY 2 X # X
20100   004 10 2 X 1,685.82 X
20100   001 10 2 X 1,892.80 X
20100   002 10 2 X 1,810.58 X
20100   003 10 2 X 1,709.44 X
20101   004 10 2 X 532.72 X
20101   003 10 2 X 540.17 X
20101   002 10 2 X 572.21 X
20101   001 10 2 X 598.32 X
20102   002 10 2 X 700.81 X
20102   003 10 2 X 661.68 X
20102   004 10 2 X 652.57 X
20102   001 10 2 X 732.72 X
20103   004 10 2 X 878.05 X
20103   002 10 2 X 943.04 X
20103   003 10 2 X 890.38 X
20103   001 10 2 X 985.72 X
20150   001 90 2 X 3,165.92 X
20150   002 90 2 X 2,832.26 X
20150   003 90 2 X 2,756.16 X
20150   004 90 2 X 2,756.16 X
20200   001 0 2 X 401.41 X
20200   003 0 2 X 381.52 X
20200   002 0 2 X 394.06 X
20200   004 0 2 X 377.05 X
20205   003 0 2 X 637.34 X
20205   002 0 2 X 648.29 X
20205   004 0 2 X 599.71 X
20205   001 0 2 X 660.28 X
20206   004 0 2 X 353.96 X
20206   001 0 2 X 375.07 X
20206   002 0 2 X 362.42 X
20206   003 0 2 X 359.04 X
20220   001 0 2 X 310.37 X
20220   003 0 2 X 276.38 X
20220   002 0 2 X 308.33 X
20220   004 0 2 X 312.71 X
20225   004 0 2 X 499.08 X
20225   002 0 2 X 472.33 X
20225   003 0 2 X 554.59 X
20225   001 0 2 X 479.75 X
20240   002 0 2 X 564.12 X
20240   003 0 2 X 535.89 X
20240   004 0 2 X 529.64 X
20240   001 0 2 X 561.70 X
20245   003 0 2 X 1,120.07 X
20245   002 0 2 X 1,211.18 X
20245   001 0 2 X 1,106.02 X
20245   004 0 2 X 1,190.58 X
20250   001 10 2 X 1,325.74 X
20250   004 10 2 X 1,076.17 X
20250   003 10 2 X 1,340.66 X
20250   002 10 2 X 1,218.21 X
20251   001 10 2 X 1,452.93 X
20251   004 10 2 X 1,327.10 X
20251   003 10 2 X 1,242.73 X
20251   002 10 2 X 1,374.94 X
20500   003 10 2 X 154.77 137.86
20500   002 10 2 X 157.10 139.88
20500   004 10 2 X 153.18 136.50
20500   001 10 2 X 163.12 144.90
20501   001 0 2 X 111.39 X
20501   004 0 2 X 104.74 X
20501   002 0 2 X 110.38 X
20501   003 0 2 X 105.91 X
20520   004 10 2 X 213.05 185.38
20520   002 10 2 X 241.59 208.28
20520   003 10 2 X 238.13 206.60
20520   001 10 2 X 210.03 181.13
20525   004 10 2 X 564.80 X
20525   002 10 2 X 642.56 X
20525   003 10 2 X 566.92 X
20525   001 10 2 X 603.84 X
20526   004 0 2 X 132.84 103.18
20526   002 0 2 X 132.84 103.18
20526   003 0 2 X 132.84 103.18
20526   001 0 2 X 148.78 113.89
20527   004 0 2 X 123.59 98.50
20527   002 0 2 X 123.59 98.50
20527   003 0 2 X 123.59 98.50
20527   001 0 2 X 137.79 108.61
20550   003 0 2 X 114.19 99.22
20550   001 0 2 X 112.82 97.98
20550   002 0 2 X 118.24 102.82
20550   004 0 2 X 111.73 96.88
20551   004 0 2 X 132.84 103.18
20551   002 0 2 X 132.84 103.18
20551   003 0 2 X 132.84 103.18
20551   001 0 2 X 148.78 113.89
20552   004 0 2 X 132.84 103.18
20552   003 0 2 X 132.84 103.18
20552   002 0 2 X 132.84 103.18
20552   001 0 2 X 148.78 113.89
20553   003 0 2 X 132.84 103.18
20553   002 0 2 X 132.84 103.18
20553   001 0 2 X 148.78 113.89
20553   004 0 2 X 132.84 103.18
20555   001 0 2 X 594.01 X
