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2021 Workers' Compensation Part B Fee Schedule

33677-35011

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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
33677   2 90 2 X 3,289.74 X
33677   3 90 2 X 3,289.74 X
33677   4 90 2 X 3,289.74 X
33677   1 90 2 X 3,754.33 X
33681   4 90 2 X 6,229.57 X
33681   3 90 2 X 6,319.99 X
33681   2 90 2 X 6,828.61 X
33681   1 90 2 X 7,069.51 X
33684   4 90 2 X 6,417.49 X
33684   3 90 2 X 6,509.91 X
33684   2 90 2 X 7,022.96 X
33684   1 90 2 X 7,266.35 X
33688   4 90 2 X 6,511.02 X
33688   3 90 2 X 6,604.37 X
33688   2 90 2 X 7,119.64 X
33688   1 90 2 X 7,364.29 X
33690   4 90 2 X 4,126.00 X
33690   3 90 2 X 4,185.10 X
33690   2 90 2 X 4,521.03 X
33690   1 90 2 X 4,681.57 X
33692   4 90 2 X 6,947.08 X
33692   3 90 2 X 7,047.78 X
33692   2 90 2 X 7,627.13 X
33692   1 90 2 X 7,903.48 X
33694   4 90 2 X 7,041.59 X
33694   3 90 2 X 7,143.19 X
33694   2 90 2 X 7,724.79 X
33694   1 90 2 X 8,002.39 X
33697   4 90 2 X 7,229.59 X
33697   3 90 2 X 7,333.08 X
33697   2 90 2 X 7,919.15 X
33697   1 90 2 X 8,199.28 X
33702   4 90 2 X 5,653.32 X
33702   3 90 2 X 5,734.45 X
33702   2 90 2 X 6,178.95 X
33702   1 90 2 X 6,389.30 X
33710   4 90 2 X 6,421.36 X
33710   3 90 2 X 6,513.80 X
33710   2 90 2 X 7,026.97 X
33710   1 90 2 X 7,270.43 X
33720   4 90 2 X 5,653.32 X
33720   3 90 2 X 5,734.45 X
33720   2 90 2 X 6,178.95 X
33720   1 90 2 X 6,389.30 X
33722   4 90 2 X 3,861.47 X
33722   3 90 2 X 3,905.99 X
33722   2 90 2 X 4,184.87 X
33722   1 90 2 X 4,252.50 X
33724   2 90 2 X 2,201.01 X
33724   3 90 2 X 2,201.01 X
33724   4 90 2 X 2,201.01 X
33724   1 90 2 X 2,496.73 X
33726   2 90 2 X 2,903.19 X
33726   3 90 2 X 2,903.19 X
33726   4 90 2 X 2,903.19 X
33726   1 90 2 X 3,280.28 X
33730   4 90 2 X 7,005.91 X
33730   3 90 2 X 7,107.14 X
33730   2 90 2 X 7,687.91 X
33730   1 90 2 X 7,965.12 X
33732   4 90 2 X 5,897.21 X
33732   3 90 2 X 5,981.48 X
33732   2 90 2 X 6,438.29 X
33732   1 90 2 X 6,654.59 X
33735   4 90 2 X 4,659.70 X
33735   3 90 2 X 4,727.04 X
33735   2 90 2 X 5,110.59 X
33735   1 90 2 X 5,293.42 X
33736   4 90 2 X 4,427.27 X
33736   3 90 2 X 4,481.63 X
33736   2 90 2 X 4,861.37 X
33736   1 90 2 X 4,953.34 X
33737   4 90 2 X 4,710.80 X
33737   3 90 2 X 4,778.68 X
33737   2 90 2 X 5,163.45 X
33737   1 90 2 X 5,346.91 X
33741   2 0 2 X 845.62 X
33741   3 0 2 X 845.62 X
33741   4 0 2 X 845.62 X
33741   1 0 2 X 924.31 X
