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2021 Workers' Compensation Part B Fee Schedule

43262-44145

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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
43262   4 0 3 X 1,390.40 X
43262   3 0 3 X 1,408.49 X
43262   2 0 3 X 1,490.07 X
43262   1 0 3 X 1,509.57 X
43263   4 0 3 X 931.97 X
43263   2 0 3 X 938.88 X
43263   1 0 3 X 1,028.99 X
43263   3 0 3 X 1,031.00 X
43264   3 0 3 X 1,554.42 X
43264   4 0 3 X 1,578.42 X
43264   2 0 3 X 1,618.30 X
43264   1 0 3 X 1,638.81 X
43265   4 0 3 X 1,335.78 X
43265   3 0 3 X 1,352.08 X
43265   2 0 3 X 1,422.77 X
43265   1 0 3 X 1,439.79 X
43266   2 0 3 X 323.53 X
43266   3 0 3 X 323.53 X
43266   4 0 3 X 323.53 X
43266   1 0 3 X 354.04 X
43270   2 0 3 X 950.03 339.52
43270   3 0 3 X 950.03 339.52
43270   4 0 3 X 950.03 339.52
43270   1 0 3 X 1,082.71 371.53
43273   2 ZZZ 0 X 188.00 X
43273   3 ZZZ 0 X 188.00 X
43273   4 ZZZ 0 X 188.00 X
43273   1 ZZZ 0 X 204.93 X
43274   2 0 3 X 669.79 X
43274   3 0 3 X 669.79 X
43274   4 0 3 X 669.79 X
43274   1 0 3 X 731.81 X
43275   2 0 3 X 552.19 X
43275   3 0 3 X 552.19 X
43275   4 0 3 X 552.19 X
43275   1 0 3 X 603.52 X
43276   2 0 3 X 696.80 X
43276   3 0 3 X 696.80 X
43276   4 0 3 X 696.80 X
43276   1 0 3 X 761.06 X
43277   2 0 3 X 555.52 X
43277   3 0 3 X 555.52 X
43277   4 0 3 X 555.52 X
43277   1 0 3 X 607.11 X
43278   2 0 3 X 631.73 X
43278   3 0 3 X 631.73 X
43278   4 0 3 X 631.73 X
43278   1 0 3 X 690.21 X
43279   2 90 2 X 1,779.64 X
43279   3 90 2 X 1,779.64 X
43279   4 90 2 X 1,779.64 X
43279   1 90 2 X 1,952.92 X
43280   2 90 2 X 2,166.32 X
43280   3 90 2 X 2,166.32 X
43280   4 90 2 X 2,166.32 X
43280   1 90 2 X 2,419.37 X
43281   2 90 2 X 2,285.29 X
43281   3 90 2 X 2,285.29 X
43281   4 90 2 X 2,285.29 X
43281   1 90 2 X 2,549.59 X
43282   2 90 2 X 2,571.14 X
43282   3 90 2 X 2,571.14 X
43282   4 90 2 X 2,571.14 X
43282   1 90 2 X 2,867.41 X
43283   2 ZZZ 0 X 244.67 X
43283   3 ZZZ 0 X 244.67 X
43283   4 ZZZ 0 X 244.67 X
43283   1 ZZZ 0 X 270.79 X
43284   2 90 2 X 847.68 X
43284   3 90 2 X 847.68 X
43284   4 90 2 X 847.68 X
43284   1 90 2 X 935.16 X
43285   2 90 2 X 858.46 X
43285   3 90 2 X 858.46 X
43285   4 90 2 X 858.46 X
43285   1 90 2 X 946.08 X
43286   2 90 2 X 4,029.85 X
43286   3 90 2 X 4,029.85 X
43286   4 90 2 X 4,029.85 X
43286   1 90 2 X 4,407.74 X
43287   2 90 2 X 4,605.59 X
43287   3 90 2 X 4,605.59 X
43287   4 90 2 X 4,605.59 X
43287   1 90 2 X 5,041.67 X
43288   2 90 2 X 4,804.32 X
43288   3 90 2 X 4,804.32 X
43288   4 90 2 X 4,804.32 X
43288   1 90 2 X 5,249.42 X
43289     YYY 2 X # X
43300   3 90 2 X 1,921.70 X
43300   2 90 2 X 2,173.99 X
