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2024 Workers' Compensation Part B Fee Schedule

31636-33211

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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
31636   002 0 3 X 488.37 X
31636   003 0 3 X 488.37 X
31636   004 0 3 X 488.37 X
31636   001 0 3 X 534.83 X
31637   001 ZZZ 0 X 190.73 X
31637   002 ZZZ 0 X 174.19 X
31637   003 ZZZ 0 X 174.19 X
31637   004 ZZZ 0 X 174.19 X
31638   004 0 3 X 543.87 X
31638   001 0 3 X 590.12 X
31638   003 0 3 X 543.87 X
31638   002 0 3 X 543.87 X
31640   004 0 3 X 1,094.03 X
31640   002 0 3 X 1,183.50 X
31640   003 0 3 X 1,107.44 X
31640   001 0 3 X 1,201.83 X
31641   001 0 3 X 1,326.58 X
31641   003 0 3 X 1,271.80 X
31641   002 0 3 X 1,314.15 X
31641   004 0 3 X 1,125.59 X
31643   003 0 2 X 485.97 444.80
31643   002 0 2 X 485.97 444.80
31643   004 0 2 X 485.97 444.80
31643   001 0 2 X 554.31 506.07
31645   001 0 3 X 806.50 X
31645   004 0 3 X 753.57 X
31645   002 0 3 X 786.23 X
31645   003 0 3 X 770.65 X
31646   001 0 2 X 755.93 X
31646   003 0 2 X 720.68 X
31646   002 0 2 X 749.12 X
31646   004 0 2 X 659.70 X
31647   004 0 3 X 364.49 X
31647   002 0 3 X 364.49 X
31647   003 0 3 X 364.49 X
31647   001 0 3 X 397.30 X
31648   004 0 3 X 378.60 X
31648   002 0 3 X 378.60 X
31648   003 0 3 X 378.60 X
31648   001 0 3 X 415.12 X
31649   001 ZZZ 0 X 127.69 X
31649   004 ZZZ 0 X 118.61 X
31649   003 ZZZ 0 X 118.61 X
31649   002 ZZZ 0 X 118.61 X
31651   004 ZZZ 0 X 126.01 X
31651   001 ZZZ 0 X 135.34 X
31651   002 ZZZ 0 X 126.01 X
31651   003 ZZZ 0 X 126.01 X
31652   002 0 2 X 1,328.36 363.26
31652   003 0 2 X 1,328.36 363.26
31652   004 0 2 X 1,328.36 363.26
31652   001 0 2 X 1,518.36 389.16
31653   001 0 2 X 1,613.50 429.52
31653   004 0 2 X 1,412.90 400.98
31653   003 0 2 X 1,412.90 400.98
31653   002 0 2 X 1,412.90 400.98
31654   002 ZZZ 0 X 214.53 105.11
31654   003 ZZZ 0 X 214.53 105.11
31654   001 ZZZ 0 X 240.39 112.35
31654   004 ZZZ 0 X 214.53 105.11
31660   001 0 3 X 398.21 X
31660   003 0 3 X 364.54 X
31660   002 0 3 X 364.54 X
31660   004 0 3 X 364.54 X
31661   004 0 3 X 385.09 X
31661   001 0 3 X 420.90 X
31661   002 0 3 X 385.09 X
31661   003 0 3 X 385.09 X
31717   003 0 2 X 285.99 X
31717   002 0 2 X 297.95 X
31717   001 0 2 X 300.88 X
31717   004 0 2 X 282.87 X
31720   004 0 2 X 169.25 X
31720   002 0 2 X 172.20 X
31720   003 0 2 X 170.50 X
31720   001 0 2 X 178.12 X
31725   003 0 2 X 344.18 X
31725   002 0 2 X 363.75 X
31725   004 0 2 X 340.15 X
31725   001 0 2 X 368.48 X
