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2024 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   004 90 2 X 3,855.02 X
33677   003 90 2 X 3,855.02 X
33677   002 90 2 X 3,855.02 X
33677   001 90 2 X 4,399.45 X
33681   002 90 2 X 8,001.99 X
33681   003 90 2 X 7,405.98 X
33681   004 90 2 X 7,300.01 X
33681   001 90 2 X 8,284.29 X
33684   001 90 2 X 8,514.95 X
33684   004 90 2 X 7,520.22 X
33684   003 90 2 X 7,628.51 X
33684   002 90 2 X 8,229.74 X
33688   002 90 2 X 8,343.03 X
33688   003 90 2 X 7,739.21 X
33688   001 90 2 X 8,629.71 X
33688   004 90 2 X 7,629.82 X
33690   004 90 2 X 4,834.98 X
33690   002 90 2 X 5,297.90 X
33690   003 90 2 X 4,904.24 X
33690   001 90 2 X 5,486.01 X
33692   001 90 2 X 9,261.55 X
33692   004 90 2 X 8,140.82 X
33692   003 90 2 X 8,258.82 X
33692   002 90 2 X 8,937.72 X
33694   003 90 2 X 8,370.62 X
33694   002 90 2 X 9,052.16 X
33694   004 90 2 X 8,251.56 X
33694   001 90 2 X 9,377.46 X
33697   003 90 2 X 8,593.14 X
33697   002 90 2 X 9,279.91 X
33697   004 90 2 X 8,471.86 X
33697   001 90 2 X 9,608.18 X
33702   003 90 2 X 6,719.81 X
33702   002 90 2 X 7,240.70 X
33702   004 90 2 X 6,624.75 X
33702   001 90 2 X 7,487.19 X
33710   001 90 2 X 8,519.73 X
33710   004 90 2 X 7,524.75 X
33710   002 90 2 X 8,234.43 X
33710   003 90 2 X 7,633.08 X
33720   004 90 2 X 6,624.75 X
33720   001 90 2 X 7,487.19 X
33720   003 90 2 X 6,719.81 X
33720   002 90 2 X 7,240.70 X
33724   002 90 2 X 2,579.22 X
33724   003 90 2 X 2,579.22 X
33724   001 90 2 X 2,925.75 X
33724   004 90 2 X 2,579.22 X
33726   001 90 2 X 3,843.94 X
33726   004 90 2 X 3,402.05 X
33726   002 90 2 X 3,402.05 X
33726   003 90 2 X 3,402.05 X
33730   001 90 2 X 9,333.79 X
33730   004 90 2 X 8,209.75 X
33730   003 90 2 X 8,328.37 X
33730   002 90 2 X 9,008.94 X
33732   004 90 2 X 6,910.55 X
33732   001 90 2 X 7,798.07 X
33732   003 90 2 X 7,009.30 X
33732   002 90 2 X 7,544.60 X
33735   004 90 2 X 5,460.38 X
33735   002 90 2 X 5,988.76 X
33735   001 90 2 X 6,203.01 X
33735   003 90 2 X 5,539.29 X
33736   001 90 2 X 5,804.48 X
33736   004 90 2 X 5,188.02 X
33736   003 90 2 X 5,251.72 X
33736   002 90 2 X 5,696.71 X
33737   004 90 2 X 5,520.27 X
33737   001 90 2 X 6,265.69 X
33737   003 90 2 X 5,599.81 X
33737   002 90 2 X 6,050.70 X
33741   002 0 2 X 990.92 X
33741   003 0 2 X 990.92 X
33741   001 0 2 X 1,083.13 X
33741   004 0 2 X 990.92 X
33745   001 0 2 X 1,526.08 X
33745   002 0 2 X 1,400.68 X
33745   003 0 2 X 1,400.68 X
33745   004 0 2 X 1,400.68 X
33746   004 ZZZ 0 X 554.09 X
33746   001 ZZZ 0 X 602.21 X
33746   002 ZZZ 0 X 554.09 X
33746   003 ZZZ 0 X 554.09 X
33750   004 90 2 X 5,042.89 X
33750   001 90 2 X 5,703.63 X
33750   002 90 2 X 5,512.76 X
33750   003 90 2 X 5,114.30 X
