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2024 Workers' Compensation Part B Fee Schedule

35606-36578

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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
35606   004 90 2 X 3,962.07 X
35606   001 90 2 X 4,809.96 X
35606   002 90 2 X 4,724.51 X
35606   003 90 2 X 4,511.71 X
35612   004 90 2 X 4,066.83 X
35612   001 90 2 X 4,321.94 X
35612   003 90 2 X 3,586.39 X
35612   002 90 2 X 3,886.58 X
35616   004 90 2 X 3,560.04 X
35616   002 90 2 X 3,909.28 X
35616   003 90 2 X 4,011.29 X
35616   001 90 2 X 3,983.49 X
35621   001 90 2 X 5,164.11 X
35621   002 90 2 X 5,068.17 X
35621   003 90 2 X 4,909.34 X
35621   004 90 2 X 4,948.86 X
35623   004 90 2 X 2,629.04 X
35623   002 90 2 X 2,838.58 X
35623   003 90 2 X 2,657.92 X
35623   001 90 2 X 2,882.56 X
35626   001 90 2 X 5,362.15 X
35626   004 90 2 X 4,831.10 X
35626   003 90 2 X 4,888.08 X
35626   002 90 2 X 5,269.69 X
35631   003 90 2 X 4,659.70 X
35631   002 90 2 X 5,002.49 X
35631   004 90 2 X 4,606.42 X
35631   001 90 2 X 5,085.69 X
35632   002 90 2 X 3,446.18 X
35632   003 90 2 X 3,446.18 X
35632   004 90 2 X 3,446.18 X
35632   001 90 2 X 3,799.44 X
35633   001 90 2 X 4,103.23 X
35633   004 90 2 X 3,722.26 X
35633   002 90 2 X 3,722.26 X
35633   003 90 2 X 3,722.26 X
35634   004 90 2 X 3,372.47 X
35634   001 90 2 X 3,718.43 X
35634   003 90 2 X 3,372.47 X
35634   002 90 2 X 3,372.47 X
35636   003 90 2 X 3,882.20 X
35636   002 90 2 X 4,138.58 X
35636   001 90 2 X 4,200.91 X
35636   004 90 2 X 3,838.34 X
35637   001 90 2 X 3,334.06 X
35637   003 90 2 X 2,957.12 X
35637   002 90 2 X 2,957.12 X
35637   004 90 2 X 2,957.12 X
35638   004 90 2 X 3,003.86 X
35638   002 90 2 X 3,003.86 X
35638   003 90 2 X 3,003.86 X
35638   001 90 2 X 3,386.77 X
35642   001 90 2 X 3,323.88 X
35642   004 90 2 X 3,024.82 X
35642   002 90 2 X 3,271.98 X
35642   003 90 2 X 3,058.94 X
35645   001 90 2 X 5,228.80 X
35645   004 90 2 X 3,037.28 X
35645   003 90 2 X 3,072.21 X
35645   002 90 2 X 5,207.42 X
35646   004 90 2 X 5,245.41 X
35646   003 90 2 X 5,473.86 X
35646   002 90 2 X 5,911.16 X
35646   001 90 2 X 6,017.09 X
35647   001 90 2 X 3,762.13 X
35647   004 90 2 X 3,368.36 X
35647   002 90 2 X 3,368.36 X
35647   003 90 2 X 3,368.36 X
35650   004 90 2 X 3,426.40 X
35650   001 90 2 X 5,681.04 X
35650   002 90 2 X 5,612.52 X
35650   003 90 2 X 5,445.42 X
35654   002 90 2 X 5,515.66 X
35654   003 90 2 X 5,216.31 X
35654   004 90 2 X 5,418.42 X
35654   001 90 2 X 5,459.00 X
35656   004 90 2 X 4,354.47 X
