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2024 Workers' Compensation Part B Fee Schedule

43262-44145

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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
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