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2021 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   2 0 3 X 416.76 X
31636   3 0 3 X 416.76 X
31636   4 0 3 X 416.76 X
31636   1 0 3 X 456.41 X
31637   2 ZZZ 0 X 148.65 X
31637   3 ZZZ 0 X 148.65 X
31637   4 ZZZ 0 X 148.65 X
31637   1 ZZZ 0 X 162.76 X
31638   2 0 3 X 464.12 X
31638   3 0 3 X 464.12 X
31638   4 0 3 X 464.12 X
31638   1 0 3 X 503.58 X
31640   4 0 3 X 933.60 X
31640   3 0 3 X 945.06 X
31640   2 0 3 X 1,009.95 X
31640   1 0 3 X 1,025.60 X
31641   4 0 3 X 960.54 X
31641   3 0 3 X 1,085.30 X
31641   2 0 3 X 1,121.45 X
31641   1 0 3 X 1,132.05 X
31643   2 0 2 X 414.71 379.58
31643   3 0 2 X 414.71 379.58
31643   4 0 2 X 414.71 379.58
31643   1 0 2 X 473.03 431.87
31645   4 0 3 X 643.08 X
31645   3 0 3 X 657.65 X
31645   2 0 3 X 670.94 X
31645   1 0 3 X 688.24 X
31646   4 0 2 X 562.96 X
31646   3 0 2 X 615.00 X
31646   2 0 2 X 639.28 X
31646   1 0 2 X 645.08 X
31647   2 0 3 X 311.04 X
31647   3 0 3 X 311.04 X
31647   4 0 3 X 311.04 X
31647   1 0 3 X 339.04 X
31648   2 0 3 X 323.09 X
31648   3 0 3 X 323.09 X
31648   4 0 3 X 323.09 X
31648   1 0 3 X 354.25 X
31649   2 ZZZ 0 X 101.22 X
31649   3 ZZZ 0 X 101.22 X
31649   4 ZZZ 0 X 101.22 X
31649   1 ZZZ 0 X 108.97 X
31651   2 ZZZ 0 X 107.53 X
31651   3 ZZZ 0 X 107.53 X
31651   4 ZZZ 0 X 107.53 X
31651   1 ZZZ 0 X 115.49 X
31652   2 0 2 X 1,133.57 309.99
31652   3 0 2 X 1,133.57 309.99
31652   4 0 2 X 1,133.57 309.99
31652   1 0 2 X 1,295.71 332.09
31653   2 0 2 X 1,205.72 342.19
31653   3 0 2 X 1,205.72 342.19
31653   4 0 2 X 1,205.72 342.19
31653   1 0 2 X 1,376.90 366.54
31654   2 ZZZ 0 X 183.08 89.70
31654   3 ZZZ 0 X 183.08 89.70
31654   4 ZZZ 0 X 183.08 89.70
31654   1 ZZZ 0 X 205.14 95.87
31660   2 0 3 X 311.09 X
31660   3 0 3 X 311.09 X
31660   4 0 3 X 311.09 X
31660   1 0 3 X 339.81 X
31661   2 0 3 X 328.62 X
31661   3 0 3 X 328.62 X
31661   4 0 3 X 328.62 X
31661   1 0 3 X 359.18 X
31717   4 0 2 X 241.39 X
31717   3 0 2 X 244.05 X
31717   2 0 2 X 254.26 X
31717   1 0 2 X 256.76 X
31720   4 0 2 X 144.43 X
31720   3 0 2 X 145.50 X
31720   2 0 2 X 146.95 X
31720   1 0 2 X 152.00 X
31725   4 0 2 X 290.27 X
31725   3 0 2 X 293.71 X
31725   2 0 2 X 310.41 X
31725   1 0 2 X 314.45 X
31730   3 0 2 X 462.06 X
31730   1 0 2 X 495.27 X
31730   4 0 2 X 938.37 X
31730   2 0 2 X 963.30 X
