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Fee Schedule
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Fee Schedule 30630-31635
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2024 Workers' Compensation Part B Fee Schedule
30630-31635
View the PDF
CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
30630
001
90
2
X
1,549.20
X
30630
003
90
2
X
1,437.22
X
30630
002
90
2
X
1,671.24
X
30630
004
90
2
X
1,619.61
X
30801
003
10
2
X
143.25
X
30801
002
10
2
X
154.64
X
30801
001
10
2
X
151.34
X
30801
004
10
2
X
157.81
X
30802
001
10
2
X
317.44
X
30802
003
10
2
X
305.99
X
30802
002
10
2
X
313.21
X
30802
004
10
2
X
303.77
X
30901
004
0
2
X
164.95
141.74
30901
001
0
2
X
171.24
146.32
30901
003
0
2
X
187.03
160.33
30901
002
0
2
X
173.59
148.74
30903
004
0
2
X
264.58
X
30903
001
0
2
X
275.01
X
30903
003
0
2
X
258.92
X
30903
002
0
2
X
271.89
X
30905
001
0
2
X
439.20
X
30905
004
0
2
X
404.26
X
30905
003
0
2
X
457.61
X
30905
002
0
2
X
451.69
X
30906
002
0
2
X
482.88
X
30906
003
0
2
X
423.79
X
30906
001
0
2
X
404.41
X
30906
004
0
2
X
486.37
X
30915
001
90
2
X
1,388.22
X
30915
004
90
2
X
1,305.64
X
30915
002
90
2
X
1,345.45
X
30915
003
90
2
X
1,272.55
X
30920
002
90
2
X
2,208.85
X
30920
003
90
2
X
2,058.44
X
30920
001
90
2
X
2,245.12
X
30920
004
90
2
X
2,192.08
X
30930
004
10
2
X
222.76
X
30930
002
10
2
X
220.40
X
30930
003
10
2
X
214.76
X
30930
001
10
2
X
223.10
X
30999
YYY
2
X
#
X
31000
004
10
2
X
158.20
137.49
31000
002
10
2
X
163.33
141.33
31000
003
10
2
X
158.60
137.45
31000
001
10
2
X
161.46
139.79
31002
003
10
2
X
249.97
X
31002
002
10
2
X
215.68
X
31002
004
10
2
X
247.43
X
31002
001
10
2
X
262.49
X
31020
002
90
2
X
637.16
X
31020
003
90
2
X
640.11
X
31020
004
90
2
X
617.05
X
31020
001
90
2
X
679.69
X
31030
002
90
2
X
1,658.43
X
31030
003
90
2
X
1,562.93
X
31030
004
90
2
X
1,565.89
X
31030
001
90
2
X
1,702.78
X
31032
004
90
2
X
1,769.86
X
31032
003
90
2
X
1,782.64
X
31032
002
90
2
X
1,839.05
X
31032
001
90
2
X
1,948.15
X
31040
001
90
2
X
2,330.22
X
31040
004
90
2
X
1,820.07
X
31040
002
90
2
X
2,233.97
X
31040
003
90
2
X
1,842.48
X
31050
002
90
2
X
1,690.72
X
31050
003
90
2
X
1,656.88
X
31050
001
90
2
X
1,698.80
X
31050
004
90
2
X
1,650.46
X
31051
001
90
2
X
1,894.04
X
31051
004
90
2
X
1,624.92
X
31051
003
90
2
X
1,645.56
X
31051
002
90
2
X
1,883.09
X
31070
001
90
2
X
998.60
X
31070
004
90
2
X
947.72
X
31070
003
90
2
X
892.89
X
31070
002
90
2
X
928.62
X
31075
004
90
2
X
2,071.94
X
31075
001
90
2
X
2,271.46
X
31075
003
90
2
X
2,098.45
X
31075
002
90
2
X
2,237.92
X
31080
001
90
2
X
2,367.78
X
31080
004
90
2
X
2,169.99
X
31080
003
90
2
X
2,196.28
X
31080
002
90
2
X
2,334.39
X
31081
001
90
2
X
2,649.61
