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2024 Workers' Compensation Part B Fee Schedule

63287-64766

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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
63287   001 90 2 X 7,337.17 X
63287   004 90 2 X 6,680.00 X
63287   002 90 2 X 6,231.87 X
63287   003 90 2 X 6,757.80 X
63290   001 90 2 X 7,581.00 X
63290   004 90 2 X 6,900.82 X
63290   003 90 2 X 6,981.74 X
63290   002 90 2 X 7,464.12 X
63295   004 ZZZ 0 X 637.26 X
63295   001 ZZZ 0 X 723.81 X
63295   003 ZZZ 0 X 637.26 X
63295   002 ZZZ 0 X 637.26 X
63300   002 90 2 X 6,585.33 X
63300   003 90 2 X 6,475.89 X
63300   004 90 2 X 4,340.21 X
63300   001 90 2 X 6,611.81 X
63301   004 90 2 X 4,867.74 X
63301   001 90 2 X 5,360.99 X
63301   003 90 2 X 4,923.87 X
63301   002 90 2 X 5,275.67 X
63302   003 90 2 X 6,784.75 X
63302   002 90 2 X 6,928.66 X
63302   004 90 2 X 5,153.24 X
63302   001 90 2 X 5,640.88 X
63303   001 90 2 X 7,793.04 X
63303   002 90 2 X 5,620.56 X
63303   003 90 2 X 5,268.98 X
63303   004 90 2 X 5,209.43 X
63304   001 90 2 X 5,821.48 X
63304   003 90 2 X 5,419.78 X
63304   002 90 2 X 5,743.23 X
63304   004 90 2 X 5,355.65 X
63305   001 90 2 X 6,305.32 X
63305   002 90 2 X 7,989.04 X
63305   003 90 2 X 5,813.92 X
63305   004 90 2 X 5,746.57 X
63306   004 90 2 X 5,717.93 X
63306   001 90 2 X 6,214.58 X
63306   002 90 2 X 6,131.24 X
63306   003 90 2 X 5,786.32 X
63307   001 90 2 X 6,387.18 X
63307   004 90 2 X 5,857.73 X
63307   003 90 2 X 5,928.46 X
63307   002 90 2 X 6,297.95 X
63308   001 ZZZ 0 X 1,140.42 X
63308   004 ZZZ 0 X 1,036.42 X
63308   002 ZZZ 0 X 1,122.46 X
63308   003 ZZZ 0 X 1,048.54 X
63600   001 90 2 X 2,846.99 X
63600   002 90 2 X 2,950.74 X
63600   003 90 2 X 2,770.21 X
63600   004 90 2 X 2,553.34 X
63610     0 2 X * X
63620   004 90 0 X 1,290.15 X
63620   001 90 0 X 1,468.75 X
63620   003 90 0 X 1,290.15 X
63620   002 90 0 X 1,290.15 X
63621   002 ZZZ 0 X 408.17 X
63621   003 ZZZ 0 X 408.17 X
63621   004 ZZZ 0 X 408.17 X
63621   001 ZZZ 0 X 458.20 X
63650   002 10 2 X 2,128.42 X
63650   003 10 2 X 1,788.71 X
63650   004 10 2 X 1,767.14 X
63650   001 10 2 X 2,146.31 X
63655   002 90 2 X 3,469.14 X
63655   003 90 2 X 3,159.70 X
63655   001 90 2 X 3,543.91 X
63655   004 90 2 X 3,120.10 X
63661   001 10 2 X 1,012.92 554.46
63661   004 10 2 X 898.16 511.61
63661   002 10 2 X 898.16 511.61
63661   003 10 2 X 898.16 511.61
63662   004 90 2 X 1,183.50 X
63662   001 90 2 X 1,313.29 X
63662   003 90 2 X 1,183.50 X
63662   002 90 2 X 1,183.50 X
63663   002 10 2 X 1,338.77 797.33
63663   003 10 2 X 1,338.77 797.33
