Begin Main Content Area

2021 Workers' Compensation Part B Fee Schedule

36580-38564

     View the PDF


CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
36580   2 0 0 X 533.73 125.69
36580   3 0 0 X 533.73 125.69
36580   4 0 0 X 533.73 125.69
36580   1 0 0 X 618.76 139.18
36581   2 10 2 X 1,122.20 387.69
36581   3 10 2 X 1,122.20 387.69
36581   4 10 2 X 1,122.20 387.69
36581   1 10 2 X 1,302.12 438.83
36582   2 10 2 X 2,102.37 568.57
36582   3 10 2 X 2,102.37 568.57
36582   4 10 2 X 2,102.37 568.57
36582   1 10 2 X 2,435.77 632.83
36583   2 10 2 X 1,238.38 572.63
36583   3 10 2 X 1,238.38 572.63
36583   4 10 2 X 1,238.38 572.63
36583   1 10 2 X 1,419.63 637.16
36584   2 0 0 X 556.34 126.46
36584   3 0 0 X 556.34 126.46
36584   4 0 0 X 556.34 126.46
36584   1 0 0 X 646.50 141.19
36585   2 10 2 X 2,642.11 531.92
36585   3 10 2 X 2,642.11 531.92
36585   4 10 2 X 2,642.11 531.92
36585   1 10 2 X 3,074.43 593.94
36589   2 10 2 X 312.05 261.29
36589   3 10 2 X 312.05 261.29
36589   4 10 2 X 312.05 261.29
36589   1 10 2 X 351.02 291.31
36590   2 10 2 X 662.56 356.02
36590   3 10 2 X 662.56 356.02
36590   4 10 2 X 662.56 356.02
36590   1 10 2 X 757.37 397.07
36591   2 XXX 0 X 30.33 X
36591   3 XXX 0 X 30.33 X
36591   4 XXX 0 X 30.33 X
36591   1 XXX 0 X 36.79 X
36592   2 XXX 0 X 37.48 X
36592   3 XXX 0 X 37.48 X
36592   4 XXX 0 X 37.48 X
36592   1 XXX 0 X 45.44 X
36593   2 XXX 0 X 53.99 X
36593   3 XXX 0 X 53.99 X
36593   4 XXX 0 X 53.99 X
36593   1 XXX 0 X 73.16 X
36595   2 0 2 X 1,530.16 357.43
36595   3 0 2 X 1,530.16 357.43
36595   4 0 2 X 1,530.16 357.43
36595   1 0 2 X 1,769.87 391.41
36596   2 0 2 X 336.68 86.12
36596   3 0 2 X 336.68 86.12
36596   4 0 2 X 336.68 86.12
36596   1 0 2 X 389.50 94.90
36597   2 0 2 X 291.83 115.16
36597   3 0 2 X 291.83 115.16
36597   4 0 2 X 291.83 115.16
36597   1 0 2 X 332.59 124.88
36598   2 0 2 X 196.73 X
36598   3 0 2 X 196.73 X
36598   4 0 2 X 196.73 X
36598   1 0 2 X 232.52 X
36600   4 XXX 2 X 32.75 X
36600   3 XXX 2 X 33.12 X
36600   2 XXX 2 X 34.69 X
36600   1 XXX 2 X 35.10 X
36620   4 0 0 X 161.16 X
36620   3 0 0 X 163.02 X
36620   2 0 0 X 173.94 X
36620   1 0 0 X 176.61 X
36625   4 0 0 X 260.92 X
36625   3 0 0 X 263.73 X
36625   2 0 0 X 279.22 X
36625   1 0 0 X 299.16 X
36640   4 0 2 X 417.35 X
36640   1 0 2 X 449.64 X
36640   3 0 2 X 468.02 X
36640   2 0 2 X 472.40 X
36660   4 0 0 X 160.91 X
36660   3 0 0 X 162.62 X
36660   2 0 0 X 169.46 X
