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2021 Workers' Compensation Part B Fee Schedule

33212-33676

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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
33212   4 90 2 X 1,084.69 X
33212   2 90 2 X 1,095.97 X
33212   3 90 2 X 1,098.86 X
33212   1 90 2 X 1,114.39 X
33213   4 90 2 X 1,112.54 X
33213   3 90 2 X 1,126.93 X
33213   2 90 2 X 1,183.16 X
33213   1 90 2 X 1,202.03 X
33214   4 90 2 X 1,224.37 X
33214   3 90 2 X 1,238.46 X
33214   2 90 2 X 1,326.95 X
33214   1 90 2 X 1,348.45 X
33215   2 90 2 X 551.07 X
33215   3 90 2 X 551.07 X
33215   4 90 2 X 551.07 X
33215   1 90 2 X 614.10 X
33216   4 90 2 X 986.32 X
33216   3 90 2 X 990.00 X
33216   1 90 2 X 999.32 X
33216   2 90 2 X 1,011.18 X
33217   4 90 2 X 996.20 X
33217   3 90 2 X 1,000.00 X
33217   1 90 2 X 1,009.55 X
33217   2 90 2 X 1,021.34 X
33218   4 90 2 X 899.84 X
33218   3 90 2 X 910.84 X
33218   2 90 2 X 971.51 X
33218   1 90 2 X 986.27 X
33220   4 90 2 X 906.99 X
33220   3 90 2 X 917.95 X
33220   2 90 2 X 978.90 X
33220   1 90 2 X 993.67 X
33221   2 90 2 X 508.26 X
33221   3 90 2 X 508.26 X
33221   4 90 2 X 508.26 X
33221   1 90 2 X 568.40 X
33222   3 90 2 X 1,356.41 X
33222   4 90 2 X 1,481.87 X
33222   1 90 2 X 1,492.15 X
33222   2 90 2 X 1,515.55 X
33223   3 90 2 X 1,402.87 X
33223   4 90 2 X 1,527.86 X
33223   1 90 2 X 1,539.99 X
33223   2 90 2 X 1,563.07 X
33224   2 90 2 X 896.41 X
33224   3 90 2 X 896.41 X
33224   4 90 2 X 896.41 X
33224   1 90 2 X 978.33 X
33225   2 0 2 X 795.06 X
33225   3 0 2 X 795.06 X
33225   4 0 2 X 795.06 X
33225   1 0 2 X 866.16 X
33226   2 ZZZ 0 X 863.17 X
33226   3 ZZZ 0 X 863.17 X
33226   4 ZZZ 0 X 863.17 X
33226   1 ZZZ 0 X 942.80 X
33227   2 90 2 X 484.92 X
33227   3 90 2 X 484.92 X
33227   4 90 2 X 484.92 X
33227   1 90 2 X 542.50 X
33228   2 90 2 X 505.90 X
33228   3 90 2 X 505.90 X
33228   4 90 2 X 505.90 X
33228   1 90 2 X 565.88 X
33229   2 90 2 X 526.89 X
33229   3 90 2 X 526.89 X
33229   4 90 2 X 526.89 X
33229   1 90 2 X 589.23 X
33230   2 90 2 X 547.47 X
33230   3 90 2 X 547.47 X
33230   4 90 2 X 547.47 X
33230   1 90 2 X 612.05 X
33231   2 90 2 X 568.45 X
33231   3 90 2 X 568.45 X
33231   4 90 2 X 568.45 X
33231   1 90 2 X 635.42 X
33233   4 90 2 X 821.78 X
33233   1 90 2 X 823.30 X
33233   3 90 2 X 824.71 X
33233   2 90 2 X 837.08 X
33234   3 90 2 X 912.42 X
33234   4 90 2 X 912.42 X
33234   2 90 2 X 937.67 X
33234   1 90 2 X 993.61 X
33235   3 90 2 X 869.88 X
33235   4 90 2 X 869.88 X