20555   004 0 2 X 542.26 X
20555   002 0 2 X 542.26 X
20555   003 0 2 X 542.26 X
20560     XXX 0 X * X
20561     XXX 0 X * X
20600   003 0 2 X 115.09 92.84
20600   002 0 2 X 120.52 96.90
20600   001 0 2 X 119.50 95.89
20600   004 0 2 X 114.04 91.86
20604   001 0 2 X 121.16 76.42
20604   003 0 2 X 109.58 71.35
20604   002 0 2 X 109.58 71.35
20604   004 0 2 X 109.58 71.35
20605   001 0 2 X 132.65 107.78
20605   004 0 2 X 122.62 99.83
20605   002 0 2 X 130.96 106.41
20605   003 0 2 X 124.08 100.91
20606   004 0 2 X 120.49 80.70
20606   003 0 2 X 120.49 80.70
20606   002 0 2 X 120.49 80.70
20606   001 0 2 X 133.02 86.46
20610   002 0 2 X 133.70 110.69
20610   003 0 2 X 126.92 105.25
20610   004 0 2 X 125.54 104.17
20610   001 0 2 X 134.89 111.34
20611   001 0 2 X 153.25 102.40
20611   004 0 2 X 138.32 94.85
20611   003 0 2 X 138.32 94.85
20611   002 0 2 X 138.32 94.85
20612   001 0 2 X 133.98 90.32
20612   004 0 2 X 118.65 81.53
20612   002 0 2 X 118.65 81.53
20612   003 0 2 X 118.65 81.53
20615   002 10 2 X 242.04 220.47
20615   003 10 2 X 236.29 216.27
20615   001 10 2 X 244.10 222.40
20615   004 10 2 X 234.72 214.21
20650   004 10 2 X 383.82 X
20650   003 10 2 X 371.95 X
20650   002 10 2 X 395.41 X
20650   001 10 2 X 603.57 X
20660   001 0 2 X 580.65 X
20660   003 0 2 X 573.90 X
20660   002 0 2 X 579.21 X
20660   004 0 2 X 541.65 X
20661   002 90 2 X 1,042.61 X
20661   003 90 2 X 1,020.53 X
20661   004 90 2 X 1,016.05 X
20661   001 90 2 X 1,054.96 X
20662   001 90 2 X 1,490.78 X
20662   002 90 2 X 1,465.58 X
20662   003 90 2 X 1,361.47 X
20662   004 90 2 X 1,344.84 X
20663   001 90 2 X 1,168.11 X
20663   003 90 2 X 1,071.27 X
20663   002 90 2 X 1,149.25 X
20663   004 90 2 X 1,058.57 X
20664   003 90 2 X 1,107.65 X
20664   002 90 2 X 1,107.65 X
20664   004 90 2 X 1,107.65 X
20664   001 90 2 X 1,230.17 X
20665   001 10 2 X 284.58 X
20665   004 10 2 X 190.01 X
20665   003 10 2 X 192.09 X
20665   002 10 2 X 305.25 X
20670   001 10 2 X 499.34 X
20670   004 10 2 X 495.83 X
20670   003 10 2 X 446.92 X
20670   002 10 2 X 452.80 X
20680   001 90 2 X 806.48 X
20680   003 90 2 X 739.82 X
20680   002 90 2 X 793.52 X
20680   004 90 2 X 730.86 X
20690   003 90 2 X 808.77 X
20690   002 90 2 X 857.72 X
20690   004 90 2 X 798.96 X
20690   001 90 2 X 865.97 X
20692   004 90 2 X 1,122.85 X
20692   002 90 2 X 1,186.35 X
20692   003 90 2 X 1,132.03 X
20692   001 90 2 X 1,199.53 X
20693   003 90 2 X 873.44 X
20693   002 90 2 X 922.88 X
20693   001 90 2 X 934.94 X
20693   004 90 2 X 863.89 X
20694   001 90 2 X 768.83 X
20694   003 90 2 X 712.36 X
20694   002 90 2 X 757.81 X
20694   004 90 2 X 704.17 X
20696   004 90 2 X 1,793.46 X
20696   001 90 2 X 1,998.74 X
20696   002 90 2 X 1,793.46 X
20696   003 90 2 X 1,793.46 X
20697   001 0 0 X 2,344.31 X
20697   004 0 0 X 1,976.51 X
20697   002 0 0 X 1,976.51 X
20697   003 0 0 X 1,976.51 X
20700   002 ZZZ 0 X 118.80 X