X
31081
003
90
2
X
2,455.20
X
31081
002
90
2
X
2,611.78
X
31081
004
90
2
X
2,425.77
X
31084
003
90
2
X
3,073.41
X
31084
002
90
2
X
3,227.95
X
31084
004
90
2
X
2,988.59
X
31084
001
90
2
X
3,276.45
X
31085
004
90
2
X
3,162.33
X
31085
002
90
2
X
4,031.96
X
31085
003
90
2
X
4,031.24
X
31085
001
90
2
X
4,104.33
X
31086
003
90
2
X
2,501.13
X
31086
002
90
2
X
2,654.01
X
31086
004
90
2
X
2,470.74
X
31086
001
90
2
X
2,979.10
X
31087
004
90
2
X
2,458.65
X
31087
003
90
2
X
2,488.45
X
31087
002
90
2
X
2,647.56
X
31087
001
90
2
X
2,685.99
X
31090
002
90
2
X
3,066.76
X
31090
003
90
2
X
3,112.96
X
31090
004
90
2
X
3,143.83
X
31090
001
90
2
X
3,121.32
X
31200
004
90
2
X
1,130.66
X
31200
001
90
2
X
1,184.28
X
31200
002
90
2
X
1,185.82
X
31200
003
90
2
X
1,138.09
X
31201
001
90
2
X
1,758.12
X
31201
003
90
2
X
1,645.56
X
31201
002
90
2
X
1,734.13
X
31201
004
90
2
X
1,634.17
X
31205
004
90
2
X
2,159.96
X
31205
002
90
2
X
2,217.27
X
31205
003
90
2
X
2,169.82
X
31205
001
90
2
X
2,228.71
X
31225
003
90
2
X
4,261.71
X
31225
002
90
2
X
4,400.35
X
31225
004
90
2
X
4,314.64
X
31225
001
90
2
X
4,580.17
X
31230
002
90
2
X
5,021.98
X
31230
003
90
2
X
4,714.66
X
31230
001
90
2
X
5,096.06
X
31230
004
90
2
X
4,656.66
X
31231
001
0
2
X
203.72
X
31231
004
0
2
X
185.60
X
31231
002
0
2
X
200.65
X
31231
003
0
2
X
188.01
X
31233
002
0
3
X
587.24
X
31233
003
0
3
X
561.53
X
31233
004
0
3
X
555.98
X
31233
001
0
3
X
593.38
X
31235
004
0
3
X
679.89
X
31235
003
0
3
X
688.62
X
31235
002
0
3
X
735.34
X
31235
001
0
3
X
746.60
X
31237
001
0
3
X
517.30
X
31237
004
0
3
X
460.19
X
31237
002
0
3
X
537.69
X
31237
003
0
3
X
512.48
X
31238
001
0
3
X
889.61
X
31238
003
0
3
X
551.41
X
31238
002
0
3
X
565.82
X
31238
004
0
3
X
518.02
X
31239
003
10
3
X
2,380.02
X
31239
002
10
3
X
2,585.19
X
31239
004
10
3
X
2,233.54
X
31239
001
10
3
X
2,800.84
X
31240
004
0
3
X
805.62
X
31240
002
0
3
X
829.26
X
31240
003
0
3
X
819.50
X
31240
001
0
3
X
835.69
X
31241
003
0
3
X
664.73
X
31241
002
0
3
X
664.73
X
31241
004
0
3
X
664.73
X
31241
001
0
3
X
722.35
X
31242
001
0
3
X
2,924.20
182.83
31242
002
0
3
X
2,581.30
167.96
31242
003
0
3
X
2,581.30
167.96
31242
004
0
3
X
2,581.30
167.96
31243
001
0
3
X
2,838.49
182.83
31243
002
0
3
X
2,505.84
167.96
31243
003
0
3
X
2,505.84
167.96
31243
004
0
3
X
2,505.84
167.96
31253
002
0
3
X
744.79
X
31253
003
0
3
X
744.79
X
31253
004
0
3
X
744.79
X
31253
001
0
3
X
808.44
X
31254
004
0
3
X
1,160.05
X
31254
001
0
3
X
1,271.94
X
31254
003
0
3
X
1,174.89
X
31254
002
0
3
X
1,270.97
X
31255
001
0
3
X
2,654.84
X
31255
003
0
3
X
2,560.04
X
31255
002
0
3
X
2,637.14
X
31255
004
0
3
X
2,575.36
X
31256
003
0
3
X
776.74
X
31256
002
0
3
X
827.93
X
31256
