2018 Workers' Compensation Part B Fee Schedule

62162-63286

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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
62162   1 90 2 0 2,964.97 0
62162   2 90 2 0 2,555.69 0
62162   3 90 2 0 2,555.69 0
62162   4 90 2 0 2,555.69 0
62163   1 90 2 0 1,880.47 0
62163   2 90 2 0 1,615.95 0
62163   3 90 2 0 1,615.95 0
62163   4 90 2 0 1,615.95 0
62164   1 90 2 0 3,195.08 0
62164   2 90 2 0 2,768.31 0
62164   3 90 2 0 2,768.31 0
62164   4 90 2 0 2,768.31 0
62165   1 90 2 0 2,480.80 0
62165   2 90 2 0 2,177.24 0
62165   3 90 2 0 2,177.24 0
62165   4 90 2 0 2,177.24 0
62180   1 90 2 0 3,154.99 0
62180   2 90 2 0 3,112.34 0
62180   3 90 2 0 2,386.87 0
62180   4 90 2 0 3,152.81 0
62190   1 90 2 0 2,527.23 0
62190   2 90 2 0 2,476.05 0
62190   3 90 2 0 2,264.71 0
62190   4 90 2 0 2,237.39 0
62192   1 90 2 0 2,536.89 0
62192   2 90 2 0 2,489.91 0
62192   3 90 2 0 2,295.88 0
62192   4 90 2 0 2,320.67 0
62194   1 10 2 0 821.28 0
62194   2 10 2 0 782.18 0
62194   3 10 2 0 376.56 0
62194   4 10 2 0 372.28 0
62200   1 90 2 0 2,616.45 0
62200   2 90 2 0 2,649.59 0
62200   3 90 2 0 2,677.58 0
62200   4 90 2 0 2,645.05 0
62201   1 90 2 0 1,989.14 0
62201   2 90 2 0 1,957.49 0
62201   3 90 2 0 1,827.10 0
62201   4 90 2 0 1,806.26 0
62220   1 90 2 0 2,765.48 0
62220   2 90 2 0 2,713.08 0
62220   3 90 2 0 2,496.85 0
62220   4 90 2 0 2,466.59 0
62223   1 90 2 0 2,861.38 0
62223   2 90 2 0 2,809.05 0
62223   3 90 2 0 2,592.49 0
62223   4 90 2 0 2,561.01 0
62225   1 90 2 0 846.86 0
62225   2 90 2 0 814.07 0
62225   3 90 2 0 1,289.06 0
62225   4 90 2 0 802.73 0
62230   1 90 2 0 1,888.98 0
62230   2 90 2 0 1,879.90 0
62230   3 90 2 0 1,722.15 0
62230   4 90 2 0 1,701.70 0
62252   1 XXX 0 0 160.80 0
62252 26 1 XXX 0 0 76.43 0
62252 TC 1 XXX 0 0 84.34 0
62252   2 XXX 0 0 141.98 0
62252 26 2 XXX 0 0 70.54 0
62252 TC 2 XXX 0 0 71.39 0
62252   3 XXX 0 0 141.98 0
62252 26 3 XXX 0 0 70.54 0
62,252.00 TC 3 XXX 0 0 71.39 0
62252   4 XXX 0 0 141.98 0
62252 26 4 XXX 0 0 70.54 0
62252 TC 4 XXX 0 0 71.39 0
62256   1 90 2 0 1,379.33 0
62256   2 90 2 0 1,331.91 0
62256   3 90 2 0 1,294.27 0
62256   4 90 2 0 1,070.76 0
62258   1 90 2 0 2,730.92 0
62258   2 90 2 0 2,684.28 0
62258   3 90 2 0 2,632.78 0
62258   4 90 2 0 2,461.41 0
62263   1 10 2 0 849.67 666.07
62263   2 10 2 0 749.73 592.73
62263   3 10 2 0 749.73 592.73
62263   4 10 2 0 749.73 592.73
62264   1 10 2 0 1,097.33 403.85
62264   2 10 2 0 958.63 368.66
62264   3 10 2 0 958.63 368.66
62264   4 10 2 0 958.63 368.66
62267   1 0 2 0 356.02 233.81
62267   2 0 2 0 318.42 215.40
