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Health Care Services Review
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Fee Schedule
>
Fee Schedule 47135-49423
Begin Main Content Area
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2024 Workers' Compensation Part B Fee Schedule
47135-49423
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
47135
001
90
2
X
24,631.78
X
47135
004
90
2
X
24,631.78
X
47135
002
90
2
X
24,631.78
X
47135
003
90
2
X
24,631.78
X
47140
001
90
2
X
7,111.22
X
47140
003
90
2
X
6,471.08
X
47140
002
90
2
X
6,471.08
X
47140
004
90
2
X
6,471.08
X
47141
004
90
2
X
7,832.75
X
47141
002
90
2
X
7,832.75
X
47141
003
90
2
X
7,832.75
X
47141
001
90
2
X
8,557.60
X
47142
004
90
2
X
8,634.13
X
47142
003
90
2
X
8,634.13
X
47142
002
90
2
X
8,634.13
X
47142
001
90
2
X
9,407.03
X
47143
XXX
2
X
*
X
47144
90
2
X
*
X
47145
XXX
2
X
*
X
47146
002
XXX
2
X
677.38
X
47146
003
XXX
2
X
677.38
X
47146
001
XXX
2
X
754.62
X
47146
004
XXX
2
X
677.38
X
47147
004
XXX
2
X
790.28
X
47147
001
XXX
2
X
880.45
X
47147
002
XXX
2
X
790.28
X
47147
003
XXX
2
X
790.28
X
47300
003
90
2
X
2,297.78
X
47300
001
90
2
X
2,063.25
X
47300
002
90
2
X
2,424.31
X
47300
004
90
2
X
1,858.85
X
47350
004
90
2
X
2,093.86
X
47350
002
90
2
X
2,265.15
X
47350
003
90
2
X
2,117.71
X
47350
001
90
2
X
2,300.84
X
47360
003
90
2
X
2,973.51
X
47360
002
90
2
X
3,185.76
X
47360
004
90
2
X
2,939.66
X
47360
001
90
2
X
3,237.25
X
47361
001
90
2
X
5,576.69
X
47361
003
90
2
X
5,036.74
X
47361
002
90
2
X
5,334.67
X
47361
004
90
2
X
4,967.04
X
47362
003
90
2
X
1,799.17
X
47362
002
90
2
X
1,905.58
X
47362
001
90
2
X
1,992.18
X
47362
004
90
2
X
1,774.24
X
47370
002
90
2
X
2,059.41
X
47370
003
90
2
X
2,059.41
X
47370
004
90
2
X
2,059.41
X
47370
001
90
2
X
2,250.03
X
47371
002
90
2
X
1,940.75
X
47371
003
90
2
X
1,940.75
X
47371
004
90
2
X
1,940.75
X
47371
001
90
2
X
2,122.74
X
47379
YYY
2
X
#
X
47380
004
90
2
X
2,420.86
X
47380
002
90
2
X
2,420.86
X
47380
003
90
2
X
2,420.86
X
47380
001
90
2
X
2,637.72
X
47381
004
90
2
X
2,392.90
X
47381
003
90
2
X
2,392.90
X
47381
002
90
2
X
2,392.90
X
47381
001
90
2
X
2,607.83
X
47382
001
10
2
X
1,584.34
X
47382
004
10
2
X
1,434.76
X
47382
002
10
2
X
1,434.76
X
47382
003
10
2
X
1,434.76
X
47383
001
10
2
X
13,229.02
864.74
47383
004
10
2
X
11,364.10
797.02
47383
003
10
2
X
11,364.10
797.02
47383
002
10
2
X
11,364.10
797.02
47399
YYY
2
X
#
X
47400
001
90
2
X
2,616.18
X
47400
002
90
2
X
2,533.94
X
47400
003
90
2
X
3,020.14
X
47400
004
90
2
X
2,987.08
X
47420
004
90
2
X
2,771.84
X
47420
002
90
2
X
2,997.40
X
47420
003
90
2
X
2,803.13
X
47420
001
90
2
X
3,044.65
X
47425
001
90
2
X
3,308.46
X