33755   003 90 2 X 5,154.17 X
33755   002 90 2 X 5,553.59 X
33755   004 90 2 X 5,082.40 X
33755   001 90 2 X 5,745.11 X
33762   003 90 2 X 5,154.17 X
33762   001 90 2 X 5,745.11 X
33762   002 90 2 X 5,553.59 X
33762   004 90 2 X 5,082.40 X
33764   001 90 2 X 7,216.25 X
33764   004 90 2 X 7,216.25 X
33764   002 90 2 X 7,216.25 X
33764   003 90 2 X 7,216.25 X
33766   002 90 2 X 5,666.87 X
33766   003 90 2 X 5,264.90 X
33766   001 90 2 X 5,859.85 X
33766   004 90 2 X 5,192.03 X
33767   001 90 2 X 6,612.28 X
33767   003 90 2 X 5,934.10 X
33767   002 90 2 X 6,392.90 X
33767   004 90 2 X 5,851.25 X
33768   004 ZZZ 0 X 826.60 X
33768   002 ZZZ 0 X 826.60 X
33768   003 ZZZ 0 X 826.60 X
33768   001 ZZZ 0 X 925.32 X
33770   002 90 2 X 9,250.76 X
33770   003 90 2 X 8,564.58 X
33770   001 90 2 X 9,578.55 X
33770   004 90 2 X 8,443.64 X
33771   001 90 2 X 9,724.11 X
33771   004 90 2 X 8,582.55 X
33771   003 90 2 X 8,705.07 X
33771   002 90 2 X 9,394.40 X
33774   001 90 2 X 8,057.11 X
33774   002 90 2 X 7,800.43 X
33774   003 90 2 X 7,259.19 X
33774   004 90 2 X 7,157.98 X
33775   001 90 2 X 8,201.46 X
33775   004 90 2 X 7,295.75 X
33775   002 90 2 X 7,942.83 X
33775   003 90 2 X 7,398.37 X
33776   002 90 2 X 8,685.23 X
33776   003 90 2 X 8,073.56 X
33776   004 90 2 X 7,960.80 X
33776   001 90 2 X 8,976.35 X
33777   004 90 2 X 7,434.71 X
33777   001 90 2 X 8,346.97 X
33777   003 90 2 X 7,538.78 X
33777   002 90 2 X 8,086.51 X
33778   002 90 2 X 15,353.83 X
33778   003 90 2 X 15,353.83 X
33778   004 90 2 X 15,353.83 X
33778   001 90 2 X 15,353.83 X
33779   001 90 2 X 15,353.83 X
33779   004 90 2 X 15,353.83 X
33779   003 90 2 X 15,353.83 X
33779   002 90 2 X 15,353.83 X
33780   002 90 2 X 15,353.83 X
33780   003 90 2 X 15,353.83 X
33780   001 90 2 X 15,353.83 X
33780   004 90 2 X 15,353.83 X
33781   001 90 2 X 15,353.83 X
33781   004 90 2 X 15,353.83 X
33781   003 90 2 X 15,353.83 X
33781   002 90 2 X 15,353.83 X
33782   001 90 2 X 5,354.34 X
33782   004 90 2 X 5,037.02 X
33782   002 90 2 X 5,037.02 X
33782   003 90 2 X 5,037.02 X
33783   002 90 2 X 5,501.55 X
33783   003 90 2 X 5,501.55 X
33783   004 90 2 X 5,501.55 X
33783   001 90 2 X 5,871.57 X
33786   002 90 2 X 13,511.38 X
33786   003 90 2 X 13,511.38 X
33786   004 90 2 X 13,511.38 X
33786   001 90 2 X 13,511.38 X
33788     90 2 X * X
33800   004 90 2 X 2,931.83 X
33800   002 90 2 X 3,177.18 X
33800   003 90 2 X 2,965.67 X
33800   001 90 2 X 3,228.56 X
33802   001 90 2 X 5,283.69 X
33802   002 90 2 X 5,098.12 X
33802   003 90 2 X 4,709.11 X
33802   004 90 2 X 4,641.85 X
33803   004 90 2 X 4,860.95 X
33803   001 90 2 X 5,513.24 X
33803   002 90 2 X 5,324.63 X
33803   003 90 2 X 4,930.58 X
33813   004 90 2 X 7,369.86 X
