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2021 Workers' Compensation Part B Fee Schedule

21436-22849

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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
21436   4 90 2 X 3,793.09 X
21436   3 90 2 X 3,836.35 X
21436   2 90 2 X 4,056.58 X
21436   1 90 2 X 4,109.97 X
21440     90 2 X * X
21445     90 2 X * X
21450   3 90 2 X 563.49 X
21450   2 90 2 X 579.88 X
21450   1 90 2 X 596.06 X
21450   4 90 2 X 626.05 X
21451   4 90 2 X 1,058.28 X
21451   3 90 2 X 1,072.11 X
21451   2 90 2 X 1,148.30 X
21451   1 90 2 X 1,166.56 X
21452   4 90 2 X 300.54 X
21452   3 90 2 X 304.08 X
21452   1 90 2 X 326.78 X
21452   2 90 2 X 416.74 X
21453   2 90 2 X 1,080.92 X
21453   4 90 2 X 1,082.84 X
21453   3 90 2 X 1,096.91 X
21453   1 90 2 X 1,182.22 X
21454   4 90 2 X 1,740.59 X
21454   3 90 2 X 1,763.93 X
21454   2 90 2 X 1,901.30 X
21454   1 90 2 X 1,934.27 X
21461   4 90 2 X 1,770.78 X
21461   3 90 2 X 1,793.85 X
21461   2 90 2 X 1,923.50 X
21461   1 90 2 X 1,954.64 X
21462   3 90 2 X 2,025.09 X
21462   2 90 2 X 2,185.98 X
21462   1 90 2 X 2,198.47 X
21462   4 90 2 X 2,355.37 X
21465   4 90 2 X 1,809.67 X
21465   3 90 2 X 1,831.36 X
21465   2 90 2 X 1,940.72 X
21465   1 90 2 X 1,967.14 X
21470   3 90 2 X 2,480.78 X
21470   4 90 2 X 2,896.43 X
21470   1 90 2 X 2,922.41 X
21470   2 90 2 X 3,018.67 X
21480   3 0 2 X 208.24 X
21480   1 0 2 X 225.28 X
21480   2 0 2 X 227.87 X
21480   4 0 2 X 236.78 X
21485   4 90 2 X 579.07 X
21485   3 90 2 X 581.77 X
21485   2 90 2 X 593.75 X
21485   1 90 2 X 596.61 X
21490   4 90 2 X 1,581.24 X
21490   3 90 2 X 1,599.69 X
21490   2 90 2 X 1,678.57 X
21490   1 90 2 X 1,697.67 X
21497   4 90 2 X 697.24 X
21497   3 90 2 X 706.08 X
21497   2 90 2 X 750.18 X
21497   1 90 2 X 760.78 X
21499     YYY 2 X # X
21501   4 90 2 X 494.94 X
21501   3 90 2 X 500.54 X
21501   2 90 2 X 528.43 X
21501   1 90 2 X 535.21 X
21502   4 90 2 X 1,007.22 X
21502   3 90 2 X 1,018.74 X
21502   2 90 2 X 1,086.12 X
21502   1 90 2 X 1,102.52 X
21510   4 90 2 X 823.99 X
21510   2 90 2 X 885.65 X
21510   3 90 2 X 917.52 X
21510   1 90 2 X 1,020.23 X
21550   4 10 2 X 215.49 X
21550   3 10 2 X 221.32 X
21550   1 10 2 X 225.72 X
21550   2 10 2 X 231.33 X
21552   2 90 2 X 644.17 X
21552   3 90 2 X 644.17 X
21552   4 90 2 X 644.17 X
21552   1 90 2 X 723.36 X
21554   2 90 2 X 1,058.64 X
21554   3 90 2 X 1,058.64 X
21554   4 90 2 X 1,058.64 X
21554   1 90 2 X 1,184.41 X
21555   4 90 2 X 510.80 X
21555   3 90 2 X 517.78 X
21555   1 90 2 X 549.17 X