36660   1 0 0 X 171.16 X
36680   4 0 2 X 207.88 X
36680   3 0 2 X 210.49 X
36680   2 0 2 X 222.78 X
36680   1 0 2 X 225.75 X
36800   4 0 2 X 405.26 X
36800   1 0 2 X 465.22 X
36800   3 0 2 X 477.94 X
36800   2 0 2 X 512.06 X
36810   4 0 2 X 837.67 X
36810   2 0 2 X 937.53 X
36810   3 0 2 X 1,031.91 X
36810   1 0 2 X 1,086.76 X
36815   4 0 2 X 587.31 X
36815   3 0 2 X 704.21 X
36815   1 0 2 X 824.04 X
36815   2 0 2 X 824.14 X
36818   2 90 2 X 1,255.22 X
36818   3 90 2 X 1,255.22 X
36818   4 90 2 X 1,255.22 X
36818   1 90 2 X 1,418.78 X
36819   2 90 2 X 1,609.16 X
36819   3 90 2 X 1,609.16 X
36819   4 90 2 X 1,609.16 X
36819   1 90 2 X 1,794.70 X
36820   2 90 2 X 1,476.70 X
36820   3 90 2 X 1,476.70 X
36820   4 90 2 X 1,476.70 X
36820   1 90 2 X 1,653.09 X
36821   3 90 2 X 2,029.67 X
36821   4 90 2 X 2,029.76 X
36821   2 90 2 X 2,078.95 X
36821   1 90 2 X 2,098.12 X
36823     90 2 X * X
36823 26   90 2 X * X
36823 TC   90 2 X * X
36825   4 90 2 X 2,417.92 X
36825   3 90 2 X 2,488.87 X
36825   1 90 2 X 2,540.35 X
36825   2 90 2 X 2,550.44 X
36830   4 90 2 X 2,403.53 X
36830   3 90 2 X 2,454.95 X
36830   2 90 2 X 2,515.36 X
36830   1 90 2 X 2,529.17 X
36831   2 90 2 X 826.78 868.95
36831   3 90 2 X 826.78 868.95
36831   4 90 2 X 826.78 868.95
36831   1 90 2 X 931.87 981.13
36832   4 90 2 X 2,279.62 X
36832   3 90 2 X 2,329.10 X
36832   1 90 2 X 2,391.04 X
36832   2 90 2 X 2,426.74 X
36833   2 90 2 X 1,272.18 1,270.07
36833   3 90 2 X 1,272.18 1,270.07
36833   4 90 2 X 1,272.18 1,270.07
36833   1 90 2 X 1,413.21 1,410.72
36835   1 90 2 X 2,882.51 X
36835   2 90 2 X 2,882.51 X
36835   3 90 2 X 2,882.51 X
36835   4 90 2 X 2,882.51 X
36838   2 90 2 X 2,189.69 X
36838   3 90 2 X 2,189.69 X
36838   4 90 2 X 2,189.69 X
36838   1 90 2 X 2,454.15 X
36860   4 0 2 X 314.39 X
36860   3 0 2 X 332.53 X
36860   1 0 2 X 365.65 X
36860   2 0 2 X 406.72 X
36861   3 0 2 X 532.64 X
36861   4 0 2 X 534.43 X
36861   1 0 2 X 573.63 X
36861   2 0 2 X 592.85 X
36901   2 0 2 X 706.04 191.39
36901   3 0 2 X 706.04 191.39
36901   4 0 2 X 706.04 191.39
36901   1 0 2 X 803.58 207.26
36902   2 0 2 X 1,495.05 285.17
36902   3 0 2 X 1,495.05 285.17
36902   4 0 2 X 1,495.05 285.17
36902   1 0 2 X 1,710.42 308.59
36903   2 0 2 X 6,806.13 390.37
36903   3 0 2 X 6,806.13 390.37
36903   4 0 2 X 6,806.13 390.37
36903   1 0 2 X 7,855.66 422.18
36904   2 0 2 X 2,181.80 449.51
36904   3 0 2 X 2,181.80 449.51
