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Health Care Services Review
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Fee Schedule
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Fee Schedule 43262-44145
Begin Main Content Area
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2024 Workers' Compensation Part B Fee Schedule
43262-44145
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
43262
001
0
3
X
1,768.96
X
43262
004
0
3
X
1,629.32
X
43262
002
0
3
X
1,746.11
X
43262
003
0
3
X
1,650.51
X
43263
003
0
3
X
1,208.17
X
43263
002
0
3
X
1,100.22
X
43263
001
0
3
X
1,205.80
X
43263
004
0
3
X
1,092.11
X
43264
001
0
3
X
1,920.41
X
43264
004
0
3
X
1,849.65
X
43264
002
0
3
X
1,896.38
X
43264
003
0
3
X
1,821.52
X
43265
004
0
3
X
1,565.30
X
43265
001
0
3
X
1,687.19
X
43265
003
0
3
X
1,584.42
X
43265
002
0
3
X
1,667.24
X
43266
001
0
3
X
414.88
X
43266
003
0
3
X
379.12
X
43266
002
0
3
X
379.12
X
43266
004
0
3
X
379.12
X
43270
004
0
3
X
1,113.28
397.86
43270
001
0
3
X
1,268.76
435.36
43270
002
0
3
X
1,113.28
397.86
43270
003
0
3
X
1,113.28
397.86
43273
002
ZZZ
0
X
220.30
X
43273
003
ZZZ
0
X
220.30
X
43273
004
ZZZ
0
X
220.30
X
43273
001
ZZZ
0
X
240.15
X
43274
003
0
3
X
784.89
X
43274
002
0
3
X
784.89
X
43274
001
0
3
X
857.56
X
43274
004
0
3
X
784.89
X
43275
002
0
3
X
647.07
X
43275
003
0
3
X
647.07
X
43275
004
0
3
X
647.07
X
43275
001
0
3
X
707.22
X
43276
001
0
3
X
891.83
X
43276
003
0
3
X
816.54
X
43276
002
0
3
X
816.54
X
43276
004
0
3
X
816.54
X
43277
001
0
3
X
711.43
X
43277
004
0
3
X
650.97
X
43277
002
0
3
X
650.97
X
43277
003
0
3
X
650.97
X
43278
001
0
3
X
808.81
X
43278
004
0
3
X
740.27
X
43278
002
0
3
X
740.27
X
43278
003
0
3
X
740.27
X
43279
003
90
2
X
2,085.44
X
43279
002
90
2
X
2,085.44
X
43279
004
90
2
X
2,085.44
X
43279
001
90
2
X
2,288.49
X
43280
001
90
2
X
2,835.10
X
43280
004
90
2
X
2,538.57
X
43280
003
90
2
X
2,538.57
X
43280
002
90
2
X
2,538.57
X
43281
002
90
2
X
2,677.98
X
43281
003
90
2
X
2,677.98
X
43281
001
90
2
X
2,987.69
X
43281
004
90
2
X
2,677.98
X
43282
001
90
2
X
3,360.13
X
43282
004
90
2
X
3,012.95
X
43282
002
90
2
X
3,012.95
X
43282
003
90
2
X
3,012.95
X
43283
001
ZZZ
0
X
317.31
X
43283
002
ZZZ
0
X
286.72
X
43283
003
ZZZ
0
X
286.72
X
43283
004
ZZZ
0
X
286.72
X
43284
002
90
2
X
993.35
X
43284
003
90
2
X
993.35
X
43284
004
90
2
X
993.35
X
43284
001