43300   4 90 2 X 2,212.06 X
43300   1 90 2 X 2,227.82 X
43305   4 90 2 X 2,782.21 X
43305   3 90 2 X 2,815.79 X
43305   1 90 2 X 2,964.73 X
43305   2 90 2 X 3,313.80 X
43310   2 90 2 X 3,677.55 X
43310   4 90 2 X 3,918.40 X
43310   3 90 2 X 3,963.38 X
43310   1 90 2 X 4,306.70 X
43312   4 90 2 X 3,828.33 X
43312   3 90 2 X 3,871.10 X
43312   2 90 2 X 4,098.33 X
43312   1 90 2 X 4,153.57 X
43313   2 90 2 X 4,853.65 X
43313   3 90 2 X 4,853.65 X
43313   4 90 2 X 4,853.65 X
43313   1 90 2 X 5,454.66 X
43314   2 90 2 X 5,337.82 X
43314   3 90 2 X 5,337.82 X
43314   4 90 2 X 5,337.82 X
43314   1 90 2 X 5,978.62 X
43320   4 90 2 X 2,399.07 X
43320   3 90 2 X 3,106.84 X
43320   2 90 2 X 3,188.05 X
43320   1 90 2 X 3,538.14 X
43325   4 90 2 X 2,513.87 X
43325   3 90 2 X 2,543.06 X
43325   2 90 2 X 2,731.12 X
43325   1 90 2 X 2,776.71 X
43327   2 90 2 X 1,226.99 X
43327   3 90 2 X 1,226.99 X
43327   4 90 2 X 1,226.99 X
43327   1 90 2 X 1,363.29 X
43328   2 90 2 X 1,808.89 X
43328   3 90 2 X 1,808.89 X
43328   4 90 2 X 1,808.89 X
43328   1 90 2 X 2,023.43 X
43330   3 90 2 X 3,132.33 X
43330   4 90 2 X 3,133.92 X
43330   1 90 2 X 3,208.17 X
43330   2 90 2 X 3,225.70 X
43331   4 90 2 X 2,786.70 X
43331   3 90 2 X 2,819.97 X
43331   2 90 2 X 3,036.77 X
43331   1 90 2 X 3,089.25 X
43332   2 90 2 X 1,759.36 X
43332   3 90 2 X 1,759.36 X
43332   4 90 2 X 1,759.36 X
43332   1 90 2 X 1,954.00 X
43333   2 90 2 X 1,910.83 X
43333   3 90 2 X 1,910.83 X
43333   4 90 2 X 1,910.83 X
43333   1 90 2 X 2,121.55 X
43334   2 90 2 X 1,933.27 X
43334   3 90 2 X 1,933.27 X
43334   4 90 2 X 1,933.27 X
43334   1 90 2 X 2,146.07 X
43335   2 90 2 X 2,083.33 X
43335   3 90 2 X 2,083.33 X
43335   4 90 2 X 2,083.33 X
43335   1 90 2 X 2,311.93 X
43336   2 90 2 X 2,283.71 X
43336   3 90 2 X 2,283.71 X
43336   4 90 2 X 2,283.71 X
43336   1 90 2 X 2,542.40 X
43337   2 90 2 X 2,490.83 X
43337   3 90 2 X 2,490.83 X
43337   4 90 2 X 2,490.83 X
43337   1 90 2 X 2,773.79 X
43338   2 ZZZ 0 X 202.62 X
43338   3 ZZZ 0 X 202.62 X
43338   4 ZZZ 0 X 202.62 X
43338   1 ZZZ 0 X 225.72 X
43340   4 90 2 X 2,563.76 X
43340   3 90 2 X 3,083.69 X
43340   2 90 2 X 3,397.29 X
43340   1 90 2 X 3,486.53 X
43341   4 90 2 X 2,357.88 X
43341   3 90 2 X 2,385.14 X
43341   2 90 2 X 2,795.22 X
43341   1 90 2 X 3,395.19 X
43351   4 90 2 X 2,093.69 X
43351   3 90 2 X 2,117.78 X
43351   2 90 2 X 2,256.69 X
43351   1 90 2 X 2,290.38 X
43352   4 90 2 X 1,871.44 X
43352   3 90 2 X 1,928.83 X
43352   1 90 2 X 2,056.67 X
43352   2 90 2 X 2,075.63 X
43360   3 90 2 X 4,763.07 X
43360   4 90 2 X 4,782.70 X
43360   2 90 2 X 4,942.06 X
43360   1 90 2 X 5,621.96 X
43361   4 90 2 X 5,305.01 X