33813   001 90 2 X 7,369.86 X
33813   003 90 2 X 7,369.86 X
33813   002 90 2 X 7,369.86 X
33814   001 90 2 X 8,598.09 X
33814   004 90 2 X 8,598.09 X
33814   003 90 2 X 8,598.09 X
33814   002 90 2 X 8,598.09 X
33820   004 90 2 X 4,105.32 X
33820   001 90 2 X 4,105.32 X
33820   003 90 2 X 4,105.32 X
33820   002 90 2 X 4,105.32 X
33822   001 90 2 X 5,283.69 X
33822   003 90 2 X 4,709.11 X
33822   002 90 2 X 5,098.12 X
33822   004 90 2 X 4,641.85 X
33824   001 90 2 X 5,513.24 X
33824   004 90 2 X 4,860.95 X
33824   002 90 2 X 5,324.63 X
33824   003 90 2 X 4,930.58 X
33840   002 90 2 X 7,247.00 X
33840   003 90 2 X 7,247.00 X
33840   001 90 2 X 7,247.00 X
33840   004 90 2 X 7,247.00 X
33845   004 90 2 X 8,871.39 X
33845   002 90 2 X 8,871.39 X
33845   003 90 2 X 8,871.39 X
33845   001 90 2 X 8,871.39 X
33851   001 90 2 X 8,598.09 X
33851   004 90 2 X 8,598.09 X
33851   003 90 2 X 8,598.09 X
33851   002 90 2 X 8,598.09 X
33852   004 90 2 X 9,212.33 X
33852   001 90 2 X 9,212.33 X
33852   003 90 2 X 9,212.33 X
33852   002 90 2 X 9,212.33 X
33853   004 90 2 X 10,619.74 X
33853   002 90 2 X 10,619.74 X
33853   001 90 2 X 10,619.74 X
33853   003 90 2 X 10,619.74 X
33858   004 90 2 X 4,809.52 X
33858   001 90 2 X 5,286.22 X
33858   003 90 2 X 4,809.52 X
33858   002 90 2 X 4,809.52 X
33859   003 90 2 X 3,451.44 X
33859   002 90 2 X 3,451.44 X
33859   004 90 2 X 3,451.44 X
33859   001 90 2 X 3,794.55 X
33863   003 90 2 X 9,658.93 X
33863   002 90 2 X 9,718.54 X
33863   001 90 2 X 9,973.17 X
33863   004 90 2 X 9,603.13 X
33864   003 90 2 X 5,477.22 X
33864   002 90 2 X 5,477.22 X
33864   004 90 2 X 5,477.22 X
33864   001 90 2 X 6,067.40 X
33866   002 ZZZ 0 X 1,477.38 X
33866   003 ZZZ 0 X 1,477.38 X
33866   001 ZZZ 0 X 1,610.87 X
33866   004 ZZZ 0 X 1,477.38 X
33871   003 90 2 X 4,624.00 X
33871   002 90 2 X 4,624.00 X
33871   004 90 2 X 4,624.00 X
33871   001 90 2 X 5,083.93 X
33875   004 90 2 X 8,744.34 X
33875   003 90 2 X 8,873.24 X
33875   002 90 2 X 9,331.82 X
33875   001 90 2 X 9,099.84 X
33877   004 90 2 X 10,343.41 X
33877   001 90 2 X 10,804.00 X
33877   003 90 2 X 10,332.86 X
33877   002 90 2 X 10,687.36 X
33880   001 90 2 X 3,798.64 X
33880   004 90 2 X 3,446.25 X
33880   003 90 2 X 3,446.25 X
33880   002 90 2 X 3,446.25 X
33881   003 90 2 X 2,958.37 X
33881   002 90 2 X 2,958.37 X
33881   001 90 2 X 3,264.91 X
33881   004 90 2 X 2,958.37 X
33883   001 90 2 X 2,428.54 X
33883   004 90 2 X 2,181.42 X
33883   003 90 2 X 2,181.42 X
33883   002 90 2 X 2,181.42 X
33884   001 ZZZ 0 X 899.57 X
33884   004 ZZZ 0 X 815.85 X
33884   002 ZZZ 0 X 815.85 X
33884   003 ZZZ 0 X 815.85 X
33886   003 90 2 X 1,882.15 X
33886   002 90 2 X 1,882.15 X
33886   004 90 2 X 1,882.15 X