90
2
X
1,095.85
X
43285
001
90
2
X
1,108.65
X
43285
003
90
2
X
1,005.97
X
43285
002
90
2
X
1,005.97
X
43285
004
90
2
X
1,005.97
X
43286
003
90
2
X
4,722.31
X
43286
002
90
2
X
4,722.31
X
43286
004
90
2
X
4,722.31
X
43286
001
90
2
X
5,165.13
X
43287
004
90
2
X
5,396.98
X
43287
003
90
2
X
5,396.98
X
43287
002
90
2
X
5,396.98
X
43287
001
90
2
X
5,907.99
X
43288
004
90
2
X
5,629.86
X
43288
001
90
2
X
6,151.44
X
43288
002
90
2
X
5,629.86
X
43288
003
90
2
X
5,629.86
X
43289
YYY
2
X
#
X
43290
002
0
3
X
3,010.16
206.37
43290
003
0
3
X
3,010.16
206.37
43290
001
0
3
X
3,434.66
225.18
43290
004
0
3
X
3,010.16
206.37
43291
001
0
3
X
586.21
197.04
43291
002
0
3
X
522.07
182.08
43291
003
0
3
X
522.07
182.08
43291
004
0
3
X
522.07
182.08
43300
003
90
2
X
2,251.91
X
43300
002
90
2
X
2,547.55
X
43300
004
90
2
X
2,592.17
X
43300
001
90
2
X
2,610.64
X
43305
001
90
2
X
3,474.16
X
43305
004
90
2
X
3,260.29
X
43305
002
90
2
X
3,883.21
X
43305
003
90
2
X
3,299.63
X
43310
001
90
2
X
5,046.72
X
43310
004
90
2
X
4,591.70
X
43310
003
90
2
X
4,644.41
X
43310
002
90
2
X
4,309.48
X
43312
004
90
2
X
4,486.16
X
43312
003
90
2
X
4,536.28
X
43312
002
90
2
X
4,802.55
X
43312
001
90
2
X
4,867.29
X
43313
003
90
2
X
5,687.67
X
43313
002
90
2
X
5,687.67
X
43313
004
90
2
X
5,687.67
X
43313
001
90
2
X
6,391.95
X
43314
003
90
2
X
6,255.04
X
43314
002
90
2
X
6,255.04
X
43314
004
90
2
X
6,255.04
X
43314
001
90
2
X
7,005.94
X
43320
001
90
2
X
4,146.11
X
43320
004
90
2
X
2,811.31
X
43320
002
90
2
X
3,735.86
X
43320
003
90
2
X
3,640.70
X
43325
002
90
2
X
3,200.41
X
43325
003
90
2
X
2,980.04
X
43325
001
90
2
X
3,253.84
X
43325
004
90
2
X
2,945.84
X
43327
004
90
2
X
1,437.82
X
43327
001
90
2
X
1,597.55
X
43327
002
90
2
X
1,437.82
X
43327
003
90
2
X
1,437.82
X
43328
001
90
2
X
2,371.13
X
43328
004
90
2
X
2,119.72
X
43328
003
90
2
X
2,119.72
X
43328
002
90
2
X
2,119.72
X
43330
003
90
2
X
3,670.57
X
43330
002
90
2
X
3,779.98
X
43330
001
90
2
X
3,759.43
X
43330
004
90
2
X
3,672.43
X
43331
004
90
2
X
3,265.55
X
43331
003
90
2
X
3,304.54
X
43331
002
90
2
X
3,558.59
X
43331
001
90
2
X
3,620.08
X
43332
001
90
2
X
2,289.76
X
43332
004
90
2
X
2,061.68
X
43332
002
90
2
X
2,061.68
X
43332
003
90
2
X
2,061.68
X
43333
003
90
2
X
2,239.17
X
43333
001
90
2
X
2,486.10
X
43333
002
90
2
X
2,239.17
X
43333
004
90
2
X
2,239.17
X
43334
001
90
2
X
2,514.83