35656   001 90 2 X 4,539.92 X
35656   003 90 2 X 4,369.61 X
35656   002 90 2 X 4,326.49 X
35661   001 90 2 X 3,929.67 X
35661   003 90 2 X 3,627.93 X
35661   002 90 2 X 3,830.39 X
35661   004 90 2 X 3,734.26 X
35663   004 90 2 X 3,445.53 X
35663   001 90 2 X 3,886.28 X
35663   002 90 2 X 4,096.60 X
35663   003 90 2 X 4,249.28 X
35665   001 90 2 X 4,371.58 X
35665   004 90 2 X 4,088.52 X
35665   003 90 2 X 4,068.46 X
35665   002 90 2 X 4,266.66 X
35666   003 90 2 X 4,691.35 X
35666   002 90 2 X 4,522.80 X
35666   001 90 2 X 5,339.31 X
35666   004 90 2 X 4,114.55 X
35671   001 90 2 X 6,082.93 X
35671   004 90 2 X 5,873.38 X
35671   003 90 2 X 5,892.26 X
35671   002 90 2 X 6,073.64 X
35681   004 ZZZ 0 X 2,739.40 X
35681   001 ZZZ 0 X 3,127.13 X
35681   003 ZZZ 0 X 2,773.32 X
35681   002 ZZZ 0 X 3,058.11 X
35682   004 ZZZ 0 X 1,016.57 1,010.74
35682   001 ZZZ 0 X 1,216.81 1,210.05
35682   003 ZZZ 0 X 1,016.57 1,010.74
35682   002 ZZZ 0 X 1,016.57 1,010.74
35683   004 ZZZ 0 X 1,172.33 1,164.07
35683   002 ZZZ 0 X 1,172.33 1,164.07
35683   003 ZZZ 0 X 1,172.33 1,164.07
35683   001 ZZZ 0 X 1,383.76 1,374.13
35685   004 ZZZ 0 X 468.28 X
35685   002 ZZZ 0 X 468.28 X
35685   003 ZZZ 0 X 468.28 X
35685   001 ZZZ 0 X 521.02 X
35686   001 ZZZ 0 X 430.99 X
35686   003 ZZZ 0 X 387.36 X
35686   002 ZZZ 0 X 387.36 X
35686   004 ZZZ 0 X 387.36 X
35691   004 90 2 X 4,127.86 X
35691   001 90 2 X 4,610.57 X
35691   002 90 2 X 5,832.08 X
35691   003 90 2 X 4,177.99 X
35693   002 90 2 X 2,834.61 X
35693   003 90 2 X 2,648.11 X
35693   001 90 2 X 2,879.93 X
35693   004 90 2 X 2,618.28 X
35694   002 90 2 X 3,279.95 X
35694   003 90 2 X 3,071.57 X
35694   004 90 2 X 3,038.12 X
35694   001 90 2 X 3,330.75 X
35695   001 90 2 X 3,330.75 X
35695   004 90 2 X 3,038.12 X
35695   003 90 2 X 3,071.57 X
35695   002 90 2 X 3,279.95 X
35697   002 ZZZ 0 X 346.96 X
35697   003 ZZZ 0 X 346.96 X
35697   004 ZZZ 0 X 346.96 X
35697   001 ZZZ 0 X 386.45 X
35700   001 ZZZ 0 X 575.65 X
35700   003 ZZZ 0 X 530.77 X
35700   002 ZZZ 0 X 566.88 X
35700   004 ZZZ 0 X 524.96 X
35701   004 90 2 X 1,234.31 X
35701   003 90 2 X 1,561.80 X
35701   002 90 2 X 1,608.54 X
35701   001 90 2 X 1,619.78 X
35702   001 90 2 X 637.81 X
35702   002 90 2 X 579.09 X
35702   003 90 2 X 579.09 X
35702   004 90 2 X 579.09 X
35703   001 90 2 X 648.02 X
35703   004 90 2 X 588.76 X
35703   002 90 2 X 588.76 X
35703   003 90 2 X 588.76 X
35800   001 90 2 X 1,400.80 X
35800   004 90 2 X 1,267.82 X
35800   003 90 2 X 1,282.79 X
35800   002 90 2 X 1,377.79 X