47425
003
90
2
X
3,023.78
X
47425
002
90
2
X
3,252.86
X
47425
004
90
2
X
2,989.13
X
47460
004
90
2
X
3,215.14
X
47460
001
90
2
X
3,350.61
X
47460
003
90
2
X
3,231.17
X
47460
002
90
2
X
3,300.96
X
47480
002
90
2
X
2,061.06
X
47480
003
90
2
X
1,991.55
X
47480
001
90
2
X
2,160.56
X
47480
004
90
2
X
1,950.32
X
47490
003
10
2
X
947.88
X
47490
002
10
2
X
954.29
X
47490
004
10
2
X
967.01
X
47490
001
10
2
X
1,028.92
X
47531
004
0
2
X
546.56
149.04
47531
002
0
2
X
546.56
149.04
47531
001
0
2
X
625.85
160.70
47531
003
0
2
X
546.56
149.04
47532
001
0
2
X
1,377.16
362.34
47532
004
0
2
X
1,204.43
337.07
47532
003
0
2
X
1,204.43
337.07
47532
002
0
2
X
1,204.43
337.07
47533
002
0
2
X
1,961.34
477.60
47533
003
0
2
X
1,961.34
477.60
47533
004
0
2
X
1,961.34
477.60
47533
001
0
2
X
2,250.12
514.04
47534
001
0
2
X
2,771.53
681.67
47534
003
0
2
X
2,419.91
633.84
47534
002
0
2
X
2,419.91
633.84
47534
004
0
2
X
2,419.91
633.84
47535
004
0
2
X
1,619.63
364.46
47535
002
0
2
X
1,619.63
364.46
47535
003
0
2
X
1,619.63
364.46
47535
001
0
2
X
1,861.82
393.13
47536
003
0
2
X
1,192.90
229.89
47536
002
0
2
X
1,192.90
229.89
47536
004
0
2
X
1,192.90
229.89
47536
001
0
2
X
1,373.84
247.01
47537
002
0
2
X
591.73
155.00
47537
003
0
2
X
591.73
155.00
47537
001
0
2
X
678.83
167.84
47537
004
0
2
X
591.73
155.00
47538
002
0
2
X
6,544.26
513.62
47538
003
0
2
X
6,544.26
513.62
47538
004
0
2
X
6,544.26
513.62
47538
001
0
2
X
7,606.83
550.52
47539
003
0
2
X
7,158.95
694.64
47539
002
0
2
X
7,158.95
694.64
47539
004
0
2
X
7,158.95
694.64
47539
001
0
2
X
8,307.73
744.00
47540
001
0
2
X
8,633.41
888.04
47540
004
0
2
X
7,448.75
829.17
47540
003
0
2
X
7,448.75
829.17
47540
002
0
2
X
7,448.75
829.17
47541
001
0
2
X
1,985.26
474.29
47541
004
0
2
X
1,732.88
441.56
47541
003
0
2
X
1,732.88
441.56
47541
002
0
2
X
1,732.88
441.56
47542
004
ZZZ
0
X
759.84
209.09
47542
002
ZZZ
0
X
759.84
209.09
47542
003
ZZZ
0
X
759.84
209.09
47542
001
ZZZ
0
X
872.15
227.77
47543
001
ZZZ
0
X
2,241.28
286.62
47543
004
ZZZ
0
X
1,933.18
262.65
47543
002
ZZZ
0
X
1,933.18
262.65
47543
003
ZZZ
0
X
1,933.18
262.65
47544
002
ZZZ
0
X
1,199.83
336.58
47544
003
ZZZ
0
X
1,199.83
336.58
47544
001
ZZZ
0
X
1,372.12
362.04
47544
004
ZZZ
0
X
1,199.83
336.58
47550
001
ZZZ
0
X
558.77
X
47550
004
ZZZ
0
X
510.69
X
47550
002
ZZZ
0
X
550.46
X
47550
003
ZZZ
0
X
516.20
X
47552
003
0
2
X
802.59
X
47552
002
0
2
X
836.62
X
47552
001
0
2
X
844.96
X
47552
004
0
2
X
824.95
X
47553
003
0
3
X
1,055.04
X
47553
001
0
3
X
1,112.58
X
47553
002
0
3
X
1,120.44
X
47553
004
0
3
X
1,043.14
X
47554
004
0
3
X
1,417.69
X
47554
003
0
3
X
1,433.26
X
47554
002
0
3
X
1,513.46
X
47554
001
0
3
X
1,532.85
X
