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2021 Workers' Compensation Part B Fee Schedule

35606-36578

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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
35606   4 90 2 X 3,381.09 X
35606   3 90 2 X 3,850.13 X
35606   2 90 2 X 4,031.73 X
35606   1 90 2 X 4,104.64 X
35612   3 90 2 X 3,060.50 X
35612   2 90 2 X 3,316.67 X
35612   4 90 2 X 3,470.49 X
35612   1 90 2 X 3,688.19 X
35616   4 90 2 X 3,038.01 X
35616   2 90 2 X 3,336.04 X
35616   1 90 2 X 3,399.37 X
35616   3 90 2 X 3,423.10 X
35621   3 90 2 X 4,189.46 X
35621   4 90 2 X 4,223.18 X
35621   2 90 2 X 4,324.99 X
35621   1 90 2 X 4,406.87 X
35623   4 90 2 X 2,243.53 X
35623   3 90 2 X 2,268.17 X
35623   2 90 2 X 2,422.34 X
35623   1 90 2 X 2,459.87 X
35626   4 90 2 X 4,122.69 X
35626   3 90 2 X 4,171.31 X
35626   2 90 2 X 4,496.97 X
35626   1 90 2 X 4,575.86 X
35631   4 90 2 X 3,930.96 X
35631   3 90 2 X 3,976.42 X
35631   2 90 2 X 4,268.95 X
35631   1 90 2 X 4,339.95 X
35632   2 90 2 X 2,940.84 X
35632   3 90 2 X 2,940.84 X
35632   4 90 2 X 2,940.84 X
35632   1 90 2 X 3,242.31 X
35633   2 90 2 X 3,176.44 X
35633   3 90 2 X 3,176.44 X
35633   4 90 2 X 3,176.44 X
35633   1 90 2 X 3,501.55 X
35634   2 90 2 X 2,877.95 X
35634   3 90 2 X 2,877.95 X
35634   4 90 2 X 2,877.95 X
35634   1 90 2 X 3,173.17 X
35636   4 90 2 X 3,275.50 X
35636   3 90 2 X 3,312.93 X
35636   2 90 2 X 3,531.72 X
35636   1 90 2 X 3,584.91 X
35637   2 90 2 X 2,523.50 X
35637   3 90 2 X 2,523.50 X
35637   4 90 2 X 2,523.50 X
35637   1 90 2 X 2,845.17 X
35638   2 90 2 X 2,563.39 X
35638   3 90 2 X 2,563.39 X
35638   4 90 2 X 2,563.39 X
35638   1 90 2 X 2,890.15 X
35642   4 90 2 X 2,581.28 X
35642   3 90 2 X 2,610.39 X
35642   2 90 2 X 2,792.19 X
35642   1 90 2 X 2,836.48 X
35645   4 90 2 X 2,591.90 X
35645   3 90 2 X 2,621.72 X
35645   2 90 2 X 4,443.82 X
35645   1 90 2 X 4,462.07 X
35646   4 90 2 X 4,476.24 X
35646   3 90 2 X 4,671.20 X
35646   2 90 2 X 5,044.37 X
35646   1 90 2 X 5,134.77 X
35647   2 90 2 X 2,874.44 X
35647   3 90 2 X 2,874.44 X
35647   4 90 2 X 2,874.44 X
35647   1 90 2 X 3,210.47 X
35650   4 90 2 X 2,923.97 X
35650   3 90 2 X 4,646.92 X
35650   2 90 2 X 4,789.52 X
35650   1 90 2 X 4,848.00 X
35654   3 90 2 X 4,451.41 X
35654   4 90 2 X 4,623.88 X
35654   1 90 2 X 4,658.52 X
35654   2 90 2 X 4,706.87 X
35656   2 90 2 X 3,692.07 X