36904   4 0 2 X 2,181.80 449.51
36904   1 0 2 X 2,493.27 486.21
36905   2 0 2 X 2,791.39 564.22
36905   3 0 2 X 2,791.39 564.22
36905   4 0 2 X 2,791.39 564.22
36905   1 0 2 X 3,190.71 610.25
36906   2 0 2 X 8,263.47 658.46
36906   3 0 2 X 8,263.47 658.46
36906   4 0 2 X 8,263.47 658.46
36906   1 0 2 X 9,523.57 712.18
36907   2 ZZZ 0 X 894.39 164.33
36907   3 ZZZ 0 X 894.39 164.33
36907   4 ZZZ 0 X 894.39 164.33
36907   1 ZZZ 0 X 1,023.51 177.65
36908   2 ZZZ 0 X 3,274.49 246.32
36908   3 ZZZ 0 X 3,274.49 246.32
36908   4 ZZZ 0 X 3,274.49 246.32
36908   1 ZZZ 0 X 3,774.76 266.25
36909   2 ZZZ 0 X 2,391.29 233.79
36909   3 ZZZ 0 X 2,391.29 233.79
36909   4 ZZZ 0 X 2,391.29 233.79
36909   1 ZZZ 0 X 2,752.79 253.04
37140   4 90 2 X 3,684.42 X
37140   3 90 2 X 3,983.81 X
37140   2 90 2 X 4,503.00 X
37140   1 90 2 X 4,530.79 X
37145   4 90 2 X 3,699.72 X
37145   3 90 2 X 3,744.14 X
37145   2 90 2 X 3,955.46 X
37145   1 90 2 X 4,006.54 X
37160   4 90 2 X 3,669.05 X
37160   3 90 2 X 3,711.79 X
37160   2 90 2 X 4,505.86 X
37160   1 90 2 X 4,535.80 X
37180   4 90 2 X 3,542.78 X
37180   3 90 2 X 3,582.81 X
37180   1 90 2 X 3,880.69 X
37180   2 90 2 X 3,975.20 X
37181   4 90 2 X 3,981.49 X
37181   3 90 2 X 4,486.56 X
37181   2 90 2 X 4,607.13 X
37181   1 90 2 X 4,636.45 X
37182   2 90 2 X 1,663.44 X
37182   3 90 2 X 1,663.44 X
37182   4 90 2 X 1,663.44 X
37182   1 90 2 X 1,842.29 X
37183   2 0 2 X 776.09 X
37183   3 0 2 X 776.09 X
37183   4 0 2 X 776.09 X
37183   1 0 2 X 849.58 X
37184   2 0 2 X 4,589.18 752.96
37184   3 0 2 X 4,589.18 752.96
37184   4 0 2 X 4,589.18 752.96
37184   1 0 2 X 5,518.78 823.44
37185   2 ZZZ 0 X 1,498.56 276.19
37185   3 ZZZ 0 X 1,498.56 276.19
37185   4 ZZZ 0 X 1,498.56 276.19
37185   1 ZZZ 0 X 1,797.04 300.87
37186   2 ZZZ 0 X 3,093.52 414.23
37186   3 ZZZ 0 X 3,093.52 414.23
37186   4 ZZZ 0 X 3,093.52 414.23
37186   1 ZZZ 0 X 3,730.74 451.40
37187   2 0 2 X 4,462.99 700.09
37187   3 0 2 X 4,462.99 700.09
37187   4 0 2 X 4,462.99 700.09
37187   1 0 2 X 5,371.49 765.90
37188   2 0 2 X 3,851.40 505.47
37188   3 0 2 X 3,851.40 505.47
37188   4 0 2 X 3,851.40 505.47
37188   1 0 2 X 4,649.38 554.15
37191   2 0 2 X 3,537.71 343.66
37191   3 0 2 X 3,537.71 343.66
37191   4 0 2 X 3,537.71 343.66
37191   1 0 2 X 4,080.64 375.83
37192   2 0 2 X 2,396.95 532.35
37192   3 0 2 X 2,396.95 532.35
37192   4 0 2 X 2,396.95 532.35
37192   1 0 2 X 2,744.76 581.97
37193   2 0 2 X 2,289.65 531.91
