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2021 Workers' Compensation Part B Fee Schedule

19105-21014

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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
19105   2 0 2 X 2,658.41 261.72
19105   3 0 2 X 2,658.41 261.72
19105   4 0 2 X 2,658.41 261.72
19105   1 0 2 X 3,220.69 288.48
19110   4 90 2 X 630.03 X
19110   3 90 2 X 637.17 X
19110   2 90 2 X 680.43 X
19110   1 90 2 X 742.49 X
19112   4 90 2 X 547.80 X
19112   3 90 2 X 595.53 X
19112   1 90 2 X 596.89 X
19112   2 90 2 X 640.28 X
19120   2 90 2 X 681.33 X
19120   3 90 2 X 681.33 X
19120   4 90 2 X 681.33 X
19120   1 90 2 X 764.27 X
19125   4 90 2 X 754.88 X
19125   3 90 2 X 760.33 X
19125   2 90 2 X 890.20 X
19125   1 90 2 X 903.12 X
19126   2 ZZZ 0 X 446.17 X
19126   1 ZZZ 0 X 452.74 X
19126   4 ZZZ 0 X 618.50 X
19126   3 ZZZ 0 X 622.44 X
19281   2 0 2 X 319.23 141.50
19281   3 0 2 X 319.23 141.50
19281   4 0 2 X 319.23 141.50
19281   1 0 2 X 359.48 152.42
19282   2 ZZZ 0 X 219.33 67.37
19282   3 ZZZ 0 X 219.33 67.37
19282   4 ZZZ 0 X 219.33 67.37
19282   1 ZZZ 0 X 248.61 71.60
19283   2 0 2 X 361.29 142.86
19283   3 0 2 X 361.29 142.86
19283   4 0 2 X 361.29 142.86
19283   1 0 2 X 408.47 154.02
19284   2 ZZZ 0 X 262.28 67.82
19284   3 ZZZ 0 X 262.28 67.82
19284   4 ZZZ 0 X 262.28 67.82
19284   1 ZZZ 0 X 298.66 72.12
19285   2 0 2 X 603.64 121.15
19285   3 0 2 X 603.64 121.15
19285   4 0 2 X 603.64 121.15
19285   1 0 2 X 692.69 130.55
19286   2 ZZZ 0 X 503.18 58.21
19286   3 ZZZ 0 X 503.18 58.21
19286   4 ZZZ 0 X 503.18 58.21
19286   1 ZZZ 0 X 580.39 61.99
19287   2 0 2 X 1,117.79 198.02
19287   3 0 2 X 1,117.79 198.02
19287   4 0 2 X 1,117.79 198.02
19287   1 0 2 X 1,289.68 218.09
19288   2 ZZZ 0 X 884.32 87.08
19288   3 ZZZ 0 X 884.32 87.08
19288   4 ZZZ 0 X 884.32 87.08
19288   1 ZZZ 0 X 1,021.45 92.63
19294   2 ZZZ 0 X 209.33 X
19294   3 ZZZ 0 X 209.33 X
19294   4 ZZZ 0 X 209.33 X
19294   1 ZZZ 0 X 228.16 X
19296   2 0 2 X 8,033.55 359.94
19296   3 0 2 X 8,033.55 359.94
19296   4 0 2 X 8,033.55 359.94
19296   1 0 2 X 9,596.09 397.78
19297   2 ZZZ 0 X 165.24 X
19297   3 ZZZ 0 X 165.24 X
19297   4 ZZZ 0 X 165.24 X
19297   1 ZZZ 0 X 182.13 X
19298   2 0 2 X 3,041.26 578.55
19298   3 0 2 X 3,041.26 578.55
19298   4 0 2 X 3,041.26 578.55
19298   1 0 2 X 3,585.20 633.19
19300   2 90 2 X 697.79 492.94
19300   3 90 2 X 697.79 492.94
19300   4 90 2 X 697.79 492.94
19300   1 90 2 X 815.12 564.54
19301   2 90 2 X 539.32 X
19301   3 90 2 X 539.32 X
19301   4 90 2 X 539.32 X
19301   1 90 2 X 615.01 X
19302   2 90 2 X 1,150.29 X
19302   3 90 2 X 1,150.29 X