43361   3 90 2 X 5,367.18 X
43361   2 90 2 X 6,200.76 X
43361   1 90 2 X 6,256.30 X
43400   4 90 2 X 2,468.53 X
43400   3 90 2 X 2,497.41 X
43400   2 90 2 X 2,655.69 X
43400   1 90 2 X 3,021.55 X
43405   4 90 2 X 2,786.70 X
43405   3 90 2 X 2,819.97 X
43405   2 90 2 X 3,036.77 X
43405   1 90 2 X 3,089.25 X
43410   4 90 2 X 1,763.82 X
43410   3 90 2 X 1,785.00 X
43410   1 90 2 X 1,948.41 X
43410   2 90 2 X 1,992.11 X
43415   4 90 2 X 2,741.86 X
43415   3 90 2 X 3,201.39 X
43415   2 90 2 X 3,348.01 X
43415   1 90 2 X 3,368.99 X
43420   2 90 2 X 919.39 X
43420   1 90 2 X 931.19 X
43420   4 90 2 X 1,488.27 X
43420   3 90 2 X 1,505.40 X
43425   4 90 2 X 2,403.17 X
43425   3 90 2 X 2,430.74 X
43425   2 90 2 X 2,587.87 X
43425   1 90 2 X 2,625.94 X
43450   3 0 2 X 189.94 X
43450   2 0 2 X 201.08 X
43450   1 0 2 X 210.87 X
43450   4 0 2 X 218.82 X
43453   4 0 2 X 257.47 X
43453   3 0 2 X 260.65 X
43453   2 0 2 X 275.41 X
43453   1 0 2 X 278.92 X
43460   3 0 2 X 407.87 X
43460   4 0 2 X 408.52 X
43460   2 0 2 X 429.02 X
43460   1 0 2 X 435.70 X
43496     90 2 X * X
43499     YYY 2 X # X
43500   4 90 2 X 1,394.83 X
43500   1 90 2 X 1,558.11 X
43500   2 90 2 X 1,624.62 X
43500   3 90 2 X 1,625.11 X
43501   3 90 2 X 1,986.73 X
43501   4 90 2 X 2,006.96 X
43501   2 90 2 X 2,174.85 X
43501   1 90 2 X 2,213.69 X
43502   3 90 2 X 1,986.73 X
43502   4 90 2 X 2,006.96 X
43502   2 90 2 X 2,174.85 X
43502   1 90 2 X 2,213.69 X
43510   4 90 2 X 1,521.50 X
43510   1 90 2 X 1,659.11 X
43510   3 90 2 X 1,699.50 X
43510   2 90 2 X 1,699.63 X
43520   4 90 2 X 1,090.49 X
43520   3 90 2 X 1,102.92 X
43520   2 90 2 X 1,177.84 X
43520   1 90 2 X 1,451.42 X
43605   4 90 2 X 1,360.89 X
43605   3 90 2 X 1,424.69 X
43605   2 90 2 X 1,478.83 X
43605   1 90 2 X 1,503.67 X
43610   3 90 2 X 1,895.15 X
43610   4 90 2 X 1,913.36 X
43610   2 90 2 X 1,968.33 X
43610   1 90 2 X 2,026.43 X
43611   3 90 2 X 1,964.60 X
43611   4 90 2 X 1,982.26 X
43611   2 90 2 X 2,039.51 X
43611   1 90 2 X 2,098.00 X
43620   4 90 2 X 3,707.98 X
43620   3 90 2 X 3,744.30 X
43620   2 90 2 X 3,853.12 X
43620   1 90 2 X 4,030.44 X
43621   4 90 2 X 3,721.17 X
43621   3 90 2 X 3,757.68 X
43621   2 90 2 X 3,866.74 X
43621   1 90 2 X 4,044.11 X
43622   4 90 2 X 3,761.00 X
43622   3 90 2 X 3,797.88 X
43622   2 90 2 X 3,907.92 X
43622   1 90 2 X 4,085.51 X
43631   4 90 2 X 2,927.94 X
43631   3 90 2 X 2,961.26 X
43631   2 90 2 X 3,176.42 X
43631   1 90 2 X 3,228.72 X
43632   4 90 2 X 2,927.94 X
43632   3 90 2 X 2,961.26 X
43632   2 90 2 X 3,176.42 X
43632   1 90 2 X 3,228.72 X
43633   4 90 2 X 2,967.94 X
43633   3 90 2 X 3,001.53 X
43633   2 90 2 X 3,217.72 X
43633   1 90 2 X 3,270.25 X