31750   4 90 2 X 1,437.99 X
31750   2 90 2 X 1,464.80 X
31750   1 90 2 X 1,506.06 X
31750   3 90 2 X 1,690.90 X
31755   4 90 2 X 1,670.31 X
31755   3 90 2 X 1,690.90 X
31755   2 90 2 X 1,802.11 X
31755   1 90 2 X 1,828.96 X
31760   4 90 2 X 3,039.83 X
31760   3 90 2 X 3,073.20 X
31760   2 90 2 X 3,282.30 X
31760   1 90 2 X 3,333.16 X
31766   4 90 2 X 4,260.82 X
31766   3 90 2 X 4,311.85 X
31766   2 90 2 X 4,517.00 X
31766   1 90 2 X 4,566.48 X
31770   4 90 2 X 3,375.89 X
31770   3 90 2 X 3,415.62 X
31770   2 90 2 X 3,626.84 X
31770   1 90 2 X 3,677.91 X
31775   4 90 2 X 3,561.99 X
31775   3 90 2 X 3,604.46 X
31775   2 90 2 X 3,817.89 X
31775   1 90 2 X 3,869.54 X
31780   2 90 2 X 2,338.90 X
31780   4 90 2 X 3,118.73 X
31780   3 90 2 X 3,157.59 X
31780   1 90 2 X 3,420.42 X
31781   4 90 2 X 3,614.07 X
31781   3 90 2 X 3,657.26 X
31781   2 90 2 X 3,875.16 X
31781   1 90 2 X 3,927.83 X
31785   3 90 2 X 1,789.44 X
31785   4 90 2 X 2,317.31 X
31785   2 90 2 X 2,474.19 X
31785   1 90 2 X 2,505.82 X
31786   4 90 2 X 3,363.13 X
31786   3 90 2 X 3,401.36 X
31786   2 90 2 X 3,613.21 X
31786   1 90 2 X 3,664.61 X
31800   4 90 2 X 1,095.73 X
31800   3 90 2 X 1,108.57 X
31800   2 90 2 X 1,334.51 X
31800   1 90 2 X 1,446.59 X
31805   4 90 2 X 2,098.04 X
31805   3 90 2 X 2,122.97 X
31805   2 90 2 X 2,260.48 X
31805   1 90 2 X 2,293.76 X
31820   4 90 2 X 716.68 X
31820   3 90 2 X 725.35 X
31820   2 90 2 X 772.31 X
31820   1 90 2 X 783.63 X
31825   4 90 2 X 1,141.31 X
31825   3 90 2 X 1,161.84 X
31825   2 90 2 X 1,173.49 X
31825   1 90 2 X 1,206.99 X
31830   4 90 2 X 733.14 X
31830   3 90 2 X 742.12 X
31830   2 90 2 X 787.71 X
31830   1 90 2 X 798.74 X
31899     YYY 2 X # X
32035   1 90 2 X 1,594.89 X
32035   2 90 2 X 1,886.25 X
32035   3 90 2 X 1,906.50 X
32035   4 90 2 X 1,931.34 X
32036   3 90 2 X 1,424.08 X
32036   4 90 2 X 1,429.65 X
32036   2 90 2 X 1,532.42 X
32036   1 90 2 X 1,558.73 X
32096   2 90 2 X 1,175.74 X
32096   3 90 2 X 1,175.74 X
32096   4 90 2 X 1,175.74 X
32096   1 90 2 X 1,316.19 X
32097   2 90 2 X 1,175.74 X
32097   3 90 2 X 1,175.74 X
32097   4 90 2 X 1,175.74 X
32097   1 90 2 X 1,316.19 X
32098   2 90 2 X 1,104.74 X
32098   3 90 2 X 1,104.74 X
32098   4 90 2 X 1,104.74 X
32098   1 90 2 X 1,236.55 X
32100   4 90 2 X 2,335.64 X
32100   3 90 2 X 2,374.47 X
32100   2 90 2 X 2,437.20 X