63663   004 10 2 X 1,338.77 797.33
63663   001 10 2 X 1,524.16 882.03
63664   003 90 2 X 1,233.06 X
63664   002 90 2 X 1,233.06 X
63664   004 90 2 X 1,233.06 X
63664   001 90 2 X 1,367.96 X
63685   001 10 2 X 1,742.06 X
63685   003 10 2 X 1,633.94 X
63685   002 10 2 X 1,710.00 X
63685   004 10 2 X 1,558.46 X
63688   004 10 2 X 1,263.19 X
63688   001 10 2 X 1,226.10 X
63688   003 10 2 X 1,278.69 X
63688   002 10 2 X 1,210.33 X
63700   004 90 2 X 3,187.03 X
63700   002 90 2 X 3,449.20 X
63700   003 90 2 X 3,229.89 X
63700   001 90 2 X 3,555.52 X
63702   001 90 2 X 3,999.88 X
63702   004 90 2 X 3,585.59 X
63702   002 90 2 X 3,880.30 X
63702   003 90 2 X 3,633.76 X
63704   001 90 2 X 4,443.38 X
63704   004 90 2 X 3,983.03 X
63704   002 90 2 X 4,310.49 X
63704   003 90 2 X 4,036.48 X
63706   004 90 2 X 4,581.35 X
63706   001 90 2 X 5,110.62 X
63706   003 90 2 X 4,642.86 X
63706   002 90 2 X 4,957.84 X
63707   004 90 2 X 4,467.49 X
63707   002 90 2 X 4,120.10 X
63707   003 90 2 X 4,416.46 X
63707   001 90 2 X 4,456.07 X
63709   001 90 2 X 4,503.27 X
63709   004 90 2 X 4,436.47 X
63709   002 90 2 X 4,627.08 X
63709   003 90 2 X 3,489.89 X
63710   001 90 2 X 2,753.91 X
63710   003 90 2 X 2,542.60 X
63710   002 90 2 X 2,712.63 X
63710   004 90 2 X 2,513.18 X
63740   001 90 2 X 3,478.42 X
63740   004 90 2 X 2,892.59 X
63740   002 90 2 X 3,451.55 X
63740   003 90 2 X 3,340.47 X
63741   002 90 2 X 2,368.62 X
63741   003 90 2 X 2,164.68 X
63741   001 90 2 X 2,418.00 X
63741   004 90 2 X 2,138.21 X
63744   001 90 2 X 3,136.47 X
63744   003 90 2 X 3,000.39 X
63744   002 90 2 X 2,990.29 X
63744   004 90 2 X 1,714.13 X
63746   001 90 2 X 1,396.26 X
63746   003 90 2 X 1,271.34 X
63746   002 90 2 X 2,703.00 X
63746   004 90 2 X 1,256.35 X
64400   004 0 2 X 154.26 134.38
64400   002 0 2 X 144.75 125.28
64400   003 0 2 X 151.21 131.57
64400   001 0 2 X 165.43 143.05
64405   004 0 2 X 200.25 170.55
64405   002 0 2 X 180.96 154.14
64405   003 0 2 X 205.65 175.14
64405   001 0 2 X 201.94 171.61
64408   002 0 2 X 228.52 X
64408   003 0 2 X 250.38 X
64408   001 0 2 X 231.58 X
64408   004 0 2 X 247.44 X
64415   004 0 2 X 167.84 X
64415   003 0 2 X 168.96 X
64415   002 0 2 X 170.55 X
64415   001 0 2 X 172.97 X
64416   004 0 2 X 344.44 X
64416   001 0 2 X 368.28 X
64416   003 0 2 X 344.44 X
64416   002 0 2 X 344.44 X
64417   003 0 2 X 201.38 X
64417   001 0 2 X 209.37 X
64417   002 0 2 X 214.56 X
64417   004 0 2 X 206.25 X
64418   003 0 2 X 193.28 160.09
64418   002 0 2 X 200.06 165.45
64418   001 0 2 X 202.33 167.54
64418   004 0 2 X 191.83 158.44