47555
004
0
3
X
1,019.99
X
47555
001
0
3
X
1,085.32
X
47555
003
0
3
X
1,031.07
X
47555
002
0
3
X
1,078.83
X
47556
001
0
3
X
1,180.80
X
47556
004
0
3
X
1,119.27
X
47556
002
0
3
X
1,173.08
X
47556
003
0
3
X
1,141.55
X
47562
004
90
2
X
1,617.15
X
47562
001
90
2
X
1,804.60
X
47562
003
90
2
X
1,617.15
X
47562
002
90
2
X
1,617.15
X
47563
003
90
2
X
1,739.64
X
47563
002
90
2
X
1,739.64
X
47563
001
90
2
X
1,941.16
X
47563
004
90
2
X
1,739.64
X
47564
002
90
2
X
2,066.12
X
47564
003
90
2
X
2,066.12
X
47564
004
90
2
X
2,066.12
X
47564
001
90
2
X
2,304.02
X
47570
001
90
2
X
2,074.21
X
47570
003
90
2
X
1,856.43
X
47570
002
90
2
X
1,856.43
X
47570
004
90
2
X
1,856.43
X
47579
YYY
2
X
#
X
47600
001
90
2
X
2,296.90
X
47600
002
90
2
X
2,263.85
X
47600
003
90
2
X
2,109.86
X
47600
004
90
2
X
2,080.34
X
47605
002
90
2
X
2,422.63
X
47605
003
90
2
X
2,251.34
X
47605
001
90
2
X
2,456.56
X
47605
004
90
2
X
2,208.56
X
47610
001
90
2
X
2,857.77
X
47610
004
90
2
X
2,583.61
X
47610
002
90
2
X
2,818.10
X
47610
003
90
2
X
2,642.65
X
47612
004
90
2
X
3,769.55
X
47612
002
90
2
X
3,974.15
X
47612
003
90
2
X
3,823.13
X
47612
001
90
2
X
3,966.63
X
47620
001
90
2
X
3,350.94
X
47620
002
90
2
X
3,296.40
X
47620
003
90
2
X
3,129.90
X
47620
004
90
2
X
3,104.87
X
47700
001
90
2
X
2,916.56
X
47700
004
90
2
X
2,940.56
X
47700
003
90
2
X
2,884.51
X
47700
002
90
2
X
2,959.18
X
47701
004
90
2
X
3,819.32
X
47701
001
90
2
X
4,122.26
X
47701
002
90
2
X
4,070.59
X
47701
003
90
2
X
3,859.19
X
47711
002
90
2
X
3,688.59
X
47711
003
90
2
X
3,447.39
X
47711
004
90
2
X
3,408.74
X
47711
001
90
2
X
3,747.17
X
47712
001
90
2
X
3,747.17
X
47712
004
90
2
X
3,408.74
X
47712
003
90
2
X
3,447.39
X
47712
002
90
2
X
3,688.59
X
47715
001
90
2
X
2,771.08
X
47715
004
90
2
X
2,530.27
X
47715
003
90
2
X
2,558.58
X
47715
002
90
2
X
2,729.57
X
47720
001
90
2
X
2,869.20
X
47720
003
90
2
X
2,497.30
X
47720
002
90
2
X
2,850.74
X
47720
004
90
2
X
2,374.02
X
47721
004
90
2
X
2,922.99
X
47721
001
90
2
X
3,239.34
X
47721
002
90
2
X
3,184.16
X
47721
003
90
2
X
2,956.72
X
47740
004
90
2
X
3,187.49
X
47740
001
90
2
X
3,306.12
X
47740
003
90
2
X
3,200.54
X
47740
002
90
2
X
3,285.53
X
47741
001
90
2
X
4,586.43
X
47741
004
90
2
X
4,261.78
X
47741
003
90
2
X
4,292.69
X
47741
002
90
2
X
4,503.68
X
47760
001
90
2
X
3,873.31
X
47760
002
90
2
X
3,813.65
X
47760
003
90
2
X
3,567.92
X
47760
004
90
2
X
3,528.53
X
47765
004
90
2
X
3,781.49
X
47765
003
90
2
X
4,126.19
X
47765
002
90
2
X
4,360.45
X
47765
001
90
2
X
4,306.90
X
47780
002
90
2
X
4,053.98
X
47780
003
90
2
X
3,788.60
X
47780
004
90
2
X
3,746.15
X
47780
001
90
2
X
4,118.51
X
47785
004
90
2
X
3,746.15
X
47785
001
90
2