32100   1 90 2 X 2,446.38 X
32110   4 90 2 X 2,221.98 X
32110   3 90 2 X 2,287.19 X
32110   1 90 2 X 2,490.22 X
32110   2 90 2 X 2,522.82 X
32120   4 90 2 X 2,013.03 X
32120   3 90 2 X 2,019.27 X
32120   2 90 2 X 2,111.09 X
32120   1 90 2 X 2,155.00 X
32124   3 90 2 X 2,030.25 X
32124   4 90 2 X 2,044.26 X
32124   1 90 2 X 2,068.38 X
32124   2 90 2 X 2,314.17 X
32140   4 90 2 X 2,510.83 X
32140   3 90 2 X 2,531.12 X
32140   2 90 2 X 2,627.32 X
32140   1 90 2 X 2,634.49 X
32141   3 90 2 X 2,537.10 X
32141   4 90 2 X 2,552.66 X
32141   2 90 2 X 2,699.00 X
32141   1 90 2 X 2,747.85 X
32150   4 90 2 X 2,181.60 X
32150   3 90 2 X 2,207.16 X
32150   2 90 2 X 2,589.61 X
32150   1 90 2 X 2,606.39 X
32151   4 90 2 X 2,021.87 X
32151   3 90 2 X 2,045.64 X
32151   2 90 2 X 2,177.67 X
32151   1 90 2 X 2,314.24 X
32160   4 90 2 X 1,575.69 X
32160   2 90 2 X 2,334.31 X
32160   3 90 2 X 2,351.96 X
32160   1 90 2 X 2,551.78 X
32200   4 90 2 X 1,849.88 X
32200   3 90 2 X 1,870.91 X
32200   1 90 2 X 1,999.30 X
32200   2 90 2 X 2,349.82 X
32215   3 90 2 X 1,490.45 X
32215   4 90 2 X 1,613.06 X
32215   1 90 2 X 1,628.19 X
32215   2 90 2 X 1,664.18 X
32220   4 90 2 X 3,552.97 X
32220   3 90 2 X 3,570.96 X
32220   2 90 2 X 3,674.25 X
32220   1 90 2 X 3,699.28 X
32225   4 90 2 X 2,305.21 X
32225   3 90 2 X 2,332.64 X
32225   2 90 2 X 2,515.82 X
32225   1 90 2 X 2,560.24 X
32310   1 90 2 X 2,713.73 X
32310   4 90 2 X 3,234.45 X
32310   3 90 2 X 3,246.92 X
32310   2 90 2 X 3,328.45 X
32320   3 90 2 X 3,785.73 X
32320   4 90 2 X 3,786.53 X
32320   2 90 2 X 3,895.09 X
32320   1 90 2 X 3,962.42 X
32400   4 0 2 X 271.98 X
32400   3 0 2 X 277.31 X
32400   2 0 2 X 298.32 X
32400   1 0 2 X 350.17 X
32408   2 0 2 X 1,033.06 171.51
32408   3 0 2 X 1,033.06 171.51
32408   4 0 2 X 1,033.06 171.51
32408   1 0 2 X 1,176.80 183.14
32440   4 90 2 X 3,855.16 X
32440   3 90 2 X 3,915.88 X
32440   2 90 2 X 4,157.18 X
32440   1 90 2 X 4,191.29 X
32442   4 90 2 X 4,066.39 X
32442   3 90 2 X 4,113.25 X
32442   2 90 2 X 4,406.56 X
32442   1 90 2 X 4,477.74 X
32445   4 90 2 X 4,199.01 X
32445   3 90 2 X 4,248.46 X
32445   2 90 2 X 4,567.66 X
32445   1 90 2 X 4,644.97 X
32480   3 90 2 X 3,534.35 X
32480   4 90 2 X 3,653.56 X
32480   2 90 2 X 3,832.68 X
32480   1 90 2 X 3,844.36 X
32482   3 90 2 X 3,585.19 X
32482   4 90 2 X 3,703.96 X