33235   2 90 2 X 893.95 X
33235   1 90 2 X 948.63 X
33236   4 90 2 X 1,447.43 X
33236   3 90 2 X 1,462.96 X
33236   2 90 2 X 1,535.38 X
33236   1 90 2 X 1,553.02 X
33237   4 90 2 X 2,092.10 X
33237   3 90 2 X 2,116.23 X
33237   2 90 2 X 2,267.40 X
33237   1 90 2 X 2,304.06 X
33238   4 90 2 X 2,331.92 X
33238   3 90 2 X 2,358.74 X
33238   2 90 2 X 2,526.96 X
33238   1 90 2 X 2,567.78 X
33240   4 90 2 X 1,143.62 X
33240   3 90 2 X 1,158.29 X
33240   2 90 2 X 1,280.36 X
33240   1 90 2 X 1,299.91 X
33241   4 90 2 X 463.89 X
33241   3 90 2 X 469.28 X
33241   2 90 2 X 502.60 X
33241   1 90 2 X 510.74 X
33243   3 90 2 X 2,196.02 X
33243   1 90 2 X 2,281.79 X
33243   2 90 2 X 2,298.69 X
33243   4 90 2 X 2,838.27 X
33244   4 90 2 X 1,659.53 X
33244   3 90 2 X 1,803.47 X
33244   1 90 2 X 1,877.27 X
33244   2 90 2 X 1,896.57 X
33249   4 90 2 X 2,772.86 X
33249   2 90 2 X 3,345.89 X
33249   1 90 2 X 3,408.36 X
33249   3 90 2 X 3,776.47 X
33250   4 90 2 X 2,820.60 X
33250   3 90 2 X 2,853.81 X
33250   2 90 2 X 2,992.48 X
33250   1 90 2 X 3,026.04 X
33251   4 90 2 X 3,720.20 X
33251   3 90 2 X 3,763.09 X
33251   2 90 2 X 4,031.85 X
33251   1 90 2 X 4,097.05 X
33254   2 90 2 X 1,928.53 X
33254   3 90 2 X 1,928.53 X
33254   4 90 2 X 1,928.53 X
33254   1 90 2 X 2,189.91 X
33255   2 90 2 X 2,323.47 X
33255   3 90 2 X 2,323.47 X
33255   4 90 2 X 2,323.47 X
33255   1 90 2 X 2,630.96 X
33256   2 90 2 X 2,775.25 X
33256   3 90 2 X 2,775.25 X
33256   4 90 2 X 2,775.25 X
33256   1 90 2 X 3,145.65 X
33257   2 ZZZ 0 X 862.91 X
33257   3 ZZZ 0 X 862.91 X
33257   4 ZZZ 0 X 862.91 X
33257   1 ZZZ 0 X 962.84 X
33258   2 ZZZ 0 X 975.84 X
33258   3 ZZZ 0 X 975.84 X
33258   4 ZZZ 0 X 975.84 X
33258   1 ZZZ 0 X 1,089.46 X
33259   2 ZZZ 0 X 1,280.97 X
33259   3 ZZZ 0 X 1,280.97 X
33259   4 ZZZ 0 X 1,280.97 X
33259   1 ZZZ 0 X 1,440.84 X
33261   4 90 2 X 3,467.34 X
33261   2 90 2 X 3,742.53 X
33261   3 90 2 X 7,247.72 X
33261   1 90 2 X 7,371.50 X
33262   2 90 2 X 527.41 X
33262   3 90 2 X 527.41 X
33262   4 90 2 X 527.41 X
33262   1 90 2 X 589.69 X
33263   2 90 2 X 548.40 X
33263   3 90 2 X 548.40 X
33263   4 90 2 X 548.40 X
33263   1 90 2 X 613.06 X
33264   2 90 2 X 569.40 X
33264   3 90 2 X 569.40 X
33264   4 90 2 X 569.40 X
33264   1 90 2 X 636.41 X
33265   2 90 2 X 1,928.53 X
33265   3 90 2 X 1,928.53 X
33265   4 90 2 X 1,928.53 X
33265   1 90 2 X 2,189.91 X
33266   2 90 2 X 2,640.05 X
33266   3 90 2 X 2,640.05 X
33266   4 90 2 X 2,640.05 X
33266   1 90 2 X 2,996.28 X
33270   2 90 2 X 860.52 X
33270   3 90 2 X 860.52 X