33745   2 0 2 X 1,195.29 X
33745   3 0 2 X 1,195.29 X
33745   4 0 2 X 1,195.29 X
33745   1 0 2 X 1,302.30 X
33746   2 ZZZ 0 X 472.84 X
33746   3 ZZZ 0 X 472.84 X
33746   4 ZZZ 0 X 472.84 X
33746   1 ZZZ 0 X 513.90 X
33750   4 90 2 X 4,303.42 X
33750   3 90 2 X 4,364.36 X
33750   2 90 2 X 4,704.39 X
33750   1 90 2 X 4,867.27 X
33755   4 90 2 X 4,337.14 X
33755   3 90 2 X 4,398.39 X
33755   2 90 2 X 4,739.23 X
33755   1 90 2 X 4,902.66 X
33762   4 90 2 X 4,337.14 X
33762   3 90 2 X 4,398.39 X
33762   2 90 2 X 4,739.23 X
33762   1 90 2 X 4,902.66 X
33764   1 90 2 X 6,158.09 X
33764   2 90 2 X 6,158.09 X
33764   3 90 2 X 6,158.09 X
33764   4 90 2 X 6,158.09 X
33766   4 90 2 X 4,430.69 X
33766   3 90 2 X 4,492.87 X
33766   2 90 2 X 4,835.90 X
33766   1 90 2 X 5,000.58 X
33767   4 90 2 X 4,993.25 X
33767   3 90 2 X 5,063.95 X
33767   2 90 2 X 5,455.47 X
33767   1 90 2 X 5,642.68 X
33768   2 ZZZ 0 X 705.39 X
33768   3 ZZZ 0 X 705.39 X
33768   4 ZZZ 0 X 705.39 X
33768   1 ZZZ 0 X 789.63 X
33770   4 90 2 X 7,205.50 X
33770   3 90 2 X 7,308.71 X
33770   2 90 2 X 7,894.27 X
33770   1 90 2 X 8,173.99 X
33771   4 90 2 X 7,324.04 X
33771   3 90 2 X 7,428.59 X
33771   2 90 2 X 8,016.85 X
33771   1 90 2 X 8,298.21 X
33774   4 90 2 X 6,108.36 X
33774   3 90 2 X 6,194.74 X
33774   2 90 2 X 6,656.60 X
33774   1 90 2 X 6,875.65 X
33775   4 90 2 X 6,225.93 X
33775   3 90 2 X 6,313.51 X
33775   2 90 2 X 6,778.13 X
33775   1 90 2 X 6,998.84 X
33776   4 90 2 X 6,793.47 X
33776   3 90 2 X 6,889.69 X
33776   2 90 2 X 7,411.66 X
33776   1 90 2 X 7,660.10 X
33777   4 90 2 X 6,344.51 X
33777   3 90 2 X 6,433.33 X
33777   2 90 2 X 6,900.74 X
33777   1 90 2 X 7,123.00 X
33778   1 90 2 X 13,102.41 X
33778   2 90 2 X 13,102.41 X
33778   3 90 2 X 13,102.41 X
33778   4 90 2 X 13,102.41 X
33779   1 90 2 X 13,102.41 X
33779   2 90 2 X 13,102.41 X
33779   3 90 2 X 13,102.41 X
33779   4 90 2 X 13,102.41 X
33780   1 90 2 X 13,102.41 X
33780   2 90 2 X 13,102.41 X
33780   3 90 2 X 13,102.41 X
33780   4 90 2 X 13,102.41 X
33781   1 90 2 X 13,102.41 X
33781   2 90 2 X 13,102.41 X
33781   3 90 2 X 13,102.41 X
33781   4 90 2 X 13,102.41 X
33782   2 90 2 X 4,298.41 X
33782   3 90 2 X 4,298.41 X
33782   4 90 2 X 4,298.41 X
33782   1 90 2 X 4,569.20 X
33783   2 90 2 X 4,694.82 X
33783   3 90 2 X 4,694.82 X
33783   4 90 2 X 4,694.82 X
33783   1 90 2 X 5,010.59 X
33786   1 90 2 X 11,530.13 X
33786   2 90 2 X 11,530.13 X
33786   3 90 2 X 11,530.13 X
33786   4 90 2 X 11,530.13 X