X
43334
002
90
2
X
2,265.47
X
43334
003
90
2
X
2,265.47
X
43334
004
90
2
X
2,265.47
X
43335
002
90
2
X
2,441.32
X
43335
003
90
2
X
2,441.32
X
43335
004
90
2
X
2,441.32
X
43335
001
90
2
X
2,709.20
X
43336
002
90
2
X
2,676.12
X
43336
003
90
2
X
2,676.12
X
43336
004
90
2
X
2,676.12
X
43336
001
90
2
X
2,979.27
X
43337
001
90
2
X
3,250.42
X
43337
004
90
2
X
2,918.83
X
43337
003
90
2
X
2,918.83
X
43337
002
90
2
X
2,918.83
X
43338
004
ZZZ
0
X
237.43
X
43338
002
ZZZ
0
X
237.43
X
43338
003
ZZZ
0
X
237.43
X
43338
001
ZZZ
0
X
264.51
X
43340
002
90
2
X
3,981.06
X
43340
003
90
2
X
3,613.56
X
43340
004
90
2
X
3,004.30
X
43340
001
90
2
X
4,085.63
X
43341
002
90
2
X
3,275.52
X
43341
003
90
2
X
2,794.99
X
43341
004
90
2
X
2,763.04
X
43341
001
90
2
X
3,978.59
X
43351
001
90
2
X
2,683.95
X
43351
003
90
2
X
2,481.68
X
43351
002
90
2
X
2,644.46
X
43351
004
90
2
X
2,453.45
X
43352
001
90
2
X
2,410.08
X
43352
004
90
2
X
2,193.02
X
43352
003
90
2
X
2,260.26
X
43352
002
90
2
X
2,432.29
X
43360
004
90
2
X
5,604.53
X
43360
003
90
2
X
5,581.51
X
43360
002
90
2
X
5,791.27
X
43360
001
90
2
X
6,587.99
X
43361
002
90
2
X
7,266.25
X
43361
003
90
2
X
6,289.43
X
43361
004
90
2
X
6,216.58
X
43361
001
90
2
X
7,331.34
X
43400
001
90
2
X
3,540.75
X
43400
004
90
2
X
2,892.70
X
43400
003
90
2
X
2,926.55
X
43400
002
90
2
X
3,112.03
X
43405
002
90
2
X
3,558.59
X
43405
003
90
2
X
3,304.54
X
43405
001
90
2
X
3,620.08
X
43405
004
90
2
X
3,265.55
X
43410
001
90
2
X
2,283.22
X
43410
004
90
2
X
2,066.90
X
43410
003
90
2
X
2,091.72
X
43410
002
90
2
X
2,334.42
X
43415
004
90
2
X
3,213.00
X
43415
002
90
2
X
3,923.31
X
43415
003
90
2
X
3,751.49
X
43415
001
90
2
X
3,947.89
X
43420
002
90
2
X
1,077.37
X
43420
003
90
2
X
1,764.08
X
43420
001
90
2
X
1,091.20
X
43420
004
90
2
X
1,744.01
X
43425
004
90
2
X
2,816.11
X
43425
001
90
2
X
3,077.16
X
43425
002
90
2
X
3,032.55
X
43425
003
90
2
X
2,848.42
X
43450
001
0
2
X
247.10
X
43450
002
0
2
X
235.63
X
43450
003
0
2
X
222.58
X
43450
004
0
2
X
256.42
X
43453
004
0
2
X
301.70
X
43453
001
0
2
X
326.85
X
43453
002
0
2
X
322.73
X
43453
003
0
2
X
305.44
X
43460
002
0
2
X
502.75
X
43460
003
0
2
X
477.95
X
43460
004
0
2
X
478.71
X
43460
001
0
2
X
510.57
X
43496
90
2
X
*
X
43497
002
90
3
X
946.74
X
43497
003
90
3
X
946.74
X
43497
001
90
3
X
1,033.22
X
43497
004
90
3
X
946.74
X
43499
YYY
2
X
#
X
43500
004