37193   3 0 2 X 2,289.65 531.91
37193   4 0 2 X 2,289.65 531.91
37193   1 0 2 X 2,620.31 581.45
37195   2 XXX 0 X 626.75 X
37195   3 XXX 0 X 626.75 X
37195   4 XXX 0 X 626.75 X
37195   1 XXX 0 X 756.66 X
37197   2 0 2 X 2,046.08 421.77
37197   3 0 2 X 2,046.08 421.77
37197   4 0 2 X 2,046.08 421.77
37197   1 0 2 X 2,338.46 454.40
37200   4 0 2 X 521.28 X
37200   3 0 2 X 527.06 X
37200   2 0 2 X 549.18 X
37200   1 0 2 X 554.54 X
37211   2 0 2 X 563.72 X
37211   3 0 2 X 563.72 X
37211   4 0 2 X 563.72 X
37211   1 0 2 X 619.72 X
37212   2 0 2 X 497.71 X
37212   3 0 2 X 497.71 X
37212   4 0 2 X 497.71 X
37212   1 0 2 X 547.20 X
37213   2 0 2 X 348.08 X
37213   3 0 2 X 348.08 X
37213   4 0 2 X 348.08 X
37213   1 0 2 X 382.42 X
37214   2 0 2 X 203.37 X
37214   3 0 2 X 203.37 X
37214   4 0 2 X 203.37 X
37214   1 0 2 X 224.27 X
37215   2 90 2 X 1,888.04 X
37215   3 90 2 X 1,888.04 X
37215   4 90 2 X 1,888.04 X
37215   1 90 2 X 2,067.99 X
37216   2 90 2 X 1,818.60 X
37216   3 90 2 X 1,818.60 X
37216   4 90 2 X 1,818.60 X
37216   1 90 2 X 1,992.15 X
37217   2 90 2 X 1,576.02 X
37217   3 90 2 X 1,576.02 X
37217   4 90 2 X 1,576.02 X
37217   1 90 2 X 1,732.78 X
37218   2 90 2 X 1,105.26 1,181.26
37218   3 90 2 X 1,105.26 1,181.26
37218   4 90 2 X 1,105.26 1,181.26
37218   1 90 2 X 1,207.04 1,295.92
37220   2 0 2 X 4,553.27 651.64
37220   3 0 2 X 4,553.27 651.64
37220   4 0 2 X 4,553.27 651.64
37220   1 0 2 X 5,135.62 720.84
37221   2 0 2 X 6,719.19 791.88
37221   3 0 2 X 6,719.19 791.88
37221   4 0 2 X 6,719.19 791.88
37221   1 0 2 X 7,579.67 872.76
37222   2 ZZZ 0 X 1,318.00 295.94
37222   3 ZZZ 0 X 1,318.00 295.94
37222   4 ZZZ 0 X 1,318.00 295.94
37222   1 ZZZ 0 X 1,483.70 327.23
37223   2 ZZZ 0 X 3,696.24 335.91
37223   3 ZZZ 0 X 3,696.24 335.91
37223   4 ZZZ 0 X 3,696.24 335.91
37223   1 ZZZ 0 X 4,173.17 370.91
37224   2 0 2 X 5,467.16 717.47
37224   3 0 2 X 5,467.16 717.47
37224   4 0 2 X 5,467.16 717.47
37224   1 0 2 X 6,167.31 792.93
37225   2 0 2 X 15,387.07 966.91
37225   3 0 2 X 15,387.07 966.91
37225   4 0 2 X 15,387.07 966.91
37225   1 0 2 X 17,387.68 1,070.92
37226   2 0 2 X 12,874.35 791.98
37226   3 0 2 X 12,874.35 791.98
37226   4 0 2 X 12,874.35 791.98
37226   1 0 2 X 14,530.17 858.66
37227   2 0 2 X 20,795.79 1,167.96
37227   3 0 2 X 20,795.79 1,167.96
37227   4 0 2 X 20,795.79 1,167.96
37227   1 0 2 X 23,503.04 1,293.71
37228   2 0 2 X 7,776.10 877.13
37228   3 0 2 X 7,776.10 877.13