X
4,118.51
X
47785
003
90
2
X
3,788.60
X
47785
002
90
2
X
4,053.98
X
47800
004
90
2
X
3,446.57
X
47800
002
90
2
X
3,731.47
X
47800
003
90
2
X
3,544.95
X
47800
001
90
2
X
3,790.86
X
47801
002
90
2
X
1,944.50
X
47801
003
90
2
X
1,842.48
X
47801
001
90
2
X
1,969.24
X
47801
004
90
2
X
1,822.07
X
47802
002
90
2
X
3,158.76
X
47802
003
90
2
X
2,932.05
X
47802
001
90
2
X
3,167.15
X
47802
004
90
2
X
2,898.83
X
47900
002
90
2
X
3,731.47
X
47900
003
90
2
X
3,544.95
X
47900
004
90
2
X
3,446.57
X
47900
001
90
2
X
3,790.86
X
47999
YYY
2
X
#
X
48000
001
90
2
X
2,439.59
X
48000
003
90
2
X
2,258.94
X
48000
002
90
2
X
2,404.27
X
48000
004
90
2
X
2,234.08
X
48001
004
90
2
X
2,649.55
X
48001
001
90
2
X
2,904.73
X
48001
002
90
2
X
2,860.51
X
48001
003
90
2
X
2,678.64
X
48020
001
90
2
X
2,424.51
X
48020
003
90
2
X
2,236.00
X
48020
002
90
2
X
2,387.58
X
48020
004
90
2
X
2,211.70
X
48100
004
90
2
X
1,594.21
X
48100
002
90
2
X
1,648.35
X
48100
003
90
2
X
1,555.28
X
48100
001
90
2
X
1,686.35
X
48102
002
10
2
X
730.67
X
48102
003
10
2
X
721.81
X
48102
001
10
2
X
739.35
X
48102
004
10
2
X
687.01
X
48105
003
90
2
X
4,356.99
X
48105
002
90
2
X
4,356.99
X
48105
004
90
2
X
4,356.99
X
48105
001
90
2
X
4,878.96
X
48120
004
90
2
X
3,015.04
X
48120
001
90
2
X
3,182.46
X
48120
003
90
2
X
2,568.10
X
48120
002
90
2
X
3,086.89
X
48140
004
90
2
X
3,801.30
X
48140
003
90
2
X
3,741.75
X
48140
002
90
2
X
3,913.45
X
48140
001
90
2
X
4,022.83
X
48145
001
90
2
X
4,335.23
X
48145
003
90
2
X
4,001.70
X
48145
002
90
2
X
4,262.67
X
48145
004
90
2
X
3,917.75
X
48146
003
90
2
X
4,190.75
X
48146
002
90
2
X
4,440.51
X
48146
004
90
2
X
4,141.20
X
48146
001
90
2
X
4,178.41
X
48148
001
90
2
X
2,757.46
X
48148
003
90
2
X
2,546.93
X
48148
002
90
2
X
2,716.30
X
48148
004
90
2
X
2,518.78
X
48150
002
90
2
X
6,825.34
X
48150
003
90
2
X
6,529.18
X
48150
004
90
2
X
6,621.68
X
48150
001
90
2
X
7,024.61
X
48152
001
90
2
X
6,909.65
X
48152
004
90
2
X
6,511.20
X
48152
002
90
2
X
6,711.12
X
48152
003
90
2
X
6,417.66
X
48153
001
90
2
X
7,024.61
X
48153
004
90
2
X
6,621.68
X
48153
003
90
2
X
6,529.18
X
48153
002
90
2
X
6,825.34
X
48154
001
90
2
X
6,909.65
X
48154
004
90
2
X
6,511.20
X
48154
002
90
2
X
6,711.12
X
48154
003
90
2
X
6,417.66
X
48155
001
90
2
X
5,748.75
X
48155
004
90
2
X
4,541.66
X
48155
003
90
2
X
5,589.51
X
48155
002
90
2
X
5,826.51
X
48400
003
ZZZ
0
X
336.84
X
48400
002
ZZZ
0
X
359.79
X
48400
004
ZZZ
0
X
333.20
X
48400
001
ZZZ
0
X
365.30
X
48500
001
90
2
X
2,527.05
X
48500
004
90
2
X
2,296.77
X
48500
003
90
2
X
2,323.19
X
48500
002
90
2
X
2,633.52
X
48510
001
90
2
X
2,176.11
X
48510
003
90
2
X
1,934.71
X
48510
002
90
2
X
1,934.71
X
48510