19302   4 90 2 X 1,150.29 X
19302   1 90 2 X 1,303.57 X
19303   2 90 2 X 1,174.45 X
19303   3 90 2 X 1,174.45 X
19303   4 90 2 X 1,174.45 X
19303   1 90 2 X 1,299.95 X
19305   2 90 2 X 1,424.88 X
19305   3 90 2 X 1,424.88 X
19305   4 90 2 X 1,424.88 X
19305   1 90 2 X 1,607.36 X
19306   2 90 2 X 1,481.19 X
19306   3 90 2 X 1,481.19 X
19306   4 90 2 X 1,481.19 X
19306   1 90 2 X 1,673.27 X
19307   2 90 2 X 1,489.33 X
19307   3 90 2 X 1,489.33 X
19307   4 90 2 X 1,489.33 X
19307   1 90 2 X 1,683.35 X
19316     90 2 X * X
19318   3 90 2 X 3,350.51 X
19318   4 90 2 X 3,367.24 X
19318   2 90 2 X 3,481.83 X
19318   1 90 2 X 3,506.30 X
19325   4 90 2 X 1,327.12 X
19325   2 90 2 X 1,437.71 X
19325   1 90 2 X 1,460.78 X
19325   3 90 2 X 1,881.41 X
19328   3 90 2 X 761.06 X
19328   2 90 2 X 813.50 X
19328   4 90 2 X 865.29 X
19328   1 90 2 X 951.95 X
19330   4 90 2 X 1,044.12 X
19330   3 90 2 X 1,055.78 X
19330   2 90 2 X 1,123.01 X
19330   1 90 2 X 1,139.39 X
19340   4 ZZZ 0 X 1,588.61 X
19340   3 ZZZ 0 X 2,751.58 X
19340   2 ZZZ 0 X 2,815.16 X
19340   1 ZZZ 0 X 2,830.55 X
19342   4 90 2 X 2,063.41 X
19342   3 90 2 X 2,088.12 X
19342   2 90 2 X 2,495.98 X
19342   1 90 2 X 2,512.67 X
19350   4 90 2 X 1,467.94 X
19350   3 90 2 X 1,603.81 X
19350   1 90 2 X 1,624.89 X
19350   2 90 2 X 1,651.05 X
19355   4 90 2 X 1,164.27 X
19355   3 90 2 X 1,177.47 X
19355   2 90 2 X 1,260.63 X
19355   1 90 2 X 1,280.89 X
19357   4 90 2 X 2,755.68 X
19357   3 90 2 X 2,787.44 X
19357   2 90 2 X 2,986.26 X
19357   1 90 2 X 3,034.50 X
19361   3 90 2 X 3,041.26 X
19361   2 90 2 X 3,236.24 X
19361   4 90 2 X 3,672.31 X
19361   1 90 2 X 4,095.71 X
19364   4 90 2 X 4,228.90 X
19364   3 90 2 X 4,276.33 X
19364   2 90 2 X 4,572.89 X
19364   1 90 2 X 4,645.01 X
19367   3 90 2 X 3,950.10 X
19367   2 90 2 X 4,191.34 X
19367   1 90 2 X 4,236.39 X
19367   4 90 2 X 4,459.62 X
19368   3 90 2 X 3,950.10 X
19368   2 90 2 X 4,191.34 X
19368   1 90 2 X 4,236.39 X
19368   4 90 2 X 4,459.62 X
19369   3 90 2 X 3,950.10 X
19369   2 90 2 X 4,191.34 X
19369   1 90 2 X 4,236.39 X
19369   4 90 2 X 4,459.62 X
19370   4 90 2 X 1,316.21 X
19370   3 90 2 X 1,735.49 X
19370   2 90 2 X 1,776.71 X
19370   1 90 2 X 1,786.69 X
19371   4 90 2 X 1,610.11 X
19371   3 90 2 X 1,860.41 X
19371   2 90 2 X 1,912.78 X
19371   1 90 2 X 1,925.43 X
19380   4 90 2 X 1,611.07 X
19380   3 90 2 X 1,630.19 X
19380   2 90 2 X 1,756.74 X
19380   1 90 2 X 1,787.44 X
19396     0 2 X * X
19499     YYY 2 X # X
20100   4 10 2 X 1,438.62 X
20100   3 10 2 X 1,458.77 X
20100   2 10 2 X 1,545.08 X
20100   1 10 2 X 1,615.24 X
20101   4 10 2 X 454.61 X
20101   3 10 2 X 460.96 X