31730   001 0 2 X 580.37 X
31730   004 0 2 X 1,099.61 X
31730   002 0 2 X 1,128.83 X
31730   003 0 2 X 541.47 X
31750   004 90 2 X 1,685.09 X
31750   003 90 2 X 1,981.45 X
31750   002 90 2 X 1,716.50 X
31750   001 90 2 X 1,764.85 X
31755   002 90 2 X 2,111.77 X
31755   003 90 2 X 1,981.45 X
31755   004 90 2 X 1,957.32 X
31755   001 90 2 X 2,143.23 X
31760   001 90 2 X 3,905.91 X
31760   004 90 2 X 3,562.18 X
31760   002 90 2 X 3,846.30 X
31760   003 90 2 X 3,601.27 X
31766   001 90 2 X 5,351.15 X
31766   003 90 2 X 5,052.77 X
31766   002 90 2 X 5,293.16 X
31766   004 90 2 X 4,992.97 X
31770   002 90 2 X 4,250.04 X
31770   003 90 2 X 4,002.53 X
31770   001 90 2 X 4,309.90 X
31770   004 90 2 X 3,955.98 X
31775   001 90 2 X 4,534.45 X
31775   002 90 2 X 4,473.92 X
31775   003 90 2 X 4,223.81 X
31775   004 90 2 X 4,174.05 X
31780   001 90 2 X 4,008.16 X
31780   004 90 2 X 3,654.63 X
31780   003 90 2 X 3,700.16 X
31780   002 90 2 X 2,740.81 X
31781   004 90 2 X 4,235.09 X
31781   001 90 2 X 4,602.76 X
31781   002 90 2 X 4,541.04 X
31781   003 90 2 X 4,285.69 X
31785   002 90 2 X 2,899.34 X
31785   003 90 2 X 2,096.92 X
31785   004 90 2 X 2,715.49 X
31785   001 90 2 X 2,936.40 X
31786   001 90 2 X 4,294.31 X
31786   003 90 2 X 3,985.82 X
31786   002 90 2 X 4,234.08 X
31786   004 90 2 X 3,941.03 X
31800   001 90 2 X 1,695.16 X
31800   004 90 2 X 1,284.02 X
31800   003 90 2 X 1,299.06 X
31800   002 90 2 X 1,563.83 X
31805   004 90 2 X 2,458.55 X
31805   001 90 2 X 2,687.90 X
31805   002 90 2 X 2,648.90 X
31805   003 90 2 X 2,487.77 X
31820   002 90 2 X 905.02 X
31820   003 90 2 X 849.98 X
31820   004 90 2 X 839.83 X
31820   001 90 2 X 918.28 X
31825   003 90 2 X 1,361.48 X
31825   002 90 2 X 1,375.13 X
31825   004 90 2 X 1,337.43 X
31825   001 90 2 X 1,414.39 X
31830   002 90 2 X 923.06 X
31830   003 90 2 X 869.64 X
31830   001 90 2 X 935.99 X
31830   004 90 2 X 859.12 X
31899     YYY 2 X # X
32035   002 90 2 X 2,210.36 X
32035   003 90 2 X 2,234.10 X
32035   001 90 2 X 1,868.94 X
32035   004 90 2 X 2,263.21 X
32036   001 90 2 X 1,826.57 X
32036   004 90 2 X 1,675.32 X
32036   002 90 2 X 1,795.74 X
32036   003 90 2 X 1,668.78 X
32096   004 90 2 X 1,377.77 X
32096   001 90 2 X 1,542.35 X
32096   002 90 2 X 1,377.77 X
32096   003 90 2 X 1,377.77 X
32097   004 90 2 X 1,377.77 X
32097   001 90 2 X 1,542.35 X
32097   003 90 2 X 1,377.77 X
32097   002 90 2 X 1,377.77 X
32098   004 90 2 X 1,294.57 X
32098   001 90 2 X 1,449.03 X
32098   003 90 2 X 1,294.57 X
32098   002 90 2 X 1,294.57 X