33788     90 2 X * X
33800   4 90 2 X 2,501.92 X
33800   3 90 2 X 2,530.80 X
33800   2 90 2 X 2,711.29 X
33800   1 90 2 X 2,755.13 X
33802   4 90 2 X 3,961.19 X
33802   3 90 2 X 4,018.58 X
33802   2 90 2 X 4,350.55 X
33802   1 90 2 X 4,508.91 X
33803   4 90 2 X 4,148.16 X
33803   3 90 2 X 4,207.58 X
33803   2 90 2 X 4,543.86 X
33803   1 90 2 X 4,704.80 X
33813   1 90 2 X 6,289.17 X
33813   2 90 2 X 6,289.17 X
33813   3 90 2 X 6,289.17 X
33813   4 90 2 X 6,289.17 X
33814   1 90 2 X 7,337.30 X
33814   2 90 2 X 7,337.30 X
33814   3 90 2 X 7,337.30 X
33814   4 90 2 X 7,337.30 X
33820   1 90 2 X 3,503.33 X
33820   2 90 2 X 3,503.33 X
33820   3 90 2 X 3,503.33 X
33820   4 90 2 X 3,503.33 X
33822   4 90 2 X 3,961.19 X
33822   3 90 2 X 4,018.58 X
33822   2 90 2 X 4,350.55 X
33822   1 90 2 X 4,508.91 X
33824   4 90 2 X 4,148.16 X
33824   3 90 2 X 4,207.58 X
33824   2 90 2 X 4,543.86 X
33824   1 90 2 X 4,704.80 X
33840   1 90 2 X 6,184.33 X
33840   2 90 2 X 6,184.33 X
33840   3 90 2 X 6,184.33 X
33840   4 90 2 X 6,184.33 X
33845   1 90 2 X 7,570.53 X
33845   2 90 2 X 7,570.53 X
33845   3 90 2 X 7,570.53 X
33845   4 90 2 X 7,570.53 X
33851   1 90 2 X 7,337.30 X
33851   2 90 2 X 7,337.30 X
33851   3 90 2 X 7,337.30 X
33851   4 90 2 X 7,337.30 X
33852   1 90 2 X 7,861.47 X
33852   2 90 2 X 7,861.47 X
33852   3 90 2 X 7,861.47 X
33852   4 90 2 X 7,861.47 X
33853   1 90 2 X 9,062.50 X
33853   2 90 2 X 9,062.50 X
33853   3 90 2 X 9,062.50 X
33853   4 90 2 X 9,062.50 X
33858   2 90 2 X 4,104.28 X
33858   3 90 2 X 4,104.28 X
33858   4 90 2 X 4,104.28 X
33858   1 90 2 X 4,511.07 X
33859   2 90 2 X 2,945.34 X
33859   3 90 2 X 2,945.34 X
33859   4 90 2 X 2,945.34 X
33859   1 90 2 X 3,238.13 X
33863   4 90 2 X 8,194.97 X
33863   3 90 2 X 8,242.58 X
33863   2 90 2 X 8,293.45 X
33863   1 90 2 X 8,510.75 X
33864   2 90 2 X 4,674.06 X
33864   3 90 2 X 4,674.06 X
33864   4 90 2 X 4,674.06 X
33864   1 90 2 X 5,177.70 X
33866   2 ZZZ 0 X 1,260.74 X
33866   3 ZZZ 0 X 1,260.74 X
33866   4 ZZZ 0 X 1,260.74 X
33866   1 ZZZ 0 X 1,374.65 X
33871   2 90 2 X 3,945.96 X
33871   3 90 2 X 3,945.96 X
33871   4 90 2 X 3,945.96 X
33871   1 90 2 X 4,338.44 X
33875   4 90 2 X 7,462.11 X
33875   3 90 2 X 7,572.10 X
33875   1 90 2 X 7,765.48 X
33875   2 90 2 X 7,963.44 X
33877   3 90 2 X 8,817.69 X
33877   4 90 2 X 8,826.70 X
33877   2 90 2 X 9,120.22 X
33877   1 90 2 X 9,219.75 X
33880   2 90 2 X 2,940.90 X
33880   3 90 2 X 2,940.90 X
33880   4 90 2 X 2,940.90 X