62267   3 0 2 0 318.42 215.40
62267   4 0 2 0 318.42 215.40
62268     0 2 0 * 0
62269     0 2 0 * 0
62270   1 0 2 0 152.82 0
62270   2 0 2 0 151.41 0
62270   3 0 2 0 143.77 0
62270   4 0 2 0 142.08 0
62272   1 0 2 0 201.49 0
62272   2 0 2 0 184.49 0
62272   3 0 2 0 187.67 0
62272   4 0 2 0 170.40 0
62273   1 0 2 0 291.77 0
62273   2 0 2 0 281.98 0
62273   3 0 2 0 267.20 0
62273   4 0 2 0 264.30 0
62280   1 10 2 0 412.98 0
62280   2 10 2 0 283.45 0
62280   3 10 2 0 279.95 0
62280   4 10 2 0 221.40 0
62281   1 10 2 0 309.23 0
62281   2 10 2 0 315.31 0
62281   3 10 2 0 286.23 0
62281   4 10 2 0 283.23 0
62282   1 10 2 0 363.53 0
62282   2 10 2 0 357.27 0
62282   3 10 2 0 337.62 0
62282   4 10 2 0 327.80 0
62284   1 0 0 0 348.07 0
62284   2 0 0 0 396.42 0
62284   3 0 0 0 316.52 0
62284   4 0 0 0 352.83 0
62287   1 90 2 0 1,760.62 0
62287   2 90 2 0 1,720.09 0
62287   3 90 2 0 1,552.46 0
62287   4 90 2 0 1,532.52 0
62290   1 0 2 0 459.49 0
62290   2 0 2 0 453.81 0
62290   3 0 2 0 430.58 0
62290   4 0 2 0 425.73 0
62291   1 0 2 0 417.93 0
62291   2 0 2 0 405.26 0
62291   3 0 2 0 356.01 0
62291   4 0 2 0 380.23 0
62292   1 90 2 0 1,828.31 0
62292   2 90 2 0 2,176.93 0
62292   3 90 2 0 1,831.52 0
62292   4 90 2 0 2,054.88 0
62294   1 90 2 0 1,263.10 0
62294   2 90 2 0 1,246.40 0
62294   3 90 2 0 1,177.17 0
62294   4 90 2 0 1,163.29 0
62302   1 0 2 0 320.43 161.64
62302   2 0 2 0 285.86 150.15
62302   3 0 2 0 285.86 150.15
62302   4 0 2 0 285.86 150.15
62303   1 0 2 0 333.25 164.02
62303   2 0 2 0 296.80 152.16
62303   3 0 2 0 296.80 152.16
62303   4 0 2 0 296.80 152.16
62304   1 0 2 0 315.83 158.92
62304   2 0 2 0 281.67 147.59
62304   3 0 2 0 281.67 147.59
62304   4 0 2 0 281.67 147.59
62305   1 0 2 0 344.92 165.74
62305   2 0 2 0 307.09 153.96
62305   3 0 2 0 307.09 153.96
62305   4 0 2 0 307.09 153.96
62320   1 0 2 0 212.26 130.53
62320   2 0 2 0 190.87 120.32
62320   3 0 2 0 190.87 120.32
62320   4 0 2 0 190.87 120.32
62321   1 0 2 0 316.40 140.75
62321   2 0 2 0 281.38 129.77
62321   3 0 2 0 281.38 129.77
62321   4 0 2 0 281.38 129.77
62322   1 0 2 0 198.03 112.24
62322   2 0 2 0 177.56 103.52
62322   3 0 2 0 177.56 103.52
62322   4 0 2 0 177.56 103.52
62323   1 0 2 0 310.49 128.08
62323   2 0 2 0 275.76 118.31
62323   3 0 2 0 275.76 118.31
62323   4 0 2 0 275.76 118.31
62324   1 0 2 0 185.15 118.78
62324   2 0 2 0 167.80 110.51
62324   3 0 2 0 167.80 110.51
62324   4 0 2 0 167.80 110.51
62325   1 0 2 0 280.06 136.46
62325   2 0 2 0 251.02 127.08
62325   3 0 2 0 251.02 127.08
62325   4 0 2 0 251.02 127.08
62326   1 0 2 0 194.61 116.48