33270   4 90 2 X 860.52 X
33270   1 90 2 X 959.13 X
33271   2 90 2 X 652.67 X
33271   3 90 2 X 652.67 X
33271   4 90 2 X 652.67 X
33271   1 90 2 X 716.66 X
33272   2 90 2 X 582.68 X
33272   3 90 2 X 582.68 X
33272   4 90 2 X 582.68 X
33272   1 90 2 X 659.19 X
33273   2 90 2 X 527.11 X
33273   3 90 2 X 527.11 X
33273   4 90 2 X 527.11 X
33273   1 90 2 X 575.80 X
33274   2 90 2 X 595.32 X
33274   3 90 2 X 595.32 X
33274   4 90 2 X 595.32 X
33274   1 90 2 X 656.34 X
33275   2 90 2 X 633.87 X
33275   3 90 2 X 633.87 X
33275   4 90 2 X 633.87 X
33275   1 90 2 X 698.17 X
33285   2 0 2 X 5,829.65 108.92
33285   3 0 2 X 5,829.65 108.92
33285   4 0 2 X 5,829.65 108.92
33285   1 0 2 X 6,683.94 119.78
33286   2 0 2 X 157.05 106.81
33286   3 0 2 X 157.05 106.81
33286   4 0 2 X 157.05 106.81
33286   1 0 2 X 175.08 117.43
33289   2 0 2 X 400.82 X
33289   3 0 2 X 400.82 X
33289   4 0 2 X 400.82 X
33289   1 0 2 X 438.42 X
33300   4 90 2 X 2,916.99 X
33300   3 90 2 X 2,951.59 X
33300   2 90 2 X 3,170.08 X
33300   1 90 2 X 3,223.03 X
33305   4 90 2 X 3,490.44 X
33305   3 90 2 X 3,531.99 X
33305   2 90 2 X 3,548.73 X
33305   1 90 2 X 3,855.22 X
33310   4 90 2 X 2,676.42 X
33310   3 90 2 X 2,867.32 X
33310   2 90 2 X 2,883.78 X
33310   1 90 2 X 2,926.63 X
33315   4 90 2 X 3,279.50 X
33315   3 90 2 X 3,317.47 X
33315   2 90 2 X 3,544.14 X
33315   1 90 2 X 3,599.06 X
33320   4 90 2 X 2,818.45 X
33320   3 90 2 X 3,294.38 X
33320   2 90 2 X 3,383.29 X
33320   1 90 2 X 3,404.86 X
33321   4 90 2 X 3,838.22 X
33321   3 90 2 X 3,885.50 X
33321   2 90 2 X 4,189.13 X
33321   1 90 2 X 4,484.73 X
33322   4 90 2 X 3,838.22 X
33322   3 90 2 X 3,885.50 X
33322   2 90 2 X 4,189.13 X
33322   1 90 2 X 4,484.73 X
33330   4 90 2 X 2,976.76 X
33330   3 90 2 X 3,011.28 X
33330   2 90 2 X 3,199.44 X
33330   1 90 2 X 3,245.07 X
33335   4 90 2 X 3,988.64 X
33335   3 90 2 X 4,033.78 X
33335   2 90 2 X 4,272.59 X
33335   1 90 2 X 4,330.53 X
33340   2 0 2 X 1,052.52 X
33340   3 0 2 X 1,052.52 X
33340   4 0 2 X 1,052.52 X
33340   1 0 2 X 1,152.86 X
33361   2 0 2 X 1,878.86 X
33361   3 0 2 X 1,878.86 X
33361   4 0 2 X 1,878.86 X
33361   1 0 2 X 2,091.01 X
33362   2 0 2 X 2,055.76 X
33362   3 0 2 X 2,055.76 X
33362   4 0 2 X 2,055.76 X
33362   1 0 2 X 2,287.75 X
33363   2 0 2 X 2,128.62 X
33363   3 0 2 X 2,128.62 X
33363   4 0 2 X 2,128.62 X
33363   1 0 2 X 2,368.84 X
33364   2 0 2 X 2,262.76 X
33364   3 0 2 X 2,262.76 X
33364   4 0 2 X 2,262.76 X
33364   1 0 2 X 2,519.25 X
33365   2 0 2 X 2,488.13 X