33880   1 90 2 X 3,241.62 X
33881   2 90 2 X 2,524.57 X
33881   3 90 2 X 2,524.57 X
33881   4 90 2 X 2,524.57 X
33881   1 90 2 X 2,786.16 X
33883   2 90 2 X 1,861.55 X
33883   3 90 2 X 1,861.55 X
33883   4 90 2 X 1,861.55 X
33883   1 90 2 X 2,072.43 X
33884   2 ZZZ 0 X 696.22 X
33884   3 ZZZ 0 X 696.22 X
33884   4 ZZZ 0 X 696.22 X
33884   1 ZZZ 0 X 767.66 X
33886   2 90 2 X 1,606.16 X
33886   3 90 2 X 1,606.16 X
33886   4 90 2 X 1,606.16 X
33886   1 90 2 X 1,790.86 X
33889   2 0 2 X 1,386.87 X
33889   3 0 2 X 1,386.87 X
33889   4 0 2 X 1,386.87 X
33889   1 0 2 X 1,545.85 X
33891   2 0 2 X 1,767.72 X
33891   3 0 2 X 1,767.72 X
33891   4 0 2 X 1,767.72 X
33891   1 0 2 X 1,973.01 X
33910   4 90 2 X 3,465.38 X
33910   3 90 2 X 3,505.05 X
33910   1 90 2 X 3,802.69 X
33910   2 90 2 X 5,261.94 X
33915   4 90 2 X 2,919.44 X
33915   3 90 2 X 2,952.77 X
33915   1 90 2 X 3,196.51 X
33915   2 90 2 X 3,839.66 X
33916   4 90 2 X 3,983.53 X
33916   3 90 2 X 4,029.47 X
33916   2 90 2 X 4,316.86 X
33916   1 90 2 X 4,386.63 X
33917   4 90 2 X 5,929.81 X
33917   3 90 2 X 6,017.00 X
33917   2 90 2 X 6,518.14 X
33917   1 90 2 X 6,755.10 X
33920   4 90 2 X 7,088.80 X
33920   3 90 2 X 7,190.96 X
33920   2 90 2 X 7,773.62 X
33920   1 90 2 X 8,051.84 X
33922   4 90 2 X 3,465.38 X
33922   3 90 2 X 3,505.05 X
33922   2 90 2 X 3,744.54 X
33922   1 90 2 X 3,802.69 X
33924   4 ZZZ 0 X 940.43 X
33924   3 ZZZ 0 X 954.26 X
33924   2 ZZZ 0 X 1,015.83 X
33924   1 ZZZ 0 X 1,063.61 X
33925   2 90 2 X 2,883.36 X
33925   3 90 2 X 2,883.36 X
33925   4 90 2 X 2,883.36 X
33925   1 90 2 X 3,262.45 X
33926   2 90 2 X 3,908.63 X
33926   3 90 2 X 3,908.63 X
33926   4 90 2 X 3,908.63 X
33926   1 90 2 X 4,395.69 X
33927   2 XXX 2 X 3,291.63 X
33927   3 XXX 2 X 3,291.63 X
33927   4 XXX 2 X 3,291.63 X
33927   1 XXX 2 X 3,600.02 X
33928         X # X
33929         X # X
33933     XXX 2 X * X
33935   4 90 2 X 12,275.88 X
33935   3 90 2 X 12,451.06 X
33935   2 90 2 X 13,393.45 X
33935   1 90 2 X 13,839.18 X
33944     XXX 2 X * X
33945   1 90 2 X 14,210.85 X
33945   2 90 2 X 14,210.85 X
33945   3 90 2 X 14,210.85 X
33945   4 90 2 X 14,210.85 X
33946   2 XXX 0 X 433.02 X
33946   3 XXX 0 X 433.02 X
33946   4 XXX 0 X 433.02 X
33946   1 XXX 0 X 470.42 X
33947   2 XXX 0 X 471.84 X
33947   3 XXX 0 X 471.84 X
33947   4 XXX 0 X 471.84 X
33947   1 XXX 0 X 511.31 X
33948   2 XXX 0 X 330.58 X
33948   3 XXX 0 X 330.58 X
33948   4 XXX 0 X 330.58 X
33948   1 XXX 0 X 356.73 X