62326   2 0 2 0 175.57 108.15
62326   3 0 2 0 175.57 108.15
62326   4 0 2 0 175.57 108.15
62327   1 0 2 0 285.71 124.06
62327   2 0 2 0 254.70 115.17
62327   3 0 2 0 254.70 115.17
62327   4 0 2 0 254.70 115.17
62350   1 90 2 0 1,011.74 0
62350   2 90 2 0 962.72 0
62350   3 90 2 0 904.96 0
62350   4 90 2 0 892.19 0
62351   1 90 2 0 1,495.86 0
62351   2 90 2 0 1,423.56 0
62351   3 90 2 0 1,338.31 0
62351   4 90 2 0 1,319.39 0
62355   1 90 2 0 841.24 0
62355   2 90 2 0 803.46 0
62355   3 90 2 0 754.74 0
62355   4 90 2 0 743.79 0
62360   1 90 2 0 324.43 0
62360   2 90 2 0 308.67 0
62360   3 90 2 0 290.12 0
62360   4 90 2 0 285.98 0
62361   1 90 2 0 776.64 0
62361   2 90 2 0 739.12 0
62361   3 90 2 0 694.80 0
62361   4 90 2 0 684.94 0
62362   1 90 2 0 1,017.25 0
62362   2 90 2 0 968.15 0
62362   3 90 2 0 910.16 0
62362   4 90 2 0 897.28 0
62365   1 90 2 0 836.63 0
62365   2 90 2 0 798.93 0
62365   3 90 2 0 750.48 0
62365   4 90 2 0 739.51 0
62367   1 XXX 0 0 112.56 0
62367 26 1 XXX 0 0 71.68 0
62367 TC 1 XXX 0 0 40.90 0
62367   2 XXX 0 0 107.10 0
62367 26 2 XXX 0 0 68.44 0
62367 TC 2 XXX 0 0 38.67 0
62367   3 XXX 0 0 99.29 0
62367 26 3 XXX 0 0 64.26 0
62367 TC 3 XXX 0 0 35.02 0
62367   4 XXX 0 0 97.63 0
62367 26 4 XXX 0 0 63.30 0
62367 TC 4 XXX 0 0 34.33 0
62368   1 XXX 0 0 154.78 0
62368 26 1 XXX 0 0 112.27 0
62368 TC 1 XXX 0 0 42.47 0
62368   2 XXX 0 0 147.40 0
62368 26 2 XXX 0 0 107.18 0
62368 TC 2 XXX 0 0 40.21 0
62368   3 XXX 0 0 137.08 0
62368 26 3 XXX 0 0 100.63 0
62368 TC 3 XXX 0 0 36.43 0
62368   4 XXX 0 0 134.87 0
62368 26 4 XXX 0 0 99.19 0
62368 TC 4 XXX 0 0 35.70 0
62369   1 XXX 0 0 171.69 48.06
62369   2 XXX 0 0 151.27 44.70
62369   3 XXX 0 0 151.27 44.70
62369   4 XXX 0 0 151.27 44.70
62370   1 XXX 0 0 179.72 64.57
62370   2 XXX 0 0 159.23 59.95
62370   3 XXX 0 0 159.23 59.95
62370   4 XXX 0 0 159.23 59.95
62380         0 * 0
63001   1 90 2 0 3,239.41 0
63001   2 90 2 0 3,180.01 0
63001   3 90 2 0 3,230.72 0
63001   4 90 2 0 2,899.08 0
63003   1 90 2 0 3,173.21 0
63003   2 90 2 0 3,116.24 0
63003   3 90 2 0 3,019.17 0
63003   4 90 2 0 2,845.75 0
63005   1 90 2 0 3,010.51 0
63005   2 90 2 0 2,956.07 0
63005   3 90 2 0 2,730.83 0
63005   4 90 2 0 2,697.54 0
63011   1 90 2 0 2,026.77 0
63011   2 90 2 0 1,992.89 0
63011   3 90 2 0 1,853.19 0
63011   4 90 2 0 1,831.50 0
63012   1 90 2 0 3,002.17 0
63012   2 90 2 0 2,951.39 0
63012   3 90 2 0 2,817.62 0
63012   4 90 2 0 2,853.19 0
63015   1 90 2 0 3,766.40 0
63015   2 90 2 0 3,695.70 0
63015   3 90 2 0 3,403.39 0
63015   4 90 2 0 3,362.18 0
63016   1 90 2 0 3,893.82 0