35656   4 90 2 X 3,715.95 X
35656   3 90 2 X 3,728.87 X
35656   1 90 2 X 3,874.21 X
35661   3 90 2 X 3,095.94 X
35661   4 90 2 X 3,186.68 X
35661   2 90 2 X 3,268.72 X
35661   1 90 2 X 3,353.44 X
35663   4 90 2 X 2,940.29 X
35663   1 90 2 X 3,316.42 X
35663   2 90 2 X 3,495.89 X
35663   3 90 2 X 3,626.19 X
35665   3 90 2 X 3,471.88 X
35665   4 90 2 X 3,489.00 X
35665   2 90 2 X 3,641.01 X
35665   1 90 2 X 3,730.54 X
35666   4 90 2 X 3,511.21 X
35666   2 90 2 X 3,859.60 X
35666   3 90 2 X 4,003.42 X
35666   1 90 2 X 4,556.38 X
35671   4 90 2 X 5,012.13 X
35671   3 90 2 X 5,028.24 X
35671   2 90 2 X 5,183.03 X
35671   1 90 2 X 5,190.96 X
35681   4 ZZZ 0 X 2,337.71 X
35681   3 ZZZ 0 X 2,366.65 X
35681   2 ZZZ 0 X 2,609.68 X
35681   1 ZZZ 0 X 2,668.58 X
35682   2 ZZZ 0 X 867.50 862.53
35682   3 ZZZ 0 X 867.50 862.53
35682   4 ZZZ 0 X 867.50 862.53
35682   1 ZZZ 0 X 1,038.39 1,032.62
35683   2 ZZZ 0 X 1,000.42 993.38
35683   3 ZZZ 0 X 1,000.42 993.38
35683   4 ZZZ 0 X 1,000.42 993.38
35683   1 ZZZ 0 X 1,180.85 1,172.64
35685   2 ZZZ 0 X 399.62 X
35685   3 ZZZ 0 X 399.62 X
35685   4 ZZZ 0 X 399.62 X
35685   1 ZZZ 0 X 444.62 X
35686   2 ZZZ 0 X 330.55 X
35686   3 ZZZ 0 X 330.55 X
35686   4 ZZZ 0 X 330.55 X
35686   1 ZZZ 0 X 367.79 X
35691   4 90 2 X 3,522.57 X
35691   3 90 2 X 3,565.35 X
35691   1 90 2 X 3,934.49 X
35691   2 90 2 X 4,976.89 X
35693   4 90 2 X 2,234.35 X
35693   3 90 2 X 2,259.80 X
35693   2 90 2 X 2,418.96 X
35693   1 90 2 X 2,457.63 X
35694   4 90 2 X 2,592.63 X
35694   3 90 2 X 2,621.16 X
35694   2 90 2 X 2,799.00 X
35694   1 90 2 X 2,842.34 X
35695   4 90 2 X 2,592.63 X
35695   3 90 2 X 2,621.16 X
35695   2 90 2 X 2,799.00 X
35695   1 90 2 X 2,842.34 X
35697   2 ZZZ 0 X 296.09 X
35697   3 ZZZ 0 X 296.09 X
35697   4 ZZZ 0 X 296.09 X
35697   1 ZZZ 0 X 329.78 X
35700   4 ZZZ 0 X 447.98 X
35700   3 ZZZ 0 X 452.95 X
35700   2 ZZZ 0 X 483.76 X
35700   1 ZZZ 0 X 491.24 X
35701   4 90 2 X 1,053.32 X
35701   3 90 2 X 1,332.79 X
35701   2 90 2 X 1,372.66 X
35701   1 90 2 X 1,382.26 X
35702   2 90 2 X 494.17 X
35702   3 90 2 X 494.17 X
35702   4 90 2 X 494.17 X
35702   1 90 2 X 544.29 X
35703   2 90 2 X 502.43 X
35703   3 90 2 X 502.43 X
35703   4 90 2 X 502.43 X
35703   1 90 2 X 553.00 X
35800   4 90 2 X 1,081.91 X
35800   3 90 2 X 1,094.68 X
35800   2 90 2 X 1,175.76 X
35800   1 90 2 X 1,195.39 X