37228   4 0 2 X 7,776.10 877.13
37228   1 0 2 X 8,776.65 970.31
37229   2 0 2 X 15,263.90 1,132.59
37229   3 0 2 X 15,263.90 1,132.59
37229   4 0 2 X 15,263.90 1,132.59
37229   1 0 2 X 17,244.92 1,254.98
37230   2 0 2 X 12,000.21 1,091.09
37230   3 0 2 X 12,000.21 1,091.09
37230   4 0 2 X 12,000.21 1,091.09
37230   1 0 2 X 13,546.48 1,202.52
37231   2 0 2 X 19,229.51 1,185.91
37231   3 0 2 X 19,229.51 1,185.91
37231   4 0 2 X 19,229.51 1,185.91
37231   1 0 2 X 21,723.88 1,307.09
37232   2 ZZZ 0 X 1,752.25 317.34
37232   3 ZZZ 0 X 1,752.25 317.34
37232   4 ZZZ 0 X 1,752.25 317.34
37232   1 ZZZ 0 X 1,974.64 350.96
37233   2 ZZZ 0 X 2,147.77 521.43
37233   3 ZZZ 0 X 2,147.77 521.43
37233   4 ZZZ 0 X 2,147.77 521.43
37233   1 ZZZ 0 X 2,417.82 577.54
37234   2 ZZZ 0 X 5,552.41 434.40
37234   3 ZZZ 0 X 5,552.41 434.40
37234   4 ZZZ 0 X 5,552.41 434.40
37234   1 ZZZ 0 X 6,270.85 479.69
37235   2 ZZZ 0 X 5,939.13 616.60
37235   3 ZZZ 0 X 5,939.13 616.60
37235   4 ZZZ 0 X 5,939.13 616.60
37235   1 ZZZ 0 X 6,703.50 680.99
37236   2 0 2 X 3,659.18 654.23
37236   3 0 2 X 3,659.18 654.23
37236   4 0 2 X 3,659.18 654.23
37236   1 0 2 X 4,215.18 714.32
37237   2 ZZZ 0 X 1,591.36 306.17
37237   3 ZZZ 0 X 1,591.36 306.17
37237   4 ZZZ 0 X 1,591.36 306.17
37237   1 ZZZ 0 X 1,831.77 334.47
37238   2 0 2 X 5,315.87 458.27
37238   3 0 2 X 5,315.87 458.27
37238   4 0 2 X 5,315.87 458.27
37238   1 0 2 X 6,159.71 500.39
37239   2 ZZZ 0 X 2,641.63 213.71
37239   3 ZZZ 0 X 2,641.63 213.71
37239   4 ZZZ 0 X 2,641.63 213.71
37239   1 ZZZ 0 X 3,062.05 233.45
37241   2 0 2 X 5,891.58 627.43
37241   3 0 2 X 5,891.58 627.43
37241   4 0 2 X 5,891.58 627.43
37241   1 0 2 X 6,810.00 677.08
37242   2 0 2 X 9,899.90 700.64
37242   3 0 2 X 9,899.90 700.64
37242   4 0 2 X 9,899.90 700.64
37242   1 0 2 X 11,473.64 756.15
37243   2 0 2 X 12,494.19 835.38
37243   3 0 2 X 12,494.19 835.38
37243   4 0 2 X 12,494.19 835.38
37243   1 0 2 X 14,484.51 901.58
37244   2 0 2 X 8,774.17 974.50
37244   3 0 2 X 8,774.17 974.50
37244   4 0 2 X 8,774.17 974.50
37244   1 0 2 X 10,138.44 1,051.54
37246   2 0 2 X 2,631.39 468.28
37246   3 0 2 X 2,631.39 468.28
37246   4 0 2 X 2,631.39 468.28
37246   1 0 2 X 3,013.13 506.89
37247   2 ZZZ 0 X 1,067.18 232.20
37247   3 ZZZ 0 X 1,067.18 232.20
37247   4 ZZZ 0 X 1,067.18 232.20
37247   1 ZZZ 0 X 1,218.63 251.21
37248   2 0 2 X 1,827.12 402.70
37248   3 0 2 X 1,827.12 402.70