64420   001 0 2 X 211.21 X
64420   003 0 2 X 185.12 X
64420   002 0 2 X 194.80 X
64420   004 0 2 X 202.87 X
64421   003 ZZZ 0 X 263.02 X
64421   002 ZZZ 0 X 279.50 X
64421   004 ZZZ 0 X 288.11 X
64421   001 ZZZ 0 X 283.50 X
64425   001 0 2 X 235.63 207.93
64425   004 0 2 X 185.14 164.04
64425   002 0 2 X 228.11 202.14
64425   003 0 2 X 238.47 211.13
64430   003 0 2 X 239.52 X
64430   002 0 2 X 272.57 X
64430   004 0 2 X 236.88 X
64430   001 0 2 X 279.13 X
64435   004 0 2 X 209.87 X
64435   002 0 2 X 199.36 X
64435   001 0 2 X 216.60 X
64435   003 0 2 X 192.93 X
64445   002 0 2 X 178.59 159.58
64445   003 0 2 X 187.40 167.23
64445   001 0 2 X 194.80 173.59
64445   004 0 2 X 189.88 169.90
64446   002 0 2 X 354.59 X
64446   003 0 2 X 354.59 X
64446   001 0 2 X 383.05 X
64446   004 0 2 X 354.59 X
64447   003 0 2 X 165.51 X
64447   001 0 2 X 180.82 X
64447   002 0 2 X 165.51 X
64447   004 0 2 X 165.51 X
64448   001 0 2 X 352.37 X
64448   003 0 2 X 325.99 X
64448   002 0 2 X 325.99 X
64448   004 0 2 X 325.99 X
64449   001 0 2 X 345.92 X
64449   004 0 2 X 322.61 X
64449   002 0 2 X 322.61 X
64449   003 0 2 X 322.61 X
64450   004 0 2 X 170.96 149.01
64450   002 0 2 X 192.08 167.71
64450   003 0 2 X 181.08 157.86
64450   001 0 2 X 184.63 160.50
64451   001 0 2 X 320.31 120.74
64451   004 0 2 X 284.99 111.68
64451   002 0 2 X 284.99 111.68
64451   003 0 2 X 284.99 111.68
64454   003 0 2 X 287.79 114.95
64454   002 0 2 X 287.79 114.95
64454   001 0 2 X 323.55 124.53
64454   004 0 2 X 287.79 114.95
64455   003 0 2 X 85.79 69.07
64455   002 0 2 X 85.79 69.07
64455   001 0 2 X 95.44 75.58
64455   004 0 2 X 85.79 69.07
64461   003 0 2 X 222.12 134.05
64461   002 0 2 X 222.12 134.05
64461   004 0 2 X 222.12 134.05
64461   001 0 2 X 246.58 143.51
64462   002 ZZZ 0 X 126.26 84.50
64462   003 ZZZ 0 X 126.26 84.50
64462   001 ZZZ 0 X 139.35 90.51
64462   004 ZZZ 0 X 126.26 84.50
64463   003 0 2 X 241.11 130.15
64463   002 0 2 X 241.11 130.15
64463   004 0 2 X 241.11 130.15
64463   001 0 2 X 268.17 138.34
64479   001 0 2 X 579.66 272.01
64479   004 0 2 X 512.66 249.64
64479   002 0 2 X 512.66 249.64
64479   003 0 2 X 512.66 249.64
64480   004 ZZZ 0 X 460.19 172.95
64480   001 ZZZ 0 X 524.44 188.45
64480   003 ZZZ 0 X 460.19 172.95
64480   002 ZZZ 0 X 460.19 172.95
64483   001 0 2 X 534.99 231.18
64483   004 0 2 X 473.23 213.45
64483   002 0 2 X 473.23 213.45
64483   003 0 2 X 473.23 213.45
64484   003 ZZZ 0 X 434.34 149.57
64484   002 ZZZ 0 X 434.34 149.57
64484   001 ZZZ 0 X 496.34 163.23
64484   004 ZZZ 0 X 434.34 149.57
64486   002 0 2 X 188.22 100.74
64486   003 0 2 X 188.22 100.74
