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2024 Workers' Compensation Part B Fee Schedule

30630-31635

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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
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