33365   3 0 2 X 2,488.13 X
33365   4 0 2 X 2,488.13 X
33365   1 0 2 X 2,777.82 X
33366   2 0 2 X 2,711.54 X
33366   3 0 2 X 2,711.54 X
33366   4 0 2 X 2,711.54 X
33366   1 0 2 X 2,986.60 X
33367   2 ZZZ 0 X 875.31 X
33367   3 ZZZ 0 X 875.31 X
33367   4 ZZZ 0 X 875.31 X
33367   1 ZZZ 0 X 976.41 X
33368   2 ZZZ 0 X 1,060.87 X
33368   3 ZZZ 0 X 1,060.87 X
33368   4 ZZZ 0 X 1,060.87 X
33368   1 ZZZ 0 X 1,183.58 X
33369   2 ZZZ 0 X 1,400.51 X
33369   3 ZZZ 0 X 1,400.51 X
33369   4 ZZZ 0 X 1,400.51 X
33369   1 ZZZ 0 X 1,562.42 X
33390   2 90 2 X 2,514.67 X
33390   3 90 2 X 2,514.67 X
33390   4 90 2 X 2,514.67 X
33390   1 90 2 X 2,744.31 X
33391   2 90 2 X 2,979.79 X
33391   3 90 2 X 2,979.79 X
33391   4 90 2 X 2,979.79 X
33391   1 90 2 X 3,251.73 X
33404   4 90 2 X 4,387.31 X
33404   3 90 2 X 4,437.89 X
33404   2 90 2 X 4,754.34 X
33404   1 90 2 X 4,831.19 X
33405   3 90 2 X 6,194.40 X
33405   4 90 2 X 6,229.52 X
33405   2 90 2 X 6,606.71 X
33405   1 90 2 X 6,681.43 X
33406   4 90 2 X 5,645.64 X
33406   3 90 2 X 5,714.15 X
33406   2 90 2 X 6,156.87 X
33406   1 90 2 X 6,264.07 X
33410   2 90 2 X 4,320.47 X
33410   3 90 2 X 4,320.47 X
33410   4 90 2 X 4,320.47 X
33410   1 90 2 X 4,872.51 X
33411   4 90 2 X 6,706.72 X
33411   3 90 2 X 6,788.81 X
33411   2 90 2 X 7,366.28 X
33411   1 90 2 X 7,506.10 X
33412   4 90 2 X 5,246.12 X
33412   3 90 2 X 5,308.94 X
33412   2 90 2 X 5,625.67 X
33412   1 90 2 X 5,702.20 X
33413   4 90 2 X 5,645.64 X
33413   3 90 2 X 5,714.15 X
33413   2 90 2 X 6,156.87 X
33413   1 90 2 X 6,264.07 X
33414   1 90 2 X 5,178.62 X
33414   2 90 2 X 5,178.62 X
33414   3 90 2 X 5,178.62 X
33414   4 90 2 X 5,178.62 X
33415   4 90 2 X 4,058.58 X
33415   3 90 2 X 4,107.09 X
33415   2 90 2 X 4,352.06 X
33415   1 90 2 X 4,411.34 X
33416   4 90 2 X 5,389.84 X
33416   3 90 2 X 5,454.63 X
33416   2 90 2 X 5,870.68 X
33416   1 90 2 X 5,971.36 X
33417   1 90 2 X 7,861.47 X
33417   2 90 2 X 7,861.47 X
33417   3 90 2 X 7,861.47 X
33417   4 90 2 X 7,861.47 X
33418   2 90 2 X 2,343.03 2,446.72
33418   3 90 2 X 2,343.03 2,446.72
33418   4 90 2 X 2,343.03 2,446.72
33418   1 90 2 X 2,536.36 2,657.71
33419   2 ZZZ 0 X 753.37 X
33419   3 ZZZ 0 X 753.37 X
33419   4 ZZZ 0 X 753.37 X
33419   1 ZZZ 0 X 850.80 X
33420   1 90 2 X 4,131.31 X
33420   3 90 2 X 5,820.35 X
33420   4 90 2 X 6,007.15 X
33420   2 90 2 X 6,211.84 X
33422   4 90 2 X 5,434.29 X
33422   3 90 2 X 7,394.17 X
33422   1 90 2 X 7,854.38 X
33422   2 90 2 X 7,903.86 X
33425   4 90 2 X 7,143.44 X
33425   3 90 2 X 7,519.30 X