004
90
2
X
1,934.71
X
48520
002
90
2
X
3,076.96
X
48520
003
90
2
X
2,948.90
X
48520
001
90
2
X
3,172.23
X
48520
004
90
2
X
2,755.08
X
48540
003
90
2
X
3,340.47
X
48540
002
90
2
X
3,493.61
X
48540
001
90
2
X
3,607.69
X
48540
004
90
2
X
3,209.37
X
48545
003
90
2
X
2,526.25
X
48545
002
90
2
X
2,698.14
X
48545
004
90
2
X
2,498.82
X
48545
001
90
2
X
2,739.97
X
48547
004
90
2
X
3,612.39
X
48547
001
90
2
X
3,960.64
X
48547
003
90
2
X
3,652.08
X
48547
002
90
2
X
3,900.19
X
48548
003
90
2
X
2,535.68
X
48548
002
90
2
X
2,535.68
X
48548
004
90
2
X
2,535.68
X
48548
001
90
2
X
2,847.88
X
48551
XXX
2
X
*
X
48552
003
XXX
2
X
466.61
X
48552
001
XXX
2
X
508.73
X
48552
004
XXX
2
X
466.61
X
48552
002
XXX
2
X
466.61
X
48556
90
2
X
*
X
48999
YYY
2
X
#
X
49000
001
90
2
X
1,961.53
X
49000
004
90
2
X
1,775.64
X
49000
002
90
2
X
1,929.20
X
49000
003
90
2
X
1,796.09
X
49002
003
90
2
X
1,742.51
X
49002
002
90
2
X
1,862.49
X
49002
004
90
2
X
1,722.93
X
49002
001
90
2
X
1,891.66
X
49010
001
90
2
X
2,202.41
X
49010
004
90
2
X
2,011.92
X
49010
002
90
2
X
2,169.66
X
49010
003
90
2
X
2,034.76
X
49013
001
0
2
X
676.76
X
49013
004
0
2
X
620.33
X
49013
003
0
2
X
620.33
X
49013
002
0
2
X
620.33
X
49014
002
0
2
X
512.44
X
49014
003
0
2
X
512.44
X
49014
004
0
2
X
512.44
X
49014
001
0
2
X
559.86
X
49020
002
90
2
X
2,066.66
X
49020
003
90
2
X
2,010.90
X
49020
001
90
2
X
2,211.46
X
49020
004
90
2
X
2,010.90
X
49040
002
90
2
X
1,563.82
X
49040
004
90
2
X
1,563.82
X
49040
001
90
2
X
1,770.28
X
49040
003
90
2
X
1,563.82
X
49060
002
90
2
X
1,608.40
X
49060
003
90
2
X
1,608.40
X
49060
004
90
2
X
1,608.40
X
49060
001
90
2
X
1,789.69
X
49062
004
90
2
X
1,796.86
X
49062
001
90
2
X
2,005.06
X
49062
003
90
2
X
1,796.86
X
49062
002
90
2
X
1,796.86
X
49082
003
0
2
X
260.01
114.89
49082
002
0
2
X
260.01
114.89
49082
001
0
2
X
293.26
124.90
49082
004
0
2
X
260.01
114.89
49083
001
0
2
X
553.00
192.67
49083
003
0
2
X
488.32
177.68
49083
002
0
2
X
488.32
177.68
49083
004
0
2
X
488.32
177.68
49084
003
0
2
X
163.53
X
49084
002
0
2
X
163.53
X
49084
001
0
2
X
176.26
X
49084
004
0
2
X
163.53
X
49180
004
0
2
X
744.24
X
49180
001
0
2
X
567.78
X
49180
003
0
2
X
728.43
X
49180
002
0
2
X
688.77
X
49185
002
0
0
X
1,448.84
191.63
49185
003
0
0
X
1,448.84
191.63
49185
001
0
0
X
1,677.50
206.44
49185
004
0
0
X
1,448.84
191.63
49203
002
90
2
X
1,889.04
X
49203
003
90
2
X
1,889.04
X
49203
001
90
2
X
2,099.50
X
49203
004
90
2
X
1,889.04
X
49204
004
90
2
X
2,411.13
X
49204
001
90
2
X
2,675.13
X
49204
003
90
2
X
2,411.13
X
49204
002
90
2
X
2,411.13
X
49205
003
90
2
X
2,759.96
X
49205
001
90
2
X
3,060.38
X
49205
004
90
2
X
2,759.96
X
49205
002
90
2
X
2,759.96