21555   2 90 2 X 555.25 X
21556   4 90 2 X 683.13 X
21556   2 90 2 X 721.13 X
21556   1 90 2 X 732.89 X
21556   3 90 2 X 833.88 X
21557   4 90 2 X 1,470.93 X
21557   3 90 2 X 1,482.23 X
21557   2 90 2 X 1,534.95 X
21557   1 90 2 X 1,569.05 X
21558   2 90 2 X 1,991.17 X
21558   3 90 2 X 1,991.17 X
21558   4 90 2 X 1,991.17 X
21558   1 90 2 X 2,224.19 X
21600   3 90 2 X 1,102.19 X
21600   2 90 2 X 1,137.37 X
21600   4 90 2 X 1,185.11 X
21600   1 90 2 X 1,228.60 X
21601   2 90 2 X 1,412.31 X
21601   3 90 2 X 1,412.31 X
21601   4 90 2 X 1,412.31 X
21601   1 90 2 X 1,566.69 X
21602   2 90 2 X 1,889.78 X
21602   3 90 2 X 1,889.78 X
21602   4 90 2 X 1,889.78 X
21602   1 90 2 X 2,100.62 X
21603   2 90 2 X 2,093.12 X
21603   3 90 2 X 2,093.12 X
21603   4 90 2 X 2,093.12 X
21603   1 90 2 X 2,325.60 X
21610   3 90 2 X 810.11 X
21610   1 90 2 X 842.11 X
21610   2 90 2 X 882.33 X
21610   4 90 2 X 1,278.27 X
21615   4 90 2 X 1,854.11 X
21615   3 90 2 X 1,876.48 X
21615   2 90 2 X 2,030.45 X
21615   1 90 2 X 2,067.77 X
21616   4 90 2 X 1,753.94 X
21616   2 90 2 X 1,898.61 X
21616   3 90 2 X 2,051.90 X
21616   1 90 2 X 2,117.05 X
21620   4 90 2 X 1,239.71 X
21620   3 90 2 X 1,295.63 X
21620   2 90 2 X 1,354.72 X
21620   1 90 2 X 1,378.97 X
21627   4 90 2 X 1,056.22 X
21627   3 90 2 X 1,068.66 X
21627   2 90 2 X 1,145.61 X
21627   1 90 2 X 1,164.30 X
21630   4 90 2 X 2,540.14 X
21630   3 90 2 X 2,569.55 X
21630   2 90 2 X 2,746.87 X
21630   1 90 2 X 2,789.85 X
21632   4 90 2 X 2,679.12 X
21632   3 90 2 X 2,709.90 X
21632   2 90 2 X 2,898.66 X
21632   1 90 2 X 2,944.51 X
21685   2 90 2 X 1,629.19 X
21685   3 90 2 X 1,629.19 X
21685   4 90 2 X 1,629.19 X
21685   1 90 2 X 1,827.73 X
21700   2 90 2 X 860.35 X
21700   4 90 2 X 926.35 X
21700   3 90 2 X 937.35 X
21700   1 90 2 X 1,006.20 X
21705   4 90 2 X 1,311.83 X
21705   3 90 2 X 1,326.45 X
21705   2 90 2 X 1,411.46 X
21705   1 90 2 X 1,432.15 X
21720   4 90 2 X 863.88 X
21720   3 90 2 X 874.06 X
21720   2 90 2 X 1,024.56 X
21720   1 90 2 X 1,166.22 X
21725   4 90 2 X 1,068.46 X
21725   3 90 2 X 1,080.97 X
21725   2 90 2 X 1,151.41 X
21725   1 90 2 X 1,168.47 X
21740   4 90 2 X 2,301.50 X
21740   3 90 2 X 2,327.54 X
21740   2 90 2 X 2,476.55 X
21740   1 90 2 X 2,512.73 X
21742     90 2 X * X
21743     90 2 X * X
21750   4 90 2 X 1,660.39 X
21750   3 90 2 X 1,679.52 X
21750   2 90 2 X 1,799.44 X
21750   1 90 2 X 1,828.60 X
21811   2 0 2 X 719.63 743.76
21811   3 0 2 X 719.63 743.76
21811   4 0 2 X 719.63 743.76
21811   1 0 2 X 767.71 795.94
21812   2 0 2 X 861.23 885.36