004
0
3
X
767.03
X
31256
001
0
3
X
840.23
X
31257
003
0
3
X
662.81
X
31257
002
0
3
X
662.81
X
31257
001
0
3
X
719.39
X
31257
004
0
3
X
662.81
X
31259
001
0
3
X
762.83
X
31259
004
0
3
X
702.75
X
31259
003
0
3
X
702.75
X
31259
002
0
3
X
702.75
X
31267
004
0
3
X
1,042.02
X
31267
002
0
3
X
1,141.66
X
31267
003
0
3
X
1,055.82
X
31267
001
0
3
X
1,162.30
X
31276
002
0
3
X
1,748.12
X
31276
003
0
3
X
1,645.33
X
31276
001
0
3
X
1,795.25
X
31276
004
0
3
X
1,622.69
X
31287
004
0
3
X
1,086.08
X
31287
002
0
3
X
1,397.81
X
31287
003
0
3
X
1,361.67
X
31287
001
0
3
X
1,404.81
X
31288
001
0
3
X
1,334.50
X
31288
004
0
3
X
1,251.37
X
31288
002
0
3
X
1,314.76
X
31288
003
0
3
X
1,249.35
X
31290
004
10
3
X
3,194.64
X
31290
001
10
3
X
5,072.07
X
31290
003
10
3
X
4,753.51
X
31290
002
10
3
X
4,865.56
X
31291
001
10
3
X
5,130.35
X
31291
004
10
3
X
3,355.94
X
31291
002
10
3
X
4,922.93
X
31291
003
10
3
X
4,807.49
X
31292
001
10
3
X
3,966.02
X
31292
003
10
3
X
3,716.41
X
31292
002
10
3
X
3,805.74
X
31292
004
10
3
X
2,594.85
X
31293
004
10
3
X
2,838.42
X
31293
002
10
3
X
4,160.87
X
31293
003
10
3
X
4,063.21
X
31293
001
10
3
X
4,336.16
X
31294
002
10
3
X
4,756.62
X
31294
003
10
3
X
4,644.83
X
31294
004
10
3
X
3,244.42
X
31294
001
10
3
X
4,957.06
X
31295
001
0
3
X
3,844.61
331.65
31295
003
0
3
X
3,407.34
302.73
31295
002
0
3
X
3,407.34
302.73
31295
004
0
3
X
3,407.34
302.73
31296
002
0
3
X
6,373.19
361.58
31296
003
0
3
X
6,373.19
361.58
31296
004
0
3
X
6,373.19
361.58
31296
001
0
3
X
7,198.01
395.69
31297
004
0
3
X
6,311.30
296.22
31297
001
0
3
X
7,130.65
324.50
31297
002
0
3
X
6,311.30
296.22
31297
003
0
3
X
6,311.30
296.22
31298
001
0
3
X
6,201.98
411.98
31298
004
0
3
X
5,425.24
379.23
31298
002
0
3
X
5,425.24
379.23
31298
003
0
3
X
5,425.24
379.23
31299
YYY
2
X
#
X
31300
001
90
2
X
3,126.23
X
31300
002
90
2
X
3,041.65
X
31300
003
90
2
X
2,918.50
X
31300
004
90
2
X
2,962.85
X
31360
002
90
2
X
4,346.53
X
31360
003
90
2
X
4,134.01
X
31360
004
90
2
X
4,091.52
X
31360
001
90
2
X
4,398.98
X
31365
002
90
2
X
6,139.83
X
31365
003
90
2
X
5,779.99
X
31365
004
90
2
X
5,865.31
X
31365
001
90
2
X
6,198.18
X
31367
001
90
2
X
4,273.59
X
31367
004
90
2
X
3,921.14
X
31367
002
90
2
X
4,214.45
X
31367
003
90
2
X
3,969.32
X
31368
001
90
2
X
6,231.16
X
31368
003
90
2
X
5,570.14
X
31368
002
90
2
X
6,039.08
X
31368
004
90
2
X
5,500.92
X
31370
001
90
2
X
4,217.36
X
31370
002
90
2
X
4,642.93
X
31370
003
90
2
X
3,914.87
X
31370
004
90
2
X
3,867.29
X
31375
001
90
2
X
3,908.03
X
31375
004
90
2
X
3,598.82
X
31375
003
90
2
X
3,642.36
X
31375
002
90
2
X
3,856.33
X
31380
002
90
2
X
4,168.22
X
31380
003
90
2
X
3,923.98
X
31380
004
90
2
X
3,890.13
X
31380
001
90
2
X