20101   2 10 2 X 488.30 X
20101   1 10 2 X 510.59 X
20102   4 10 2 X 556.88 X
20102   3 10 2 X 564.65 X
20102   2 10 2 X 598.05 X
20102   1 10 2 X 625.28 X
20103   4 10 2 X 749.30 X
20103   3 10 2 X 759.81 X
20103   2 10 2 X 804.76 X
20103   1 10 2 X 841.18 X
20150   3 90 2 X 2,352.01 X
20150   4 90 2 X 2,352.01 X
20150   2 90 2 X 2,416.95 X
20150   1 90 2 X 2,701.68 X
20200   4 0 2 X 321.76 X
20200   3 0 2 X 325.58 X
20200   2 0 2 X 336.28 X
20200   1 0 2 X 342.55 X
20205   4 0 2 X 511.76 X
20205   3 0 2 X 543.88 X
20205   2 0 2 X 553.23 X
20205   1 0 2 X 563.45 X
20206   4 0 2 X 302.06 X
20206   3 0 2 X 306.39 X
20206   2 0 2 X 309.28 X
20206   1 0 2 X 320.07 X
20220   3 0 2 X 235.85 X
20220   2 0 2 X 263.11 X
20220   1 0 2 X 264.86 X
20220   4 0 2 X 266.86 X
20225   2 0 2 X 403.07 X
20225   1 0 2 X 409.40 X
20225   4 0 2 X 425.89 X
20225   3 0 2 X 473.26 X
20240   4 10 2 X 451.98 X
20240   3 10 2 X 457.31 X
20240   1 10 2 X 479.33 X
20240   2 10 2 X 481.40 X
20245   1 10 2 X 943.84 X
20245   3 10 2 X 955.83 X
20245   4 10 2 X 1,016.00 X
20245   2 10 2 X 1,033.58 X
20250   4 10 2 X 918.37 X
20250   2 10 2 X 1,039.58 X
20250   1 10 2 X 1,131.34 X
20250   3 10 2 X 1,144.07 X
20251   3 10 2 X 1,060.50 X
20251   4 10 2 X 1,132.50 X
20251   2 10 2 X 1,173.33 X
20251   1 10 2 X 1,239.88 X
20500   4 10 2 X 130.72 116.48
20500   3 10 2 X 132.07 117.65
20500   2 10 2 X 134.06 119.37
20500   1 10 2 X 139.20 123.66
20501   4 0 2 X 89.38 X
20501   3 0 2 X 90.38 X
20501   2 0 2 X 94.19 X
20501   1 0 2 X 95.06 X
20520   1 10 2 X 179.23 154.57
20520   4 10 2 X 181.81 158.20
20520   3 10 2 X 203.21 176.30
20520   2 10 2 X 206.16 177.74
20525   4 10 2 X 481.98 X
20525   3 10 2 X 483.79 X
20525   1 10 2 X 515.30 X
20525   2 10 2 X 548.34 X
20526   2 0 2 X 113.36 88.05
20526   3 0 2 X 113.36 88.05
20526   4 0 2 X 113.36 88.05
20526   1 0 2 X 126.97 97.19
20527   2 0 2 X 105.47 84.05
20527   3 0 2 X 105.47 84.05
20527   4 0 2 X 105.47 84.05
20527   1 0 2 X 117.59 92.68
20550   4 0 2 X 95.35 82.67
20550   1 0 2 X 96.28 83.61
20550   3 0 2 X 97.45 84.67
20550   2 0 2 X 100.90 87.75
20551   2 0 2 X 113.36 88.05
20551   3 0 2 X 113.36 88.05
20551   4 0 2 X 113.36 88.05
20551   1 0 2 X 126.97 97.19
20552   2 0 2 X 113.36 88.05
20552   3 0 2 X 113.36 88.05
20552   4 0 2 X 113.36 88.05
20552   1 0 2 X 126.97 97.19
20553   2 0 2 X 113.36 88.05
20553   3 0 2 X 113.36 88.05
20553   4 0 2 X 113.36 88.05
20553   1 0 2 X 126.97 97.19
20555   2 0 2 X 462.74 X
20555   3 0 2 X 462.74 X
20555   4 0 2 X 462.74 X
20555   1 0 2 X 506.90 X
20560         X * X
20561         X * X
20600   4 0 2 X 97.32 78.40