64486   004 0 2 X 188.22 100.74
64486   001 0 2 X 210.25 107.91
64487   004 0 2 X 229.94 115.76
64487   002 0 2 X 229.94 115.76
64487   003 0 2 X 229.94 115.76
64487   001 0 2 X 257.35 123.78
64488   001 0 2 X 258.02 133.65
64488   003 0 2 X 231.46 125.13
64488   002 0 2 X 231.46 125.13
64488   004 0 2 X 231.46 125.13
64489   004 0 2 X 320.27 139.56
64489   002 0 2 X 320.27 139.56
64489   003 0 2 X 320.27 139.56
64489   001 0 2 X 360.34 148.94
64490   002 0 2 X 307.21 185.42
64490   003 0 2 X 307.21 185.42
64490   004 0 2 X 307.21 185.42
64490   001 0 2 X 348.52 204.13
64491   001 ZZZ 0 X 175.03 116.86
64491   003 ZZZ 0 X 156.08 107.04
64491   002 ZZZ 0 X 156.08 107.04
64491   004 ZZZ 0 X 156.08 107.04
64492   001 ZZZ 0 X 177.15 118.97
64492   004 ZZZ 0 X 157.86 108.80
64492   003 ZZZ 0 X 157.86 108.80
64492   002 ZZZ 0 X 157.86 108.80
64493   004 0 2 X 274.28 157.24
64493   001 0 2 X 311.96 173.14
64493   003 0 2 X 274.28 157.24
64493   002 0 2 X 274.28 157.24
64494   002 ZZZ 0 X 141.58 91.36
64494   003 ZZZ 0 X 141.58 91.36
64494   001 ZZZ 0 X 159.08 99.48
64494   004 ZZZ 0 X 141.58 91.36
64495   001 ZZZ 0 X 161.18 101.60
64495   004 ZZZ 0 X 143.34 93.11
64495   003 ZZZ 0 X 143.34 93.11
64495   002 ZZZ 0 X 143.34 93.11
64505   002 0 2 X 183.13 157.45
64505   003 0 2 X 189.88 164.36
64505   004 0 2 X 200.02 172.95
64505   001 0 2 X 203.65 175.39
64510   004 0 2 X 268.14 X
64510   001 0 2 X 280.10 X
64510   003 0 2 X 265.45 X
64510   002 0 2 X 270.45 X
64517   001 0 2 X 436.18 274.16
64517   004 0 2 X 389.91 252.17
64517   003 0 2 X 389.91 252.17
64517   002 0 2 X 389.91 252.17
64520   003 0 2 X 274.12 X
64520   002 0 2 X 235.25 X
64520   004 0 2 X 274.02 X
64520   001 0 2 X 243.12 X
64530   002 0 2 X 340.84 X
64530   003 0 2 X 296.11 X
64530   004 0 2 X 292.77 X
64530   001 0 2 X 312.07 X
64553     10 2 X * X
64555   001 10 2 X 791.87 X
64555   004 10 2 X 266.82 X
64555   003 10 2 X 819.00 X
64555   002 10 2 X 757.00 X
64561   001 10 2 X 1,944.39 920.18
64561   004 10 2 X 1,715.85 844.45
64561   003 10 2 X 1,715.85 844.45
64561   002 10 2 X 1,715.85 844.45
64566   004 0 2 X 217.71 51.90
64566   001 0 2 X 243.31 55.68
64566   003 0 2 X 217.71 51.90
64566   002 0 2 X 217.71 51.90
64568   001 90 2 X 1,216.68 X
64568   004 90 2 X 1,105.73 X
64568   003 90 2 X 1,105.73 X
64568   002 90 2 X 1,105.73 X
64569   003 90 2 X 1,113.30 X
64569   002 90 2 X 1,113.30 X
64569   004 90 2 X 1,113.30 X
64569   001 90 2 X 1,253.63 X
64570   001 90 2 X 1,121.59 X
64570   004 90 2 X 982.82 X
64570   002 90 2 X 982.82 X
64570   003 90 2 X 982.82 X