35820   003 90 2 X 2,560.04 X
35820   002 90 2 X 2,622.21 X
35820   001 90 2 X 2,612.15 X
35820   004 90 2 X 2,549.60 X
35840   001 90 2 X 2,553.95 X
35840   004 90 2 X 2,442.41 X
35840   003 90 2 X 2,508.32 X
35840   002 90 2 X 2,516.72 X
35860   001 90 2 X 1,702.64 X
35860   004 90 2 X 1,638.94 X
35860   003 90 2 X 1,648.93 X
35860   002 90 2 X 1,683.20 X
35870   001 90 2 X 9,212.33 X
35870   003 90 2 X 9,212.33 X
35870   002 90 2 X 9,212.33 X
35870   004 90 2 X 9,212.33 X
35875   003 90 2 X 2,452.43 X
35875   002 90 2 X 2,510.03 X
35875   001 90 2 X 2,532.06 X
35875   004 90 2 X 2,444.59 X
35876   002 90 2 X 2,647.66 X
35876   003 90 2 X 2,586.79 X
35876   001 90 2 X 2,670.52 X
35876   004 90 2 X 2,577.74 X
35879   001 90 2 X 2,509.08 X
35879   004 90 2 X 2,238.20 X
35879   003 90 2 X 2,238.20 X
35879   002 90 2 X 2,238.20 X
35881   004 90 2 X 2,455.26 X
35881   002 90 2 X 2,455.26 X
35881   003 90 2 X 2,455.26 X
35881   001 90 2 X 2,749.00 X
35883   004 90 2 X 2,158.32 X
35883   001 90 2 X 2,443.89 X
35883   002 90 2 X 2,158.32 X
35883   003 90 2 X 2,158.32 X
35884   004 90 2 X 2,292.40 X
35884   002 90 2 X 2,292.40 X
35884   003 90 2 X 2,292.40 X
35884   001 90 2 X 2,595.39 X
35901   003 90 2 X 1,674.24 X
35901   002 90 2 X 1,752.07 X
35901   004 90 2 X 1,662.45 X
35901   001 90 2 X 1,771.76 X
35903   001 90 2 X 1,821.78 X
35903   003 90 2 X 1,722.76 X
35903   002 90 2 X 1,801.79 X
35903   004 90 2 X 1,710.55 X
35905   002 90 2 X 2,098.03 X
35905   003 90 2 X 2,011.96 X
35905   004 90 2 X 1,997.13 X
35905   001 90 2 X 2,119.83 X
35907   002 90 2 X 2,126.40 X
35907   003 90 2 X 2,039.75 X
35907   001 90 2 X 2,148.41 X
35907   004 90 2 X 2,024.60 X
36000   001 XXX 9 X 100.15 X
36000   004 XXX 9 X 153.47 X
36000   003 XXX 9 X 135.72 X
36000   002 XXX 9 X 94.06 X
36002   003 0 2 X 388.36 242.23
36002   002 0 2 X 388.36 242.23
36002   001 0 2 X 437.43 265.63
36002   004 0 2 X 388.36 242.23
36005   002 0 2 X 135.72 X
36005   003 0 2 X 176.29 X
36005   004 0 2 X 193.61 X
36005   001 0 2 X 142.05 X
36010   003 XXX 2 X 580.42 X
36010   002 XXX 2 X 607.82 X
36010   004 XXX 2 X 568.71 X
36010   001 XXX 2 X 619.38 X
36011   003 XXX 2 X 514.27 X
36011   002 XXX 2 X 542.56 X
36011   001 XXX 2 X 549.40 X
36011   004 XXX 2 X 508.35 X
36012   003 XXX 2 X 636.02 X
36012   002 XXX 2 X 674.08 X
36012   004 XXX 2 X 628.49 X
36012   001 XXX 2 X 683.33 X
36013   002 XXX 2 X 614.16 X
36013   003 XXX 2 X 586.26 X
36013   004 XXX 2 X 574.52 X
36013   001 XXX 2 X 625.90 X
36014   004 XXX 2 X 537.76 X