33886   001 90 2 X 2,098.60 X
33889   002 0 2 X 1,625.18 X
33889   003 0 2 X 1,625.18 X
33889   001 0 2 X 1,811.48 X
33889   004 0 2 X 1,625.18 X
33891   002 0 2 X 2,071.47 X
33891   003 0 2 X 2,071.47 X
33891   004 0 2 X 2,071.47 X
33891   001 0 2 X 2,312.03 X
33894   003 0 2 X 1,154.89 X
33894   002 0 2 X 1,154.89 X
33894   001 0 2 X 1,258.34 X
33894   004 0 2 X 1,154.89 X
33895   002 0 2 X 918.90 X
33895   003 0 2 X 918.90 X
33895   001 0 2 X 1,001.19 X
33895   004 0 2 X 918.90 X
33897   001 0 2 X 745.50 X
33897   004 0 2 X 684.04 X
33897   003 0 2 X 684.04 X
33897   002 0 2 X 684.04 X
33900   002 0 2 X 663.19 X
33900   003 0 2 X 663.19 X
33900   004 0 2 X 663.19 X
33900   001 0 2 X 718.85 X
33901   002 0 2 X 871.61 X
33901   003 0 2 X 871.61 X
33901   004 0 2 X 871.61 X
33901   001 0 2 X 944.70 X
33902   004 0 2 X 842.13 X
33902   001 0 2 X 912.89 X
33902   003 0 2 X 842.13 X
33902   002 0 2 X 842.13 X
33903   002 0 2 X 992.43 X
33903   003 0 2 X 992.43 X
33903   004 0 2 X 992.43 X
33903   001 0 2 X 1,075.78 X
33904   003 ZZZ 0 X 333.10 X
33904   002 ZZZ 0 X 333.10 X
33904   004 ZZZ 0 X 333.10 X
33904   001 ZZZ 0 X 361.17 X
33910   001 90 2 X 4,456.12 X
33910   002 90 2 X 6,166.12 X
33910   003 90 2 X 4,107.32 X
33910   004 90 2 X 4,060.85 X
33915   001 90 2 X 3,745.78 X
33915   004 90 2 X 3,421.09 X
33915   003 90 2 X 3,460.15 X
33915   002 90 2 X 4,499.45 X
33916   004 90 2 X 4,668.03 X
33916   001 90 2 X 5,140.40 X
33916   003 90 2 X 4,721.87 X
33916   002 90 2 X 5,058.63 X
33917   004 90 2 X 6,948.75 X
33917   002 90 2 X 7,638.18 X
33917   003 90 2 X 7,050.91 X
33917   001 90 2 X 7,915.85 X
33920   002 90 2 X 9,109.38 X
33920   003 90 2 X 8,426.60 X
33920   001 90 2 X 9,435.41 X
33920   004 90 2 X 8,306.89 X
33922   001 90 2 X 4,456.12 X
33922   004 90 2 X 4,060.85 X
33922   002 90 2 X 4,387.98 X
33922   003 90 2 X 4,107.32 X
33924   001 ZZZ 0 X 1,246.38 X
33924   004 ZZZ 0 X 1,102.03 X
33924   002 ZZZ 0 X 1,190.37 X
33924   003 ZZZ 0 X 1,118.23 X
33925   004 90 2 X 3,378.81 X
33925   003 90 2 X 3,378.81 X
33925   002 90 2 X 3,378.81 X
33925   001 90 2 X 3,823.04 X
33926   004 90 2 X 4,580.26 X
33926   001 90 2 X 5,151.02 X
33926   003 90 2 X 4,580.26 X
33926   002 90 2 X 4,580.26 X
33927   002 XXX 2 X 3,857.25 X
33927   003 XXX 2 X 3,857.25 X
33927   004 XXX 2 X 3,857.25 X
33927   001 XXX 2 X 4,218.61 X
33928     XXX 2 X # X
33929     ZZZ 0 X # X
33933     XXX 2 X * X
33935   004 90 2 X 14,385.28 X
33935   001 90 2 X 16,217.21 X
33935   002 90 2 X 15,694.88 X
33935   003 90 2 X 14,590.56 X
33944     XXX 2 X * X
33945   003 90 2 X 16,652.74 X
33945   002 90 2 X 16,652.74 X
33945   001 90 2 X 16,652.74 X
33945   004 90 2 X 16,652.74 X
33946   002 XXX 0 X 507.43 X