21812   3 0 2 X 861.23 885.36
21812   4 0 2 X 861.23 885.36
21812   1 0 2 X 917.59 945.81
21813   2 0 2 X 1,175.98 1,194.74
21813   3 0 2 X 1,175.98 1,194.74
21813   4 0 2 X 1,175.98 1,194.74
21813   1 0 2 X 1,252.77 1,274.74
21820   4 90 2 X 282.24 X
21820   3 90 2 X 283.48 X
21820   2 90 2 X 287.79 X
21820   1 90 2 X 292.25 X
21825   3 90 2 X 976.04 X
21825   2 90 2 X 1,029.75 X
21825   4 90 2 X 1,304.13 X
21825   1 90 2 X 1,440.90 X
21899     YYY 2 X # X
21920   3 10 2 X 212.69 X
21920   4 10 2 X 220.72 X
21920   1 10 2 X 222.20 X
21920   2 10 2 X 231.31 X
21925   3 90 2 X 470.08 X
21925   2 90 2 X 476.72 X
21925   1 90 2 X 493.39 X
21925   4 90 2 X 575.20 X
21930   4 90 2 X 769.09 X
21930   3 90 2 X 774.32 X
21930   2 90 2 X 801.73 X
21930   1 90 2 X 809.58 X
21931   2 90 2 X 675.20 X
21931   3 90 2 X 675.20 X
21931   4 90 2 X 675.20 X
21931   1 90 2 X 758.58 X
21932   2 90 2 X 969.55 X
21932   3 90 2 X 969.55 X
21932   4 90 2 X 969.55 X
21932   1 90 2 X 1,090.31 X
21933   2 90 2 X 1,070.45 X
21933   3 90 2 X 1,070.45 X
21933   4 90 2 X 1,070.45 X
21933   1 90 2 X 1,202.05 X
21935   3 90 2 X 1,607.29 X
21935   2 90 2 X 1,680.88 X
21935   1 90 2 X 1,694.99 X
21935   4 90 2 X 2,217.23 X
21936   2 90 2 X 2,076.04 X
21936   3 90 2 X 2,076.04 X
21936   4 90 2 X 2,076.04 X
21936   1 90 2 X 2,322.82 X
22010   2 90 2 X 1,270.88 X
22010   3 90 2 X 1,270.88 X
22010   4 90 2 X 1,270.88 X
22010   1 90 2 X 1,455.81 X
22015   2 90 2 X 1,259.73 X
22015   3 90 2 X 1,259.73 X
22015   4 90 2 X 1,259.73 X
22015   1 90 2 X 1,443.04 X
22100   4 90 2 X 1,354.94 X
22100   3 90 2 X 1,371.11 X
22100   2 90 2 X 1,456.77 X
22100   1 90 2 X 1,477.46 X
22101   4 90 2 X 1,404.15 X
22101   3 90 2 X 1,420.64 X
22101   2 90 2 X 1,522.14 X
22101   1 90 2 X 1,546.74 X
22102   4 90 2 X 1,219.36 X
22102   2 90 2 X 1,301.11 X
22102   1 90 2 X 1,317.64 X
22102   3 90 2 X 1,638.57 X
22103   4 ZZZ 0 X 449.79 X
22103   3 ZZZ 0 X 456.69 X
22103   2 ZZZ 0 X 488.05 X
22103   1 ZZZ 0 X 511.47 X
22110   1 90 2 X 1,921.23 X
22110   4 90 2 X 2,020.56 X
22110   3 90 2 X 2,044.51 X
22110   2 90 2 X 2,188.85 X
22112   1 90 2 X 1,930.00 X
22112   4 90 2 X 2,034.90 X
22112   3 90 2 X 2,059.10 X
22112   2 90 2 X 2,203.94 X
22114   4 90 2 X 1,766.09 X
22114   3 90 2 X 1,786.39 X
22114   2 90 2 X 1,898.06 X
22114   1 90 2 X 1,925.22 X
22116   4 ZZZ 0 X 445.36 X
22116   3 ZZZ 0 X 452.16 X
22116   2 ZZZ 0 X 483.15 X
22116   1 ZZZ 0 X 506.17 X
22206   2 90 2 X 3,293.28 X
22206   3 90 2 X 3,293.28 X
22206   4 90 2 X 3,293.28 X
22206   1 90 2 X 3,733.71 X