32100   001 90 2 X 2,866.75 X
32100   002 90 2 X 2,856.00 X
32100   003 90 2 X 2,782.49 X
32100   004 90 2 X 2,736.98 X
32110   003 90 2 X 2,680.19 X
32110   002 90 2 X 2,956.32 X
32110   004 90 2 X 2,603.79 X
32110   001 90 2 X 2,918.12 X
32120   004 90 2 X 2,358.94 X
32120   001 90 2 X 2,525.30 X
32120   003 90 2 X 2,366.24 X
32120   002 90 2 X 2,473.84 X
32124   001 90 2 X 2,423.79 X
32124   003 90 2 X 2,379.11 X
32124   002 90 2 X 2,711.82 X
32124   004 90 2 X 2,395.53 X
32140   004 90 2 X 2,942.26 X
32140   002 90 2 X 3,078.77 X
32140   003 90 2 X 2,966.05 X
32140   001 90 2 X 3,087.19 X
32141   002 90 2 X 3,162.78 X
32141   003 90 2 X 2,973.06 X
32141   004 90 2 X 2,991.29 X
32141   001 90 2 X 3,220.02 X
32150   001 90 2 X 3,054.25 X
32150   004 90 2 X 2,556.48 X
32150   002 90 2 X 3,034.58 X
32150   003 90 2 X 2,586.42 X
32151   002 90 2 X 2,551.87 X
32151   003 90 2 X 2,397.15 X
32151   004 90 2 X 2,369.29 X
32151   001 90 2 X 2,711.90 X
32160   001 90 2 X 2,990.26 X
32160   002 90 2 X 2,735.42 X
32160   003 90 2 X 2,756.10 X
32160   004 90 2 X 1,846.45 X
32200   004 90 2 X 2,167.74 X
32200   002 90 2 X 2,753.60 X
32200   003 90 2 X 2,192.39 X
32200   001 90 2 X 2,342.84 X
32215   003 90 2 X 1,746.56 X
32215   002 90 2 X 1,950.15 X
32215   001 90 2 X 1,907.96 X
32215   004 90 2 X 1,890.23 X
32220   004 90 2 X 4,163.49 X
32220   001 90 2 X 4,334.94 X
32220   002 90 2 X 4,305.60 X
32220   003 90 2 X 4,184.56 X
32225   002 90 2 X 2,948.12 X
32225   003 90 2 X 2,733.46 X
32225   001 90 2 X 3,000.18 X
32225   004 90 2 X 2,701.32 X
32310   003 90 2 X 3,804.85 X
32310   002 90 2 X 3,900.38 X
32310   001 90 2 X 3,180.04 X
32310   004 90 2 X 3,790.23 X
32320   004 90 2 X 4,437.18 X
32320   002 90 2 X 4,564.39 X
32320   003 90 2 X 4,436.24 X
32320   001 90 2 X 4,643.29 X
32400   004 0 2 X 318.72 X
32400   002 0 2 X 349.59 X
32400   003 0 2 X 324.96 X
32400   001 0 2 X 410.34 X
32408   003 0 2 X 1,210.57 200.98
32408   002 0 2 X 1,210.57 200.98
32408   004 0 2 X 1,210.57 200.98
32408   001 0 2 X 1,379.01 214.61
32440   003 90 2 X 4,588.76 X
32440   002 90 2 X 4,871.52 X
32440   004 90 2 X 4,517.60 X
32440   001 90 2 X 4,911.49 X
32442   003 90 2 X 4,820.04 X
32442   002 90 2 X 5,163.75 X
32442   001 90 2 X 5,247.16 X
32442   004 90 2 X 4,765.12 X
32445   001 90 2 X 5,443.13 X
32445   004 90 2 X 4,920.53 X
32445   003 90 2 X 4,978.49 X
32445   002 90 2 X 5,352.54 X
32480   004 90 2 X 4,281.36 X
32480   001 90 2 X 4,504.95 X
32480   003 90 2 X 4,141.66 X
32480   002 90 2 X 4,491.26 X
