An Official Pennsylvania Government Website
Translate
Begin Main Content Area

​​

 Content Editor

2024 Workers' Compensation Part B Fee Schedule

21436-22849

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
21436   003 90 2 X 4,495.56 X
21436   002 90 2 X 4,753.63 X
21436   004 90 2 X 4,444.87 X
21436   001 90 2 X 4,816.20 X
21440     90 2 X * X
21445     90 2 X * X
21450   004 90 2 X 733.63 X
21450   002 90 2 X 679.52 X
21450   003 90 2 X 660.32 X
21450   001 90 2 X 698.48 X
21451   001 90 2 X 1,367.01 X
21451   003 90 2 X 1,256.33 X
21451   002 90 2 X 1,345.61 X
21451   004 90 2 X 1,240.13 X
21452   003 90 2 X 356.34 X
21452   002 90 2 X 488.34 X
21452   001 90 2 X 382.94 X
21452   004 90 2 X 352.19 X
21453   001 90 2 X 1,385.36 X
21453   002 90 2 X 1,266.66 X
21453   003 90 2 X 1,285.40 X
21453   004 90 2 X 1,268.91 X
21454   001 90 2 X 2,266.64 X
21454   004 90 2 X 2,039.68 X
21454   002 90 2 X 2,228.01 X
21454   003 90 2 X 2,067.03 X
21461   001 90 2 X 2,290.52 X
21461   004 90 2 X 2,075.06 X
21461   003 90 2 X 2,102.09 X
21461   002 90 2 X 2,254.02 X
21462   003 90 2 X 2,373.07 X
21462   002 90 2 X 2,561.59 X
21462   004 90 2 X 2,760.10 X
21462   001 90 2 X 2,576.24 X
21465   003 90 2 X 2,146.05 X
21465   002 90 2 X 2,274.20 X
21465   004 90 2 X 2,120.63 X
21465   001 90 2 X 2,305.16 X
21470   004 90 2 X 3,394.12 X
21470   001 90 2 X 3,424.57 X
21470   002 90 2 X 3,537.37 X
21470   003 90 2 X 2,907.06 X
21480   004 0 2 X 277.47 X
21480   003 0 2 X 244.02 X
21480   002 0 2 X 267.03 X
21480   001 0 2 X 263.99 X
21485   002 90 2 X 695.78 X
21485   003 90 2 X 681.74 X
21485   004 90 2 X 678.58 X
21485   001 90 2 X 699.13 X
21490   001 90 2 X 1,989.38 X
21490   004 90 2 X 1,852.95 X
21490   003 90 2 X 1,874.57 X
21490   002 90 2 X 1,967.00 X
21497   001 90 2 X 891.51 X
21497   004 90 2 X 817.06 X
21497   002 90 2 X 879.08 X
21497   003 90 2 X 827.40 X
21499     YYY 2 X # X
21501   001 90 2 X 627.17 X
21501   004 90 2 X 579.99 X
21501   003 90 2 X 586.55 X
21501   002 90 2 X 619.24 X
21502   004 90 2 X 1,180.30 X
21502   001 90 2 X 1,291.97 X
21502   003 90 2 X 1,193.80 X
21502   002 90 2 X 1,272.74 X
21510   001 90 2 X 1,195.54 X
21510   004 90 2 X 965.58 X
21510   003 90 2 X 1,075.18 X
21510   002 90 2 X 1,037.83 X
21550   001 10 2 X 264.51 X
21550   004 10 2 X 252.51 X
21550   003 10 2 X 259.36 X
21550   002 10 2 X 271.09 X
21552   004 90 2 X 754.86 X
21552   003 90 2 X 754.86 X
21552   002 90 2 X 754.86 X
21552   001 90 2 X 847.65 X
21554   004 90 2 X 1,240.55 X
21554   001 90 2 X 1,387.93 X
21554   002 90 2 X 1,240.55 X
21554   003 90 2 X 1,240.55 X
21555   004 90 2 X 598.57 X
21555   002 90 2 X 650.67 X
21555   003 90 2 X 606.75 X
21555   001 90 2 X 643.54 X
21556   001 90 2 X 858.82 X
21556   003 90 2 X 977.17 X
21556   002 90 2 X 845.04 X
21556   004 90 2 X 800.52 X
21557   002 90 2 X 1,798.71 X
21557   003 90 2 X 1,736.92 X