22207   2 90 2 X 3,251.11 X
22207   3 90 2 X 3,251.11 X
22207   4 90 2 X 3,251.11 X
22207   1 90 2 X 3,684.41 X
22208   2 ZZZ 0 X 835.61 X
22208   3 ZZZ 0 X 835.61 X
22208   4 ZZZ 0 X 835.61 X
22208   1 ZZZ 0 X 955.19 X
22210   4 90 2 X 3,423.21 X
22210   3 90 2 X 3,462.23 X
22210   2 90 2 X 3,684.90 X
22210   1 90 2 X 3,911.83 X
22212   4 90 2 X 3,362.86 X
22212   3 90 2 X 3,403.35 X
22212   2 90 2 X 3,650.73 X
22212   1 90 2 X 3,710.60 X
22214   4 90 2 X 3,163.31 X
22214   3 90 2 X 3,200.58 X
22214   2 90 2 X 3,430.64 X
22214   1 90 2 X 3,486.27 X
22216   4 ZZZ 0 X 1,095.33 X
22216   3 ZZZ 0 X 1,111.78 X
22216   2 ZZZ 0 X 1,185.82 X
22216   1 ZZZ 0 X 1,241.77 X
22220   4 90 2 X 3,470.09 X
22220   3 90 2 X 3,511.29 X
22220   2 90 2 X 3,751.55 X
22220   1 90 2 X 3,809.66 X
22222   4 90 2 X 3,115.35 X
22222   3 90 2 X 3,152.05 X
22222   2 90 2 X 3,984.28 X
22222   1 90 2 X 4,334.85 X
22224   4 90 2 X 3,304.49 X
22224   3 90 2 X 3,342.76 X
22224   2 90 2 X 3,574.12 X
22224   1 90 2 X 3,630.24 X
22226   4 ZZZ 0 X 1,095.33 X
22226   3 ZZZ 0 X 1,111.78 X
22226   2 ZZZ 0 X 1,185.82 X
22226   1 ZZZ 0 X 1,241.77 X
22310   3 90 2 X 803.89 X
22310   4 90 2 X 861.45 X
22310   2 90 2 X 986.74 X
22310   1 90 2 X 998.64 X
22315   3 90 2 X 1,314.20 X
22315   1 90 2 X 1,417.14 X
22315   4 90 2 X 1,419.96 X
22315   2 90 2 X 1,460.15 X
22318   2 90 2 X 2,850.36 X
22318   3 90 2 X 2,850.36 X
22318   4 90 2 X 2,850.36 X
22318   1 90 2 X 3,253.02 X
22319   2 90 2 X 3,219.67 X
22319   3 90 2 X 3,219.67 X
22319   4 90 2 X 3,219.67 X
22319   1 90 2 X 3,675.56 X
22325   4 90 2 X 2,375.01 X
22325   3 90 2 X 2,401.53 X
22325   2 90 2 X 3,568.27 X
22325   1 90 2 X 3,582.20 X
22326   4 90 2 X 3,264.62 X
22326   3 90 2 X 3,303.37 X
22326   2 90 2 X 3,540.67 X
22326   1 90 2 X 3,598.16 X
22327   4 90 2 X 3,154.16 X
22327   2 90 2 X 3,411.58 X
22327   1 90 2 X 3,464.60 X
22327   3 90 2 X 3,579.37 X
22328   4 ZZZ 0 X 886.02 X
22328   3 ZZZ 0 X 899.63 X
22328   2 ZZZ 0 X 961.34 X
22328   1 ZZZ 0 X 1,007.24 X
22505   4 10 2 X 202.51 X
22505   2 10 2 X 211.40 X
22505   1 10 2 X 216.16 X
22505   3 10 2 X 323.16 X
22510   2 10 2 X 2,217.67 597.58
22510   3 10 2 X 2,217.67 597.58
22510   4 10 2 X 2,217.67 597.58
22510   1 10 2 X 2,539.60 643.96
22511   2 10 2 X 2,195.05 559.76
22511   3 10 2 X 2,195.05 559.76
22511   4 10 2 X 2,195.05 559.76
22511   1 10 2 X 2,517.01 603.59
22512   2 ZZZ 0 X 1,226.08 273.23
22512   3 ZZZ 0 X 1,226.08 273.23
22512   4 ZZZ 0 X 1,226.08 273.23
22512   1 ZZZ 0 X 1,407.43 292.53