33946   003 XXX 0 X 507.43 X
33946   001 XXX 0 X 551.25 X
33946   004 XXX 0 X 507.43 X
33947   001 XXX 0 X 599.18 X
33947   003 XXX 0 X 552.92 X
33947   002 XXX 0 X 552.92 X
33947   004 XXX 0 X 552.92 X
33948   002 XXX 0 X 387.39 X
33948   003 XXX 0 X 387.39 X
33948   004 XXX 0 X 387.39 X
33948   001 XXX 0 X 418.03 X
33949   002 XXX 0 X 378.00 X
33949   003 XXX 0 X 378.00 X
33949   004 XXX 0 X 378.00 X
33949   001 XXX 0 X 408.06 X
33951   001 0 2 X 665.11 660.84
33951   004 0 2 X 625.07 621.40
33951   003 0 2 X 625.07 621.40
33951   002 0 2 X 625.07 621.40
33952   003 0 2 X 609.89 605.16
33952   001 0 2 X 647.34 641.84
33952   002 0 2 X 609.89 605.16
33952   004 0 2 X 609.89 605.16
33953   004 0 2 X 695.96 692.30
33953   001 0 2 X 739.97 735.72
33953   002 0 2 X 695.96 692.30
33953   003 0 2 X 695.96 692.30
33954   002 0 2 X 679.18 673.96
33954   003 0 2 X 679.18 673.96
33954   001 0 2 X 720.36 714.23
33954   004 0 2 X 679.18 673.96
33955   001 0 2 X 1,563.70 1,558.20
33955   003 0 2 X 1,431.99 1,427.26
33955   002 0 2 X 1,431.99 1,427.26
33955   004 0 2 X 1,431.99 1,427.26
33956   002 0 2 X 1,358.13 1,352.90
33956   003 0 2 X 1,358.13 1,352.90
33956   001 0 2 X 1,477.28 1,471.18
33956   004 0 2 X 1,358.13 1,352.90
33957   001 0 2 X 551.89 546.36
33957   004 0 2 X 477.53 472.83
33957   002 0 2 X 477.53 472.83
33957   003 0 2 X 477.53 472.83
33958   001 0 2 X 540.23 535.94
33958   002 0 2 X 467.56 463.89
33958   003 0 2 X 467.56 463.89
33958   004 0 2 X 467.56 463.89
33959   004 0 2 X 551.01 546.31
33959   003 0 2 X 551.01 546.31
33959   002 0 2 X 551.01 546.31
33959   001 0 2 X 629.83 624.30
33962   001 0 2 X 602.23 596.11
33962   004 0 2 X 527.46 522.23
33962   003 0 2 X 527.46 522.23
33962   002 0 2 X 527.46 522.23
33963   004 0 2 X 896.99 892.30
33963   003 0 2 X 896.99 892.30
33963   002 0 2 X 896.99 892.30
33963   001 0 2 X 996.56 991.05
33964   003 0 2 X 909.49 905.82
33964   002 0 2 X 909.49 905.82
33964   001 0 2 X 1,006.95 1,002.68
33964   004 0 2 X 909.49 905.82
33965   001 0 2 X 546.36 551.89
33965   004 0 2 X 472.83 477.53
33965   002 0 2 X 472.83 477.53
33965   003 0 2 X 472.83 477.53
33966   002 0 2 X 524.43 529.65
33966   003 0 2 X 524.43 529.65
33966   001 0 2 X 598.45 604.58
33966   004 0 2 X 524.43 529.65
33967   001 0 2 X 617.49 613.05
33967   002 0 2 X 563.00 559.22
33967   003 0 2 X 563.00 559.22
33967   004 0 2 X 563.00 559.22
33968   002 0 0 X 93.09 X
33968   003 0 0 X 93.09 X
33968   004 0 0 X 93.09 X
33968   001 0 0 X 112.44 X
33969   003 0 2 X 549.56 545.37
33969   002 0 2 X 549.56 545.37
33969   004 0 2 X 549.56 545.37
33969   001 0 2 X 615.33 610.40
33970   001 0 2 X 2,379.79 X
33970   004 0 2 X 2,294.28 X
33970   002 0 2 X 2,234.61 X
33970   003 0 2 X 2,295.16 X