35820   4 90 2 X 2,175.74 X
35820   3 90 2 X 2,184.65 X
35820   1 90 2 X 2,229.11 X
35820   2 90 2 X 2,237.70 X
35840   4 90 2 X 2,084.27 X
35840   3 90 2 X 2,140.52 X
35840   2 90 2 X 2,147.67 X
35840   1 90 2 X 2,179.45 X
35860   4 90 2 X 1,398.61 X
35860   3 90 2 X 1,407.14 X
35860   2 90 2 X 1,436.38 X
35860   1 90 2 X 1,452.96 X
35870   1 90 2 X 7,861.47 X
35870   2 90 2 X 7,861.47 X
35870   3 90 2 X 7,861.47 X
35870   4 90 2 X 7,861.47 X
35875   4 90 2 X 2,086.13 X
35875   3 90 2 X 2,092.82 X
35875   2 90 2 X 2,141.97 X
35875   1 90 2 X 2,160.77 X
35876   4 90 2 X 2,199.76 X
35876   3 90 2 X 2,207.48 X
35876   2 90 2 X 2,259.42 X
35876   1 90 2 X 2,278.93 X
35879   2 90 2 X 1,910.00 X
35879   3 90 2 X 1,910.00 X
35879   4 90 2 X 1,910.00 X
35879   1 90 2 X 2,141.16 X
35881   2 90 2 X 2,095.23 X
35881   3 90 2 X 2,095.23 X
35881   4 90 2 X 2,095.23 X
35881   1 90 2 X 2,345.90 X
35883   2 90 2 X 1,841.84 X
35883   3 90 2 X 1,841.84 X
35883   4 90 2 X 1,841.84 X
35883   1 90 2 X 2,085.53 X
35884   2 90 2 X 1,956.25 X
35884   3 90 2 X 1,956.25 X
35884   4 90 2 X 1,956.25 X
35884   1 90 2 X 2,214.81 X
35901   4 90 2 X 1,418.68 X
35901   3 90 2 X 1,428.74 X
35901   2 90 2 X 1,495.15 X
35901   1 90 2 X 1,511.96 X
35903   4 90 2 X 1,459.72 X
35903   3 90 2 X 1,470.14 X
35903   2 90 2 X 1,537.58 X
35903   1 90 2 X 1,554.64 X
35905   4 90 2 X 1,704.28 X
35905   3 90 2 X 1,716.94 X
35905   2 90 2 X 1,790.38 X
35905   1 90 2 X 1,808.99 X
35907   4 90 2 X 1,727.72 X
35907   3 90 2 X 1,740.65 X
35907   2 90 2 X 1,814.60 X
35907   1 90 2 X 1,833.38 X
36000   2 XXX 2 X 80.26 X
36000   1 XXX 2 X 85.47 X
36000   3 XXX 2 X 115.82 X
36000   4 XXX 2 X 130.97 X
36002   2 0 2 X 331.41 206.71
36002   3 0 2 X 331.41 206.71
36002   4 0 2 X 331.41 206.71
36002   1 0 2 X 373.29 226.68
36005   2 0 2 X 115.82 X
36005   1 0 2 X 121.22 X
36005   3 0 2 X 150.44 X
36005   4 0 2 X 165.22 X
36010   4 XXX 2 X 485.32 X
36010   3 XXX 2 X 495.31 X
36010   2 XXX 2 X 518.69 X
36010   1 XXX 2 X 528.56 X
36011   4 XXX 2 X 433.81 X
36011   3 XXX 2 X 438.86 X
36011   2 XXX 2 X 463.00 X
36011   1 XXX 2 X 468.84 X
36012   4 XXX 2 X 536.33 X
36012   3 XXX 2 X 542.76 X
36012   2 XXX 2 X 575.23 X
36012   1 XXX 2 X 583.13 X
36013   4 XXX 2 X 490.27 X
36013   3 XXX 2 X 500.29 X
36013   2 XXX 2 X 524.10 X
36013   1 XXX 2 X 534.13 X
36014   4 XXX 2 X 458.91 X
36014   3 XXX 2 X 464.33 X