33425   1 90 2 X 7,640.70 X
33425   2 90 2 X 7,884.88 X
33426   4 90 2 X 5,599.02 X
33426   3 90 2 X 5,667.69 X
33426   1 90 2 X 7,100.67 X
33426   2 90 2 X 8,089.92 X
33427   4 90 2 X 6,418.65 X
33427   3 90 2 X 6,496.33 X
33427   2 90 2 X 7,009.41 X
33427   1 90 2 X 7,133.58 X
33430   4 90 2 X 7,786.72 X
33430   3 90 2 X 7,802.09 X
33430   1 90 2 X 8,071.91 X
33430   2 90 2 X 8,256.52 X
33440   2 90 2 X 4,144.02 X
33440   3 90 2 X 4,144.02 X
33440   4 90 2 X 4,144.02 X
33440   1 90 2 X 4,529.22 X
33460   4 90 2 X 4,596.82 X
33460   2 90 2 X 5,925.83 X
33460   3 90 2 X 5,989.51 X
33460   1 90 2 X 6,138.27 X
33463   4 90 2 X 3,982.71 X
33463   3 90 2 X 4,028.59 X
33463   2 90 2 X 4,315.91 X
33463   1 90 2 X 4,385.71 X
33464   4 90 2 X 4,263.53 X
33464   3 90 2 X 4,312.61 X
33464   2 90 2 X 4,620.06 X
33464   1 90 2 X 4,694.64 X
33465   4 90 2 X 5,718.66 X
33465   3 90 2 X 6,396.08 X
33465   2 90 2 X 6,447.39 X
33465   1 90 2 X 6,669.56 X
33468   4 90 2 X 4,564.80 X
33468   3 90 2 X 4,617.51 X
33468   2 90 2 X 4,933.52 X
33468   1 90 2 X 5,010.18 X
33470   4 90 2 X 5,645.64 X
33470   3 90 2 X 5,714.15 X
33470   2 90 2 X 6,156.87 X
33470   1 90 2 X 6,264.07 X
33471   4 90 2 X 5,645.64 X
33471   3 90 2 X 5,714.15 X
33471   2 90 2 X 6,156.87 X
33471   1 90 2 X 6,264.07 X
33474   4 90 2 X 3,164.38 X
33474   3 90 2 X 3,201.39 X
33474   2 90 2 X 3,384.13 X
33474   1 90 2 X 3,428.35 X
33475   4 90 2 X 5,645.64 X
33475   3 90 2 X 5,714.15 X
33475   2 90 2 X 6,156.87 X
33475   1 90 2 X 6,264.07 X
33476   4 90 2 X 5,319.50 X
33476   3 90 2 X 5,395.38 X
33476   2 90 2 X 5,810.22 X
33476   1 90 2 X 6,007.05 X
33477   2 0 2 X 1,725.08 X
33477   3 0 2 X 1,725.08 X
33477   4 0 2 X 1,725.08 X
33477   1 0 2 X 1,863.43 X
33478   4 90 2 X 5,732.40 X
33478   3 90 2 X 5,814.94 X
33478   2 90 2 X 6,267.83 X
33478   1 90 2 X 6,481.98 X
33496   2 90 2 X 4,699.46 X
33496   3 90 2 X 4,699.46 X
33496   4 90 2 X 4,699.46 X
33496   1 90 2 X 5,434.25 X
33500   4 90 2 X 3,732.36 X
33500   3 90 2 X 3,774.84 X
33500   1 90 2 X 4,094.61 X
33500   2 90 2 X 5,372.84 X
33501   4 90 2 X 3,034.80 X
33501   3 90 2 X 3,070.72 X
33501   1 90 2 X 3,369.09 X
33501   2 90 2 X 5,014.27 X
33502   3 90 2 X 3,118.31 X
33502   2 90 2 X 3,308.29 X
33502   1 90 2 X 3,354.26 X
33502   4 90 2 X 4,369.55 X
33503   3 90 2 X 3,099.11 X
33503   1 90 2 X 3,293.18 X
33503   2 90 2 X 3,826.92 X
33503   4 90 2 X 4,686.81 X
33504   4 90 2 X 3,466.70 X
33504   3 90 2 X 3,505.73 X
33504   2 90 2 X 3,735.38 X
33504   1 90 2 X 3,791.15 X