33971   004 90 2 X 924.98 X
33971   001 90 2 X 992.99 X
33971   003 90 2 X 932.58 X
33971   002 90 2 X 971.33 X
33973   004 0 2 X 2,353.69 X
33973   002 0 2 X 2,296.03 X
33973   003 0 2 X 2,355.08 X
33973   001 0 2 X 2,441.52 X
33974   001 90 2 X 1,319.22 X
33974   004 90 2 X 1,238.08 X
33974   002 90 2 X 1,295.60 X
33974   003 90 2 X 1,248.63 X
33975     XXX 2 X * X
33976   001 XXX 2 X 5,657.03 X
33976   004 XXX 2 X 5,137.10 X
33976   003 XXX 2 X 5,196.36 X
33976   002 XXX 2 X 5,567.05 X
33977     XXX 2 X * X
33978   001 XXX 2 X 4,151.09 X
33978   004 XXX 2 X 3,769.84 X
33978   003 XXX 2 X 3,813.25 X
33978   002 XXX 2 X 4,085.14 X
33979     XXX 2 X * X
33980     XXX 2 X * X
33981     XXX 2 X * X
33982     XXX 2 X * X
33983     XXX 2 X * X
33984   001 0 2 X 601.56 595.43
33984   002 0 2 X 539.50 534.29
33984   003 0 2 X 539.50 534.29
33984   004 0 2 X 539.50 534.29
33985   003 0 2 X 1,016.74 1,011.99
33985   002 0 2 X 1,016.74 1,011.99
33985   004 0 2 X 1,016.74 1,011.99
33985   001 0 2 X 1,134.90 1,129.37
33986   003 0 2 X 972.12 966.91
33986   002 0 2 X 972.12 966.91
33986   001 0 2 X 1,081.79 1,075.66
33986   004 0 2 X 972.12 966.91
33987   004 ZZZ 0 X 409.32 X
33987   002 ZZZ 0 X 409.32 X
33987   003 ZZZ 0 X 409.32 X
33987   001 ZZZ 0 X 458.57 X
33988   001 0 2 X 1,283.63 1,276.90
33988   004 0 2 X 1,193.21 1,187.47
33988   002 0 2 X 1,193.21 1,187.47
33988   003 0 2 X 1,193.21 1,187.47
33989   004 0 2 X 796.94 791.72
33989   002 0 2 X 796.94 791.72
33989   001 0 2 X 865.56 859.44
33989   003 0 2 X 796.94 791.72
33990   004 0 2 X 716.00 X
33990   001 0 2 X 796.96 X
33990   003 0 2 X 716.00 X
33990   002 0 2 X 716.00 X
33991   002 0 2 X 1,043.28 X
33991   003 0 2 X 1,043.28 X
33991   004 0 2 X 1,043.28 X
33991   001 0 2 X 1,161.15 X
33992   002 0 2 X 341.43 X
33992   003 0 2 X 341.43 X
33992   004 0 2 X 341.43 X
33992   001 0 2 X 379.50 X
33993   002 0 2 X 299.75 X
33993   003 0 2 X 299.75 X
33993   001 0 2 X 333.18 X
33993   004 0 2 X 299.75 X
33995   004 0 2 X 476.00 X
33995   001 0 2 X 519.50 X
33995   003 0 2 X 476.00 X
33995   002 0 2 X 476.00 X
33997   001 0 2 X 231.11 X
33997   004 0 2 X 211.75 X
33997   003 0 2 X 211.75 X
33997   002 0 2 X 211.75 X
33999     YYY 2 X # X
34001   002 90 2 X 3,412.80 X
34001   003 90 2 X 3,227.48 X
34001   004 90 2 X 3,232.02 X
34001   001 90 2 X 3,478.58 X
34051   001 90 2 X 2,719.86 X
34051   004 90 2 X 2,484.54 X
34051   003 90 2 X 2,654.67 X
34051   002 90 2 X 2,679.41 X
34101   004 90 2 X 2,328.14 X
34101   001 90 2 X 2,419.44 X
34101   003 90 2 X 1,958.69 X
34101   002 90 2 X 2,290.05 X
34111   004 90 2 X 2,221.42 X
34111   001 90 2 X 2,304.09 X
34111   003 90 2 X 2,229.88 X
34111   002 90 2 X 2,289.63 X