4,227.09
X
31382
003
90
2
X
3,790.45
X
31382
002
90
2
X
4,022.60
X
31382
004
90
2
X
3,744.79
X
31382
001
90
2
X
4,078.56
X
31390
002
90
2
X
6,632.79
X
31390
003
90
2
X
5,880.35
X
31390
001
90
2
X
6,594.99
X
31390
004
90
2
X
5,805.53
X
31395
001
90
2
X
7,397.96
X
31395
002
90
2
X
7,435.59
X
31395
003
90
2
X
6,785.13
X
31395
004
90
2
X
6,699.88
X
31400
001
90
2
X
2,902.81
X
31400
004
90
2
X
2,833.49
X
31400
003
90
2
X
2,842.82
X
31400
002
90
2
X
2,891.19
X
31420
001
90
2
X
2,268.20
X
31420
003
90
2
X
1,874.53
X
31420
002
90
2
X
1,987.98
X
31420
004
90
2
X
1,851.82
X
31500
001
0
0
X
377.05
X
31500
003
0
0
X
354.14
X
31500
002
0
0
X
372.56
X
31500
004
0
0
X
350.17
X
31502
001
0
2
X
146.79
X
31502
004
0
2
X
134.47
X
31502
002
0
2
X
144.71
X
31502
003
0
2
X
136.16
X
31505
002
0
2
X
112.64
91.14
31505
003
0
2
X
107.21
86.69
31505
004
0
2
X
103.17
83.42
31505
001
0
2
X
114.29
92.35
31510
004
0
3
X
264.63
X
31510
002
0
3
X
279.19
X
31510
003
0
3
X
267.50
X
31510
001
0
3
X
282.01
X
31511
001
0
3
X
395.75
X
31511
004
0
3
X
333.32
X
31511
002
0
3
X
417.62
X
31511
003
0
3
X
447.90
X
31512
001
0
3
X
636.46
X
31512
004
0
3
X
417.74
X
31512
003
0
3
X
611.80
X
31512
002
0
3
X
608.61
X
31513
004
0
3
X
711.39
X
31513
002
0
3
X
684.85
X
31513
003
0
3
X
580.03
X
31513
001
0
3
X
632.94
X
31515
001
0
2
X
343.28
X
31515
004
0
2
X
317.00
X
31515
003
0
2
X
320.64
X
31515
002
0
2
X
339.00
X
31520
004
0
2
X
452.80
X
31520
001
0
2
X
489.53
X
31520
002
0
2
X
483.41
X
31520
003
0
2
X
458.18
X
31525
004
0
2
X
520.89
X
31525
002
0
2
X
558.46
X
31525
003
0
2
X
527.22
X
31525
001
0
2
X
582.84
X
31526
003
0
2
X
648.60
X
31526
002
0
2
X
693.52
X
31526
004
0
2
X
607.19
X
31526
001
0
2
X
704.34
X
31527
003
0
3
X
683.47
X
31527
002
0
3
X
724.48
X
31527
004
0
3
X
675.13
X
31527
001
0
3
X
734.43
X
31528
004
0
3
X
547.80
X
31528
002
0
3
X
591.39
X
31528
003
0
3
X
651.02
X
31528
001
0
3
X
684.21
X
31529
002
0
3
X
595.66
X
31529
003
0
3
X
604.01
X
31529
004
0
3
X
554.92
X
31529
001
0
3
X
603.83
X
31530
004
0
3
X
761.53
X
31530
001
0
3
X
832.57
X
31530
003
0
3
X
771.06
X
31530
002
0
3
X
820.63
X
31531
004
0
3
X
971.67
X
31531
003
0
3
X
984.11
X
31531
002
0
3
X
987.13
X
31531
001
0
3
X
997.08
X
31535
004
0
3
X
827.79
X
31535
002
0
3
X
872.49
X
31535
003
0
3
X
791.52
X
31535
001
0
3
X
872.96
X
31536
001
0
3
X
990.71
X
31536
004
0
3
X
895.48
X
31536
002
0
3
X
974.46
X
31536
003
0
3
X
907.12
X
31540
003
0
3
X
1,043.30
X
31540
002
0
3
X
1,116.04
X
31540
004
0
3
X
1,030.17
X
31540
001
0
3
X
1,133.56
X
31541
001
0
3
X
1,231.52
X
31541
004
0
3
X
1,064.78
X
31541
002
0
3
X
1,219.22
X
31541
003
0
3
X
1,078.83
X
31545
001
0
3
X
851.93
X
31545
004
0
3
X
774.89
X