33949   2 XXX 0 X 322.57 X
33949   3 XXX 0 X 322.57 X
33949   4 XXX 0 X 322.57 X
33949   1 XXX 0 X 348.23 X
33951   2 0 2 X 533.41 530.28
33951   3 0 2 X 533.41 530.28
33951   4 0 2 X 533.41 530.28
33951   1 0 2 X 567.58 563.93
33952   2 0 2 X 520.46 516.42
33952   3 0 2 X 520.46 516.42
33952   4 0 2 X 520.46 516.42
33952   1 0 2 X 552.41 547.72
33953   2 0 2 X 593.90 590.78
33953   3 0 2 X 593.90 590.78
33953   4 0 2 X 593.90 590.78
33953   1 0 2 X 631.46 627.83
33954   2 0 2 X 579.59 575.13
33954   3 0 2 X 579.59 575.13
33954   4 0 2 X 579.59 575.13
33954   1 0 2 X 614.73 609.50
33955   2 0 2 X 1,222.01 1,217.97
33955   3 0 2 X 1,222.01 1,217.97
33955   4 0 2 X 1,222.01 1,217.97
33955   1 0 2 X 1,334.41 1,329.71
33956   2 0 2 X 1,158.98 1,154.52
33956   3 0 2 X 1,158.98 1,154.52
33956   4 0 2 X 1,158.98 1,154.52
33956   1 0 2 X 1,260.66 1,255.46
33957   2 0 2 X 407.50 403.49
33957   3 0 2 X 407.50 403.49
33957   4 0 2 X 407.50 403.49
33957   1 0 2 X 470.96 466.25
33958   2 0 2 X 399.01 395.87
33958   3 0 2 X 399.01 395.87
33958   4 0 2 X 399.01 395.87
33958   1 0 2 X 461.01 457.35
33959   2 0 2 X 470.22 466.20
33959   3 0 2 X 470.22 466.20
33959   4 0 2 X 470.22 466.20
33959   1 0 2 X 537.48 532.76
33962   2 0 2 X 450.11 445.65
33962   3 0 2 X 450.11 445.65
33962   4 0 2 X 450.11 445.65
33962   1 0 2 X 513.92 508.70
33963   2 0 2 X 765.46 761.45
33963   3 0 2 X 765.46 761.45
33963   4 0 2 X 765.46 761.45
33963   1 0 2 X 850.43 845.72
33964   2 0 2 X 776.13 772.99
33964   3 0 2 X 776.13 772.99
33964   4 0 2 X 776.13 772.99
33964   1 0 2 X 859.30 855.66
33965   2 0 2 X 403.49 407.50
33965   3 0 2 X 403.49 407.50
33965   4 0 2 X 403.49 407.50
33965   1 0 2 X 466.25 470.96
33966   2 0 2 X 447.53 451.99
33966   3 0 2 X 447.53 451.99
33966   4 0 2 X 447.53 451.99
33966   1 0 2 X 510.69 515.93
33967   2 0 2 X 480.45 477.21
33967   3 0 2 X 480.45 477.21
33967   4 0 2 X 480.45 477.21
33967   1 0 2 X 526.94 523.15
33968   2 0 0 X 79.44 X
33968   3 0 0 X 79.44 X
33968   4 0 0 X 79.44 X
33968   1 0 0 X 95.96 X
33969   2 0 2 X 468.97 465.39
33969   3 0 2 X 468.97 465.39
33969   4 0 2 X 468.97 465.39
33969   1 0 2 X 525.09 520.89
33970   2 0 2 X 1,906.93 X
33970   4 0 2 X 1,957.86 X
33970   3 0 2 X 1,958.60 X
33970   1 0 2 X 2,030.83 X
33971   4 90 2 X 789.34 X
33971   3 90 2 X 795.83 X
33971   2 90 2 X 828.89 X
33971   1 90 2 X 847.38 X
33973   2 0 2 X 1,959.35 X
33973   4 0 2 X 2,008.56 X
33973   3 0 2 X 2,009.74 X
33973   1 0 2 X 2,083.51 X