37248   4 0 2 X 1,827.12 402.70
37248   1 0 2 X 2,086.38 435.99
37249   2 ZZZ 0 X 784.46 197.58
37249   3 ZZZ 0 X 784.46 197.58
37249   4 ZZZ 0 X 784.46 197.58
37249   1 ZZZ 0 X 893.78 213.80
37252   2 ZZZ 0 X 1,736.71 124.33
37252   3 ZZZ 0 X 1,736.71 124.33
37252   4 ZZZ 0 X 1,736.71 124.33
37252   1 ZZZ 0 X 2,021.57 134.98
37253   2 ZZZ 0 X 274.54 99.49
37253   3 ZZZ 0 X 274.54 99.49
37253   4 ZZZ 0 X 274.54 99.49
37253   1 ZZZ 0 X 312.88 108.06
37500   2 ZZZ 0 X 1,342.11 X
37500   3 ZZZ 0 X 1,342.11 X
37500   4 ZZZ 0 X 1,342.11 X
37500   1 ZZZ 0 X 1,484.74 X
37501     90 2 X # X
37565   1 90 2 X 1,367.33 X
37565   3 90 2 X 1,407.03 X
37565   4 90 2 X 1,438.61 X
37565   2 90 2 X 1,484.72 X
37600   4 90 2 X 1,267.56 X
37600   3 90 2 X 1,272.53 X
37600   2 90 2 X 1,302.83 X
37600   1 90 2 X 1,310.12 X
37605   4 90 2 X 984.92 X
37605   1 90 2 X 1,099.14 X
37605   3 90 2 X 1,130.92 X
37605   2 90 2 X 1,196.17 X
37606   4 90 2 X 1,008.64 X
37606   3 90 2 X 1,021.57 X
37606   2 90 2 X 1,093.74 X
37606   1 90 2 X 1,111.17 X
37607   4 90 2 X 850.49 X
37607   3 90 2 X 859.84 X
37607   2 90 2 X 918.22 X
37607   1 90 2 X 932.51 X
37609   3 10 2 X 523.28 X
37609   4 10 2 X 528.07 X
37609   2 10 2 X 540.15 X
37609   1 10 2 X 547.56 X
37615   4 90 2 X 1,030.79 X
37615   3 90 2 X 1,072.73 X
37615   1 90 2 X 1,113.98 X
37615   2 90 2 X 1,115.77 X
37616   4 90 2 X 1,753.72 X
37616   3 90 2 X 1,772.10 X
37616   2 90 2 X 1,860.99 X
37616   1 90 2 X 1,882.72 X
37617   3 90 2 X 1,718.46 X
37617   2 90 2 X 1,791.48 X
37617   1 90 2 X 1,802.76 X
37617   4 90 2 X 2,097.93 X
37618   4 90 2 X 1,088.17 X
37618   3 90 2 X 1,147.22 X
37618   2 90 2 X 1,180.33 X
37618   1 90 2 X 1,188.35 X
37619   2 90 2 X 2,379.73 X
37619   3 90 2 X 2,379.73 X
37619   4 90 2 X 2,379.73 X
37619   1 90 2 X 2,654.38 X
37650   3 90 2 X 827.89 X
37650   4 90 2 X 1,027.44 X
37650   2 90 2 X 1,060.66 X
37650   1 90 2 X 1,080.53 X
37660   4 90 2 X 1,454.59 X
37660   3 90 2 X 1,471.04 X
37660   2 90 2 X 1,566.65 X
37660   1 90 2 X 1,589.80 X
37700   4 90 2 X 693.62 X
37700   1 90 2 X 772.84 X
37700   3 90 2 X 792.28 X
37700   2 90 2 X 921.85 X
37718   2 90 2 X 654.27 X
37718   3 90 2 X 654.27 X
37718   4 90 2 X 654.27 X
37718   1 90 2 X 717.04 X
37722   2 90 2 X 773.81 X
37722   3 90 2 X 773.81 X
37722   4 90 2 X 773.81 X
37722   1 90 2 X 867.87 X
37735   4 90 2 X 1,753.97 X
37735   3 90 2 X 1,774.46 X
37735   2 90 2 X 1,909.57 X