36014   002 XXX 2 X 576.63 X
36014   003 XXX 2 X 544.12 X
36014   001 XXX 2 X 584.50 X
36015   002 XXX 2 X 674.08 X
36015   003 XXX 2 X 636.02 X
36015   004 XXX 2 X 628.49 X
36015   001 XXX 2 X 683.33 X
36100   002 XXX 2 X 614.80 X
36100   003 XXX 2 X 578.39 X
36100   001 XXX 2 X 623.69 X
36100   004 XXX 2 X 593.23 X
36140   002 XXX 2 X 489.16 X
36140   003 XXX 2 X 456.55 X
36140   001 XXX 2 X 507.34 X
36140   004 XXX 2 X 466.63 X
36160   004 XXX 2 X 534.97 X
36160   001 XXX 2 X 588.03 X
36160   003 XXX 2 X 541.41 X
36160   002 XXX 2 X 578.93 X
36200   002 0 2 X 622.99 X
36200   003 0 2 X 587.61 X
36200   004 0 2 X 580.51 X
36200   001 0 2 X 631.58 X
36215   001 0 2 X 777.70 X
36215   003 0 2 X 731.78 X
36215   002 0 2 X 768.80 X
36215   004 0 2 X 723.24 X
36216   004 0 2 X 855.26 X
36216   001 0 2 X 919.57 X
36216   003 0 2 X 865.40 X
36216   002 0 2 X 909.07 X
36217   001 0 2 X 1,095.36 X
36217   003 0 2 X 1,030.97 X
36217   002 0 2 X 1,082.83 X
36217   004 0 2 X 1,018.91 X
36218   004 ZZZ 0 X 162.65 X
36218   001 ZZZ 0 X 174.80 X
36218   003 ZZZ 0 X 164.55 X
36218   002 ZZZ 0 X 172.78 X
36221   001 0 2 X 2,030.55 391.32
36221   004 0 2 X 1,766.95 353.74
36221   003 0 2 X 1,766.95 353.74
36221   002 0 2 X 1,766.95 353.74
36222   001 0 2 X 2,512.20 524.94
36222   004 0 2 X 2,189.42 476.13
36222   003 0 2 X 2,189.42 476.13
36222   002 0 2 X 2,189.42 476.13
36223   004 0 2 X 2,394.88 514.77
36223   001 0 2 X 2,748.14 567.39
36223   003 0 2 X 2,394.88 514.77
36223   002 0 2 X 2,394.88 514.77
36224   003 0 2 X 2,600.52 559.75
36224   002 0 2 X 2,600.52 559.75
36224   001 0 2 X 2,983.33 616.22
36224   004 0 2 X 2,600.52 559.75
36225   004 0 2 X 2,377.51 512.65
36225   002 0 2 X 2,377.51 512.65
36225   003 0 2 X 2,377.51 512.65
36225   001 0 2 X 2,727.84 564.74
36226   001 0 2 X 3,040.95 617.38
36226   004 0 2 X 2,650.19 560.75
36226   002 0 2 X 2,650.19 560.75
36226   003 0 2 X 2,650.19 560.75
36227   002 ZZZ 0 X 389.02 177.16
36227   003 ZZZ 0 X 389.02 177.16
36227   001 ZZZ 0 X 440.22 194.45
36227   004 ZZZ 0 X 389.02 177.16
36228   004 ZZZ 0 X 1,817.20 360.86
36228   001 ZZZ 0 X 2,085.29 396.08
36228   003 ZZZ 0 X 1,817.20 360.86
36228   002 ZZZ 0 X 1,817.20 360.86
36245   001 XXX 2 X 882.56 X
36245   003 XXX 2 X 830.59 X
36245   002 XXX 2 X 872.49 X
36245   004 XXX 2 X 820.83 X
36246   002 0 2 X 909.07 X
36246   003 0 2 X 865.40 X
36246   001 0 2 X 919.57 X
36246   004 0 2 X 855.26 X
36247   002 0 2 X 1,082.83 X
36247   003 0 2 X 1,030.97 X
36247   001 0 2 X 1,095.36 X