32482   2 90 2 X 3,884.79 X
32482   1 90 2 X 3,896.75 X
32484   3 90 2 X 3,614.51 X
32484   4 90 2 X 3,732.95 X
32484   2 90 2 X 3,914.76 X
32484   1 90 2 X 3,926.95 X
32486   4 90 2 X 3,748.99 X
32486   3 90 2 X 3,792.18 X
32486   2 90 2 X 4,062.80 X
32486   1 90 2 X 4,128.53 X
32488   4 90 2 X 4,021.92 X
32488   3 90 2 X 4,068.24 X
32488   2 90 2 X 4,358.24 X
32488   1 90 2 X 4,428.67 X
32501   4 ZZZ 0 X 884.32 X
32501   3 ZZZ 0 X 897.79 X
32501   2 ZZZ 0 X 958.60 X
32501   1 ZZZ 0 X 1,003.68 X
32503   2 90 2 X 2,925.82 X
32503   3 90 2 X 2,925.82 X
32503   4 90 2 X 2,925.82 X
32503   1 90 2 X 3,302.28 X
32504   2 90 2 X 3,348.82 X
32504   3 90 2 X 3,348.82 X
32504   4 90 2 X 3,348.82 X
32504   1 90 2 X 3,775.40 X
32505   2 90 2 X 1,354.57 X
32505   3 90 2 X 1,354.57 X
32505   4 90 2 X 1,354.57 X
32505   1 90 2 X 1,515.48 X
32506   2 ZZZ 0 X 231.08 X
32506   3 ZZZ 0 X 231.08 X
32506   4 ZZZ 0 X 231.08 X
32506   1 ZZZ 0 X 257.79 X
32507   2 ZZZ 0 X 231.08 X
32507   3 ZZZ 0 X 231.08 X
32507   4 ZZZ 0 X 231.08 X
32507   1 ZZZ 0 X 257.79 X
32540   4 90 2 X 2,378.41 X
32540   3 90 2 X 2,406.63 X
32540   2 90 2 X 2,581.74 X
32540   1 90 2 X 2,624.17 X
32550   2 0 0 X 1,207.58 332.04
32550   3 0 0 X 1,207.58 332.04
32550   4 0 0 X 1,207.58 332.04
32550   1 0 0 X 1,423.17 367.52
32551   2 0 2 X 263.08 X
32551   3 0 2 X 263.08 X
32551   4 0 2 X 263.08 X
32551   1 0 2 X 293.35 X
32552   2 10 2 X 265.67 236.93
32552   3 10 2 X 265.67 236.93
32552   4 10 2 X 265.67 236.93
32552   1 10 2 X 300.44 266.32
32553   2 0 2 X 832.11 308.56
32553   3 0 2 X 832.11 308.56
32553   4 0 2 X 832.11 308.56
32553   1 0 2 X 965.06 344.10
32554   2 0 2 X 729.43 123.40
32554   3 0 2 X 729.43 123.40
32554   4 0 2 X 729.43 123.40
32554   1 0 2 X 836.08 133.16
32555   2 0 2 X 842.18 154.40
32555   3 0 2 X 842.18 154.40
32555   4 0 2 X 842.18 154.40
32555   1 0 2 X 964.66 166.91
32556   2 0 2 X 771.95 169.37
32556   3 0 2 X 771.95 169.37
32556   4 0 2 X 771.95 169.37
32556   1 0 2 X 881.91 183.00
32557   2 0 2 X 1,252.12 230.83
32557   3 0 2 X 1,252.12 230.83
32557   4 0 2 X 1,252.12 230.83
32557   1 0 2 X 1,441.28 256.68
32560   2 0 2 X 446.72 164.61
32560   3 0 2 X 446.72 164.61
32560   4 0 2 X 446.72 164.61
32560   1 0 2 X 521.54 181.41
32561   2 0 2 X 138.32 107.56
32561   3 0 2 X 138.32 107.56
32561   4 0 2 X 138.32 107.56