37735   1 90 2 X 1,942.36 X
37760   3 90 2 X 1,685.27 X
37760   4 90 2 X 1,692.04 X
37760   2 90 2 X 1,809.33 X
37760   1 90 2 X 1,839.44 X
37761   2 90 2 X 847.77 X
37761   3 90 2 X 847.77 X
37761   4 90 2 X 847.77 X
37761   1 90 2 X 950.50 X
37765   2 90 2 X 826.31 X
37765   3 90 2 X 826.31 X
37765   4 90 2 X 826.31 X
37765   1 90 2 X 909.52 X
37766   2 90 2 X 1,006.79 X
37766   3 90 2 X 1,006.79 X
37766   4 90 2 X 1,006.79 X
37766   1 90 2 X 1,101.13 X
37780   4 90 2 X 508.94 X
37780   3 90 2 X 514.64 X
37780   1 90 2 X 554.41 X
37780   2 90 2 X 565.85 X
37785   4 90 2 X 419.38 X
37785   3 90 2 X 423.80 X
37785   2 90 2 X 444.13 X
37785   1 90 2 X 449.13 X
37788   4 90 2 X 3,550.58 X
37788   3 90 2 X 3,598.50 X
37788   2 90 2 X 3,801.30 X
37788   1 90 2 X 3,894.67 X
37790   4 90 2 X 1,071.63 X
37790   3 90 2 X 1,084.44 X
37790   2 90 2 X 1,144.42 X
37790   1 90 2 X 1,158.94 X
37799     YYY 2 X # X
38100   4 90 2 X 2,081.82 X
38100   3 90 2 X 2,126.29 X
38100   1 90 2 X 2,241.03 X
38100   2 90 2 X 2,306.76 X
38101   4 90 2 X 1,865.14 X
38101   3 90 2 X 1,885.86 X
38101   1 90 2 X 2,043.90 X
38101   2 90 2 X 2,325.93 X
38102   4 ZZZ 0 X 698.25 X
38102   3 ZZZ 0 X 705.89 X
38102   2 ZZZ 0 X 753.82 X
38102   1 ZZZ 0 X 765.49 X
38115   4 90 2 X 1,919.14 X
38115   1 90 2 X 2,101.94 X
38115   3 90 2 X 2,237.22 X
38115   2 90 2 X 2,352.90 X
38120     XXX 2 X * X
38129     YYY 2 X # X
38200   4 0 2 X 396.72 X
38200   1 0 2 X 399.73 X
38200   3 0 2 X 401.51 X
38200   2 0 2 X 422.31 X
38204     XXX 9 X * X
38205   2 XXX 9 X 145.47 X
38205   3 XXX 9 X 145.47 X
38205   4 XXX 9 X 145.47 X
38205   1 XXX 9 X 158.20 X
38206   2 0 2 X 145.47 X
38206   3 0 2 X 145.47 X
38206   4 0 2 X 145.47 X
38206   1 0 2 X 158.20 X
38207     XXX 9 X * X
38208     XXX 9 X * X
38209     XXX 9 X * X
38210     XXX 9 X * X
38211     XXX 9 X * X
38212     XXX 9 X * X
38213     XXX 9 X * X
38214     XXX 9 X * X
38215     XXX 9 X * X
38220   2 XXX 2 X 377.60 104.89
38220   3 XXX 2 X 377.60 104.89
38220   4 XXX 2 X 377.60 104.89
38220   1 XXX 2 X 434.38 113.78
38221   2 XXX 2 X 404.68 133.26
38221   3 XXX 2 X 404.68 133.26
38221   4 XXX 2 X 404.68 133.26
38221   1 XXX 2 X 463.74 144.68
38222   2 XXX 2 X 207.88 98.68
38222   3 XXX 2 X 207.88 98.68
38222   4 XXX 2 X 207.88 98.68
38222   1 XXX 2 X 231.29 105.98
38230   4 10 2 X 505.87 X
38230   3 10 2 X 512.09 X
38230   2 10 2 X 540.19 X
38230   1 10 2 X 1,853.27 X
38232   2 0 2 X 263.99 X