36247   004 0 2 X 1,018.91 X
36248   001 ZZZ 0 X 174.80 X
36248   004 ZZZ 0 X 162.65 X
36248   002 ZZZ 0 X 172.78 X
36248   003 ZZZ 0 X 164.55 X
36251   001 0 2 X 2,643.54 522.91
36251   004 0 2 X 2,301.78 473.54
36251   003 0 2 X 2,301.78 473.54
36251   002 0 2 X 2,301.78 473.54
36252   004 0 2 X 2,534.66 616.83
36252   001 0 2 X 2,905.43 680.91
36252   003 0 2 X 2,534.66 616.83
36252   002 0 2 X 2,534.66 616.83
36253   001 0 2 X 4,041.96 728.00
36253   004 0 2 X 3,516.81 659.72
36253   002 0 2 X 3,516.81 659.72
36253   003 0 2 X 3,516.81 659.72
36254   004 0 2 X 3,661.01 711.69
36254   001 0 2 X 4,206.22 785.30
36254   002 0 2 X 3,661.01 711.69
36254   003 0 2 X 3,661.01 711.69
36260   001 90 2 X 1,988.02 X
36260   004 90 2 X 1,800.86 X
36260   002 90 2 X 1,955.52 X
36260   003 90 2 X 1,821.50 X
36261   001 90 2 X 864.57 X
36261   003 90 2 X 806.37 X
36261   002 90 2 X 1,124.23 X
36261   004 90 2 X 797.61 X
36262   002 90 2 X 671.84 X
36262   003 90 2 X 663.51 X
36262   004 90 2 X 624.34 X
36262   001 90 2 X 681.73 X
36299     YYY 2 X # X
36400   002 XXX 2 X 28.59 24.09
36400   003 XXX 2 X 27.10 22.93
36400   001 XXX 2 X 28.87 24.29
36400   004 XXX 2 X 26.92 22.65
36405   001 XXX 2 X 68.40 X
36405   004 XXX 2 X 62.21 X
36405   003 XXX 2 X 63.08 X
36405   002 XXX 2 X 67.43 X
36406   004 XXX 2 X 35.61 X
36406   003 XXX 2 X 36.06 X
36406   002 XXX 2 X 37.96 X
36406   001 XXX 2 X 38.42 X
36410   004 XXX 2 X 39.90 X
36410   002 XXX 2 X 42.93 X
36410   003 XXX 2 X 40.42 X
36410   001 XXX 2 X 43.62 X
36415     XXX 9 X 9.98 X
36416     XXX 9 X * X
36420   001 XXX 2 X 163.62 X
36420   002 XXX 2 X 161.84 X
36420   003 XXX 2 X 130.01 X
36420   004 XXX 2 X 191.36 X
36425   004 XXX 2 X 138.89 132.65
36425   001 XXX 2 X 166.25 158.86
36425   003 XXX 2 X 163.57 156.61
36425   002 XXX 2 X 138.67 132.60
36430   004 XXX 0 X 96.90 X
36430   002 XXX 0 X 90.67 X
36430   001 XXX 0 X 102.93 X
36430   003 XXX 0 X 87.42 X
36440   002 XXX 2 X 224.04 X
36440   003 XXX 2 X 212.33 X
36440   004 XXX 2 X 209.67 X
36440   001 XXX 2 X 226.87 X
36450   001 XXX 2 X 768.19 X
36450   004 XXX 2 X 412.99 X
36450   003 XXX 2 X 418.03 X
36450   002 XXX 2 X 875.25 X
36455   002 XXX 2 X 509.07 X
36455   003 XXX 2 X 480.32 X
36455   004 XXX 2 X 474.43 X
36455   001 XXX 2 X 516.06 X
36456   003 XXX 2 X 163.99 X
36456   002 XXX 2 X 163.99 X
36456   004 XXX 2 X 163.99 X
36456   001 XXX 2 X 177.40 X
36460   003 XXX 2 X 1,910.70 X
36460   002 XXX 2 X 1,910.70 X
36460   001 XXX 2 X 1,910.70 X
36460   004 XXX 2 X 1,910.70 X