20600   3 0 2 X 98.21 79.23
20600   1 0 2 X 101.97 81.83
20600   2 0 2 X 102.84 82.69
20604   2 0 2 X 93.52 60.89
20604   3 0 2 X 93.52 60.89
20604   4 0 2 X 93.52 60.89
20604   1 0 2 X 103.40 65.22
20605   4 0 2 X 104.63 85.19
20605   3 0 2 X 105.89 86.12
20605   2 0 2 X 111.75 90.81
20605   1 0 2 X 113.20 91.97
20606   2 0 2 X 102.82 68.87
20606   3 0 2 X 102.82 68.87
20606   4 0 2 X 102.82 68.87
20606   1 0 2 X 113.51 73.78
20610   4 0 2 X 107.13 88.89
20610   3 0 2 X 108.31 89.81
20610   2 0 2 X 114.10 94.46
20610   1 0 2 X 115.11 95.02
20611   2 0 2 X 118.04 80.94
20611   3 0 2 X 118.04 80.94
20611   4 0 2 X 118.04 80.94
20611   1 0 2 X 130.78 87.38
20612   2 0 2 X 101.26 69.57
20612   3 0 2 X 101.26 69.57
20612   4 0 2 X 101.26 69.57
20612   1 0 2 X 114.33 77.08
20615   4 10 2 X 200.30 182.80
20615   3 10 2 X 201.64 184.56
20615   2 10 2 X 206.55 188.14
20615   1 10 2 X 208.30 189.79
20650   3 10 2 X 317.40 X
20650   4 10 2 X 327.54 X
20650   2 10 2 X 337.43 X
20650   1 10 2 X 515.07 X
20660   4 0 0 X 462.22 X
20660   3 0 0 X 489.75 X
20660   2 0 0 X 494.28 X
20660   1 0 0 X 495.51 X
20661   4 90 2 X 867.06 X
20661   3 90 2 X 870.88 X
20661   2 90 2 X 889.73 X
20661   1 90 2 X 900.26 X
20662   4 90 2 X 1,147.65 X
20662   3 90 2 X 1,161.83 X
20662   2 90 2 X 1,250.68 X
20662   1 90 2 X 1,272.18 X
20663   4 90 2 X 903.35 X
20663   3 90 2 X 914.18 X
20663   2 90 2 X 980.73 X
20663   1 90 2 X 996.82 X
20664   2 90 2 X 945.23 X
20664   3 90 2 X 945.23 X
20664   4 90 2 X 945.23 X
20664   1 90 2 X 1,049.78 X
20665   4 10 2 X 162.15 X
20665   3 10 2 X 163.92 X
20665   1 10 2 X 242.84 X
20665   2 10 2 X 260.49 X
20670   3 10 2 X 381.39 X
20670   2 10 2 X 386.40 X
20670   4 10 2 X 423.12 X
20670   1 10 2 X 426.12 X
20680   4 90 2 X 623.69 X
20680   3 90 2 X 631.34 X
20680   2 90 2 X 677.16 X
20680   1 90 2 X 688.22 X
20690   4 ZZZ 0 X 681.80 X
20690   3 ZZZ 0 X 690.17 X
20690   2 ZZZ 0 X 731.95 X
20690   1 ZZZ 0 X 738.99 X
20692   4 ZZZ 0 X 958.20 X
20692   3 ZZZ 0 X 966.03 X
20692   2 ZZZ 0 X 1,012.39 X
20692   1 ZZZ 0 X 1,023.63 X
20693   4 90 2 X 737.21 X
20693   3 90 2 X 745.37 X
20693   2 90 2 X 787.55 X
20693   1 90 2 X 797.84 X
20694   4 90 2 X 600.92 X
20694   3 90 2 X 607.90 X
20694   2 90 2 X 646.69 X
20694   1 90 2 X 656.09 X
20696   2 90 2 X 1,530.48 X
20696   3 90 2 X 1,530.48 X
20696   4 90 2 X 1,530.48 X
20696   1 90 2 X 1,705.66 X
20697   2 0 2 X 1,686.68 X
20697   3 0 2 X 1,686.68 X
20697   4 0 2 X 1,686.68 X
20697   1 0 2 X 2,000.54 X
20700   2 ZZZ 0 X 101.38 X
20700   3 ZZZ 0 X 101.38 X
20700   4 ZZZ 0 X 101.38 X
20700   1 ZZZ 0 X 111.09 X
20701   2 ZZZ 0 X 75.64 X