43634   4 90 2 X 3,980.71 X
43634   3 90 2 X 4,027.82 X
43634   1 90 2 X 4,453.11 X
43634   2 90 2 X 4,678.13 X
43635   4 ZZZ 0 X 300.14 X
43635   3 ZZZ 0 X 303.41 X
43635   2 ZZZ 0 X 324.32 X
43635   1 ZZZ 0 X 329.34 X
43640   4 90 2 X 2,181.08 X
43640   3 90 2 X 2,240.25 X
43640   1 90 2 X 2,585.30 X
43640   2 90 2 X 2,866.64 X
43641   4 90 2 X 2,273.24 X
43641   3 90 2 X 2,299.52 X
43641   2 90 2 X 2,473.05 X
43641   1 90 2 X 2,515.18 X
43644   2 90 2 X 2,747.42 X
43644   3 90 2 X 2,747.42 X
43644   4 90 2 X 2,747.42 X
43644   1 90 2 X 3,045.82 X
43645   2 90 2 X 2,961.79 X
43645   3 90 2 X 2,961.79 X
43645   4 90 2 X 2,961.79 X
43645   1 90 2 X 3,287.83 X
43647     YYY 2 X * X
43648     YYY 2 X * X
43651   2 90 2 X 1,181.65 X
43651   3 90 2 X 1,181.65 X
43651   4 90 2 X 1,181.65 X
43651   1 90 2 X 1,314.72 X
43652   2 90 2 X 1,416.68 X
43652   3 90 2 X 1,416.68 X
43652   4 90 2 X 1,416.68 X
43652   1 90 2 X 1,570.01 X
43653   2 90 2 X 1,017.42 X
43653   3 90 2 X 1,017.42 X
43653   4 90 2 X 1,017.42 X
43653   1 90 2 X 1,137.62 X
43659     YYY 2 X # X
43752     0 0 X * X
43753   2 0 0 X 30.73 X
43753   3 0 0 X 30.73 X
43753   4 0 0 X 30.73 X
43753   1 0 0 X 32.69 X
43754   2 0 0 X 113.68 46.31
43754   3 0 0 X 113.68 46.31
43754   4 0 0 X 113.68 46.31
43754   1 0 0 X 126.74 50.49
43755   2 0 0 X 174.13 84.95
43755   3 0 0 X 174.13 84.95
43755   4 0 0 X 174.13 84.95
43755   1 0 0 X 193.01 92.12
43756   2 0 0 X 313.14 76.15
43756   3 0 0 X 313.14 76.15
43756   4 0 0 X 313.14 76.15
43756   1 0 0 X 350.69 82.54
43757   2 0 0 X 403.54 110.34
43757   3 0 0 X 403.54 110.34
43757   4 0 0 X 403.54 110.34
43757   1 0 0 X 450.70 118.95
43761   4 0 2 X 274.28 X
43761   3 0 2 X 277.33 X
43761   2 0 2 X 296.29 X
43761   1 0 2 X 300.88 X
43762   2 0 2 X 254.09 45.95
43762   3 0 2 X 254.09 45.95
43762   4 0 2 X 254.09 45.95
43762   1 0 2 X 288.46 49.63
43763   2 0 2 X 378.26 100.76
43763   3 0 2 X 378.26 100.76
43763   4 0 2 X 378.26 100.76
43763   1 0 2 X 428.15 109.74
43770   2 90 2 X 1,578.58 X
43770   3 90 2 X 1,578.58 X
43770   4 90 2 X 1,578.58 X
43770   1 90 2 X 1,770.49 X
43771   2 90 2 X 1,818.94 X
43771   3 90 2 X 1,818.94 X
43771   4 90 2 X 1,818.94 X
43771   1 90 2 X 2,037.66 X
43772   2 90 2 X 1,387.24 X
43772   3 90 2 X 1,387.24 X
43772   4 90 2 X 1,387.24 X
43772   1 90 2 X 1,551.98 X
43773   2 90 2 X 1,819.42 X
43773   3 90 2 X 1,819.42 X
43773   4 90 2 X 1,819.42 X
43773   1 90 2 X 2,038.50 X
43774   2 90 2 X 1,391.08 X
43774   3 90 2 X 1,391.08 X
43774   4 90 2 X 1,391.08 X
43774   1 90 2 X 1,554.66 X
43775   2 90 2 X 1,914.55 X
43775   3 90 2 X 1,914.55 X
43775   4 90 2 X 1,914.55 X
43775   1 90 2 X 2,140.24 X