63016   2 90 2 0 3,822.46 0
63016   3 90 2 0 3,527.56 0
63016   4 90 2 0 3,484.65 0
63017   1 90 2 0 3,645.04 0
63017   2 90 2 0 3,576.81 0
63017   3 90 2 0 3,295.09 0
63017   4 90 2 0 3,255.01 0
63020   1 90 2 0 2,937.21 0
63020   2 90 2 0 2,880.93 0
63020   3 90 2 0 2,648.19 0
63020   4 90 2 0 2,624.26 0
63030   1 90 2 0 2,699.00 0
63030   2 90 2 0 2,649.88 0
63030   3 90 2 0 2,453.14 0
63030   4 90 2 0 2,417.03 0
63035   1 ZZZ 0 0 1,301.88 0
63035   2 ZZZ 0 0 1,341.99 0
63035   3 ZZZ 0 0 1,244.86 0
63035   4 ZZZ 0 0 1,270.30 0
63040   1 90 2 0 5,373.55 0
63040   2 90 2 0 5,342.54 0
63040   3 90 2 0 5,214.61 0
63040   4 90 2 0 5,196.24 0
63042   1 90 2 0 5,379.98 0
63042   2 90 2 0 5,346.92 0
63042   3 90 2 0 5,062.63 0
63042   4 90 2 0 5,200.40 0
63043     ZZZ 0 0 * 0
63044     ZZZ 0 0 * 0
63045   1 90 2 0 4,661.04 0
63045   2 90 2 0 4,612.49 0
63045   3 90 2 0 4,503.91 0
63045   4 90 2 0 4,486.50 0
63046   1 90 2 0 4,632.12 0
63046   2 90 2 0 4,600.68 0
63046   3 90 2 0 4,470.75 0
63046   4 90 2 0 3,295.93 0
63047   1 90 2 0 4,596.50 0
63047   2 90 2 0 4,564.20 0
63047   3 90 2 0 4,419.66 0
63047   4 90 2 0 4,430.49 0
63048   1 ZZZ 0 0 3,397.23 0
63048   2 ZZZ 0 0 3,335.62 0
63048   3 ZZZ 0 0 3,375.65 0
63048   4 ZZZ 0 0 3,371.60 0
63050   1 90 2 0 2,488.84 0
63050   2 90 2 0 2,166.31 0
63050   3 90 2 0 2,166.31 0
63050   4 90 2 0 2,166.31 0
63051   1 90 2 0 2,817.42 0
63051   2 90 2 0 2,472.38 0
63051   3 90 2 0 2,472.38 0
63051   4 90 2 0 2,472.38 0
63055   1 90 2 0 4,297.72 0
63055   2 90 2 0 4,222.57 0
63055   3 90 2 0 3,911.85 0
63055   4 90 2 0 3,864.64 0
63056   1 90 2 0 5,094.69 0
63056   2 90 2 0 3,882.27 0
63056   3 90 2 0 4,947.36 0
63056   4 90 2 0 4,929.10 0
63057   1 ZZZ 0 0 758.60 0
63057   2 ZZZ 0 0 744.09 0
63057   3 ZZZ 0 0 684.05 0
63057   4 ZZZ 0 0 675.59 0
63064   1 90 2 0 5,609.72 0
63064   2 90 2 0 5,577.81 0
63064   3 90 2 0 5,446.08 0
63064   4 90 2 0 4,074.10 0
63066   1 ZZZ 0 0 545.09 0
63066   2 ZZZ 0 0 536.45 0
63066   3 ZZZ 0 0 501.08 0
63066   4 ZZZ 0 0 495.38 0
63075   1 90 2 0 3,575.68 0
63075   2 90 2 0 3,516.64 0
63075   3 90 2 0 3,273.16 0
63075   4 90 2 0 2,912.88 0
63076   1 ZZZ 0 0 1,768.19 0
63076   2 ZZZ 0 0 1,769.77 0
63076   3 ZZZ 0 0 1,697.43 0
63076   4 ZZZ 0 0 1,779.73 0
63077   1 90 2 0 3,467.66 0
63077   2 90 2 0 3,433.69 0
63077   3 90 2 0 3,376.03 0
63077   4 90 2 0 3,336.19 0
63078   1 ZZZ 0 0 557.64 0
63078   2 ZZZ 0 0 548.91 0
63078   3 ZZZ 0 0 512.89 0
63078   4 ZZZ 0 0 506.90 0
63081   1 90 2 0 5,140.26 0
63081   2 90 2 0 5,597.46 0
63081   3 90 2 0 5,455.72 0