64575   003 90 2 X 808.07 X
64575   002 90 2 X 857.03 X
64575   004 90 2 X 798.64 X
64575   001 90 2 X 868.90 X
64580     90 2 X * X
64581   001 90 2 X 1,775.28 X
64581   004 90 2 X 1,628.60 X
64581   002 90 2 X 1,628.60 X
64581   003 90 2 X 1,628.60 X
64582   002 90 2 X 1,034.80 X
64582   003 90 2 X 1,034.80 X
64582   004 90 2 X 1,034.80 X
64582   001 90 2 X 1,137.52 X
64583   001 90 2 X 1,023.40 X
64583   004 90 2 X 948.66 X
64583   003 90 2 X 948.66 X
64583   002 90 2 X 948.66 X
64584   004 90 2 X 798.92 X
64584   001 90 2 X 862.86 X
64584   002 90 2 X 798.92 X
64584   003 90 2 X 798.92 X
64585   002 10 2 X 336.75 X
64585   003 10 2 X 321.35 X
64585   004 10 2 X 317.70 X
64585   001 10 2 X 340.51 X
64590   001 10 2 X 516.56 X
64590   003 10 2 X 474.17 X
64590   002 10 2 X 508.34 X
64590   004 10 2 X 468.68 X
64595   004 10 2 X 310.88 X
64595   002 10 2 X 335.73 X
64595   003 10 2 X 314.43 X
64595   001 10 2 X 340.96 X
64596     10 2 X # X
64597     ZZZ 0 X # X
64598     10 2 X # X
64600   004 10 2 X 766.18 X
64600   001 10 2 X 781.88 X
64600   003 10 2 X 752.80 X
64600   002 10 2 X 649.47 X
64605   001 10 2 X 1,184.75 X
64605   004 10 2 X 726.12 X
64605   003 10 2 X 733.64 X
64605   002 10 2 X 770.95 X
64610   004 10 2 X 2,124.00 X
64610   001 10 2 X 2,194.29 X
64610   003 10 2 X 2,131.60 X
64610   002 10 2 X 2,148.46 X
64611   003 10 2 X 172.57 156.66
64611   002 10 2 X 172.57 156.66
64611   004 10 2 X 172.57 156.66
64611   001 10 2 X 194.55 176.54
64612   001 10 2 X 395.91 X
64612   004 10 2 X 364.30 X
64612   003 10 2 X 368.67 X
64612   002 10 2 X 390.64 X
64615   004 10 2 X 230.33 209.05
64615   003 10 2 X 230.33 209.05
64615   002 10 2 X 230.33 209.05
64615   001 10 2 X 262.90 238.22
64616   004 10 2 X 194.70 172.95
64616   001 10 2 X 219.17 193.87
64616   002 10 2 X 194.70 172.95
64616   003 10 2 X 194.70 172.95
64617   002 10 2 X 296.55 183.18
64617   003 10 2 X 296.55 183.18
64617   004 10 2 X 296.55 183.18
64617   001 10 2 X 332.28 200.16
64620   001 10 2 X 362.80 X
64620   004 10 2 X 386.90 X
64620   003 10 2 X 335.78 X
64620   002 10 2 X 330.39 X
64624   004 10 2 X 549.18 205.40
64624   002 10 2 X 549.18 205.40
64624   003 10 2 X 549.18 205.40
64624   001 10 2 X 619.44 223.55
64625   002 10 2 X 672.14 271.69
64625   003 10 2 X 672.14 271.69
64625   004 10 2 X 672.14 271.69
64625   001 10 2 X 756.35 295.21
64628   001 10 2 X 603.53 X
64628   004 10 2 X 546.92 X
64628   002 10 2 X 546.92 X
64628   003 10 2 X 546.92 X
64629   001 ZZZ 0 X 282.17 X
64629   004 ZZZ 0 X 256.94 X
64629   003 ZZZ 0 X 256.94 X
64629   002 ZZZ 0 X 256.94 X