43800   3 90 2 X 2,040.94 X
43800   4 90 2 X 2,054.71 X
43800   2 90 2 X 2,098.40 X
43800   1 90 2 X 2,123.61 X
43810   3 90 2 X 1,716.03 X
43810   1 90 2 X 1,872.25 X
43810   4 90 2 X 1,978.73 X
43810   2 90 2 X 2,130.16 X
43820   3 90 2 X 2,201.62 X
43820   4 90 2 X 2,205.87 X
43820   2 90 2 X 2,285.94 X
43820   1 90 2 X 2,300.05 X
43825   3 90 2 X 2,577.97 X
43825   4 90 2 X 2,599.26 X
43825   1 90 2 X 2,602.76 X
43825   2 90 2 X 2,709.49 X
43830   3 90 2 X 1,213.04 X
43830   4 90 2 X 1,331.32 X
43830   2 90 2 X 1,379.07 X
43830   1 90 2 X 1,407.72 X
43831   4 90 2 X 914.01 X
43831   2 90 2 X 1,058.04 X
43831   3 90 2 X 1,117.33 X
43831   1 90 2 X 1,216.55 X
43832   4 90 2 X 1,762.41 X
43832   3 90 2 X 1,782.97 X
43832   2 90 2 X 1,904.60 X
43832   1 90 2 X 1,934.07 X
43840   4 90 2 X 1,759.61 X
43840   2 90 2 X 1,912.79 X
43840   1 90 2 X 1,945.07 X
43840   3 90 2 X 2,157.59 X
43842   4 90 2 X 2,502.90 X
43842   3 90 2 X 2,532.93 X
43842   2 90 2 X 2,752.15 X
43842   1 90 2 X 2,805.35 X
43843   4 90 2 X 2,502.90 X
43843   3 90 2 X 2,532.93 X
43843   2 90 2 X 2,752.15 X
43843   1 90 2 X 2,805.35 X
43845     90 2 X * X
43846   4 90 2 X 2,709.93 X
43846   3 90 2 X 2,742.31 X
43846   1 90 2 X 3,043.66 X
43846   2 90 2 X 3,831.45 X
43847   4 90 2 X 2,074.40 X
43847   1 90 2 X 2,254.62 X
43847   3 90 2 X 3,583.14 X
43847   2 90 2 X 3,749.72 X
43848   4 90 2 X 2,709.93 X
43848   3 90 2 X 2,742.31 X
43848   1 90 2 X 3,043.66 X
43848   2 90 2 X 3,831.45 X
43850   4 90 2 X 2,826.97 X
43850   3 90 2 X 3,001.80 X
43850   2 90 2 X 3,053.04 X
43850   1 90 2 X 3,100.11 X
43855   4 90 2 X 2,818.79 X
43855   3 90 2 X 2,849.99 X
43855   2 90 2 X 3,041.64 X
43855   1 90 2 X 3,088.25 X
43860   4 90 2 X 2,836.03 X
43860   3 90 2 X 2,867.89 X
43860   2 90 2 X 3,072.05 X
43860   1 90 2 X 3,121.65 X
43865   4 90 2 X 3,133.66 X
43865   3 90 2 X 3,256.34 X
43865   2 90 2 X 3,404.95 X
43865   1 90 2 X 3,462.21 X
43870   3 90 2 X 1,387.74 X
43870   4 90 2 X 1,417.28 X
43870   2 90 2 X 1,460.52 X
43870   1 90 2 X 1,495.57 X
43880   4 90 2 X 2,492.89 X
43880   3 90 2 X 3,010.94 X
43880   2 90 2 X 3,160.33 X
43880   1 90 2 X 3,218.39 X
43881     YYY 2 X * X
43882     YYY 2 X * X
43886   2 90 2 X 436.46 X
43886   3 90 2 X 436.46 X
43886   4 90 2 X 436.46 X
43886   1 90 2 X 488.79 X
43887   2 90 2 X 426.20 X
43887   3 90 2 X 426.20 X
43887   4 90 2 X 426.20 X
43887   1 90 2 X 483.34 X
43888   2 90 2 X 605.93 X
43888   3 90 2 X 605.93 X
43888   4 90 2 X 605.93 X
43888   1 90 2 X 684.08 X
43999     YYY 2 X # X
44005   4 90 2 X 2,045.28 X
44005   3 90 2 X 2,067.32 X
44005   2 90 2 X 2,120.70 X
44005   1 90 2 X 2,143.36 X