32482   004 90 2 X 4,340.42 X
32482   001 90 2 X 4,566.34 X
32482   003 90 2 X 4,201.24 X
32482   002 90 2 X 4,552.33 X
32484   001 90 2 X 4,601.73 X
32484   004 90 2 X 4,374.39 X
32484   003 90 2 X 4,235.60 X
32484   002 90 2 X 4,587.44 X
32486   004 90 2 X 4,393.19 X
32486   002 90 2 X 4,760.91 X
32486   003 90 2 X 4,443.80 X
32486   001 90 2 X 4,837.94 X
32488   003 90 2 X 4,767.29 X
32488   002 90 2 X 5,107.13 X
32488   004 90 2 X 4,713.02 X
32488   001 90 2 X 5,189.65 X
32501   001 ZZZ 0 X 1,176.15 X
32501   003 ZZZ 0 X 1,052.05 X
32501   002 ZZZ 0 X 1,123.32 X
32501   004 ZZZ 0 X 1,036.28 X
32503   002 90 2 X 3,428.57 X
32503   003 90 2 X 3,428.57 X
32503   001 90 2 X 3,869.72 X
32503   004 90 2 X 3,428.57 X
32504   004 90 2 X 3,924.25 X
32504   003 90 2 X 3,924.25 X
32504   002 90 2 X 3,924.25 X
32504   001 90 2 X 4,424.14 X
32505   001 90 2 X 1,775.88 X
32505   003 90 2 X 1,587.33 X
32505   002 90 2 X 1,587.33 X
32505   004 90 2 X 1,587.33 X
32506   001 ZZZ 0 X 302.08 X
32506   004 ZZZ 0 X 270.78 X
32506   003 ZZZ 0 X 270.78 X
32506   002 ZZZ 0 X 270.78 X
32507   003 ZZZ 0 X 270.78 X
32507   002 ZZZ 0 X 270.78 X
32507   004 ZZZ 0 X 270.78 X
32507   001 ZZZ 0 X 302.08 X
32540   001 90 2 X 3,075.09 X
32540   004 90 2 X 2,787.11 X
32540   003 90 2 X 2,820.17 X
32540   002 90 2 X 3,025.36 X
32550   002 0 0 X 1,415.08 389.10
32550   003 0 0 X 1,415.08 389.10
32550   004 0 0 X 1,415.08 389.10
32550   001 0 0 X 1,667.71 430.67
32551   002 0 2 X 308.29 X
32551   003 0 2 X 308.29 X
32551   001 0 2 X 343.75 X
32551   004 0 2 X 308.29 X
32552   001 10 2 X 352.07 312.08
32552   003 10 2 X 311.31 277.65
32552   002 10 2 X 311.31 277.65
32552   004 10 2 X 311.31 277.65
32553   001 0 2 X 1,130.89 403.23
32553   004 0 2 X 975.09 361.58
32553   003 0 2 X 975.09 361.58
32553   002 0 2 X 975.09 361.58
32554   002 0 2 X 854.77 144.60
32554   003 0 2 X 854.77 144.60
32554   001 0 2 X 979.74 156.04
32554   004 0 2 X 854.77 144.60
32555   001 0 2 X 1,130.42 195.59
32555   004 0 2 X 986.89 180.93
32555   002 0 2 X 986.89 180.93
32555   003 0 2 X 986.89 180.93
32556   004 0 2 X 904.60 198.47
32556   002 0 2 X 904.60 198.47
32556   003 0 2 X 904.60 198.47
32556   001 0 2 X 1,033.46 214.45
32557   003 0 2 X 1,467.27 270.49
32557   002 0 2 X 1,467.27 270.49
32557   004 0 2 X 1,467.27 270.49
32557   001 0 2 X 1,688.93 300.79
32560   002 0 2 X 523.47 192.89
32560   003 0 2 X 523.47 192.89
32560   004 0 2 X 523.47 192.89
32560   001 0 2 X 611.16 212.58
32561   001 0 2 X 181.73 138.98