36014   2 XXX 2 X 492.07 X
36014   1 XXX 2 X 498.79 X
36015   4 XXX 2 X 536.33 X
36015   3 XXX 2 X 542.76 X
36015   2 XXX 2 X 575.23 X
36015   1 XXX 2 X 583.13 X
36100   3 XXX 2 X 493.57 X
36100   4 XXX 2 X 506.24 X
36100   2 XXX 2 X 524.64 X
36100   1 XXX 2 X 532.23 X
36140   3 XXX 2 X 389.61 X
36140   4 XXX 2 X 398.20 X
36140   2 XXX 2 X 417.44 X
36140   1 XXX 2 X 432.95 X
36160   4 XXX 2 X 456.52 X
36160   3 XXX 2 X 462.03 X
36160   2 XXX 2 X 494.03 X
36160   1 XXX 2 X 501.80 X
36200   4 XXX 2 X 495.38 X
36200   3 XXX 2 X 501.44 X
36200   2 XXX 2 X 531.64 X
36200   1 XXX 2 X 538.97 X
36215   4 XXX 2 X 617.19 X
36215   3 XXX 2 X 624.47 X
36215   2 XXX 2 X 656.07 X
36215   1 XXX 2 X 663.66 X
36216   4 XXX 2 X 729.85 X
36216   3 XXX 2 X 738.51 X
36216   2 XXX 2 X 775.77 X
36216   1 XXX 2 X 784.73 X
36217   4 XXX 2 X 869.50 X
36217   3 XXX 2 X 879.79 X
36217   2 XXX 2 X 924.04 X
36217   1 XXX 2 X 934.74 X
36218   4 XXX 0 X 138.80 X
36218   3 XXX 0 X 140.42 X
36218   2 XXX 0 X 147.44 X
36218   1 XXX 0 X 149.17 X
36221   2 0 2 X 1,507.85 301.87
36221   3 0 2 X 1,507.85 301.87
36221   4 0 2 X 1,507.85 301.87
36221   1 0 2 X 1,732.80 333.94
36222   2 0 2 X 1,868.37 406.31
36222   3 0 2 X 1,868.37 406.31
36222   4 0 2 X 1,868.37 406.31
36222   1 0 2 X 2,143.83 447.96
36223   2 0 2 X 2,043.71 439.29
36223   3 0 2 X 2,043.71 439.29
36223   4 0 2 X 2,043.71 439.29
36223   1 0 2 X 2,345.16 484.19
36224   2 0 2 X 2,219.19 477.67
36224   3 0 2 X 2,219.19 477.67
36224   4 0 2 X 2,219.19 477.67
36224   1 0 2 X 2,545.87 525.86
36225   2 0 2 X 2,028.88 437.48
36225   3 0 2 X 2,028.88 437.48
36225   4 0 2 X 2,028.88 437.48
36225   1 0 2 X 2,327.84 481.93
36226   2 0 2 X 2,261.58 478.52
36226   3 0 2 X 2,261.58 478.52
36226   4 0 2 X 2,261.58 478.52
36226   1 0 2 X 2,595.04 526.85
36227   2 ZZZ 0 X 331.98 151.18
36227   3 ZZZ 0 X 331.98 151.18
36227   4 ZZZ 0 X 331.98 151.18
36227   1 ZZZ 0 X 375.67 165.94
36228   2 ZZZ 0 X 1,550.73 307.95
36228   3 ZZZ 0 X 1,550.73 307.95
36228   4 ZZZ 0 X 1,550.73 307.95
36228   1 ZZZ 0 X 1,779.51 338.00
36245   4 XXX 2 X 700.47 X
36245   3 XXX 2 X 708.79 X
36245   2 XXX 2 X 744.55 X
36245   1 XXX 2 X 753.15 X
36246   4 XXX 2 X 729.85 X
36246   3 XXX 2 X 738.51 X
36246   2 XXX 2 X 775.77 X
36246   1 XXX 2 X 784.73 X
36247   4 XXX 2 X 869.50 X
36247   3 XXX 2 X 879.79 X
36247   2 XXX 2 X 924.04 X