90
2
X
1,634.51
X
43500
002
90
2
X
1,903.77
X
43500
003
90
2
X
1,904.36
X
43500
001
90
2
X
1,825.84
X
43501
001
90
2
X
2,594.07
X
43501
004
90
2
X
2,351.82
X
43501
002
90
2
X
2,548.56
X
43501
003
90
2
X
2,328.11
X
43502
004
90
2
X
2,351.82
X
43502
001
90
2
X
2,594.07
X
43502
003
90
2
X
2,328.11
X
43502
002
90
2
X
2,548.56
X
43510
004
90
2
X
1,782.94
X
43510
003
90
2
X
1,991.54
X
43510
002
90
2
X
1,991.68
X
43510
001
90
2
X
1,944.20
X
43520
001
90
2
X
1,700.82
X
43520
004
90
2
X
1,277.87
X
43520
003
90
2
X
1,292.44
X
43520
002
90
2
X
1,380.24
X
43605
002
90
2
X
1,732.94
X
43605
003
90
2
X
1,669.50
X
43605
001
90
2
X
1,762.05
X
43605
004
90
2
X
1,594.74
X
43610
004
90
2
X
2,242.14
X
43610
001
90
2
X
2,374.63
X
43610
003
90
2
X
2,220.80
X
43610
002
90
2
X
2,306.55
X
43611
004
90
2
X
2,322.88
X
43611
002
90
2
X
2,389.96
X
43611
003
90
2
X
2,302.18
X
43611
001
90
2
X
2,458.51
X
43620
001
90
2
X
4,723.00
X
43620
002
90
2
X
4,515.21
X
43620
003
90
2
X
4,387.69
X
43620
004
90
2
X
4,345.13
X
43621
004
90
2
X
4,360.60
X
43621
003
90
2
X
4,403.37
X
43621
002
90
2
X
4,531.17
X
43621
001
90
2
X
4,739.02
X
43622
004
90
2
X
4,407.27
X
43622
001
90
2
X
4,787.53
X
43622
003
90
2
X
4,450.48
X
43622
002
90
2
X
4,579.42
X
43631
002
90
2
X
3,722.23
X
43631
003
90
2
X
3,470.10
X
43631
004
90
2
X
3,431.05
X
43631
001
90
2
X
3,783.52
X
43632
001
90
2
X
3,783.52
X
43632
004
90
2
X
3,431.05
X
43632
002
90
2
X
3,722.23
X
43632
003
90
2
X
3,470.10
X
43633
002
90
2
X
3,770.63
X
43633
003
90
2
X
3,517.29
X
43633
004
90
2
X
3,477.93
X
43633
001
90
2
X
3,832.19
X
43634
004
90
2
X
4,664.73
X
43634
001
90
2
X
5,218.30
X
43634
003
90
2
X
4,719.94
X
43634
002
90
2
X
5,481.99
X
43635
002
ZZZ
0
X
380.06
X
43635
003
ZZZ
0
X
355.56
X
43635
001
ZZZ
0
X
385.93
X
43635
004
ZZZ
0
X
351.72
X
43640
004
90
2
X
2,555.86
X
43640
002
90
2
X
3,359.22
X
43640
003
90
2
X
2,625.20
X
43640
001
90
2
X
3,029.54
X
43641
001
90
2
X
2,947.37
X
43641
004
90
2
X
2,663.86
X
43641
002
90
2
X
2,898.00
X
43641
003
90
2
X
2,694.65
X
43644
001
90
2
X
3,569.19
X
43644
002
90
2
X
3,219.52
X
43644
003
90
2
X
3,219.52
X
43644
004
90
2
X
3,219.52
X
43645
004
90
2
X
3,470.72
X
43645
002
90
2
X
3,470.72
X
43645
003
90
2
X
3,470.72
X
43645
001
90
2
X
3,852.79
X
43647
YYY
2
X
*
X
43648
YYY
2
X
*
X
43651
002
90
2
X
1,384.70
X
43651
003
90
2
X
1,384.70
X
43651