33974   4 90 2 X 1,056.53 X
33974   3 90 2 X 1,065.54 X
33974   2 90 2 X 1,105.62 X
33974   1 90 2 X 1,125.78 X
33975     90 2 X * X
33976   4 90 2 X 4,383.82 X
33976   3 90 2 X 4,434.39 X
33976   2 90 2 X 4,750.72 X
33976   1 90 2 X 4,827.50 X
33977     90 2 X * X
33978   4 90 2 X 3,217.05 X
33978   3 90 2 X 3,254.09 X
33978   2 90 2 X 3,486.12 X
33978   1 90 2 X 3,542.39 X
33979     XXX 2 X * X
33980     90 2 X * X
33981     XXX 2 X * X
33982     XXX 2 X * X
33983     XXX 2 X * X
33984   2 0 2 X 460.39 455.95
33984   3 0 2 X 460.39 455.95
33984   4 0 2 X 460.39 455.95
33984   1 0 2 X 513.35 508.12
33985   2 0 2 X 867.65 863.60
33985   3 0 2 X 867.65 863.60
33985   4 0 2 X 867.65 863.60
33985   1 0 2 X 968.48 963.76
33986   2 0 2 X 829.57 825.12
33986   3 0 2 X 829.57 825.12
33986   4 0 2 X 829.57 825.12
33986   1 0 2 X 923.16 917.93
33987   2 ZZZ 0 X 349.31 X
33987   3 ZZZ 0 X 349.31 X
33987   4 ZZZ 0 X 349.31 X
33987   1 ZZZ 0 X 391.32 X
33988   2 0 2 X 1,018.25 1,013.35
33988   3 0 2 X 1,018.25 1,013.35
33988   4 0 2 X 1,018.25 1,013.35
33988   1 0 2 X 1,095.40 1,089.66
33989   2 0 2 X 680.08 675.63
33989   3 0 2 X 680.08 675.63
33989   4 0 2 X 680.08 675.63
33989   1 0 2 X 738.64 733.41
33990   2 XXX 2 X 611.00 X
33990   3 XXX 2 X 611.00 X
33990   4 XXX 2 X 611.00 X
33990   1 XXX 2 X 680.10 X
33991   2 XXX 2 X 890.29 X
33991   3 XXX 2 X 890.29 X
33991   4 XXX 2 X 890.29 X
33991   1 XXX 2 X 990.88 X
33992   2 XXX 2 X 291.37 X
33992   3 XXX 2 X 291.37 X
33992   4 XXX 2 X 291.37 X
33992   1 XXX 2 X 323.85 X
33993   2 XXX 2 X 255.80 X
33993   3 XXX 2 X 255.80 X
33993   4 XXX 2 X 255.80 X
33993   1 XXX 2 X 284.32 X
33995   2 0 2 X 406.20 X
33995   3 0 2 X 406.20 X
33995   4 0 2 X 406.20 X
33995   1 0 2 X 443.32 X
33997   2 0 2 X 180.70 X
33997   3 0 2 X 180.70 X
33997   4 0 2 X 180.70 X
33997   1 0 2 X 197.22 X
33999     YYY 2 X # X
34001   3 90 2 X 2,754.22 X
34001   4 90 2 X 2,758.09 X
34001   2 90 2 X 2,912.36 X
34001   1 90 2 X 2,968.50 X
34051   4 90 2 X 2,120.22 X
34051   3 90 2 X 2,265.40 X
34051   2 90 2 X 2,286.52 X
34051   1 90 2 X 2,321.03 X
34101   3 90 2 X 1,671.48 X
34101   2 90 2 X 1,954.25 X
34101   4 90 2 X 1,986.75 X
34101   1 90 2 X 2,064.66 X
34111   4 90 2 X 1,895.68 X
34111   3 90 2 X 1,902.91 X
34111   2 90 2 X 1,953.89 X
34111   1 90 2 X 1,966.23 X
34151   4 90 2 X 2,842.71 X
34151   3 90 2 X 2,864.35 X
34151   2 90 2 X 2,934.27 X
34151   1 90 2 X 2,969.97 X
34201   3 90 2 X 1,664.11 X