32561   004 0 2 X 162.08 126.05
32561   002 0 2 X 162.08 126.05
32561   003 0 2 X 162.08 126.05
32562   001 0 2 X 161.52 124.36
32562   004 0 2 X 144.13 112.81
32562   002 0 2 X 144.13 112.81
32562   003 0 2 X 144.13 112.81
32601   001 0 2 X 1,072.80 X
32601   004 0 2 X 982.97 X
32601   003 0 2 X 994.26 X
32601   002 0 2 X 1,057.47 X
32604   001 0 2 X 1,288.99 X
32604   004 0 2 X 1,379.46 X
32604   002 0 2 X 1,277.86 X
32604   003 0 2 X 1,394.66 X
32606   003 0 2 X 1,353.75 X
32606   002 0 2 X 1,264.02 X
32606   001 0 2 X 1,275.00 X
32606   004 0 2 X 1,338.92 X
32607   004 0 2 X 529.54 X
32607   003 0 2 X 529.54 X
32607   002 0 2 X 529.54 X
32607   001 0 2 X 591.80 X
32608   004 0 2 X 651.11 X
32608   002 0 2 X 651.11 X
32608   003 0 2 X 651.11 X
32608   001 0 2 X 727.50 X
32609   001 0 2 X 503.57 X
32609   003 0 2 X 449.56 X
32609   002 0 2 X 449.56 X
32609   004 0 2 X 449.56 X
32650   001 90 2 X 1,907.96 X
32650   004 90 2 X 1,890.23 X
32650   002 90 2 X 1,950.15 X
32650   003 90 2 X 1,746.56 X
32651   002 90 2 X 2,948.12 X
32651   003 90 2 X 2,733.46 X
32651   004 90 2 X 2,701.32 X
32651   001 90 2 X 3,000.18 X
32652   001 90 2 X 4,334.94 X
32652   004 90 2 X 4,163.49 X
32652   003 90 2 X 4,184.56 X
32652   002 90 2 X 4,305.60 X
32653   002 90 2 X 3,034.58 X
32653   003 90 2 X 2,586.42 X
32653   004 90 2 X 2,556.48 X
32653   001 90 2 X 3,054.25 X
32654   004 90 2 X 2,603.79 X
32654   001 90 2 X 2,918.12 X
32654   003 90 2 X 2,680.19 X
32654   002 90 2 X 2,956.32 X
32655   004 90 2 X 3,000.89 X
32655   001 90 2 X 3,250.35 X
32655   003 90 2 X 2,982.80 X
32655   002 90 2 X 3,192.88 X
32656   001 90 2 X 3,180.04 X
32656   004 90 2 X 3,790.23 X
32656   002 90 2 X 3,900.38 X
32656   003 90 2 X 3,804.85 X
32658   001 90 2 X 3,359.02 X
32658   004 90 2 X 3,223.82 X
32658   002 90 2 X 3,319.68 X
32658   003 90 2 X 3,237.99 X
32659   004 90 2 X 2,824.27 X
32659   001 90 2 X 3,411.49 X
32659   002 90 2 X 3,372.45 X
32659   003 90 2 X 3,274.24 X
32661   002 90 2 X 2,608.03 X
32661   003 90 2 X 2,447.13 X
32661   001 90 2 X 2,647.07 X
32661   004 90 2 X 2,536.09 X
32662   004 90 2 X 3,701.00 X
32662   001 90 2 X 3,876.09 X
32662   003 90 2 X 3,669.69 X
32662   002 90 2 X 3,845.68 X
32663   001 90 2 X 4,526.07 X
32663   004 90 2 X 4,301.62 X
32663   002 90 2 X 4,512.22 X
32663   003 90 2 X 4,162.10 X
32664   003 90 2 X 2,740.87 X
32664   002 90 2 X 2,939.68 X
32664   004 90 2 X 2,709.41 X
32664   001 90 2 X 3,078.73 X
32665   004 90 2 X 3,265.55 X
32665   002 90 2 X 3,558.59 X
32665   003 90 2 X 3,304.54 X