33505   4 90 2 X 3,466.70 X
33505   3 90 2 X 3,505.73 X
33505   2 90 2 X 3,735.38 X
33505   1 90 2 X 3,791.15 X
33506   4 90 2 X 3,466.70 X
33506   3 90 2 X 3,505.73 X
33506   2 90 2 X 3,735.38 X
33506   1 90 2 X 3,791.15 X
33507   2 90 2 X 2,829.79 X
33507   3 90 2 X 2,829.79 X
33507   4 90 2 X 2,829.79 X
33507   1 90 2 X 3,176.81 X
33508   2 90 2 X 30.08 X
33508   3 90 2 X 30.08 X
33508   4 90 2 X 30.08 X
33508   1 90 2 X 33.39 X
33510   4 90 2 X 5,559.25 X
33510   3 90 2 X 5,565.39 X
33510   2 90 2 X 5,936.65 X
33510   1 90 2 X 6,045.86 X
33511   4 90 2 X 6,373.80 X
33511   3 90 2 X 6,442.66 X
33511   2 90 2 X 6,862.36 X
33511   1 90 2 X 6,960.23 X
33512   4 90 2 X 6,875.39 X
33512   3 90 2 X 6,914.16 X
33512   2 90 2 X 7,389.18 X
33512   1 90 2 X 7,477.89 X
33513   4 90 2 X 7,326.07 X
33513   3 90 2 X 7,356.02 X
33513   2 90 2 X 7,889.20 X
33513   1 90 2 X 7,979.38 X
33514   4 90 2 X 7,689.62 X
33514   3 90 2 X 7,746.68 X
33514   2 90 2 X 8,208.19 X
33514   1 90 2 X 8,266.39 X
33516   4 90 2 X 8,215.85 X
33516   3 90 2 X 8,253.30 X
33516   1 90 2 X 8,433.07 X
33516   2 90 2 X 8,501.93 X
33517   4 90 0 X 573.56 X
33517   3 90 0 X 575.52 X
33517   1 90 0 X 615.08 X
33517   2 90 0 X 624.42 X
33518   3 90 0 X 1,094.72 X
33518   4 90 0 X 1,100.09 X
33518   1 90 0 X 1,183.32 X
33518   2 90 0 X 1,197.85 X
33519   4 90 0 X 1,505.51 X
33519   3 90 0 X 1,509.21 X
33519   1 90 0 X 1,565.97 X
33519   2 90 0 X 1,598.69 X
33521   1 90 0 X 1,863.27 X
33521   2 90 0 X 1,964.39 X
33521   4 90 0 X 1,973.96 X
33521   3 90 0 X 1,989.39 X
33522   1 90 0 X 2,270.91 X
33522   2 90 0 X 2,451.91 X
33522   4 90 0 X 2,557.00 X
33522   3 90 0 X 2,586.91 X
33523   1 90 0 X 2,481.99 X
33523   2 90 0 X 2,659.58 X
33523   4 90 0 X 2,748.18 X
33523   3 90 0 X 2,780.41 X
33530   4 ZZZ 0 X 1,611.81 X
33530   3 ZZZ 0 X 1,631.99 X
33530   2 ZZZ 0 X 1,789.36 X
33530   1 ZZZ 0 X 1,827.50 X
33533   4 90 2 X 5,869.50 X
33533   3 90 2 X 5,909.61 X
33533   2 90 2 X 6,321.83 X
33533   1 90 2 X 6,439.85 X
33534   4 90 2 X 6,522.42 X
33534   3 90 2 X 6,569.27 X
33534   2 90 2 X 7,008.50 X
33534   1 90 2 X 7,111.48 X
33535   4 90 2 X 7,100.80 X
33535   3 90 2 X 7,142.72 X
33535   2 90 2 X 7,622.81 X
33535   1 90 2 X 7,716.01 X
33536   4 90 2 X 7,665.31 X
33536   3 90 2 X 7,707.59 X
33536   2 90 2 X 8,220.98 X
33536   1 90 2 X 8,304.52 X
33542   3 90 2 X 9,055.96 X
33542   1 90 2 X 9,182.83 X
33542   4 90 2 X 9,283.92 X
33542   2 90 2 X 9,752.49 X
33545   4 90 2 X 6,604.15 X
33545   3 90 2 X 6,918.36 X
33545   1 90 2 X 7,174.12 X