34201   2 90 2 X 1,960.54 X
34201   4 90 2 X 2,098.37 X
34201   1 90 2 X 2,236.50 X
34203   4 90 2 X 2,288.40 X
34203   3 90 2 X 2,301.70 X
34203   2 90 2 X 2,363.49 X
34203   1 90 2 X 2,379.40 X
34401   4 90 2 X 1,861.32 X
34401   2 90 2 X 2,036.19 X
34401   1 90 2 X 2,038.92 X
34401   3 90 2 X 2,294.59 X
34421   4 90 2 X 2,072.03 X
34421   3 90 2 X 2,108.68 X
34421   2 90 2 X 2,186.31 X
34421   1 90 2 X 2,252.83 X
34451   3 90 2 X 2,077.21 X
34451   2 90 2 X 2,126.01 X
34451   1 90 2 X 2,150.79 X
34451   4 90 2 X 2,286.83 X
34471   4 90 2 X 1,168.84 X
34471   3 90 2 X 1,181.58 X
34471   2 90 2 X 1,242.97 X
34471   1 90 2 X 1,257.94 X
34490   4 90 2 X 1,543.57 X
34490   3 90 2 X 1,620.30 X
34490   1 90 2 X 1,622.58 X
34490   2 90 2 X 1,665.34 X
34501   1 90 2 X 3,144.58 X
34501   2 90 2 X 3,144.58 X
34501   3 90 2 X 3,144.58 X
34501   4 90 2 X 3,144.58 X
34502   4 90 2 X 4,227.73 X
34502   3 90 2 X 4,276.47 X
34502   2 90 2 X 4,581.41 X
34502   1 90 2 X 4,655.38 X
34510   1 90 2 X 3,144.58 X
34510   2 90 2 X 3,144.58 X
34510   3 90 2 X 3,144.58 X
34510   4 90 2 X 3,144.58 X
34520   1 90 2 X 3,930.69 X
34520   2 90 2 X 3,930.69 X
34520   3 90 2 X 3,930.69 X
34520   4 90 2 X 3,930.69 X
34530   1 90 2 X 3,144.58 X
34530   2 90 2 X 3,144.58 X
34530   3 90 2 X 3,144.58 X
34530   4 90 2 X 3,144.58 X
34701   2 90 2 X 1,589.95 X
34701   3 90 2 X 1,589.95 X
34701   4 90 2 X 1,589.95 X
34701   1 90 2 X 1,733.58 X
34702   2 90 2 X 2,376.43 X
34702   3 90 2 X 2,376.43 X
34702   4 90 2 X 2,376.43 X
34702   1 90 2 X 2,587.18 X
34703   2 90 2 X 1,792.85 X
34703   3 90 2 X 1,792.85 X
34703   4 90 2 X 1,792.85 X
34703   1 90 2 X 1,959.60 X
34704   2 90 2 X 2,983.90 X
34704   3 90 2 X 2,983.90 X
34704   4 90 2 X 2,983.90 X
34704   1 90 2 X 3,255.02 X
34705   2 90 2 X 1,974.52 X
34705   3 90 2 X 1,974.52 X
34705   4 90 2 X 1,974.52 X
34705   1 90 2 X 2,153.02 X
34706   2 90 2 X 2,973.70 X
34706   3 90 2 X 2,973.70 X
34706   4 90 2 X 2,973.70 X
34706   1 90 2 X 3,240.52 X
34707   2 90 2 X 1,483.30 X
34707   3 90 2 X 1,483.30 X
34707   4 90 2 X 1,483.30 X
34707   1 90 2 X 1,616.63 X
34708   2 90 2 X 2,389.13 X
34708   3 90 2 X 2,389.13 X
34708   4 90 2 X 2,389.13 X
34708   1 90 2 X 2,600.39 X
34709   2 ZZZ 0 X 418.75 X
34709   3 ZZZ 0 X 418.75 X
34709   4 ZZZ 0 X 418.75 X
34709   1 ZZZ 0 X 455.98 X
34710   2 90 2 X 1,033.54 X
34710   3 90 2 X 1,033.54 X
34710   4 90 2 X 1,033.54 X
34710   1 90 2 X 1,129.02 X
34711   2 ZZZ 0 X 386.62 X