004
90
2
X
1,384.70
X
43651
001
90
2
X
1,540.62
X
43652
001
90
2
X
1,839.79
X
43652
004
90
2
X
1,660.11
X
43652
003
90
2
X
1,660.11
X
43652
002
90
2
X
1,660.11
X
43653
003
90
2
X
1,192.25
X
43653
002
90
2
X
1,192.25
X
43653
004
90
2
X
1,192.25
X
43653
001
90
2
X
1,333.09
X
43659
YYY
2
X
#
X
43752
0
0
X
*
X
43753
004
0
0
X
36.02
X
43753
001
0
0
X
38.31
X
43753
002
0
0
X
36.02
X
43753
003
0
0
X
36.02
X
43754
002
0
0
X
133.21
54.27
43754
003
0
0
X
133.21
54.27
43754
001
0
0
X
148.51
59.17
43754
004
0
0
X
133.21
54.27
43755
003
0
0
X
204.05
99.55
43755
002
0
0
X
204.05
99.55
43755
001
0
0
X
226.18
107.95
43755
004
0
0
X
204.05
99.55
43756
004
0
0
X
366.95
89.24
43756
002
0
0
X
366.95
89.24
43756
003
0
0
X
366.95
89.24
43756
001
0
0
X
410.96
96.73
43757
001
0
0
X
528.15
139.39
43757
003
0
0
X
472.88
129.29
43757
002
0
0
X
472.88
129.29
43757
004
0
0
X
472.88
129.29
43761
001
0
2
X
352.58
X
43761
003
0
2
X
324.98
X
43761
002
0
2
X
347.20
X
43761
004
0
2
X
321.41
X
43762
004
0
2
X
297.75
53.84
43762
003
0
2
X
297.75
53.84
43762
002
0
2
X
297.75
53.84
43762
001
0
2
X
338.03
58.17
43763
003
0
2
X
443.26
118.07
43763
002
0
2
X
443.26
118.07
43763
004
0
2
X
443.26
118.07
43763
001
0
2
X
501.73
128.60
43770
001
90
2
X
2,074.72
X
43770
004
90
2
X
1,849.84
X
43770
003
90
2
X
1,849.84
X
43770
002
90
2
X
1,849.84
X
43771
001
90
2
X
2,387.80
X
43771
004
90
2
X
2,131.49
X
43771
002
90
2
X
2,131.49
X
43771
003
90
2
X
2,131.49
X
43772
002
90
2
X
1,625.61
X
43772
003
90
2
X
1,625.61
X
43772
004
90
2
X
1,625.61
X
43772
001
90
2
X
1,818.66
X
43773
003
90
2
X
2,132.05
X
43773
002
90
2
X
2,132.05
X
43773
004
90
2
X
2,132.05
X
43773
001
90
2
X
2,388.78
X
43774
004
90
2
X
1,630.11
X
43774
001
90
2
X
1,821.80
X
43774
002
90
2
X
1,630.11
X
43774
003
90
2
X
1,630.11
X
43775
004
90
2
X
2,243.53
X
43775
001
90
2
X
2,508.01
X
43775
002
90
2
X
2,243.53
X
43775
003
90
2
X
2,243.53
X
43800
004
90
2
X
2,407.78
X
43800
001
90
2
X
2,488.51
X
43800
003
90
2
X
2,391.64
X
43800
002
90
2
X
2,458.97
X
43810
004
90
2
X
2,318.74
X
43810
001
90
2
X
2,193.96
X
43810
003
90
2
X
2,010.90
X
43810
002
90
2
X
2,496.19
X
43820
002
90
2
X
2,678.74
X
43820
003
90
2
X
2,579.94
X
43820
001
90
2
X
2,695.27
X
43820
004
90
2
X
2,584.91
X
43825
003
90
2
X
3,020.95
X
43825
002
90
2
X
3,175.07
X
43825
004
90
2
X
3,045.90
X
43825
001
90
2
X
3,050.00