32665   001 90 2 X 3,620.08 X
32666   004 90 2 X 1,483.64 X
32666   001 90 2 X 1,661.99 X
32666   003 90 2 X 1,483.64 X
32666   002 90 2 X 1,483.64 X
32667   001 ZZZ 0 X 302.08 X
32667   004 ZZZ 0 X 270.78 X
32667   003 ZZZ 0 X 270.78 X
32667   002 ZZZ 0 X 270.78 X
32668   003 ZZZ 0 X 272.58 X
32668   002 ZZZ 0 X 272.58 X
32668   004 ZZZ 0 X 272.58 X
32668   001 ZZZ 0 X 304.54 X
32669   004 90 2 X 2,294.60 X
32669   002 90 2 X 2,294.60 X
32669   003 90 2 X 2,294.60 X
32669   001 90 2 X 2,565.61 X
32670   003 90 2 X 2,740.85 X
32670   002 90 2 X 2,740.85 X
32670   004 90 2 X 2,740.85 X
32670   001 90 2 X 3,061.72 X
32671   002 90 2 X 3,047.00 X
32671   003 90 2 X 3,047.00 X
32671   004 90 2 X 3,047.00 X
32671   001 90 2 X 3,406.11 X
32672   001 90 2 X 2,911.48 X
32672   004 90 2 X 2,603.83 X
32672   002 90 2 X 2,603.83 X
32672   003 90 2 X 2,603.83 X
32673   001 90 2 X 2,278.47 X
32673   004 90 2 X 2,045.17 X
32673   002 90 2 X 2,045.17 X
32673   003 90 2 X 2,045.17 X
32674   003 ZZZ 0 X 371.07 X
32674   002 ZZZ 0 X 371.07 X
32674   004 ZZZ 0 X 371.07 X
32674   001 ZZZ 0 X 413.63 X
32701   002 XXX 0 X 364.46 X
32701   003 XXX 0 X 364.46 X
32701   004 XXX 0 X 364.46 X
32701   001 XXX 0 X 407.62 X
32800     90 2 X * X
32810   002 90 2 X 2,146.14 X
32810   003 90 2 X 2,018.80 X
32810   004 90 2 X 1,996.34 X
32810   001 90 2 X 2,177.14 X
32815   001 90 2 X 4,416.16 X
32815   004 90 2 X 4,050.56 X
32815   003 90 2 X 4,097.58 X
32815   002 90 2 X 4,296.21 X
32820     90 2 X * X
32851     90 2 X * X
32852     90 2 X * X
32853     90 2 X * X
32854   004 90 2 X 9,571.89 X
32854   003 90 2 X 9,700.48 X
32854   002 90 2 X 10,359.30 X
32854   001 90 2 X 10,679.01 X
32855     XXX 2 X * X
32856     XXX 2 X * X
32900   004 90 2 X 2,929.44 X
32900   001 90 2 X 3,182.96 X
32900   003 90 2 X 2,961.69 X
32900   002 90 2 X 3,139.64 X
32905   003 90 2 X 3,607.29 X
32905   002 90 2 X 3,628.59 X
32905   001 90 2 X 3,922.87 X
32905   004 90 2 X 3,566.74 X
32906   004 90 2 X 4,502.38 X
32906   001 90 2 X 4,927.77 X
32906   002 90 2 X 4,854.56 X
32906   003 90 2 X 4,553.40 X
32940   001 90 2 X 3,520.84 X
32940   004 90 2 X 3,233.42 X
32940   002 90 2 X 3,472.06 X
32940   003 90 2 X 3,270.64 X
32960   003 0 2 X 284.14 X
32960   002 0 2 X 270.59 X
32960   004 0 2 X 282.33 X
32960   001 0 2 X 296.45 X
32994   001 0 2 X 9,888.86 786.75
32994   003 0 2 X 8,659.32 726.74
32994   002 0 2 X 8,659.32 726.74
32994   004 0 2 X 8,659.32 726.74
32997   003 0 2 X 755.77 X
32997   002 0 2 X 755.77 X