X
49215
004
90
2
X
3,233.96
X
49215
002
90
2
X
2,845.59
X
49215
003
90
2
X
2,739.21
X
49215
001
90
2
X
3,497.61
X
49250
004
90
2
X
1,623.68
X
49250
001
90
2
X
1,678.77
X
49250
003
90
2
X
1,629.99
X
49250
002
90
2
X
1,669.20
X
49255
002
90
2
X
1,546.43
X
49255
003
90
2
X
1,330.82
X
49255
001
90
2
X
1,680.33
X
49255
004
90
2
X
1,431.22
X
49320
002
10
2
X
802.39
X
49320
003
10
2
X
802.39
X
49320
001
10
2
X
897.24
X
49320
004
10
2
X
802.39
X
49321
004
10
3
X
855.20
X
49321
001
10
3
X
956.31
X
49321
003
10
3
X
855.20
X
49321
002
10
3
X
855.20
X
49322
003
10
3
X
889.31
X
49322
002
10
3
X
889.31
X
49322
004
10
3
X
889.31
X
49322
001
10
3
X
992.62
X
49323
004
90
3
X
1,376.65
X
49323
001
90
3
X
1,534.59
X
49323
002
90
3
X
1,376.65
X
49323
003
90
3
X
1,376.65
X
49324
003
10
3
X
601.93
X
49324
002
10
3
X
601.93
X
49324
004
10
3
X
601.93
X
49324
001
10
3
X
679.24
X
49325
002
10
3
X
648.06
X
49325
003
10
3
X
648.06
X
49325
001
10
3
X
733.05
X
49325
004
10
3
X
648.06
X
49326
001
ZZZ
0
X
333.14
X
49326
004
ZZZ
0
X
297.73
X
49326
002
ZZZ
0
X
297.73
X
49326
003
ZZZ
0
X
297.73
X
49327
002
ZZZ
0
X
230.92
X
49327
003
ZZZ
0
X
230.92
X
49327
004
ZZZ
0
X
230.92
X
49327
001
ZZZ
0
X
255.47
X
49329
YYY
2
X
#
X
49400
001
0
2
X
355.89
X
49400
004
0
2
X
327.46
X
49400
002
0
2
X
351.05
X
49400
003
0
2
X
331.27
X
49402
004
90
2
X
1,297.52
X
49402
002
90
2
X
1,297.52
X
49402
003
90
2
X
1,297.52
X
49402
001
90
2
X
1,459.36
X
49405
004
0
2
X
1,333.19
348.06
49405
001
0
2
X
1,521.81
374.14
49405
003
0
2
X
1,333.19
348.06
49405
002
0
2
X
1,333.19
348.06
49406
001
0
2
X
1,521.20
374.73
49406
003
0
2
X
1,332.64
348.60
49406
002
0
2
X
1,332.64
348.60
49406
004
0
2
X
1,332.64
348.60
49407
001
0
2
X
1,284.59
399.28
49407
004
0
2
X
1,131.06
371.13
49407
003
0
2
X
1,131.06
371.13
49407
002
0
2
X
1,131.06
371.13
49411
001
0
2
X
968.54
373.37
49411
003
0
2
X
845.43
343.58
49411
002
0
2
X
845.43
343.58
49411
004
0
2
X
845.43
343.58
49412
001
ZZZ
0
X
159.52
X
49412
004
ZZZ
0
X
144.27
X
49412
002
ZZZ
0
X
144.27
X
49412
003
ZZZ
0
X
144.27
X
49418
004
0
2
X
2,554.84
408.21
49418
001
0
2
X
2,875.72
446.79
49418
002
0
2
X
2,554.84
408.21
49418
003
0
2
X
2,554.84
408.21
49419
004
90
2
X
860.34
X
49419
001
90
2
X
958.22
X
49419
003
90
2
X
860.34
X
49419
002
90
2
X
860.34
X
49421
002
0
2
X
1,114.89
X
49421
003
0
2
X
1,027.18
X
49421
001
0
2
X
1,123.37
X
49421
004
0
2
X
1,015.34
X
49422
004
0
2
X
1,015.34
X
49422
002
0
2
X
1,114.89
X
49422
003
0
2
X
1,027.18
X
49422
001
0
2
X
1,123.37
X
49423
001
0
2
X
267.91
X
49423
004
0
2
X
238.52
X
49423
002
0
2
X
238.52
X
49423
003
0
2
X
238.52
X
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