34711   3 ZZZ 0 X 386.62 X
34711   4 ZZZ 0 X 386.62 X
34711   1 ZZZ 0 X 421.07 X
34712   2 90 2 X 879.50 X
34712   3 90 2 X 879.50 X
34712   4 90 2 X 879.50 X
34712   1 90 2 X 962.30 X
34713   2 ZZZ 0 X 166.50 X
34713   3 ZZZ 0 X 166.50 X
34713   4 ZZZ 0 X 166.50 X
34713   1 ZZZ 0 X 181.41 X
34714   2 ZZZ 0 X 349.31 X
34714   3 ZZZ 0 X 349.31 X
34714   4 ZZZ 0 X 349.31 X
34714   1 ZZZ 0 X 380.22 X
34715   2 ZZZ 0 X 390.51 X
34715   3 ZZZ 0 X 390.51 X
34715   4 ZZZ 0 X 390.51 X
34715   1 ZZZ 0 X 424.05 X
34716   2 ZZZ 0 X 484.19 X
34716   3 ZZZ 0 X 484.19 X
34716   4 ZZZ 0 X 484.19 X
34716   1 ZZZ 0 X 527.28 X
34717   2 ZZZ 0 X 540.74 X
34717   3 ZZZ 0 X 540.74 X
34717   4 ZZZ 0 X 540.74 X
34717   1 ZZZ 0 X 592.34 X
34718   2 90 2 X 1,504.91 X
34718   3 90 2 X 1,504.91 X
34718   4 90 2 X 1,504.91 X
34718   1 90 2 X 1,652.20 X
34808   2 ZZZ 0 X 442.30 X
34808   3 ZZZ 0 X 442.30 X
34808   4 ZZZ 0 X 442.30 X
34808   1 ZZZ 0 X 486.35 X
34812   2 0 2 X 723.97 X
34812   3 0 2 X 723.97 X
34812   4 0 2 X 723.97 X
34812   1 0 2 X 796.70 X
34813   2 ZZZ 0 X 514.35 X
34813   3 ZZZ 0 X 514.35 X
34813   4 ZZZ 0 X 514.35 X
34813   1 ZZZ 0 X 565.74 X
34820   2 0 2 X 1,045.33 X
34820   3 0 2 X 1,045.33 X
34820   4 0 2 X 1,045.33 X
34820   1 0 2 X 1,150.06 X
34830   2 90 2 X 3,619.38 X
34830   3 90 2 X 3,619.38 X
34830   4 90 2 X 3,619.38 X
34830   1 90 2 X 3,991.02 X
34831   2 90 2 X 3,913.11 X
34831   3 90 2 X 3,913.11 X
34831   4 90 2 X 3,913.11 X
34831   1 90 2 X 4,313.82 X
34832   2 90 2 X 3,913.11 X
34832   3 90 2 X 3,913.11 X
34832   4 90 2 X 3,913.11 X
34832   1 90 2 X 4,313.82 X
34833   2 90 2 X 1,186.48 X
34833   3 90 2 X 1,186.48 X
34833   4 90 2 X 1,186.48 X
34833   1 90 2 X 1,302.57 X
34834   2 0 2 X 555.35 X
34834   3 0 2 X 555.35 X
34834   4 0 2 X 555.35 X
34834   1 0 2 X 617.98 X
34839     YYY 0 X # X
34841     YYY 0 X * X
34842     YYY 0 X * X
34843     YYY 0 X * X
34844     YYY 0 X * X
34845     YYY 0 X * X
34846     YYY 0 X * X
34847     YYY 0 X * X
34848     YYY 0 X * X
35001   3 90 2 X 3,315.18 X
35001   4 90 2 X 3,411.10 X
35001   2 90 2 X 3,584.23 X
35001   1 90 2 X 3,632.20 X
35002   4 90 2 X 3,043.95 X
35002   3 90 2 X 3,078.63 X
35002   2 90 2 X 3,287.54 X
35002   1 90 2 X 4,397.59 X
35005   4 90 2 X 2,568.21 X
35005   3 90 2 X 2,597.12 X
35005   2 90 2 X 2,778.11 X
35005   1 90 2 X 2,822.09 X
35011   4 90 2 X 2,328.56 X
35011   3 90 2 X 2,771.13 X
35011   2 90 2 X 2,887.68 X
35011   1 90 2 X 2,981.60 X