32561   1 0 2 X 155.08 118.59
32562   2 0 2 X 123.00 96.27
32562   3 0 2 X 123.00 96.27
32562   4 0 2 X 123.00 96.27
32562   1 0 2 X 137.83 106.13
32601   4 0 2 X 838.83 X
32601   3 0 2 X 848.47 X
32601   2 0 2 X 902.41 X
32601   1 0 2 X 915.49 X
32604   2 0 2 X 1,090.48 X
32604   1 0 2 X 1,099.97 X
32604   4 0 2 X 1,177.18 X
32604   3 0 2 X 1,190.15 X
32606   2 0 2 X 1,078.67 X
32606   1 0 2 X 1,088.04 X
32606   4 0 2 X 1,142.58 X
32606   3 0 2 X 1,155.24 X
32607   2 0 2 X 451.89 X
32607   3 0 2 X 451.89 X
32607   4 0 2 X 451.89 X
32607   1 0 2 X 505.02 X
32608   2 0 2 X 555.64 X
32608   3 0 2 X 555.64 X
32608   4 0 2 X 555.64 X
32608   1 0 2 X 620.83 X
32609   2 0 2 X 383.64 X
32609   3 0 2 X 383.64 X
32609   4 0 2 X 383.64 X
32609   1 0 2 X 429.73 X
32650   3 90 2 X 1,490.45 X
32650   4 90 2 X 1,613.06 X
32650   1 90 2 X 1,628.19 X
32650   2 90 2 X 1,664.18 X
32651   4 90 2 X 2,305.21 X
32651   3 90 2 X 2,332.64 X
32651   2 90 2 X 2,515.82 X
32651   1 90 2 X 2,560.24 X
32652   4 90 2 X 3,552.97 X
32652   3 90 2 X 3,570.96 X
32652   2 90 2 X 3,674.25 X
32652   1 90 2 X 3,699.28 X
32653   4 90 2 X 2,181.60 X
32653   3 90 2 X 2,207.16 X
32653   2 90 2 X 2,589.61 X
32653   1 90 2 X 2,606.39 X
32654   4 90 2 X 2,221.98 X
32654   3 90 2 X 2,287.19 X
32654   1 90 2 X 2,490.22 X
32654   2 90 2 X 2,522.82 X
32655   3 90 2 X 2,545.42 X
32655   4 90 2 X 2,560.85 X
32655   2 90 2 X 2,724.69 X
32655   1 90 2 X 2,773.73 X
32656   1 90 2 X 2,713.73 X
32656   4 90 2 X 3,234.45 X
32656   3 90 2 X 3,246.92 X
32656   2 90 2 X 3,328.45 X
32658   4 90 2 X 2,751.10 X
32658   3 90 2 X 2,763.18 X
32658   2 90 2 X 2,832.90 X
32658   1 90 2 X 2,866.47 X
32659   4 90 2 X 2,410.13 X
32659   3 90 2 X 2,794.12 X
32659   2 90 2 X 2,877.93 X
32659   1 90 2 X 2,911.25 X
32661   3 90 2 X 2,088.29 X
32661   4 90 2 X 2,164.21 X
32661   2 90 2 X 2,225.60 X
32661   1 90 2 X 2,258.91 X
32662   3 90 2 X 3,131.59 X
32662   4 90 2 X 3,158.30 X
32662   2 90 2 X 3,281.76 X
32662   1 90 2 X 3,307.72 X
32663   3 90 2 X 3,551.79 X
32663   4 90 2 X 3,670.84 X
32663   2 90 2 X 3,850.56 X
32663   1 90 2 X 3,862.38 X
32664   4 90 2 X 2,312.11 X
32664   3 90 2 X 2,338.96 X
32664   2 90 2 X 2,508.62 X
32664   1 90 2 X 2,627.28 X
32665   4 90 2 X 2,786.70 X
32665   3 90 2 X 2,819.97 X
32665   2 90 2 X 3,036.77 X
32665   1 90 2 X 3,089.25 X