34151   003 90 2 X 3,356.54 X
34151   002 90 2 X 3,438.47 X
34151   004 90 2 X 3,331.18 X
34151   001 90 2 X 3,480.31 X
34201   002 90 2 X 2,297.43 X
34201   003 90 2 X 1,950.05 X
34201   004 90 2 X 2,458.93 X
34201   001 90 2 X 2,620.80 X
34203   001 90 2 X 2,788.26 X
34203   004 90 2 X 2,681.62 X
34203   003 90 2 X 2,697.21 X
34203   002 90 2 X 2,769.61 X
34401   002 90 2 X 2,386.07 X
34401   003 90 2 X 2,688.87 X
34401   001 90 2 X 2,389.28 X
34401   004 90 2 X 2,181.16 X
34421   003 90 2 X 2,471.02 X
34421   002 90 2 X 2,561.99 X
34421   004 90 2 X 2,428.07 X
34421   001 90 2 X 2,639.95 X
34451   003 90 2 X 2,434.15 X
34451   002 90 2 X 2,491.33 X
34451   004 90 2 X 2,679.78 X
34451   001 90 2 X 2,520.37 X
34471   001 90 2 X 1,474.09 X
34471   004 90 2 X 1,369.68 X
34471   002 90 2 X 1,456.56 X
34471   003 90 2 X 1,384.60 X
34490   001 90 2 X 1,901.39 X
34490   004 90 2 X 1,808.81 X
34490   003 90 2 X 1,898.72 X
34490   002 90 2 X 1,951.50 X
34501   001 90 2 X 3,684.92 X
34501   004 90 2 X 3,684.92 X
34501   002 90 2 X 3,684.92 X
34501   003 90 2 X 3,684.92 X
34502   004 90 2 X 4,954.20 X
34502   001 90 2 X 5,455.33 X
34502   003 90 2 X 5,011.31 X
34502   002 90 2 X 5,368.65 X
34510   001 90 2 X 3,684.92 X
34510   003 90 2 X 3,684.92 X
34510   002 90 2 X 3,684.92 X
34510   004 90 2 X 3,684.92 X
34520   004 90 2 X 4,606.12 X
34520   002 90 2 X 4,606.12 X
34520   003 90 2 X 4,606.12 X
34520   001 90 2 X 4,606.12 X
34530   002 90 2 X 3,684.92 X
34530   003 90 2 X 3,684.92 X
34530   001 90 2 X 3,684.92 X
34530   004 90 2 X 3,684.92 X
34701   004 90 2 X 1,863.16 X
34701   001 90 2 X 2,031.47 X
34701   003 90 2 X 1,863.16 X
34701   002 90 2 X 1,863.16 X
34702   004 90 2 X 2,784.78 X
34702   001 90 2 X 3,031.74 X
34702   003 90 2 X 2,784.78 X
34702   002 90 2 X 2,784.78 X
34703   004 90 2 X 2,100.92 X
34703   001 90 2 X 2,296.32 X
34703   003 90 2 X 2,100.92 X
34703   002 90 2 X 2,100.92 X
34704   002 90 2 X 3,496.64 X
34704   003 90 2 X 3,496.64 X
34704   004 90 2 X 3,496.64 X
34704   001 90 2 X 3,814.34 X
34705   001 90 2 X 2,522.98 X
34705   004 90 2 X 2,313.81 X
34705   002 90 2 X 2,313.81 X
34705   003 90 2 X 2,313.81 X
34706   001 90 2 X 3,797.34 X
34706   004 90 2 X 3,484.68 X
34706   003 90 2 X 3,484.68 X
34706   002 90 2 X 3,484.68 X
34707   004 90 2 X 1,738.18 X
34707   001 90 2 X 1,894.42 X
34707   003 90 2 X 1,738.18 X
34707   002 90 2 X 1,738.18 X
34708   004 90 2 X 2,799.66 X
34708   001 90 2 X 3,047.23 X
34708   003 90 2 X 2,799.66 X
34708   002 90 2 X 2,799.66 X
34709   001 ZZZ 0 X 534.33 X
34709   004 ZZZ 0 X 490.70 X
34709   003 ZZZ 0 X 490.70 X
34709   002 ZZZ 0 X 490.70 X
34710   004 90 2 X 1,211.13 X
34710   002 90 2 X 1,211.13 X
34710   003 90 2 X 1,211.13 X