38232   3 0 2 X 263.99 X
38232   4 0 2 X 263.99 X
38232   1 0 2 X 295.14 X
38240   4 XXX 2 X 365.69 X
38240   3 XXX 2 X 370.33 X
38240   2 XXX 2 X 390.37 X
38240   1 XXX 2 X 395.20 X
38241   4 XXX 2 X 361.70 X
38241   3 XXX 2 X 366.26 X
38241   1 XXX 2 X 390.42 X
38241   2 XXX 2 X 471.51 X
38242   2 XXX 2 X 165.77 X
38242   3 XXX 2 X 165.77 X
38242   4 XXX 2 X 165.77 X
38242   1 XXX 2 X 180.00 X
38243   2 0 2 X 157.90 X
38243   3 0 2 X 157.90 X
38243   4 0 2 X 157.90 X
38243   1 0 2 X 170.27 X
38300   4 10 2 X 188.18 X
38300   3 10 2 X 194.11 X
38300   2 10 2 X 204.51 X
38300   1 10 2 X 207.05 X
38305   4 90 2 X 580.54 X
38305   3 90 2 X 586.92 X
38305   2 90 2 X 621.26 X
38305   1 90 2 X 629.61 X
38308   4 90 2 X 737.11 X
38308   3 90 2 X 745.81 X
38308   2 90 2 X 791.85 X
38308   1 90 2 X 802.94 X
38380   4 90 2 X 1,034.63 X
38380   3 90 2 X 1,046.63 X
38380   1 90 2 X 1,132.49 X
38380   2 90 2 X 1,220.04 X
38381   4 90 2 X 1,868.04 X
38381   3 90 2 X 1,889.25 X
38381   2 90 2 X 2,017.73 X
38381   1 90 2 X 2,048.92 X
38382   4 90 2 X 1,344.86 X
38382   3 90 2 X 1,359.65 X
38382   2 90 2 X 1,452.08 X
38382   1 90 2 X 1,474.63 X
38500   3 10 2 X 422.47 X
38500   4 10 2 X 437.34 X
38500   1 10 2 X 456.39 X
38500   2 10 2 X 480.37 X
38505   1 0 2 X 299.06 X
38505   4 0 2 X 301.36 X
38505   3 0 2 X 304.66 X
38505   2 0 2 X 351.34 X
38510   3 90 2 X 606.26 X
38510   4 90 2 X 612.70 X
38510   1 90 2 X 664.52 X
38510   2 90 2 X 687.26 X
38520   4 90 2 X 727.92 X
38520   3 90 2 X 750.76 X
38520   1 90 2 X 785.64 X
38520   2 90 2 X 786.44 X
38525   4 90 2 X 617.91 X
38525   3 90 2 X 639.22 X
38525   1 90 2 X 728.14 X
38525   2 90 2 X 730.97 X
38530   4 90 2 X 715.89 X
38530   2 90 2 X 753.79 X
38530   3 90 2 X 862.09 X
38530   1 90 2 X 932.34 X
38531   2 90 2 X 525.96 X
38531   3 90 2 X 525.96 X
38531   4 90 2 X 525.96 X
38531   1 90 2 X 577.88 X
38542   4 90 2 X 820.88 X
38542   3 90 2 X 827.01 X
38542   2 90 2 X 895.55 X
38542   1 90 2 X 944.30 X
38550   4 90 2 X 910.04 X
38550   3 90 2 X 920.10 X
38550   2 90 2 X 977.41 X
38550   1 90 2 X 991.36 X
38555   4 90 2 X 1,918.89 X
38555   3 90 2 X 1,940.38 X
38555   2 90 2 X 2,064.59 X
38555   1 90 2 X 2,094.72 X
38562   4 90 2 X 1,578.10 X
38562   3 90 2 X 1,588.53 X
38562   2 90 2 X 1,649.90 X
38562   1 90 2 X 1,664.78 X
38564   3 90 2 X 1,648.13 X
38564   4 90 2 X 1,666.43 X
38564   2 90 2 X 1,718.95 X
38564   1 90 2 X 1,736.18 X