36247   1 XXX 2 X 934.74 X
36248   4 XXX 0 X 138.80 X
36248   3 XXX 0 X 140.42 X
36248   2 XXX 0 X 147.44 X
36248   1 XXX 0 X 149.17 X
36251   2 0 2 X 1,964.26 404.11
36251   3 0 2 X 1,964.26 404.11
36251   4 0 2 X 1,964.26 404.11
36251   1 0 2 X 2,255.91 446.24
36252   2 0 2 X 2,162.98 526.39
36252   3 0 2 X 2,162.98 526.39
36252   4 0 2 X 2,162.98 526.39
36252   1 0 2 X 2,479.39 581.06
36253   2 0 2 X 3,001.13 562.98
36253   3 0 2 X 3,001.13 562.98
36253   4 0 2 X 3,001.13 562.98
36253   1 0 2 X 3,449.27 621.25
36254   2 0 2 X 3,124.17 607.34
36254   3 0 2 X 3,124.17 607.34
36254   4 0 2 X 3,124.17 607.34
36254   1 0 2 X 3,589.44 670.15
36260   4 90 2 X 1,536.79 X
36260   3 90 2 X 1,554.40 X
36260   2 90 2 X 1,668.77 X
36260   1 90 2 X 1,696.51 X
36261   4 90 2 X 680.65 X
36261   3 90 2 X 688.13 X
36261   1 90 2 X 737.80 X
36261   2 90 2 X 959.38 X
36262   4 90 2 X 532.80 X
36262   3 90 2 X 566.22 X
36262   2 90 2 X 573.32 X
36262   1 90 2 X 581.76 X
36299     YYY 2 X # X
36400   4 XXX 2 X 22.96 19.33
36400   3 XXX 2 X 23.12 19.57
36400   2 XXX 2 X 24.40 20.55
36400   1 XXX 2 X 24.63 20.73
36405   4 XXX 2 X 53.09 X
36405   3 XXX 2 X 53.83 X
36405   2 XXX 2 X 57.54 X
36405   1 XXX 2 X 58.37 X
36406   4 XXX 2 X 30.38 X
36406   3 XXX 2 X 30.77 X
36406   2 XXX 2 X 32.39 X
36406   1 XXX 2 X 32.79 X
36410   4 XXX 2 X 34.05 X
36410   3 XXX 2 X 34.49 X
36410   2 XXX 2 X 36.63 X
36410   1 XXX 2 X 37.22 X
36415     XXX 9 X 8.79 X
36416     XXX 9 X * X
36420   3 XXX 2 X 110.95 X
36420   2 XXX 2 X 138.11 X
36420   1 XXX 2 X 139.63 X
36420   4 XXX 2 X 163.30 X
36425   2 XXX 2 X 118.34 113.15
36425   4 XXX 2 X 118.53 113.20
36425   3 XXX 2 X 139.59 133.65
36425   1 XXX 2 X 141.88 135.56
36430   3 XXX 0 X 74.61 X
36430   2 XXX 0 X 77.37 X
36430   4 XXX 0 X 82.69 X
36430   1 XXX 0 X 87.83 X
36440   4 XXX 2 X 178.93 X
36440   3 XXX 2 X 181.19 X
36440   2 XXX 2 X 191.18 X
36440   1 XXX 2 X 193.60 X
36450   4 XXX 2 X 352.44 X
36450   3 XXX 2 X 356.73 X
36450   1 XXX 2 X 655.54 X
36450   2 XXX 2 X 746.91 X
36455   4 XXX 2 X 404.86 X
36455   3 XXX 2 X 409.89 X
36455   2 XXX 2 X 434.42 X
36455   1 XXX 2 X 440.38 X
36456   2 XXX 2 X 139.94 X
36456   3 XXX 2 X 139.94 X
36456   4 XXX 2 X 139.94 X
36456   1 XXX 2 X 151.39 X
36460   1 XXX 2 X 1,630.53 X
36460   2 XXX 2 X 1,630.53 X
36460   3 XXX 2 X 1,630.53 X
36460   4 XXX 2 X 1,630.53 X
36465   2 0 2 X 1,904.19 154.18