X
43830
003
90
2
X
1,421.48
X
43830
002
90
2
X
1,616.05
X
43830
004
90
2
X
1,560.08
X
43830
001
90
2
X
1,649.62
X
43831
004
90
2
X
1,071.06
X
43831
002
90
2
X
1,239.85
X
43831
003
90
2
X
1,309.32
X
43831
001
90
2
X
1,425.59
X
43832
002
90
2
X
2,231.87
X
43832
003
90
2
X
2,089.35
X
43832
004
90
2
X
2,065.25
X
43832
001
90
2
X
2,266.41
X
43840
001
90
2
X
2,279.30
X
43840
004
90
2
X
2,061.97
X
43840
002
90
2
X
2,241.46
X
43840
003
90
2
X
2,528.33
X
43842
001
90
9
X
3,287.40
X
43842
003
90
9
X
2,968.17
X
43842
002
90
9
X
3,225.06
X
43842
004
90
9
X
2,932.98
X
43843
001
90
2
X
3,287.40
X
43843
004
90
2
X
2,932.98
X
43843
002
90
2
X
3,225.06
X
43843
003
90
2
X
2,968.17
X
43845
90
2
X
*
X
43846
001
90
2
X
3,566.66
X
43846
004
90
2
X
3,175.59
X
43846
003
90
2
X
3,213.53
X
43846
002
90
2
X
4,489.83
X
43847
003
90
2
X
4,198.84
X
43847
002
90
2
X
4,394.04
X
43847
004
90
2
X
2,430.84
X
43847
001
90
2
X
2,642.03
X
43848
002
90
2
X
4,489.83
X
43848
003
90
2
X
3,213.53
X
43848
004
90
2
X
3,175.59
X
43848
001
90
2
X
3,566.66
X
43860
001
90
2
X
3,658.05
X
43860
003
90
2
X
3,360.69
X
43860
002
90
2
X
3,599.93
X
43860
004
90
2
X
3,323.35
X
43865
004
90
2
X
3,672.13
X
43865
001
90
2
X
4,057.13
X
43865
003
90
2
X
3,815.88
X
43865
002
90
2
X
3,990.03
X
43870
001
90
2
X
1,752.56
X
43870
003
90
2
X
1,626.20
X
43870
002
90
2
X
1,711.48
X
43870
004
90
2
X
1,660.82
X
43880
003
90
2
X
3,528.31
X
43880
002
90
2
X
3,703.38
X
43880
004
90
2
X
2,921.25
X
43880
001
90
2
X
3,771.41
X
43881
YYY
2
X
*
X
43882
YYY
2
X
*
X
43886
001
90
2
X
572.78
X
43886
004
90
2
X
511.46
X
43886
002
90
2
X
511.46
X
43886
003
90
2
X
511.46
X
43887
003
90
2
X
499.44
X
43887
002
90
2
X
499.44
X
43887
004
90
2
X
499.44
X
43887
001
90
2
X
566.39
X
43888
001
90
2
X
801.63
X
43888
003
90
2
X
710.05
X
43888
002
90
2
X
710.05
X
43888
004
90
2
X
710.05
X
43999
YYY
2
X
#
X
44005
004
90
2
X
2,396.73
X
44005
001
90
2
X
2,511.65
X
44005
003
90
2
X
2,422.54
X
44005
002
90
2
X
2,485.11
X
44010
003
90
2
X
2,094.05
X
44010
002
90
2
X
2,173.81
X
44010
004
90
2
X
2,138.25
X
44010
001
90
2
X
2,256.97
X
44015
002
ZZZ
0
X
1,523.68
X
44015
003
ZZZ
0
X
1,468.66
X
44015
001
ZZZ
0
X
1,528.54
X
44015
004
ZZZ
0
X
1,490.50
X
44020
004
90
2
X
2,210.05
X
44020
001
90
2
X
2,385.09
X
44020
003
90
2
X
2,198.76
X
44020
002
90
2
X
2,305.46
X
44021
004
90
2
X
1,998.38
X
44021