63081   4 90 2 0 5,433.95 0
63082   1 ZZZ 0 0 1,077.06 0
63082   2 ZZZ 0 0 1,056.46 0
63082   3 ZZZ 0 0 971.27 0
63082   4 ZZZ 0 0 959.32 0
63085   1 90 2 0 5,633.05 0
63085   2 90 2 0 5,340.21 0
63085   3 90 2 0 5,247.69 0
63085   4 90 2 0 4,547.81 0
63086   1 ZZZ 0 0 856.24 0
63086   2 ZZZ 0 0 949.80 0
63086   3 ZZZ 0 0 767.30 0
63086   4 ZZZ 0 0 757.85 0
63087   1 90 2 0 5,349.08 0
63087   2 90 2 0 5,259.32 0
63087   3 90 2 0 4,888.65 0
63087   4 90 2 0 4,830.25 0
63088   1 ZZZ 0 0 1,054.36 0
63088   2 ZZZ 0 0 1,034.36 0
63088   3 ZZZ 0 0 951.52 0
63088   4 ZZZ 0 0 939.79 0
63090   1 90 2 0 5,324.60 0
63090   2 90 2 0 5,233.85 0
63090   3 90 2 0 4,858.67 0
63090   4 90 2 0 4,800.02 0
63091   1 ZZZ 0 0 547.14 0
63091   2 ZZZ 0 0 538.34 0
63091   3 ZZZ 0 0 501.90 0
63091   4 ZZZ 0 0 495.98 0
63101   1 90 2 0 3,872.71 0
63101   2 90 2 0 3,411.41 0
63101   3 90 2 0 3,411.41 0
63101   4 90 2 0 3,411.41 0
63102   1 90 2 0 3,872.71 0
63102   2 90 2 0 3,411.41 0
63102   3 90 2 0 3,411.41 0
63102   4 90 2 0 3,411.41 0
63103   1 ZZZ 0 0 453.81 0
63103   2 ZZZ 0 0 398.60 0
63103   3 ZZZ 0 0 398.60 0
63103   4 ZZZ 0 0 398.60 0
63170   1 90 2 0 4,484.34 0
63170   2 90 2 0 4,267.95 0
63170   3 90 2 0 4,252.68 0
63170   4 90 2 0 3,212.21 0
63172   1 90 2 0 3,944.33 0
63172   2 90 2 0 3,832.78 0
63172   3 90 2 0 3,460.86 0
63172   4 90 2 0 3,418.51 0
63173   1 90 2 0 3,269.12 0
63173   2 90 2 0 3,225.23 0
63173   3 90 2 0 3,043.51 0
63173   4 90 2 0 3,007.59 0
63180   1 90 2 0 2,664.83 0
63180   2 90 2 0 2,624.66 0
63180   3 90 2 0 2,459.31 0
63180   4 90 2 0 2,431.27 0
63182   1 90 2 0 3,276.01 0
63182   2 90 2 0 3,228.07 0
63182   3 90 2 0 3,029.92 0
63182   4 90 2 0 2,993.77 0
63185   1 90 2 0 2,865.79 0
63185   2 90 2 0 2,814.63 0
63185   3 90 2 0 2,732.88 0
63185   4 90 2 0 2,572.21 0
63190   1 90 2 0 3,641.85 0
63190   2 90 2 0 3,574.58 0
63190   3 90 2 0 3,296.87 0
63190   4 90 2 0 3,256.92 0
63191   1 90 2 0 2,778.12 0
63191   2 90 2 0 2,735.19 0
63191   3 90 2 0 2,557.85 0
63191   4 90 2 0 2,749.79 0
63194   1 90 2 0 2,886.03 0
63194   2 90 2 0 2,841.30 0
63194   3 90 2 0 2,656.99 0
63194   4 90 2 0 2,626.46 0
63195   1 90 2 0 2,896.70 0
63195   2 90 2 0 2,853.41 0
63195   3 90 2 0 2,674.51 0
63195   4 90 2 0 2,643.14 0
63196   1 90 2 0 3,295.94 0
63196   2 90 2 0 3,251.64 0
63196   3 90 2 0 3,068.32 0
63196   4 90 2 0 3,032.07 0
63197   1 90 2 0 3,194.21 0
63197   2 90 2 0 3,144.48 0
63197   3 90 2 0 2,939.29 0
63197   4 90 2 0 2,905.54 0
63198   1 90 2 0 3,693.53 0
63198   2 90 2 0 3,634.77 0
63198   3 90 2 0 3,392.57 0
63198   4 90 2 0 3,353.92 0