36465   3 0 2 X 1,904.19 154.18
36465   4 0 2 X 1,904.19 154.18
36465   1 0 2 X 2,175.87 167.86
36466   2 0 2 X 1,991.42 196.07
36466   3 0 2 X 1,991.42 196.07
36466   4 0 2 X 1,991.42 196.07
36466   1 0 2 X 2,273.35 213.29
36468     XXX 2 X * X
36470   4 10 2 X 95.71 86.63
36470   3 10 2 X 104.23 94.12
36470   2 10 2 X 104.72 94.65
36470   1 10 2 X 106.71 96.24
36471   4 10 2 X 171.50 154.95
36471   3 10 2 X 173.30 156.51
36471   2 10 2 X 180.67 162.95
36471   1 10 2 X 182.47 164.46
36473   2 0 2 X 1,836.66 228.20
36473   3 0 2 X 1,836.66 228.20
36473   4 0 2 X 1,836.66 228.20
36473   1 0 2 X 2,109.89 246.27
36474   2 ZZZ 0 X 340.47 114.32
36474   3 ZZZ 0 X 340.47 114.32
36474   4 ZZZ 0 X 340.47 114.32
36474   1 ZZZ 0 X 385.43 123.39
36475   2 0 2 X 3,658.49 631.42
36475   3 0 2 X 3,658.49 631.42
36475   4 0 2 X 3,658.49 631.42
36475   1 0 2 X 4,314.68 686.18
36476   2 ZZZ 0 X 726.62 309.06
36476   3 ZZZ 0 X 726.62 309.06
36476   4 ZZZ 0 X 726.62 309.06
36476   1 ZZZ 0 X 835.25 334.70
36478   2 0 2 X 3,372.26 631.42
36478   3 0 2 X 3,372.26 631.42
36478   4 0 2 X 3,372.26 631.42
36478   1 0 2 X 3,971.59 686.18
36479   2 ZZZ 0 X 733.43 309.06
36479   3 ZZZ 0 X 733.43 309.06
36479   4 ZZZ 0 X 733.43 309.06
36479   1 ZZZ 0 X 843.42 334.70
36481   4 0 2 X 1,136.44 X
36481   3 0 2 X 1,150.08 X
36481   2 0 2 X 1,218.51 X
36481   1 0 2 X 1,234.99 X
36482   2 0 2 X 2,536.03 228.60
36482   3 0 2 X 2,536.03 228.60
36482   4 0 2 X 2,536.03 228.60
36482   1 0 2 X 2,896.31 248.68
36483   2 ZZZ 0 X 177.89 114.05
36483   3 ZZZ 0 X 177.89 114.05
36483   4 ZZZ 0 X 177.89 114.05
36483   1 ZZZ 0 X 197.22 123.96
36500   4 0 2 X 181.94 179.90
36500   1 0 2 X 187.51 185.82
36500   3 0 2 X 187.82 186.24
36500   2 0 2 X 188.22 186.26
36510   4 0 2 X 120.01 X
36510   3 0 2 X 121.25 X
36510   2 0 2 X 125.89 X
36510   1 0 2 X 127.01 X
36511   2 0 2 X 168.39 X
36511   3 0 2 X 168.39 X
36511   4 0 2 X 168.39 X
36511   1 0 2 X 183.10 X
36512   2 0 2 X 168.39 X
36512   3 0 2 X 168.39 X
36512   4 0 2 X 168.39 X
36512   1 0 2 X 183.10 X
36513   2 0 2 X 168.39 X
36513   3 0 2 X 168.39 X
36513   4 0 2 X 168.39 X
36513   1 0 2 X 183.10 X
36514   2 0 2 X 168.39 X
36514   3 0 2 X 168.39 X
36514   4 0 2 X 168.39 X
36514   1 0 2 X 183.10 X
36516   2 0 2 X 168.39 X
36516   3 0 2 X 168.39 X
36516   4 0 2 X 168.39 X
36516   1 0 2 X 183.10 X