21557   004 90 2 X 1,723.69 X
21557   001 90 2 X 1,838.67 X
21558   001 90 2 X 2,606.39 X
21558   004 90 2 X 2,333.32 X
21558   003 90 2 X 2,333.32 X
21558   002 90 2 X 2,333.32 X
21600   004 90 2 X 1,388.75 X
21600   001 90 2 X 1,439.71 X
21600   003 90 2 X 1,291.58 X
21600   002 90 2 X 1,332.81 X
21601   001 90 2 X 1,835.90 X
21601   002 90 2 X 1,654.98 X
21601   003 90 2 X 1,654.98 X
21601   004 90 2 X 1,654.98 X
21602   001 90 2 X 2,461.58 X
21602   004 90 2 X 2,214.51 X
21602   003 90 2 X 2,214.51 X
21602   002 90 2 X 2,214.51 X
21603   001 90 2 X 2,725.22 X
21603   002 90 2 X 2,452.79 X
21603   003 90 2 X 2,452.79 X
21603   004 90 2 X 2,452.79 X
21610   004 90 2 X 1,497.92 X
21610   002 90 2 X 1,033.94 X
21610   003 90 2 X 949.31 X
21610   001 90 2 X 986.81 X
21615   002 90 2 X 2,379.34 X
21615   003 90 2 X 2,198.92 X
21615   001 90 2 X 2,423.08 X
21615   004 90 2 X 2,172.71 X
21616   001 90 2 X 2,480.84 X
21616   003 90 2 X 2,404.49 X
21616   002 90 2 X 2,224.85 X
21616   004 90 2 X 2,055.32 X
21620   001 90 2 X 1,615.92 X
21620   004 90 2 X 1,452.73 X
21620   003 90 2 X 1,518.25 X
21620   002 90 2 X 1,587.51 X
21627   001 90 2 X 1,364.36 X
21627   003 90 2 X 1,252.28 X
21627   002 90 2 X 1,342.46 X
21627   004 90 2 X 1,237.71 X
21630   004 90 2 X 2,976.62 X
21630   002 90 2 X 3,218.87 X
21630   003 90 2 X 3,011.08 X
21630   001 90 2 X 3,269.24 X
21632   002 90 2 X 3,396.74 X
21632   003 90 2 X 3,175.55 X
21632   001 90 2 X 3,450.47 X
21632   004 90 2 X 3,139.48 X
21685   001 90 2 X 2,141.80 X
21685   003 90 2 X 1,909.14 X
21685   002 90 2 X 1,909.14 X
21685   004 90 2 X 1,909.14 X
21700   001 90 2 X 1,179.10 X
21700   004 90 2 X 1,085.53 X
21700   003 90 2 X 1,098.43 X
21700   002 90 2 X 1,008.19 X
21705   001 90 2 X 1,678.24 X
21705   004 90 2 X 1,537.24 X
21705   002 90 2 X 1,654.00 X
21705   003 90 2 X 1,554.38 X
21720   004 90 2 X 1,012.33 X
21720   003 90 2 X 1,024.25 X
21720   002 90 2 X 1,200.61 X
21720   001 90 2 X 1,366.61 X
21725   004 90 2 X 1,252.06 X
21725   002 90 2 X 1,349.25 X
21725   003 90 2 X 1,266.71 X
21725   001 90 2 X 1,369.25 X
21740   003 90 2 X 2,727.49 X
21740   002 90 2 X 2,902.10 X
21740   001 90 2 X 2,944.50 X
21740   004 90 2 X 2,696.97 X
21742     90 2 X * X
21743     90 2 X * X
21750   004 90 2 X 1,945.70 X
21750   002 90 2 X 2,108.64 X
21750   003 90 2 X 1,968.12 X
21750   001 90 2 X 2,142.82 X
21811   001 0 2 X 899.63 932.70
21811   002 0 2 X 843.29 871.56
21811   003 0 2 X 843.29 871.56
21811   004 0 2 X 843.29 871.56
21812   002 0 2 X 1,009.22 1,037.49
21812   003 0 2 X 1,009.22 1,037.49
21812   004 0 2 X 1,009.22 1,037.49
21812   001 0 2 X 1,075.26 1,108.33
21813   002 0 2 X 1,378.04 1,400.03
21813   003 0 2 X 1,378.04 1,400.03
21813   004 0 2 X 1,378.04 1,400.03
21813   001 0 2 X 1,468.03 1,493.78
21820   001 90 2 X 342.47 X
21820   004 90 2 X 330.74 X
21820   002 90 2 X 337.24 X
21820   003 90 2 X 332.19 X