31545
002
0
3
X
774.89
X
31545
003
0
3
X
774.89
X
31546
001
0
3
X
1,304.80
X
31546
003
0
3
X
1,181.81
X
31546
002
0
3
X
1,181.81
X
31546
004
0
3
X
1,181.81
X
31551
001
90
2
X
2,347.32
X
31551
004
90
2
X
2,142.43
X
31551
003
90
2
X
2,142.43
X
31551
002
90
2
X
2,142.43
X
31552
002
90
2
X
2,160.87
X
31552
003
90
2
X
2,160.87
X
31552
004
90
2
X
2,160.87
X
31552
001
90
2
X
2,374.96
X
31553
003
90
2
X
2,354.62
X
31553
002
90
2
X
2,354.62
X
31553
004
90
2
X
2,354.62
X
31553
001
90
2
X
2,590.07
X
31554
001
90
2
X
2,729.00
X
31554
003
90
2
X
2,474.53
X
31554
002
90
2
X
2,474.53
X
31554
004
90
2
X
2,474.53
X
31560
003
0
3
X
1,881.51
X
31560
002
0
3
X
2,131.13
X
31560
004
0
3
X
2,096.09
X
31560
001
0
3
X
2,138.07
X
31561
004
0
3
X
2,266.90
X
31561
002
0
3
X
2,325.87
X
31561
003
0
3
X
1,528.42
X
31561
001
0
3
X
1,675.41
X
31570
003
0
3
X
1,040.81
X
31570
002
0
3
X
1,222.30
X
31570
001
0
3
X
1,129.37
X
31570
004
0
3
X
999.08
X
31571
001
0
3
X
1,143.44
X
31571
004
0
3
X
1,073.62
X
31571
003
0
3
X
1,027.96
X
31571
002
0
3
X
1,257.06
X
31572
002
0
3
X
725.61
275.18
31572
003
0
3
X
725.61
275.18
31572
004
0
3
X
725.61
275.18
31572
001
0
3
X
822.01
300.12
31573
001
0
3
X
436.37
247.82
31573
004
0
3
X
389.64
226.91
31573
002
0
3
X
389.64
226.91
31573
003
0
3
X
389.64
226.91
31574
002
0
3
X
1,479.42
226.91
31574
003
0
3
X
1,479.42
226.91
31574
004
0
3
X
1,479.42
226.91
31574
001
0
3
X
1,699.04
247.82
31575
001
0
2
X
385.47
282.18
31575
004
0
2
X
289.90
211.64
31575
003
0
2
X
293.66
214.00
31575
002
0
2
X
367.93
269.33
31576
003
0
3
X
605.11
X
31576
002
0
3
X
746.28
X
31576
004
0
3
X
749.65
X
31576
001
0
3
X
772.24
X
31577
004
0
3
X
904.70
X
31577
001
0
3
X
700.53
X
31577
003
0
3
X
959.30
X
31577
002
0
3
X
925.59
X
31578
001
0
3
X
926.34
X
31578
003
0
3
X
778.23
X
31578
002
0
3
X
834.50
X
31578
004
0
3
X
768.28
X
31579
004
0
3
X
499.43
X
31579
003
0
3
X
450.29
X
31579
002
0
3
X
520.05
X
31579
001
0
3
X
546.02
X
31580
001
90
2
X
3,047.73
X
31580
004
90
2
X
2,562.57
X
31580
003
90
2
X
2,805.68
X
31580
002
90
2
X
3,000.77
X
31584
003
90
2
X
3,402.42
X
31584
002
90
2
X
3,592.50
X
31584
001
90
2
X
3,638.49
X
31584
004
90
2
X
3,362.46
X
31587
001
90
2
X
1,793.99
X
31587
004
90
2
X
1,645.97
X
31587
003
90
2
X
1,666.16
X
31587
002
90
2
X
1,769.07
X
31590
002
90
2
X
1,769.07
X
31590
003
90
2
X
1,666.16
X
31590
001
90
2
X
1,793.99
X
31590
004
90
2
X
1,645.97
X
31591
003
90
2
X
1,560.70
X
31591
002
90
2
X
1,560.70
X
31591
004
90
2
X
1,560.70
X
31591
001
90
2
X
1,723.38
X
31592
001
90
2
X
2,783.60
X
31592
004
90
2
X
2,537.93
X
31592
002
90
2
X
2,537.93
X
31592
003
90
2
X
2,537.93
X
31599
YYY
2
X
#
X
31600
004
0
2
X
913.58
X
31600
002
0
2