33545   2 90 2 X 7,223.21 X
33548   2 90 2 X 3,714.68 X
33548   3 90 2 X 3,714.68 X
33548   4 90 2 X 3,714.68 X
33548   1 90 2 X 4,193.26 X
33572   4 ZZZ 0 X 774.30 X
33572   3 ZZZ 0 X 784.69 X
33572   2 ZZZ 0 X 837.93 X
33572   1 ZZZ 0 X 863.74 X
33600   4 90 2 X 4,427.27 X
33600   3 90 2 X 4,481.63 X
33600   2 90 2 X 4,861.37 X
33600   1 90 2 X 4,953.34 X
33602   4 90 2 X 3,861.47 X
33602   3 90 2 X 3,905.99 X
33602   2 90 2 X 4,184.87 X
33602   1 90 2 X 4,252.50 X
33606   4 90 2 X 6,947.08 X
33606   3 90 2 X 7,047.78 X
33606   2 90 2 X 7,627.13 X
33606   1 90 2 X 7,903.48 X
33608   4 90 2 X 7,018.42 X
33608   3 90 2 X 7,119.84 X
33608   2 90 2 X 7,700.88 X
33608   1 90 2 X 7,978.19 X
33610   4 90 2 X 6,947.08 X
33610   3 90 2 X 7,047.78 X
33610   2 90 2 X 7,627.13 X
33610   1 90 2 X 7,903.48 X
33611   4 90 2 X 7,135.09 X
33611   3 90 2 X 7,237.69 X
33611   2 90 2 X 7,821.48 X
33611   1 90 2 X 8,100.34 X
33612   4 90 2 X 7,215.08 X
33612   3 90 2 X 7,318.53 X
33612   2 90 2 X 7,904.22 X
33612   1 90 2 X 8,184.11 X
33615   4 90 2 X 7,064.77 X
33615   3 90 2 X 7,166.57 X
33615   2 90 2 X 7,748.72 X
33615   1 90 2 X 8,026.65 X
33617   4 90 2 X 7,229.59 X
33617   3 90 2 X 7,333.08 X
33617   2 90 2 X 7,919.15 X
33617   1 90 2 X 8,199.28 X
33619   4 90 2 X 8,096.97 X
33619   3 90 2 X 8,213.70 X
33619   2 90 2 X 8,865.76 X
33619   1 90 2 X 9,175.31 X
33620   2 90 2 X 2,584.67 X
33620   3 90 2 X 2,584.67 X
33620   4 90 2 X 2,584.67 X
33620   1 90 2 X 2,889.37 X
33621   2 90 2 X 1,386.02 X
33621   3 90 2 X 1,386.02 X
33621   4 90 2 X 1,386.02 X
33621   1 90 2 X 1,543.93 X
33622   2 90 2 X 5,438.43 X
33622   3 90 2 X 5,438.43 X
33622   4 90 2 X 5,438.43 X
33622   1 90 2 X 6,059.26 X
33641   4 90 2 X 4,427.27 X
33641   3 90 2 X 4,481.63 X
33641   2 90 2 X 4,861.37 X
33641   1 90 2 X 4,953.34 X
33645   4 90 2 X 3,703.78 X
33645   3 90 2 X 3,748.09 X
33645   2 90 2 X 3,971.77 X
33645   1 90 2 X 4,025.77 X
33647     90 2 X * X
33660   4 90 2 X 5,638.89 X
33660   3 90 2 X 5,720.43 X
33660   2 90 2 X 6,171.17 X
33660   1 90 2 X 6,384.05 X
33665   4 90 2 X 5,921.30 X
33665   3 90 2 X 6,005.85 X
33665   2 90 2 X 6,463.19 X
33665   1 90 2 X 6,679.79 X
33670   4 90 2 X 7,135.09 X
33670   3 90 2 X 7,237.69 X
33670   2 90 2 X 7,821.48 X
33670   1 90 2 X 8,100.34 X
33675   2 90 2 X 3,070.56 X
33675   3 90 2 X 3,070.56 X
33675   4 90 2 X 3,070.56 X
33675   1 90 2 X 3,495.43 X
33676   2 90 2 X 3,164.82 X
33676   3 90 2 X 3,164.82 X
33676   4 90 2 X 3,164.82 X
33676   1 90 2 X 3,611.66 X