32997   001 0 2 X 836.56 X
32997   004 0 2 X 755.77 X
32998   001 0 2 X 5,642.31 528.31
32998   004 0 2 X 4,660.87 480.92
32998   002 0 2 X 4,660.87 480.92
32998   003 0 2 X 4,660.87 480.92
32999     YYY 2 X # X
33016   004 0 2 X 334.21 X
33016   001 0 2 X 366.59 X
33016   002 0 2 X 334.21 X
33016   003 0 2 X 334.21 X
33017   004 0 2 X 346.52 X
33017   001 0 2 X 379.23 X
33017   003 0 2 X 346.52 X
33017   002 0 2 X 346.52 X
33018   001 0 2 X 430.61 X
33018   004 0 2 X 395.10 X
33018   003 0 2 X 395.10 X
33018   002 0 2 X 395.10 X
33019   002 0 2 X 320.66 X
33019   003 0 2 X 320.66 X
33019   004 0 2 X 320.66 X
33019   001 0 2 X 350.64 X
33020   004 90 2 X 3,223.82 X
33020   001 90 2 X 3,359.02 X
33020   003 90 2 X 3,237.99 X
33020   002 90 2 X 3,319.68 X
33025   001 90 2 X 3,411.49 X
33025   004 90 2 X 2,824.27 X
33025   003 90 2 X 3,274.24 X
33025   002 90 2 X 3,372.45 X
33030   003 90 2 X 4,387.45 X
33030   002 90 2 X 4,520.65 X
33030   004 90 2 X 4,334.61 X
33030   001 90 2 X 4,861.46 X
33031   001 90 2 X 4,016.63 X
33031   003 90 2 X 3,701.70 X
33031   002 90 2 X 4,985.33 X
33031   004 90 2 X 3,659.75 X
33050   002 90 2 X 2,608.03 X
33050   003 90 2 X 2,447.13 X
33050   001 90 2 X 2,647.07 X
33050   004 90 2 X 2,536.09 X
33120   001 90 2 X 8,902.59 X
33120   004 90 2 X 7,210.52 X
33120   002 90 2 X 9,012.34 X
33120   003 90 2 X 8,248.83 X
33130   004 90 2 X 3,642.59 X
33130   001 90 2 X 3,983.78 X
33130   003 90 2 X 3,684.83 X
33130   002 90 2 X 3,963.12 X
33140   001 90 2 X 3,398.36 X
33140   004 90 2 X 3,018.32 X
33140   002 90 2 X 3,018.32 X
33140   003 90 2 X 3,018.32 X
33141   002 ZZZ 0 X 626.72 X
33141   003 ZZZ 0 X 626.72 X
33141   004 ZZZ 0 X 626.72 X
33141   001 ZZZ 0 X 701.70 X
33202   002 90 2 X 1,294.03 X
33202   003 90 2 X 1,294.03 X
33202   001 90 2 X 1,468.06 X
33202   004 90 2 X 1,294.03 X
33203   001 90 2 X 1,491.73 X
33203   004 90 2 X 1,328.20 X
33203   002 90 2 X 1,328.20 X
33203   003 90 2 X 1,328.20 X
33206   001 90 2 X 2,065.25 X
33206   003 90 2 X 1,929.91 X
33206   002 90 2 X 2,032.90 X
33206   004 90 2 X 1,916.55 X
33207   004 90 2 X 1,997.44 X
33207   002 90 2 X 2,133.76 X
33207   003 90 2 X 2,004.95 X
33207   001 90 2 X 2,167.14 X
33208   001 90 2 X 2,446.60 X
33208   004 90 2 X 2,128.33 X
33208   002 90 2 X 2,436.71 X
33208   003 90 2 X 2,262.32 X
33210   003 0 2 X 716.25 X
33210   002 0 2 X 770.33 X
33210   001 0 2 X 775.10 X
33210   004 0 2 X 721.92 X
33211   003 0 2 X 719.49 X
33211   002 0 2 X 773.70 X
33211   004 0 2 X 725.13 X
33211   001 0 2 X 778.39 X