36522   4 0 2 X 537.59 X
36522   3 0 2 X 545.06 X
36522   2 0 2 X 585.41 X
36522   1 0 2 X 1,310.78 X
36555   2 0 0 X 582.39 249.52
36555   3 0 0 X 582.39 249.52
36555   4 0 0 X 582.39 249.52
36555   1 0 0 X 663.18 271.91
36556   2 0 0 X 554.30 225.92
36556   3 0 0 X 554.30 225.92
36556   4 0 0 X 554.30 225.92
36556   1 0 0 X 628.44 242.49
36557   2 10 2 X 1,255.61 550.09
36557   3 10 2 X 1,255.61 550.09
36557   4 10 2 X 1,255.61 550.09
36557   1 10 2 X 1,441.49 612.17
36558   2 10 2 X 1,227.82 522.27
36558   3 10 2 X 1,227.82 522.27
36558   4 10 2 X 1,227.82 522.27
36558   1 10 2 X 1,411.97 582.64
36560   2 10 2 X 2,339.53 654.04
36560   3 10 2 X 2,339.53 654.04
36560   4 10 2 X 2,339.53 654.04
36560   1 10 2 X 2,703.41 722.24
36561   2 10 2 X 2,317.09 630.97
36561   3 10 2 X 2,317.09 630.97
36561   4 10 2 X 2,317.09 630.97
36561   1 10 2 X 2,679.71 697.73
36563   2 10 2 X 2,912.85 656.78
36563   3 10 2 X 2,912.85 656.78
36563   4 10 2 X 2,912.85 656.78
36563   1 10 2 X 3,380.84 728.92
36565   2 10 2 X 1,869.86 630.97
36565   3 10 2 X 1,869.86 630.97
36565   4 10 2 X 1,869.86 630.97
36565   1 10 2 X 2,154.04 697.73
36566   2 10 2 X 1,955.85 676.48
36566   3 10 2 X 1,955.85 676.48
36566   4 10 2 X 1,955.85 676.48
36566   1 10 2 X 2,249.79 745.98
36568   2 0 0 X 670.51 182.18
36568   3 0 0 X 670.51 182.18
36568   4 0 0 X 670.51 182.18
36568   1 0 0 X 774.77 200.75
36569   2 0 0 X 609.49 171.24
36569   3 0 0 X 609.49 171.24
36569   4 0 0 X 609.49 171.24
36569   1 0 0 X 702.42 187.35
36570   2 10 2 X 2,987.14 569.15
36570   3 10 2 X 2,987.14 569.15
36570   4 10 2 X 2,987.14 569.15
36570   1 10 2 X 3,474.53 632.27
36571   2 10 2 X 2,688.26 567.12
36571   3 10 2 X 2,688.26 567.12
36571   4 10 2 X 2,688.26 567.12
36571   1 10 2 X 3,123.37 630.12
36572   2 0 0 X 480.09 111.28
36572   3 0 0 X 480.09 111.28
36572   4 0 0 X 480.09 111.28
36572   1 0 0 X 542.47 119.29
36573   2 0 0 X 451.95 103.07
36573   3 0 0 X 451.95 103.07
36573   4 0 0 X 451.95 103.07
36573   1 0 0 X 510.97 110.66
36575   2 0 2 X 293.88 95.30
36575   3 0 2 X 293.88 95.30
36575   4 0 2 X 293.88 95.30
36575   1 0 2 X 357.58 124.17
36576   2 10 2 X 748.32 365.95
36576   3 10 2 X 748.32 365.95
36576   4 10 2 X 748.32 365.95
36576   1 10 2 X 865.20 415.82
36578   2 10 2 X 950.92 415.00
36578   3 10 2 X 950.92 415.00
36578   4 10 2 X 950.92 415.00
36578   1 10 2 X 1,100.19 470.26