44010   3 90 2 X 1,786.99 X
44010   4 90 2 X 1,824.71 X
44010   2 90 2 X 1,855.05 X
44010   1 90 2 X 1,926.01 X
44015   3 ZZZ 0 X 1,253.30 X
44015   4 ZZZ 0 X 1,271.93 X
44015   2 ZZZ 0 X 1,300.25 X
44015   1 ZZZ 0 X 1,304.40 X
44020   3 90 2 X 1,876.34 X
44020   4 90 2 X 1,885.98 X
44020   2 90 2 X 1,967.40 X
44020   1 90 2 X 2,035.36 X
44021   4 90 2 X 1,705.35 X
44021   3 90 2 X 1,724.59 X
44021   2 90 2 X 1,846.57 X
44021   1 90 2 X 1,876.25 X
44025   3 90 2 X 1,894.02 X
44025   4 90 2 X 1,900.47 X
44025   2 90 2 X 1,954.02 X
44025   1 90 2 X 2,034.72 X
44050   4 90 2 X 1,715.52 X
44050   3 90 2 X 1,750.27 X
44050   2 90 2 X 1,866.16 X
44050   1 90 2 X 2,002.90 X
44055   3 90 2 X 1,840.19 X
44055   4 90 2 X 1,870.36 X
44055   2 90 2 X 2,024.33 X
44055   1 90 2 X 2,056.60 X
44100   4 0 2 X 264.96 X
44100   2 0 2 X 306.85 X
44100   3 0 2 X 345.84 X
44100   1 0 2 X 357.33 X
44110   4 90 2 X 1,760.75 X
44110   3 90 2 X 1,889.34 X
44110   1 90 2 X 1,954.76 X
44110   2 90 2 X 2,120.14 X
44111   4 90 2 X 2,012.41 X
44111   3 90 2 X 2,060.98 X
44111   1 90 2 X 2,239.03 X
44111   2 90 2 X 2,321.43 X
44120   4 90 2 X 2,332.35 X
44120   3 90 2 X 2,349.10 X
44120   2 90 2 X 2,475.47 X
44120   1 90 2 X 2,505.68 X
44121   4 ZZZ 0 X 684.41 X
44121   3 ZZZ 0 X 693.22 X
44121   2 ZZZ 0 X 737.11 X
44121   1 ZZZ 0 X 758.93 X
44125   3 90 2 X 2,486.70 X
44125   4 90 2 X 2,511.64 X
44125   2 90 2 X 2,592.25 X
44125   1 90 2 X 2,599.99 X
44126   2 90 2 X 3,644.70 X
44126   3 90 2 X 3,644.70 X
44126   4 90 2 X 3,644.70 X
44126   1 90 2 X 3,950.61 X
44127   2 90 2 X 4,192.01 X
44127   3 90 2 X 4,192.01 X
44127   4 90 2 X 4,192.01 X
44127   1 90 2 X 4,542.00 X
44128   2 ZZZ 0 X 447.59 X
44128   3 ZZZ 0 X 447.59 X
44128   4 ZZZ 0 X 447.59 X
44128   1 ZZZ 0 X 498.53 X
44130   4 90 2 X 2,102.16 X
44130   3 90 2 X 2,103.81 X
44130   2 90 2 X 2,221.46 X
44130   1 90 2 X 2,243.37 X
44132     XXX 0 X * X
44133     XXX 0 X * X
44135     XXX 0 X # X
44136     XXX 0 X # X
44137     XXX 2 X * X
44139   4 ZZZ 0 X 343.57 X
44139   3 ZZZ 0 X 348.00 X
44139   2 ZZZ 0 X 370.01 X
44139   1 ZZZ 0 X 380.96 X
44140   4 90 2 X 2,694.18 X
44140   3 90 2 X 2,748.76 X
44140   2 90 2 X 2,961.01 X
44140   1 90 2 X 3,013.92 X
44141   4 90 2 X 2,868.00 X
44141   3 90 2 X 2,890.80 X
44141   2 90 2 X 3,087.05 X
44141   1 90 2 X 3,130.22 X
44143   4 90 2 X 2,924.50 X
44143   3 90 2 X 2,939.01 X
44143   2 90 2 X 3,134.72 X
44143   1 90 2 X 3,183.00 X
44144   4 90 2 X 2,852.04 X
44144   3 90 2 X 2,857.99 X
44144   2 90 2 X 3,042.92 X
44144   1 90 2 X 3,094.09 X
44145   4 90 2 X 3,377.85 X
44145   3 90 2 X 3,415.83 X
44145   2 90 2 X 3,554.32 X
44145   1 90 2 X 3,659.25 X