64630   003 10 2 X 496.20 X
64630   002 10 2 X 530.44 X
64630   001 10 2 X 538.77 X
64630   004 10 2 X 490.79 X
64632   002 10 2 X 137.74 118.60
64632   003 10 2 X 137.74 118.60
64632   004 10 2 X 137.74 118.60
64632   001 10 2 X 151.27 128.55
64633   003 10 2 X 719.34 385.65
64633   002 10 2 X 719.34 385.65
64633   004 10 2 X 719.34 385.65
64633   001 10 2 X 808.31 421.26
64634   003 ZZZ 0 X 326.92 116.33
64634   002 ZZZ 0 X 326.92 116.33
64634   004 ZZZ 0 X 326.92 116.33
64634   001 ZZZ 0 X 370.20 125.94
64635   002 10 2 X 706.88 377.87
64635   003 10 2 X 706.88 377.87
64635   004 10 2 X 706.88 377.87
64635   001 10 2 X 794.16 412.59
64636   002 ZZZ 0 X 293.96 101.18
64636   003 ZZZ 0 X 293.96 101.18
64636   004 ZZZ 0 X 293.96 101.18
64636   001 ZZZ 0 X 332.89 109.29
64640   004 10 2 X 289.37 256.43
64640   001 10 2 X 303.02 267.75
64640   003 10 2 X 289.57 257.08
64640   002 10 2 X 298.53 263.29
64642   004 0 2 X 219.21 172.06
64642   002 0 2 X 219.21 172.06
64642   003 0 2 X 219.21 172.06
64642   001 0 2 X 245.25 190.32
64643   001 ZZZ 0 X 161.38 127.41
64643   004 ZZZ 0 X 145.03 115.87
64643   002 ZZZ 0 X 145.03 115.87
64643   003 ZZZ 0 X 145.03 115.87
64644   001 0 2 X 279.71 207.48
64644   003 0 2 X 249.82 187.81
64644   002 0 2 X 249.82 187.81
64644   004 0 2 X 249.82 187.81
64645   002 ZZZ 0 X 176.84 132.84
64645   003 ZZZ 0 X 176.84 132.84
64645   004 ZZZ 0 X 176.84 132.84
64645   001 ZZZ 0 X 197.46 146.24
64646   001 0 2 X 263.72 205.69
64646   004 0 2 X 235.97 186.11
64646   003 0 2 X 235.97 186.11
64646   002 0 2 X 235.97 186.11
64647   002 0 2 X 273.24 214.95
64647   003 0 2 X 273.24 214.95
64647   004 0 2 X 273.24 214.95
64647   001 0 2 X 305.18 237.27
64650   002 0 2 X 111.47 74.09
64650   003 0 2 X 111.47 74.09
64650   004 0 2 X 111.47 74.09
64650   001 0 2 X 127.60 81.84
64653   003 0 2 X 129.01 93.61
64653   001 0 2 X 146.91 103.57
64653   004 0 2 X 129.01 93.61
64653   002 0 2 X 129.01 93.61
64680   002 10 2 X 644.66 X
64680   003 10 2 X 637.96 X
64680   001 10 2 X 630.95 X
64680   004 10 2 X 439.03 X
64681   002 10 2 X 954.29 456.56
64681   003 10 2 X 954.29 456.56
64681   004 10 2 X 954.29 456.56
64681   001 10 2 X 1,084.87 499.82
64702   001 90 2 X 1,153.84 X
64702   004 90 2 X 1,052.27 X
64702   002 90 2 X 1,084.45 X
64702   003 90 2 X 1,043.97 X
64704   001 90 2 X 1,322.19 X
64704   004 90 2 X 1,167.09 X
64704   002 90 2 X 1,226.15 X
64704   003 90 2 X 1,098.57 X
64708   004 90 2 X 1,466.04 X
64708   002 90 2 X 1,604.65 X
64708   003 90 2 X 1,484.22 X
64708   001 90 2 X 1,633.80 X
64712   004 90 2 X 1,854.56 X