32666   2 90 2 X 1,266.09 X
32666   3 90 2 X 1,266.09 X
32666   4 90 2 X 1,266.09 X
32666   1 90 2 X 1,418.28 X
32667   2 ZZZ 0 X 231.08 X
32667   3 ZZZ 0 X 231.08 X
32667   4 ZZZ 0 X 231.08 X
32667   1 ZZZ 0 X 257.79 X
32668   2 ZZZ 0 X 232.62 X
32668   3 ZZZ 0 X 232.62 X
32668   4 ZZZ 0 X 232.62 X
32668   1 ZZZ 0 X 259.89 X
32669   2 90 2 X 1,958.13 X
32669   3 90 2 X 1,958.13 X
32669   4 90 2 X 1,958.13 X
32669   1 90 2 X 2,189.40 X
32670   2 90 2 X 2,338.94 X
32670   3 90 2 X 2,338.94 X
32670   4 90 2 X 2,338.94 X
32670   1 90 2 X 2,612.76 X
32671   2 90 2 X 2,600.21 X
32671   3 90 2 X 2,600.21 X
32671   4 90 2 X 2,600.21 X
32671   1 90 2 X 2,906.66 X
32672   2 90 2 X 2,222.02 X
32672   3 90 2 X 2,222.02 X
32672   4 90 2 X 2,222.02 X
32672   1 90 2 X 2,484.55 X
32673   2 90 2 X 1,745.27 X
32673   3 90 2 X 1,745.27 X
32673   4 90 2 X 1,745.27 X
32673   1 90 2 X 1,944.37 X
32674   2 ZZZ 0 X 316.66 X
32674   3 ZZZ 0 X 316.66 X
32674   4 ZZZ 0 X 316.66 X
32674   1 ZZZ 0 X 352.97 X
32701   2 XXX 0 X 311.01 X
32701   3 XXX 0 X 311.01 X
32701   4 XXX 0 X 311.01 X
32701   1 XXX 0 X 347.84 X
32800     90 2 X * X
32810   4 90 2 X 1,703.61 X
32810   3 90 2 X 1,722.77 X
32810   2 90 2 X 1,831.44 X
32810   1 90 2 X 1,857.89 X
32815   4 90 2 X 3,456.60 X
32815   3 90 2 X 3,496.73 X
32815   2 90 2 X 3,666.23 X
32815   1 90 2 X 3,768.59 X
32820     90 2 X * X
32851     90 2 X * X
32852     90 2 X * X
32853     90 2 X * X
32854   4 90 2 X 8,168.31 X
32854   3 90 2 X 8,278.04 X
32854   2 90 2 X 8,840.26 X
32854   1 90 2 X 9,113.09 X
32855     XXX 2 X * X
32856     XXX 2 X * X
32900   4 90 2 X 2,499.88 X
32900   3 90 2 X 2,527.40 X
32900   2 90 2 X 2,679.25 X
32900   1 90 2 X 2,716.23 X
32905   4 90 2 X 3,043.73 X
32905   3 90 2 X 3,078.33 X
32905   2 90 2 X 3,096.51 X
32905   1 90 2 X 3,347.64 X
32906   4 90 2 X 3,842.17 X
32906   3 90 2 X 3,885.71 X
32906   2 90 2 X 4,142.71 X
32906   1 90 2 X 4,205.18 X
32940   4 90 2 X 2,759.29 X
32940   3 90 2 X 2,791.05 X
32940   2 90 2 X 2,962.94 X
32940   1 90 2 X 3,004.56 X
32960   2 0 2 X 230.91 X
32960   4 0 2 X 240.93 X
32960   3 0 2 X 242.48 X
32960   1 0 2 X 252.98 X
32994   2 0 2 X 7,389.56 620.18
32994   3 0 2 X 7,389.56 620.18
32994   4 0 2 X 7,389.56 620.18
32994   1 0 2 X 8,438.80 671.39
32997   2 0 2 X 644.94 X
32997   3 0 2 X 644.94 X
32997   4 0 2 X 644.94 X