20700   003 ZZZ 0 X 118.80 X
20700   004 ZZZ 0 X 118.80 X
20700   001 ZZZ 0 X 130.18 X
20701   004 ZZZ 0 X 88.64 X
20701   002 ZZZ 0 X 88.64 X
20701   003 ZZZ 0 X 88.64 X
20701   001 ZZZ 0 X 96.95 X
20702   003 ZZZ 0 X 197.68 X
20702   002 ZZZ 0 X 197.68 X
20702   004 ZZZ 0 X 197.68 X
20702   001 ZZZ 0 X 216.68 X
20703   001 ZZZ 0 X 155.06 X
20703   004 ZZZ 0 X 141.70 X
20703   003 ZZZ 0 X 141.70 X
20703   002 ZZZ 0 X 141.70 X
20704   004 ZZZ 0 X 205.95 X
20704   002 ZZZ 0 X 205.95 X
20704   003 ZZZ 0 X 205.95 X
20704   001 ZZZ 0 X 225.78 X
20705   001 ZZZ 0 X 185.56 X
20705   004 ZZZ 0 X 169.45 X
20705   003 ZZZ 0 X 169.45 X
20705   002 ZZZ 0 X 169.45 X
20802   004 90 2 X 9,077.03 X
20802   002 90 2 X 9,853.86 X
20802   003 90 2 X 9,203.73 X
20802   001 90 2 X 10,161.72 X
20805   001 90 2 X 12,437.93 X
20805   003 90 2 X 11,264.91 X
20805   002 90 2 X 12,060.99 X
20805   004 90 2 X 11,109.88 X
20808   003 90 2 X 14,005.64 X
20808   002 90 2 X 14,995.36 X
20808   004 90 2 X 13,812.92 X
20808   001 90 2 X 15,464.05 X
20816   001 90 2 X 7,622.87 X
20816   003 90 2 X 6,904.09 X
20816   002 90 2 X 7,391.92 X
20816   004 90 2 X 6,809.07 X
20822   002 90 2 X 6,110.75 X
20822   003 90 2 X 5,707.52 X
20822   004 90 2 X 5,628.92 X
20822   001 90 2 X 6,301.74 X
20824   001 90 2 X 7,622.87 X
20824   002 90 2 X 7,391.92 X
20824   003 90 2 X 6,904.09 X
20824   004 90 2 X 6,809.07 X
20827   002 90 2 X 6,283.27 X
20827   003 90 2 X 5,868.50 X
20827   001 90 2 X 6,479.65 X
20827   004 90 2 X 5,787.76 X
20838   004 90 2 X 9,077.03 X
20838   001 90 2 X 10,161.72 X
20838   003 90 2 X 9,203.73 X
20838   002 90 2 X 9,853.86 X
20900   001 0 2 X 931.23 X
20900   003 0 2 X 1,138.57 X
20900   002 0 2 X 1,184.51 X
20900   004 0 2 X 1,293.23 X
20902   002 0 2 X 1,392.77 X
20902   003 0 2 X 1,306.14 X
20902   004 0 2 X 1,291.11 X
20902   001 0 2 X 1,413.76 X
20910   001 90 2 X 453.99 X
20910   003 90 2 X 436.44 X
20910   002 90 2 X 450.76 X
20910   004 90 2 X 618.23 X
20912   004 90 2 X 1,166.70 X
20912   002 90 2 X 1,255.58 X
20912   003 90 2 X 1,180.54 X
20912   001 90 2 X 1,273.68 X
20920   002 90 2 X 1,031.34 X
20920   003 90 2 X 970.28 X
20920   001 90 2 X 1,554.92 X
20920   004 90 2 X 958.83 X
20922   002 90 2 X 1,545.27 X
20922   003 90 2 X 1,164.68 X
20922   004 90 2 X 1,839.04 X
20922   001 90 2 X 1,260.38 X
20924   004 90 2 X 1,272.03 X
20924   001 90 2 X 1,966.00 X
20924   002 90 2 X 1,956.83 X
20924   003 90 2 X 1,287.27 X
20930     XXX 9 X * X
20931   004 ZZZ 0 X 407.69 X
20931   002 ZZZ 0 X 442.29 X
20931   003 ZZZ 0 X 413.90 X
20931   001 ZZZ 0 X 463.29 X
20932   002 ZZZ 0 X 1,011.17 X
20932   003 ZZZ 0 X 1,011.17 X
20932   004 ZZZ 0 X 1,011.17 X
20932   001 ZZZ 0 X 1,098.61 X
20933   004 ZZZ 0 X 927.46 X
20933   002 ZZZ 0 X 927.46 X
20933   001 ZZZ 0 X 1,007.50 X
20933   003 ZZZ 0 X 927.46 X
20934   001 ZZZ 0 X 1,098.12 X