64712   002 90 2 X 2,041.04 X
64712   003 90 2 X 1,877.42 X
64712   001 90 2 X 2,071.68 X
64713   004 90 2 X 2,211.42 X
64713   002 90 2 X 2,405.45 X
64713   003 90 2 X 2,334.89 X
64713   001 90 2 X 2,446.06 X
64714   001 90 2 X 2,605.42 X
64714   002 90 2 X 1,954.86 X
64714   003 90 2 X 1,823.09 X
64714   004 90 2 X 1,802.88 X
64716   004 90 2 X 1,164.66 X
64716   002 90 2 X 1,255.66 X
64716   001 90 2 X 1,274.38 X
64716   003 90 2 X 1,178.60 X
64718   004 90 2 X 1,406.38 X
64718   001 90 2 X 1,522.47 X
64718   003 90 2 X 1,411.14 X
64718   002 90 2 X 1,495.90 X
64719   001 90 2 X 1,238.49 X
64719   004 90 2 X 1,130.03 X
64719   003 90 2 X 1,132.27 X
64719   002 90 2 X 1,214.97 X
64721   001 90 2 X 1,152.17 X
64721   004 90 2 X 1,053.21 X
64721   003 90 2 X 1,056.72 X
64721   002 90 2 X 1,141.08 X
64722   002 90 2 X 1,754.43 X
64722   003 90 2 X 1,587.86 X
64722   001 90 2 X 1,752.42 X
64722   004 90 2 X 1,497.71 X
64726   003 90 2 X 501.85 X
64726   002 90 2 X 519.92 X
64726   004 90 2 X 496.79 X
64726   001 90 2 X 524.30 X
64727   001 ZZZ 0 X 1,439.12 X
64727   004 ZZZ 0 X 1,407.04 X
64727   003 ZZZ 0 X 1,410.67 X
64727   002 ZZZ 0 X 1,433.55 X
64732   002 90 2 X 1,029.33 X
64732   003 90 2 X 1,012.64 X
64732   001 90 2 X 1,066.02 X
64732   004 90 2 X 945.70 X
64734   002 90 2 X 1,364.59 X
64734   003 90 2 X 1,334.10 X
64734   001 90 2 X 1,121.82 X
64734   004 90 2 X 1,019.04 X
64736   001 90 2 X 1,038.73 X
64736   003 90 2 X 965.99 X
64736   002 90 2 X 1,024.61 X
64736   004 90 2 X 953.97 X
64738   002 90 2 X 1,343.32 X
64738   003 90 2 X 1,157.63 X
64738   004 90 2 X 1,143.58 X
64738   001 90 2 X 1,660.08 X
64740   001 90 2 X 1,248.75 X
64740   004 90 2 X 1,141.06 X
64740   002 90 2 X 1,230.49 X
64740   003 90 2 X 1,155.07 X
64742   004 90 2 X 1,169.71 X
64742   002 90 2 X 1,250.87 X
64742   003 90 2 X 1,184.11 X
64742   001 90 2 X 1,267.05 X
64744   001 90 2 X 1,383.41 X
64744   003 90 2 X 1,255.17 X
64744   002 90 2 X 1,371.06 X
64744   004 90 2 X 1,240.01 X
64746   003 90 2 X 1,055.44 X
64746   002 90 2 X 1,137.49 X
64746   004 90 2 X 1,050.44 X
64746   001 90 2 X 1,155.67 X
64755   004 90 2 X 2,669.51 X
64755   002 90 2 X 2,908.95 X
64755   003 90 2 X 2,700.38 X
64755   001 90 2 X 3,234.03 X
64760   001 90 2 X 1,693.54 X
64760   002 90 2 X 1,661.89 X
64760   003 90 2 X 2,102.44 X
64760   004 90 2 X 1,513.37 X
64763   003 90 2 X 1,299.51 X
64763   002 90 2 X 1,390.94 X
64763   004 90 2 X 1,284.69 X
64763   001 90 2 X 1,413.06 X
64766   003 90 2 X 1,688.49 X
64766   001 90 2 X 1,838.02 X
64766   002 90 2 X 1,808.81 X
64766   004 90 2 X 1,668.90 X