22513   2 10 2 X 9,263.27 680.12
22513   3 10 2 X 9,263.27 680.12
22513   4 10 2 X 9,263.27 680.12
22513   1 10 2 X 10,778.03 735.11
22514   2 10 2 X 9,226.51 635.30
22514   3 10 2 X 9,226.51 635.30
22514   4 10 2 X 9,226.51 635.30
22514   1 10 2 X 10,739.63 687.26
22515   2 ZZZ 0 X 5,595.23 284.89
22515   3 ZZZ 0 X 5,595.23 284.89
22515   4 ZZZ 0 X 5,595.23 284.89
22515   1 ZZZ 0 X 6,519.73 306.22
22526   2 10 2 X 2,854.88 484.83
22526   3 10 2 X 2,854.88 484.83
22526   4 10 2 X 2,854.88 484.83
22526   1 10 2 X 3,456.06 556.42
22527   2 ZZZ 0 X 2,314.79 224.27
22527   3 ZZZ 0 X 2,314.79 224.27
22527   4 ZZZ 0 X 2,314.79 224.27
22527   1 ZZZ 0 X 2,813.66 256.03
22532   2 90 2 X 2,858.73 X
22532   3 90 2 X 2,858.73 X
22532   4 90 2 X 2,858.73 X
22532   1 90 2 X 3,256.29 X
22533   2 90 2 X 2,673.09 X
22533   3 90 2 X 2,673.09 X
22533   4 90 2 X 2,673.09 X
22533   1 90 2 X 3,023.85 X
22534   2 ZZZ 0 X 674.15 X
22534   3 ZZZ 0 X 674.15 X
22534   4 ZZZ 0 X 674.15 X
22534   1 ZZZ 0 X 767.73 X
22548   4 90 2 X 4,452.05 X
22548   3 90 2 X 4,505.50 X
22548   1 90 2 X 4,763.48 X
22548   2 90 2 X 4,835.41 X
22551   2 90 2 X 2,586.18 X
22551   3 90 2 X 2,586.18 X
22551   4 90 2 X 2,586.18 X
22551   1 90 2 X 2,921.90 X
22552   2 ZZZ 0 X 604.36 X
22552   3 ZZZ 0 X 604.36 X
22552   4 ZZZ 0 X 604.36 X
22552   1 ZZZ 0 X 679.13 X
22554   4 90 2 X 3,599.10 X
22554   3 90 2 X 3,624.52 X
22554   2 90 2 X 3,938.67 X
22554   1 90 2 X 4,044.87 X
22556   4 90 2 X 4,258.37 X
22556   3 90 2 X 4,309.47 X
22556   2 90 2 X 4,622.03 X
22556   1 90 2 X 4,697.64 X
22558   4 90 2 X 4,016.92 X
22558   3 90 2 X 4,064.95 X
22558   2 90 2 X 4,359.08 X
22558   1 90 2 X 4,430.30 X
22585   4 ZZZ 0 X 1,042.31 X
22585   3 ZZZ 0 X 1,054.82 X
22585   2 ZZZ 0 X 1,133.74 X
22585   1 ZZZ 0 X 1,152.83 X
22586   2 90 2 X 2,140.54 X
22586   3 90 2 X 2,140.54 X
22586   4 90 2 X 2,140.54 X
22586   1 90 2 X 2,391.41 X
22590   4 90 2 X 3,728.02 X
22590   3 90 2 X 3,811.51 X
22590   2 90 2 X 3,995.01 X
22590   1 90 2 X 4,274.48 X
22595   4 90 2 X 3,997.94 X
22595   3 90 2 X 4,046.90 X
22595   2 90 2 X 4,366.80 X
22595   1 90 2 X 4,444.15 X
22600   4 90 2 X 3,577.33 X
22600   3 90 2 X 3,620.82 X
22600   2 90 2 X 3,846.47 X
22600   1 90 2 X 4,014.67 X
22610   4 90 2 X 3,133.97 X
22610   2 90 2 X 3,413.25 X
22610   1 90 2 X 3,495.23 X
22610   3 90 2 X 3,541.00 X
22612   4 90 2 X 3,920.37 X
22612   1 90 2 X 3,937.53 X
22612   3 90 2 X 3,967.05 X
22612   2 90 2 X 4,018.64 X
22614   4 ZZZ 0 X 1,187.53 X
22614   3 ZZZ 0 X 1,205.48 X
22614   2 ZZZ 0 X 1,285.84 X