36465   004 0 2 X 2,231.39 180.68
36465   002 0 2 X 2,231.39 180.68
36465   003 0 2 X 2,231.39 180.68
36465   001 0 2 X 2,549.76 196.71
36466   002 0 2 X 2,333.60 229.76
36466   003 0 2 X 2,333.60 229.76
36466   004 0 2 X 2,333.60 229.76
36466   001 0 2 X 2,663.98 249.94
36468     0 2 X * X
36470   001 0 2 X 125.04 112.78
36470   004 0 2 X 112.16 101.51
36470   002 0 2 X 122.71 110.92
36470   003 0 2 X 122.14 110.29
36471   004 0 2 X 200.97 181.58
36471   001 0 2 X 213.82 192.71
36471   002 0 2 X 211.71 190.94
36471   003 0 2 X 203.08 183.40
36473   002 0 2 X 2,152.26 267.42
36473   003 0 2 X 2,152.26 267.42
36473   001 0 2 X 2,472.43 288.58
36473   004 0 2 X 2,152.26 267.42
36474   004 ZZZ 0 X 398.98 133.97
36474   001 ZZZ 0 X 451.66 144.59
36474   003 ZZZ 0 X 398.98 133.97
36474   002 ZZZ 0 X 398.98 133.97
36475   004 0 2 X 4,287.14 739.92
36475   001 0 2 X 5,056.08 804.09
36475   003 0 2 X 4,287.14 739.92
36475   002 0 2 X 4,287.14 739.92
36476   001 ZZZ 0 X 978.78 392.22
36476   004 ZZZ 0 X 851.48 362.17
36476   003 ZZZ 0 X 851.48 362.17
36476   002 ZZZ 0 X 851.48 362.17
36478   001 0 2 X 4,654.03 804.09
36478   003 0 2 X 3,951.73 739.92
36478   002 0 2 X 3,951.73 739.92
36478   004 0 2 X 3,951.73 739.92
36479   003 ZZZ 0 X 859.46 362.17
36479   002 ZZZ 0 X 859.46 362.17
36479   004 ZZZ 0 X 859.46 362.17
36479   001 ZZZ 0 X 988.35 392.22
36481   002 0 2 X 1,427.89 X
36481   003 0 2 X 1,347.70 X
36481   001 0 2 X 1,447.20 X
36481   004 0 2 X 1,331.72 X
36482   004 0 2 X 2,971.80 267.88
36482   001 0 2 X 3,394.00 291.41
36482   003 0 2 X 2,971.80 267.88
36482   002 0 2 X 2,971.80 267.88
36483   004 ZZZ 0 X 208.46 133.65
36483   001 ZZZ 0 X 231.11 145.26
36483   003 ZZZ 0 X 208.46 133.65
36483   002 ZZZ 0 X 208.46 133.65
36500   002 0 2 X 220.56 218.26
36500   003 0 2 X 220.10 218.24
36500   004 0 2 X 213.21 210.81
36500   001 0 2 X 219.73 217.74
36510   002 0 2 X 147.52 X
36510   003 0 2 X 142.08 X
36510   001 0 2 X 148.83 X
36510   004 0 2 X 140.63 X
36511   004 0 2 X 197.32 X
36511   002 0 2 X 197.32 X
36511   003 0 2 X 197.32 X
36511   001 0 2 X 214.56 X
36512   004 0 2 X 197.32 X
36512   001 0 2 X 214.56 X
36512   002 0 2 X 197.32 X
36512   003 0 2 X 197.32 X
36513   001 0 2 X 214.56 X
36513   004 0 2 X 197.32 X
36513   002 0 2 X 197.32 X
36513   003 0 2 X 197.32 X
36514   004 0 2 X 197.32 X
36514   001 0 2 X 214.56 X
36514   002 0 2 X 197.32 X
36514   003 0 2 X 197.32 X
36516   001 0 2 X 214.56 X
36516   004 0 2 X 197.32 X
36516   003 0 2 X 197.32 X
36516   002 0 2 X 197.32 X