20934   002 ZZZ 0 X 1,010.67 X
20934   003 ZZZ 0 X 1,010.67 X
20934   004 ZZZ 0 X 1,010.67 X
20936     XXX 9 X * X
20937   002 ZZZ 0 X 681.94 X
20937   003 ZZZ 0 X 638.07 X
20937   001 ZZZ 0 X 714.59 X
20937   004 ZZZ 0 X 628.43 X
20938   003 ZZZ 0 X 690.22 X
20938   002 ZZZ 0 X 737.54 X
20938   001 ZZZ 0 X 772.70 X
20938   004 ZZZ 0 X 679.82 X
20939   004 ZZZ 0 X 100.37 X
20939   002 ZZZ 0 X 100.37 X
20939   003 ZZZ 0 X 100.37 X
20939   001 ZZZ 0 X 109.44 X
20950   001 0 2 X 284.51 X
20950   004 0 2 X 259.00 X
20950   002 0 2 X 327.50 X
20950   003 0 2 X 278.69 X
20955   001 90 2 X 9,826.43 X
20955   003 90 2 X 9,826.43 X
20955   002 90 2 X 9,826.43 X
20955   004 90 2 X 9,826.43 X
20956   004 90 2 X 6,938.59 X
20956   001 90 2 X 7,914.78 X
20956   003 90 2 X 6,938.59 X
20956   002 90 2 X 7,130.27 X
20957   002 90 2 X 7,386.98 X
20957   003 90 2 X 7,188.37 X
20957   001 90 2 X 8,199.69 X
20957   004 90 2 X 7,188.37 X
20962   002 90 2 X 7,130.27 X
20962   003 90 2 X 6,938.59 X
20962   004 90 2 X 6,938.59 X
20962   001 90 2 X 7,914.78 X
20969   002 90 2 X 9,166.91 X
20969   003 90 2 X 8,920.55 X
20969   004 90 2 X 8,920.55 X
20969   001 90 2 X 10,246.76 X
20970   002 90 2 X 9,826.43 X
20970   003 90 2 X 9,826.43 X
20970   004 90 2 X 9,826.43 X
20970   001 90 2 X 9,826.43 X
20972   004 90 2 X 9,826.43 X
20972   002 90 2 X 9,826.43 X
20972   003 90 2 X 9,826.43 X
20972   001 90 2 X 9,826.43 X
20973   001 90 2 X 9,826.43 X
20973   004 90 2 X 9,826.43 X
20973   002 90 2 X 9,826.43 X
20973   003 90 2 X 9,826.43 X
20974   004 0 0 X 465.20 X
20974   001 0 0 X 531.79 X
20974   002 0 0 X 520.15 X
20974   003 0 0 X 471.74 X
20975   004 0 0 X 667.46 X
20975   002 0 0 X 730.16 X
20975   003 0 0 X 675.76 X
20975   001 0 0 X 743.35 X
20979   001 0 0 X 41.11 23.57
20979   003 0 0 X 36.50 21.54
20979   002 0 0 X 36.50 21.54
20979   004 0 0 X 36.50 21.54
20982   001 0 2 X 10,005.65 945.77
20982   004 0 2 X 8,566.11 858.57
20982   003 0 2 X 8,566.11 858.57
20982   002 0 2 X 8,566.11 858.57
20983   004 0 2 X 10,315.99 628.21
20983   003 0 2 X 10,315.99 628.21
20983   002 0 2 X 10,315.99 628.21
20983   001 0 2 X 12,015.54 680.13
20985   001 ZZZ 0 X 285.53 X
20985   003 ZZZ 0 X 251.12 X
20985   002 ZZZ 0 X 251.12 X
20985   004 ZZZ 0 X 251.12 X
20999     YYY 2 X # X
21010   004 90 2 X 2,077.33 X
21010   001 90 2 X 2,266.05 X
21010   002 90 2 X 2,234.60 X
21010   003 90 2 X 2,103.80 X
21011   004 90 2 X 518.02 408.66
21011   001 90 2 X 590.29 460.61
21011   002 90 2 X 518.02 408.66
21011   003 90 2 X 518.02 408.66
21012   004 90 2 X 561.81 X
21012   002 90 2 X 561.81 X
21012   003 90 2 X 561.81 X
21012   001 90 2 X 631.47 X
21013   001 90 2 X 915.12 740.59
21013   004 90 2 X 808.37 661.20
21013   002 90 2 X 808.37 661.20
21013   003 90 2 X 808.37 661.20
21014   004 90 2 X 868.35 X
21014   002 90 2 X 868.35 X
21014   003 90 2 X 868.35 X
21014   001 90 2 X 973.50 X