20701   3 ZZZ 0 X 75.64 X
20701   4 ZZZ 0 X 75.64 X
20701   1 ZZZ 0 X 82.73 X
20702   2 ZZZ 0 X 168.70 X
20702   3 ZZZ 0 X 168.70 X
20702   4 ZZZ 0 X 168.70 X
20702   1 ZZZ 0 X 184.91 X
20703   2 ZZZ 0 X 120.92 X
20703   3 ZZZ 0 X 120.92 X
20703   4 ZZZ 0 X 120.92 X
20703   1 ZZZ 0 X 132.33 X
20704   2 ZZZ 0 X 175.75 X
20704   3 ZZZ 0 X 175.75 X
20704   4 ZZZ 0 X 175.75 X
20704   1 ZZZ 0 X 192.67 X
20705   2 ZZZ 0 X 144.60 X
20705   3 ZZZ 0 X 144.60 X
20705   4 ZZZ 0 X 144.60 X
20705   1 ZZZ 0 X 158.35 X
20802   4 90 2 X 7,746.01 X
20802   3 90 2 X 7,854.14 X
20802   2 90 2 X 8,408.94 X
20802   1 90 2 X 8,671.64 X
20805   4 90 2 X 9,480.78 X
20805   3 90 2 X 9,613.07 X
20805   2 90 2 X 10,292.42 X
20805   1 90 2 X 10,614.09 X
20808   4 90 2 X 11,787.45 X
20808   3 90 2 X 11,951.91 X
20808   2 90 2 X 12,796.51 X
20808   1 90 2 X 13,196.47 X
20816   4 90 2 X 5,810.62 X
20816   3 90 2 X 5,891.71 X
20816   2 90 2 X 6,308.00 X
20816   1 90 2 X 6,505.08 X
20822   4 90 2 X 4,803.52 X
20822   3 90 2 X 4,870.59 X
20822   2 90 2 X 5,214.69 X
20822   1 90 2 X 5,377.68 X
20824   4 90 2 X 5,810.62 X
20824   3 90 2 X 5,891.71 X
20824   2 90 2 X 6,308.00 X
20824   1 90 2 X 6,505.08 X
20827   4 90 2 X 4,939.06 X
20827   3 90 2 X 5,007.97 X
20827   2 90 2 X 5,361.92 X
20827   1 90 2 X 5,529.50 X
20838   4 90 2 X 7,746.01 X
20838   3 90 2 X 7,854.14 X
20838   2 90 2 X 8,408.94 X
20838   1 90 2 X 8,671.64 X
20900   1 90 2 X 794.67 X
20900   3 90 2 X 971.61 X
20900   2 90 2 X 1,010.82 X
20900   4 90 2 X 1,103.59 X
20902   4 90 2 X 1,101.78 X
20902   3 90 2 X 1,114.61 X
20902   2 90 2 X 1,188.54 X
20902   1 90 2 X 1,206.44 X
20910   3 90 2 X 372.44 X
20910   2 90 2 X 384.66 X
20910   1 90 2 X 387.42 X
20910   4 90 2 X 527.57 X
20912   4 90 2 X 995.62 X
20912   3 90 2 X 1,007.43 X
20912   2 90 2 X 1,071.47 X
20912   1 90 2 X 1,086.91 X
20920   4 90 2 X 818.23 X
20920   3 90 2 X 828.00 X
20920   2 90 2 X 880.10 X
20920   1 90 2 X 1,326.91 X
20922   3 90 2 X 993.89 X
20922   1 90 2 X 1,075.56 X
20922   2 90 2 X 1,318.68 X
20922   4 90 2 X 1,569.37 X
20924   4 90 2 X 1,085.51 X
20924   3 90 2 X 1,098.51 X
20924   2 90 2 X 1,669.89 X
20924   1 90 2 X 1,677.71 X
20930     XXX 0 X * X
20931   4 ZZZ 0 X 347.91 X
20931   3 ZZZ 0 X 353.21 X
20931   2 ZZZ 0 X 377.44 X
20931   1 ZZZ 0 X 395.36 X
20932   2 ZZZ 0 X 862.90 X
20932   3 ZZZ 0 X 862.90 X
20932   4 ZZZ 0 X 862.90 X
20932   1 ZZZ 0 X 937.51 X
20933   2 ZZZ 0 X 791.46 X
20933   3 ZZZ 0 X 791.46 X
20933   4 ZZZ 0 X 791.46 X
20933   1 ZZZ 0 X 859.77 X
20934   2 ZZZ 0 X 862.47 X
20934   3 ZZZ 0 X 862.47 X
20934   4 ZZZ 0 X 862.47 X
20934   1 ZZZ 0 X 937.09 X