36522   001 0 2 X 1,536.02 X
36522   004 0 2 X 629.96 X
36522   003 0 2 X 638.72 X
36522   002 0 2 X 686.00 X
36555   004 0 0 X 682.47 292.40
36555   002 0 0 X 682.47 292.40
36555   003 0 0 X 682.47 292.40
36555   001 0 0 X 777.14 318.64
36556   003 0 0 X 649.54 264.74
36556   002 0 0 X 649.54 264.74
36556   001 0 0 X 736.43 284.15
36556   004 0 0 X 649.54 264.74
36557   004 10 2 X 1,471.36 644.61
36557   003 10 2 X 1,471.36 644.61
36557   002 10 2 X 1,471.36 644.61
36557   001 10 2 X 1,689.19 717.36
36558   003 10 2 X 1,438.81 612.01
36558   002 10 2 X 1,438.81 612.01
36558   004 10 2 X 1,438.81 612.01
36558   001 10 2 X 1,654.59 682.75
36560   003 10 2 X 2,741.53 766.43
36560   002 10 2 X 2,741.53 766.43
36560   004 10 2 X 2,741.53 766.43
36560   001 10 2 X 3,167.94 846.34
36561   002 10 2 X 2,715.24 739.39
36561   003 10 2 X 2,715.24 739.39
36561   004 10 2 X 2,715.24 739.39
36561   001 10 2 X 3,140.17 817.63
36563   001 10 2 X 3,961.79 854.17
36563   002 10 2 X 3,413.37 769.64
36563   003 10 2 X 3,413.37 769.64
36563   004 10 2 X 3,413.37 769.64
36565   002 10 2 X 2,191.17 739.39
36565   003 10 2 X 2,191.17 739.39
36565   001 10 2 X 2,524.17 817.63
36565   004 10 2 X 2,191.17 739.39
36566   001 10 2 X 2,636.38 874.16
36566   004 10 2 X 2,291.93 792.72
36566   002 10 2 X 2,291.93 792.72
36566   003 10 2 X 2,291.93 792.72
36568   002 0 0 X 785.72 213.48
36568   003 0 0 X 785.72 213.48
36568   004 0 0 X 785.72 213.48
36568   001 0 0 X 907.90 235.25
36569   001 0 0 X 823.12 219.54
36569   004 0 0 X 714.22 200.66
36569   002 0 0 X 714.22 200.66
36569   003 0 0 X 714.22 200.66
36570   002 10 2 X 3,500.42 666.94
36570   003 10 2 X 3,500.42 666.94
36570   001 10 2 X 4,071.57 740.92
36570   004 10 2 X 3,500.42 666.94
36571   002 10 2 X 3,150.19 664.57
36571   003 10 2 X 3,150.19 664.57
36571   001 10 2 X 3,660.06 738.40
36571   004 10 2 X 3,150.19 664.57
36572   003 0 0 X 562.59 130.40
36572   002 0 0 X 562.59 130.40
36572   001 0 0 X 635.68 139.79
36572   004 0 0 X 562.59 130.40
36573   002 0 0 X 529.61 120.78
36573   003 0 0 X 529.61 120.78
36573   004 0 0 X 529.61 120.78
36573   001 0 0 X 598.77 129.67
36575   003 0 2 X 344.39 111.68
36575   002 0 2 X 344.39 111.68
36575   001 0 2 X 419.03 145.52
36575   004 0 2 X 344.39 111.68
36576   003 10 2 X 876.91 428.83
36576   002 10 2 X 876.91 428.83
36576   004 10 2 X 876.91 428.83
36576   001 10 2 X 1,013.86 487.27
36578   003 10 2 X 1,114.32 486.31
36578   002 10 2 X 1,114.32 486.31
36578   004 10 2 X 1,114.32 486.31
36578   001 10 2 X 1,289.24 551.06