002
90
2
X
2,163.87
X
44021
001
90
2
X
2,198.64
X
44021
003
90
2
X
2,020.93
X
44025
001
90
2
X
2,384.35
X
44025
004
90
2
X
2,227.04
X
44025
003
90
2
X
2,219.47
X
44025
002
90
2
X
2,289.79
X
44050
003
90
2
X
2,051.03
X
44050
002
90
2
X
2,186.83
X
44050
001
90
2
X
2,347.06
X
44050
004
90
2
X
2,010.30
X
44055
004
90
2
X
2,191.75
X
44055
001
90
2
X
2,409.99
X
44055
003
90
2
X
2,156.39
X
44055
002
90
2
X
2,372.18
X
44100
001
0
2
X
418.72
X
44100
003
0
2
X
405.27
X
44100
002
0
2
X
359.57
X
44100
004
0
2
X
310.49
X
44110
002
90
2
X
2,484.45
X
44110
003
90
2
X
2,213.99
X
44110
004
90
2
X
2,063.31
X
44110
001
90
2
X
2,290.64
X
44111
003
90
2
X
2,415.12
X
44111
002
90
2
X
2,720.32
X
44111
001
90
2
X
2,623.77
X
44111
004
90
2
X
2,358.21
X
44120
001
90
2
X
2,936.23
X
44120
004
90
2
X
2,733.13
X
44120
002
90
2
X
2,900.83
X
44120
003
90
2
X
2,752.76
X
44121
004
ZZZ
0
X
802.02
X
44121
001
ZZZ
0
X
889.34
X
44121
003
ZZZ
0
X
812.33
X
44121
002
ZZZ
0
X
863.77
X
44125
004
90
2
X
2,943.22
X
44125
001
90
2
X
3,046.75
X
44125
002
90
2
X
3,037.68
X
44125
003
90
2
X
2,914.00
X
44126
002
90
2
X
4,270.98
X
44126
003
90
2
X
4,270.98
X
44126
001
90
2
X
4,629.46
X
44126
004
90
2
X
4,270.98
X
44127
003
90
2
X
4,912.33
X
44127
002
90
2
X
4,912.33
X
44127
001
90
2
X
5,322.46
X
44127
004
90
2
X
4,912.33
X
44128
003
ZZZ
0
X
524.50
X
44128
002
ZZZ
0
X
524.50
X
44128
001
ZZZ
0
X
584.19
X
44128
004
ZZZ
0
X
524.50
X
44130
001
90
2
X
2,628.85
X
44130
004
90
2
X
2,463.38
X
44130
003
90
2
X
2,465.31
X
44130
002
90
2
X
2,603.18
X
44132
XXX
0
X
*
X
44133
XXX
0
X
*
X
44135
XXX
0
X
#
X
44136
XXX
0
X
#
X
44137
XXX
2
X
*
X
44139
003
ZZZ
0
X
407.80
X
44139
002
ZZZ
0
X
433.59
X
44139
004
ZZZ
0
X
402.62
X
44139
001
ZZZ
0
X
446.42
X
44140
004
90
2
X
3,157.13
X
44140
002
90
2
X
3,469.81
X
44140
003
90
2
X
3,221.09
X
44140
001
90
2
X
3,531.81
X
44141
002
90
2
X
3,617.52
X
44141
003
90
2
X
3,387.53
X
44141
001
90
2
X
3,668.09
X
44141
004
90
2
X
3,360.82
X
44143
003
90
2
X
3,444.02
X
44143
002
90
2
X
3,673.36
X
44143
001
90
2
X
3,729.95
X
44143
004
90
2
X
3,427.03
X
44144
003
90
2
X
3,349.09
X
44144
002
90
2
X
3,565.79
X
44144
001
90
2
X
3,625.75
X
44144
004
90
2
X
3,342.11
X
44145
003
90
2
X
4,002.77
X
44145
002
90
2
X
4,165.08
X
44145
004
90
2
X
3,958.28
X
44145
001
90
2
X
4,288.02
X
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