X
930.68
X
31600
003
0
2
X
864.95
X
31600
001
0
2
X
946.51
X
31601
001
0
2
X
1,148.26
X
31601
003
0
2
X
1,055.95
X
31601
002
0
2
X
1,158.09
X
31601
004
0
2
X
1,042.96
X
31603
001
0
2
X
1,028.21
X
31603
003
0
2
X
942.81
X
31603
002
0
2
X
1,011.61
X
31603
004
0
2
X
931.49
X
31605
002
0
2
X
945.78
X
31605
003
0
2
X
861.06
X
31605
001
0
2
X
934.67
X
31605
004
0
2
X
850.36
X
31610
004
90
2
X
1,593.70
X
31610
001
90
2
X
1,744.01
X
31610
003
90
2
X
1,612.83
X
31610
002
90
2
X
1,718.52
X
31611
001
90
2
X
1,636.33
X
31611
004
90
2
X
1,475.31
X
31611
002
90
2
X
3,031.31
X
31611
003
90
2
X
1,494.57
X
31612
001
0
2
X
232.74
X
31612
004
0
2
X
219.63
X
31612
003
0
2
X
222.01
X
31612
002
0
2
X
230.66
X
31613
004
90
2
X
770.69
X
31613
003
90
2
X
774.05
X
31613
002
90
2
X
781.61
X
31613
001
90
2
X
793.77
X
31614
004
90
2
X
1,542.09
X
31614
002
90
2
X
1,588.23
X
31614
003
90
2
X
1,549.42
X
31614
001
90
2
X
1,597.51
X
31615
001
0
2
X
513.76
X
31615
004
0
2
X
484.21
X
31615
003
0
2
X
489.68
X
31615
002
0
2
X
533.07
X
31622
002
0
2
X
694.48
X
31622
003
0
2
X
652.08
X
31622
004
0
2
X
643.76
X
31622
001
0
2
X
704.72
X
31623
001
0
3
X
627.87
427.39
31623
004
0
3
X
558.15
386.84
31623
002
0
3
X
558.15
386.84
31623
003
0
3
X
558.15
386.84
31624
003
0
3
X
563.33
391.15
31624
002
0
3
X
563.33
391.15
31624
004
0
3
X
563.33
391.15
31624
001
0
3
X
633.42
432.04
31625
002
0
3
X
780.26
X
31625
003
0
3
X
734.56
X
31625
001
0
3
X
791.21
X
31625
004
0
3
X
725.39
X
31626
003
0
2
X
712.43
365.45
31626
002
0
2
X
712.43
365.45
31626
004
0
2
X
712.43
365.45
31626
001
0
2
X
806.66
395.15
31627
001
ZZZ
0
X
2,256.79
192.39
31627
004
ZZZ
0
X
1,918.37
177.66
31627
003
ZZZ
0
X
1,918.37
177.66
31627
002
ZZZ
0
X
1,918.37
177.66
31628
002
0
3
X
934.77
X
31628
003
0
3
X
880.83
X
31628
004
0
3
X
869.45
X
31628
001
0
3
X
947.84
X
31629
001
0
3
X
839.32
X
31629
003
0
3
X
821.59
X
31629
002
0
3
X
827.88
X
31629
004
0
3
X
820.93
X
31630
003
0
3
X
926.74
X
31630
002
0
3
X
998.38
X
31630
004
0
3
X
827.75
X
31630
001
0
3
X
982.88
X
31631
002
0
3
X
926.92
X
31631
003
0
3
X
857.98
X
31631
004
0
3
X
897.55
X
31631
001
0
3
X
943.05
X
31632
003
ZZZ
0
X
151.58
118.44
31632
002
ZZZ
0
X
151.58
118.44
31632
004
ZZZ
0
X
151.58
118.44
31632
001
ZZZ
0
X
171.97
133.03
31633
002
ZZZ
0
X
186.41
147.99
31633
003
ZZZ
0
X
186.41
147.99
31633
004
ZZZ
0
X
186.41
147.99
31633
001
ZZZ
0
X
209.24
164.13
31634
002
0
3
X
3,027.66
358.05
31634
003
0
3
X
3,027.66
358.05
31634
001
0
3
X
3,405.56
384.78
31634
004
0
3
X
3,027.66
358.05
31635
004
0
3
X
962.36
X
31635
002
0
3
X
1,011.88
X
31635
003
0
3
X
1,004.13
X
31635
001
0
3
X
1,036.99
X
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