63199   1 90 2 0 4,170.23 0
63199   2 90 2 0 4,110.68 0
63199   3 90 2 0 3,863.93 0
63199   4 90 2 0 3,817.42 0
63200   1 90 2 0 1,838.08 0
63200   2 90 2 0 1,706.55 0
63200   3 90 2 0 1,662.38 0
63200   4 90 2 0 2,555.59 0
63250   1 90 2 0 5,082.81 0
63250   2 90 2 0 4,852.93 0
63250   3 90 2 0 5,811.14 0
63250   4 90 2 0 5,744.75 0
63251   1 90 2 0 5,770.77 0
63251   2 90 2 0 5,686.24 0
63251   3 90 2 0 5,338.47 0
63251   4 90 2 0 5,278.89 0
63252   1 90 2 0 6,390.86 0
63252   2 90 2 0 5,812.81 0
63252   3 90 2 0 5,870.42 0
63252   4 90 2 0 5,803.52 0
63265   1 90 2 0 4,061.44 0
63265   2 90 2 0 3,991.16 0
63265   3 90 2 0 3,700.59 0
63265   4 90 2 0 3,656.18 0
63266   1 90 2 0 4,415.98 0
63266   2 90 2 0 4,337.28 0
63266   3 90 2 0 4,012.42 0
63266   4 90 2 0 3,963.90 0
63267   1 90 2 0 3,798.23 0
63267   2 90 2 0 3,727.03 0
63267   3 90 2 0 3,432.73 0
63267   4 90 2 0 3,391.09 0
63268   1 90 2 0 2,842.40 0
63268   2 90 2 0 2,797.11 0
63268   3 90 2 0 2,610.58 0
63268   4 90 2 0 2,580.83 0
63270   1 90 2 0 4,770.22 0
63270   2 90 2 0 4,015.40 0
63270   3 90 2 0 3,751.28 0
63270   4 90 2 0 3,708.40 0
63271   1 90 2 0 5,529.72 0
63271   2 90 2 0 5,353.16 0
63271   3 90 2 0 4,540.79 0
63271   4 90 2 0 4,486.50 0
63272   1 90 2 0 4,514.63 0
63272   2 90 2 0 4,437.85 0
63272   3 90 2 0 4,120.78 0
63272   4 90 2 0 4,072.13 0
63273   1 90 2 0 3,806.33 0
63273   2 90 2 0 3,746.84 0
63273   3 90 2 0 3,501.36 0
63273   4 90 2 0 3,460.90 0
63275   1 90 2 0 5,312.58 0
63275   2 90 2 0 5,091.63 0
63275   3 90 2 0 4,988.63 0
63275   4 90 2 0 5,221.15 0
63276   1 90 2 0 5,229.21 0
63276   2 90 2 0 4,998.40 0
63276   3 90 2 0 4,926.41 0
63276   4 90 2 0 4,895.98 0
63277   1 90 2 0 4,210.44 0
63277   2 90 2 0 4,135.20 0
63277   3 90 2 0 3,913.40 0
63277   4 90 2 0 3,904.94 0
63278   1 90 2 0 5,766.66 0
63278   2 90 2 0 4,796.35 0
63278   3 90 2 0 4,767.75 0
63278   4 90 2 0 3,729.51 0
63280   1 90 2 0 5,482.19 0
63280   2 90 2 0 5,260.58 0
63280   3 90 2 0 5,103.61 0
63280   4 90 2 0 5,385.57 0
63281   1 90 2 0 5,218.92 0
63281   2 90 2 0 5,129.27 0
63281   3 90 2 0 4,951.10 0
63281   4 90 2 0 4,702.23 0
63282   1 90 2 0 4,357.99 0
63282   2 90 2 0 4,279.92 0
63282   3 90 2 0 4,315.78 0
63282   4 90 2 0 4,264.84 0
63283   1 90 2 0 4,027.62 0
63283   2 90 2 0 3,963.32 0
63283   3 90 2 0 3,698.07 0
63283   4 90 2 0 3,655.27 0
63285   1 90 2 0 5,549.82 0
63285   2 90 2 0 5,464.17 0
63285   3 90 2 0 5,111.12 0
63285   4 90 2 0 5,052.71 0
63286   1 90 2 0 5,941.28 0
63286   2 90 2 0 5,847.10 0
63286   3 90 2 0 5,458.60 0
63286   4 90 2 0 5,394.75 0