32997   1 0 2 X 713.88 X
32998   2 0 2 X 3,977.42 410.39
32998   3 0 2 X 3,977.42 410.39
32998   4 0 2 X 3,977.42 410.39
32998   1 0 2 X 4,814.94 450.84
32999     YYY 2 X # X
33016   2 0 2 X 285.21 X
33016   3 0 2 X 285.21 X
33016   4 0 2 X 285.21 X
33016   1 0 2 X 312.83 X
33017   2 0 2 X 295.70 X
33017   3 0 2 X 295.70 X
33017   4 0 2 X 295.70 X
33017   1 0 2 X 323.62 X
33018   2 0 2 X 337.16 X
33018   3 0 2 X 337.16 X
33018   4 0 2 X 337.16 X
33018   1 0 2 X 367.47 X
33019   2 0 2 X 273.64 X
33019   3 0 2 X 273.64 X
33019   4 0 2 X 273.64 X
33019   1 0 2 X 299.22 X
33020   4 90 2 X 2,751.10 X
33020   3 90 2 X 2,763.18 X
33020   2 90 2 X 2,832.90 X
33020   1 90 2 X 2,866.47 X
33025   4 90 2 X 2,410.13 X
33025   3 90 2 X 2,794.12 X
33025   2 90 2 X 2,877.93 X
33025   1 90 2 X 2,911.25 X
33030   4 90 2 X 3,699.00 X
33030   3 90 2 X 3,744.09 X
33030   2 90 2 X 3,857.76 X
33030   1 90 2 X 4,148.59 X
33031   4 90 2 X 3,123.10 X
33031   3 90 2 X 3,158.90 X
33031   1 90 2 X 3,427.65 X
33031   2 90 2 X 4,254.31 X
33050   3 90 2 X 2,088.29 X
33050   4 90 2 X 2,164.21 X
33050   2 90 2 X 2,225.60 X
33050   1 90 2 X 2,258.91 X
33120   4 90 2 X 6,153.20 X
33120   3 90 2 X 7,039.26 X
33120   1 90 2 X 7,597.15 X
33120   2 90 2 X 7,690.81 X
33130   4 90 2 X 3,108.45 X
33130   3 90 2 X 3,144.50 X
33130   2 90 2 X 3,381.98 X
33130   1 90 2 X 3,399.62 X
33140   2 90 2 X 2,575.72 X
33140   3 90 2 X 2,575.72 X
33140   4 90 2 X 2,575.72 X
33140   1 90 2 X 2,900.04 X
33141   2 ZZZ 0 X 534.82 X
33141   3 ZZZ 0 X 534.82 X
33141   4 ZZZ 0 X 534.82 X
33141   1 ZZZ 0 X 598.81 X
33202   2 90 2 X 1,104.28 X
33202   3 90 2 X 1,104.28 X
33202   4 90 2 X 1,104.28 X
33202   1 90 2 X 1,252.80 X
33203   2 90 2 X 1,133.44 X
33203   3 90 2 X 1,133.44 X
33203   4 90 2 X 1,133.44 X
33203   1 90 2 X 1,272.99 X
33206   4 90 2 X 1,635.52 X
33206   3 90 2 X 1,646.91 X
33206   2 90 2 X 1,734.80 X
33206   1 90 2 X 1,762.41 X
33207   4 90 2 X 1,704.55 X
33207   3 90 2 X 1,710.96 X
33207   2 90 2 X 1,820.87 X
33207   1 90 2 X 1,849.36 X
33208   4 90 2 X 1,816.24 X
33208   3 90 2 X 1,930.58 X
33208   2 90 2 X 2,079.40 X
33208   1 90 2 X 2,087.84 X
33210   3 0 2 X 611.22 X
33210   4 0 2 X 616.06 X
33210   2 0 2 X 657.37 X
33210   1 0 2 X 661.44 X
33211   3 0 2 X 613.99 X
33211   4 0 2 X 618.80 X
33211   2 0 2 X 660.24 X
33211   1 0 2 X 664.25 X