22614   1 ZZZ 0 X 1,345.68 X
22630   3 90 2 X 3,785.34 X
22630   4 90 2 X 4,166.40 X
22630   2 90 2 X 4,380.46 X
22630   1 90 2 X 4,447.40 X
22632   4 ZZZ 0 X 1,005.28 X
22632   3 ZZZ 0 X 1,020.69 X
22632   2 ZZZ 0 X 1,090.76 X
22632   1 ZZZ 0 X 1,142.90 X
22633   2 90 2 X 2,643.10 X
22633   3 90 2 X 2,643.10 X
22633   4 90 2 X 2,643.10 X
22633   1 90 2 X 2,983.16 X
22634   2 ZZZ 0 X 718.60 X
22634   3 ZZZ 0 X 718.60 X
22634   4 ZZZ 0 X 718.60 X
22634   1 ZZZ 0 X 810.63 X
22800   4 90 2 X 3,695.71 X
22800   3 90 2 X 3,741.58 X
22800   2 90 2 X 4,040.23 X
22800   1 90 2 X 4,112.37 X
22802   4 90 2 X 5,650.52 X
22802   3 90 2 X 5,702.92 X
22802   2 90 2 X 5,875.75 X
22802   1 90 2 X 5,950.77 X
22804   4 90 2 X 6,213.97 X
22804   3 90 2 X 6,306.76 X
22804   2 90 2 X 6,715.59 X
22804   1 90 2 X 7,021.03 X
22808   4 90 2 X 4,266.67 X
22808   3 90 2 X 4,329.46 X
22808   2 90 2 X 4,603.43 X
22808   1 90 2 X 4,810.82 X
22810   4 90 2 X 4,462.59 X
22810   3 90 2 X 4,513.75 X
22810   2 90 2 X 4,804.53 X
22810   1 90 2 X 4,875.04 X
22812   4 90 2 X 5,043.36 X
22812   3 90 2 X 5,104.08 X
22812   2 90 2 X 5,475.15 X
22812   1 90 2 X 5,564.93 X
22818   2 90 2 X 4,885.24 X
22818   3 90 2 X 4,885.24 X
22818   4 90 2 X 4,885.24 X
22818   1 90 2 X 5,585.84 X
22819   2 90 2 X 5,235.07 X
22819   3 90 2 X 5,235.07 X
22819   4 90 2 X 5,235.07 X
22819   1 90 2 X 5,948.05 X
22830   4 90 2 X 2,232.40 X
22830   3 90 2 X 2,260.12 X
22830   2 90 2 X 2,440.98 X
22830   1 90 2 X 2,484.71 X
22840   4 ZZZ 0 X 3,178.44 X
22840   3 ZZZ 0 X 3,440.60 X
22840   2 ZZZ 0 X 4,078.28 X
22840   1 ZZZ 0 X 4,133.72 X
22841     XXX 9 X * X
22842   4 ZZZ 0 X 3,559.68 X
22842   3 ZZZ 0 X 3,604.39 X
22842   1 ZZZ 0 X 3,994.59 X
22842   2 ZZZ 0 X 4,180.80 X
22843   4 ZZZ 0 X 1,722.97 X
22843   3 ZZZ 0 X 1,749.40 X
22843   2 ZZZ 0 X 1,869.40 X
22843   1 ZZZ 0 X 1,958.51 X
22844   4 ZZZ 0 X 2,105.46 X
22844   3 ZZZ 0 X 2,137.77 X
22844   2 ZZZ 0 X 2,284.37 X
22844   1 ZZZ 0 X 2,393.23 X
22845   4 ZZZ 0 X 2,907.39 X
22845   3 ZZZ 0 X 2,943.41 X
22845   2 ZZZ 0 X 3,197.54 X
22845   1 ZZZ 0 X 3,259.03 X
22846   4 ZZZ 0 X 1,590.95 X
22846   3 ZZZ 0 X 1,615.34 X
22846   2 ZZZ 0 X 1,726.11 X
22846   1 ZZZ 0 X 1,808.37 X
22847   4 ZZZ 0 X 1,767.51 X
22847   3 ZZZ 0 X 1,794.61 X
22847   2 ZZZ 0 X 1,917.74 X
22847   1 ZZZ 0 X 2,009.28 X
22848   4 ZZZ 0 X 1,152.81 X
22848   3 ZZZ 0 X 1,170.53 X
22848   2 ZZZ 0 X 1,250.89 X
22848   1 ZZZ 0 X 1,310.56 X
22849   4 90 2 X 2,337.98 X
22849   3 90 2 X 2,366.00 X
22849   2 90 2 X 2,537.25 X
22849   1 90 2 X 2,578.72 X