34710   001 90 2 X 1,323.03 X
34711   004 ZZZ 0 X 453.06 X
34711   003 ZZZ 0 X 453.06 X
34711   002 ZZZ 0 X 453.06 X
34711   001 ZZZ 0 X 493.43 X
34712   001 90 2 X 1,127.65 X
34712   003 90 2 X 1,030.63 X
34712   002 90 2 X 1,030.63 X
34712   004 90 2 X 1,030.63 X
34713   002 ZZZ 0 X 195.11 X
34713   003 ZZZ 0 X 195.11 X
34713   004 ZZZ 0 X 195.11 X
34713   001 ZZZ 0 X 212.58 X
34714   002 ZZZ 0 X 409.32 X
34714   003 ZZZ 0 X 409.32 X
34714   001 ZZZ 0 X 445.55 X
34714   004 ZZZ 0 X 409.32 X
34715   001 ZZZ 0 X 496.92 X
34715   002 ZZZ 0 X 457.61 X
34715   003 ZZZ 0 X 457.61 X
34715   004 ZZZ 0 X 457.61 X
34716   004 ZZZ 0 X 567.39 X
34716   001 ZZZ 0 X 617.88 X
34716   002 ZZZ 0 X 567.39 X
34716   003 ZZZ 0 X 567.39 X
34717   004 ZZZ 0 X 633.66 X
34717   001 ZZZ 0 X 694.12 X
34717   002 ZZZ 0 X 633.66 X
34717   003 ZZZ 0 X 633.66 X
34718   001 90 2 X 1,936.11 X
34718   004 90 2 X 1,763.50 X
34718   002 90 2 X 1,763.50 X
34718   003 90 2 X 1,763.50 X
34808   002 ZZZ 0 X 518.29 X
34808   003 ZZZ 0 X 518.29 X
34808   001 ZZZ 0 X 569.92 X
34808   004 ZZZ 0 X 518.29 X
34812   004 ZZZ 0 X 848.37 X
34812   002 ZZZ 0 X 848.37 X
34812   003 ZZZ 0 X 848.37 X
34812   001 ZZZ 0 X 933.60 X
34813   004 ZZZ 0 X 602.73 X
34813   001 ZZZ 0 X 662.96 X
34813   002 ZZZ 0 X 602.73 X
34813   003 ZZZ 0 X 602.73 X
34820   001 ZZZ 0 X 1,347.67 X
34820   004 ZZZ 0 X 1,224.95 X
34820   002 ZZZ 0 X 1,224.95 X
34820   003 ZZZ 0 X 1,224.95 X
34830   002 90 2 X 4,241.31 X
34830   003 90 2 X 4,241.31 X
34830   001 90 2 X 4,676.81 X
34830   004 90 2 X 4,241.31 X
34831   002 90 2 X 4,585.52 X
34831   003 90 2 X 4,585.52 X
34831   004 90 2 X 4,585.52 X
34831   001 90 2 X 5,055.08 X
34832   002 90 2 X 4,585.52 X
34832   003 90 2 X 4,585.52 X
34832   001 90 2 X 5,055.08 X
34832   004 90 2 X 4,585.52 X
34833   001 ZZZ 0 X 1,526.40 X
34833   003 ZZZ 0 X 1,390.36 X
34833   002 ZZZ 0 X 1,390.36 X
34833   004 ZZZ 0 X 1,390.36 X
34834   002 ZZZ 0 X 650.77 X
34834   003 ZZZ 0 X 650.77 X
34834   004 ZZZ 0 X 650.77 X
34834   001 ZZZ 0 X 724.17 X
34839     YYY 0 X # X
34841     YYY 2 X * X
34842     YYY 2 X * X
34843     YYY 2 X * X
34844     YYY 2 X * X
34845     YYY 2 X * X
34846     YYY 2 X * X
34847     YYY 2 X * X
34848     YYY 2 X * X
35001   001 90 2 X 4,256.34 X
35001   004 90 2 X 3,997.24 X
35001   003 90 2 X 3,884.84 X
35001   002 90 2 X 4,200.12 X
35002   002 90 2 X 3,852.45 X
35002   003 90 2 X 3,607.64 X
35002   004 90 2 X 3,567.00 X
35002   001 90 2 X 5,153.24 X
35005   001 90 2 X 3,307.02 X
35005   004 90 2 X 3,009.51 X
35005   003 90 2 X 3,043.39 X
35005   002 90 2 X 3,255.48 X
35011   002 90 2 X 3,383.88 X
35011   003 90 2 X 3,247.30 X
35011   001 90 2 X 3,493.94 X
35011   004 90 2 X 2,728.68 X