20936     ZZZ 0 X * X
20937   4 ZZZ 0 X 536.28 X
20937   3 ZZZ 0 X 544.50 X
20937   2 ZZZ 0 X 581.94 X
20937   1 ZZZ 0 X 609.81 X
20938   4 ZZZ 0 X 580.13 X
20938   3 ZZZ 0 X 589.01 X
20938   2 ZZZ 0 X 629.39 X
20938   1 ZZZ 0 X 659.39 X
20939   2 ZZZ 0 X 85.66 X
20939   3 ZZZ 0 X 85.66 X
20939   4 ZZZ 0 X 85.66 X
20939   1 ZZZ 0 X 93.40 X
20950   4 0 2 X 221.02 X
20950   3 0 2 X 237.82 X
20950   1 0 2 X 242.80 X
20950   2 0 2 X 279.47 X
20955   1 90 2 X 8,385.53 X
20955   2 90 2 X 8,385.53 X
20955   3 90 2 X 8,385.53 X
20955   4 90 2 X 8,385.53 X
20956   3 90 2 X 5,921.14 X
20956   4 90 2 X 5,921.14 X
20956   2 90 2 X 6,084.72 X
20956   1 90 2 X 6,754.19 X
20957   3 90 2 X 6,134.30 X
20957   4 90 2 X 6,134.30 X
20957   2 90 2 X 6,303.79 X
20957   1 90 2 X 6,997.33 X
20962   3 90 2 X 5,921.14 X
20962   4 90 2 X 5,921.14 X
20962   2 90 2 X 6,084.72 X
20962   1 90 2 X 6,754.19 X
20969   3 90 2 X 7,612.48 X
20969   4 90 2 X 7,612.48 X
20969   2 90 2 X 7,822.72 X
20969   1 90 2 X 8,744.21 X
20970   1 90 2 X 8,385.53 X
20970   2 90 2 X 8,385.53 X
20970   3 90 2 X 8,385.53 X
20970   4 90 2 X 8,385.53 X
20972   1 90 2 X 8,385.53 X
20972   2 90 2 X 8,385.53 X
20972   3 90 2 X 8,385.53 X
20972   4 90 2 X 8,385.53 X
20973   1 90 2 X 8,385.53 X
20973   2 90 2 X 8,385.53 X
20973   3 90 2 X 8,385.53 X
20973   4 90 2 X 8,385.53 X
20974   4 ZZZ 0 X 396.99 X
20974   3 ZZZ 0 X 402.57 X
20974   2 ZZZ 0 X 443.87 X
20974   1 ZZZ 0 X 453.82 X
20975   4 ZZZ 0 X 569.59 X
20975   3 ZZZ 0 X 576.67 X
20975   2 ZZZ 0 X 623.10 X
20975   1 ZZZ 0 X 634.35 X
20979   2 0 9 X 31.15 18.38
20979   3 0 9 X 31.15 18.38
20979   4 0 9 X 31.15 18.38
20979   1 0 9 X 35.08 20.11
20982   2 0 2 X 7,310.01 732.67
20982   3 0 2 X 7,310.01 732.67
20982   4 0 2 X 7,310.01 732.67
20982   1 0 2 X 8,538.47 807.08
20983   2 0 2 X 8,803.29 536.10
20983   3 0 2 X 8,803.29 536.10
20983   4 0 2 X 8,803.29 536.10
20983   1 0 2 X 10,253.63 580.39
20985   2 ZZZ 0 X 214.30 X
20985   3 ZZZ 0 X 214.30 X
20985   4 ZZZ 0 X 214.30 X
20985   1 ZZZ 0 X 243.66 X
20999     YYY 2 X # X
21010   4 90 2 X 1,772.72 X
21010   3 90 2 X 1,795.30 X
21010   2 90 2 X 1,906.92 X
21010   1 90 2 X 1,933.76 X
21011   2 90 2 X 442.06 348.73
21011   3 90 2 X 442.06 348.73
21011   4 90 2 X 442.06 348.73
21011   1 90 2 X 503.73 393.07
21012   2 90 2 X 479.43 X
21012   3 90 2 X 479.43 X
21012   4 90 2 X 479.43 X
21012   1 90 2 X 538.87 X
21013   2 90 2 X 689.83 564.25
21013   3 90 2 X 689.83 564.25
21013   4 90 2 X 689.83 564.25
21013   1 90 2 X 780.93 632.00
21014   2 90 2 X 741.01 X
21014   3 90 2 X 741.01 X
21014   4 90 2 X 741.01 X
21014   1 90 2 X 830.75 X