21825   001 90 2 X 1,688.49 X
21825   003 90 2 X 1,143.76 X
21825   002 90 2 X 1,206.69 X
21825   004 90 2 X 1,528.22 X
21899     YYY 2 X # X
21920   004 10 2 X 258.65 X
21920   002 10 2 X 271.07 X
21920   003 10 2 X 249.24 X
21920   001 10 2 X 260.38 X
21925   003 90 2 X 550.86 X
21925   002 90 2 X 558.64 X
21925   001 90 2 X 578.17 X
21925   004 90 2 X 674.03 X
21930   001 90 2 X 948.69 X
21930   002 90 2 X 939.48 X
21930   003 90 2 X 907.38 X
21930   004 90 2 X 901.24 X
21931   004 90 2 X 791.22 X
21931   002 90 2 X 791.22 X
21931   003 90 2 X 791.22 X
21931   001 90 2 X 888.93 X
21932   002 90 2 X 1,136.15 X
21932   003 90 2 X 1,136.15 X
21932   004 90 2 X 1,136.15 X
21932   001 90 2 X 1,277.66 X
21933   001 90 2 X 1,408.61 X
21933   003 90 2 X 1,254.39 X
21933   002 90 2 X 1,254.39 X
21933   004 90 2 X 1,254.39 X
21935   001 90 2 X 1,986.24 X
21935   004 90 2 X 2,598.22 X
21935   003 90 2 X 1,883.47 X
21935   002 90 2 X 1,969.71 X
21936   003 90 2 X 2,432.77 X
21936   002 90 2 X 2,432.77 X
21936   004 90 2 X 2,432.77 X
21936   001 90 2 X 2,721.96 X
22010   001 90 2 X 1,705.96 X
22010   004 90 2 X 1,489.26 X
22010   002 90 2 X 1,489.26 X
22010   003 90 2 X 1,489.26 X
22015   002 90 2 X 1,476.19 X
22015   003 90 2 X 1,476.19 X
22015   004 90 2 X 1,476.19 X
22015   001 90 2 X 1,691.00 X
22100   001 90 2 X 1,731.33 X
22100   003 90 2 X 1,606.71 X
22100   002 90 2 X 1,707.10 X
22100   004 90 2 X 1,587.77 X
22101   002 90 2 X 1,783.69 X
22101   003 90 2 X 1,664.75 X
22101   004 90 2 X 1,645.43 X
22101   001 90 2 X 1,812.51 X
22102   004 90 2 X 1,428.89 X
22102   002 90 2 X 1,524.68 X
22102   003 90 2 X 1,920.13 X
22102   001 90 2 X 1,544.05 X
22103   003 ZZZ 0 X 535.16 X
22103   001 ZZZ 0 X 599.36 X
22103   002 ZZZ 0 X 571.91 X
22103   004 ZZZ 0 X 527.08 X
22110   003 90 2 X 2,395.83 X
22110   002 90 2 X 2,564.96 X
22110   001 90 2 X 2,251.36 X
22110   004 90 2 X 2,367.76 X
22112   003 90 2 X 2,412.92 X
22112   002 90 2 X 2,582.65 X
22112   004 90 2 X 2,384.55 X
22112   001 90 2 X 2,261.64 X
22114   001 90 2 X 2,256.03 X
22114   004 90 2 X 2,069.56 X
22114   003 90 2 X 2,093.34 X
22114   002 90 2 X 2,224.21 X
22116   003 ZZZ 0 X 529.85 X
22116   002 ZZZ 0 X 566.18 X
22116   004 ZZZ 0 X 521.88 X
22116   001 ZZZ 0 X 593.15 X
22206   004 90 2 X 3,859.18 X
22206   001 90 2 X 4,375.28 X
22206   002 90 2 X 3,859.18 X
22206   003 90 2 X 3,859.18 X
22207   001 90 2 X 4,317.51 X
22207   002 90 2 X 3,809.75 X
22207   003 90 2 X 3,809.75 X
22207   004 90 2 X 3,809.75 X
22208   004 ZZZ 0 X 979.19 X
22208   003 ZZZ 0 X 979.19 X
22208   002 ZZZ 0 X 979.19 X
22208   001 ZZZ 0 X 1,119.32 X
22210   003 90 2 X 4,057.15 X
22210   002 90 2 X 4,318.08 X
22210   004 90 2 X 4,011.43 X
22210   001 90 2 X 4,584.01 X
22212   003 90 2 X 3,988.15 X
22212   002 90 2 X 4,278.05 X
22212   004 90 2 X 3,940.71 X
22212   001 90 2 X 4,348.20 X
22214   004 90 2 X 3,706.87 X
22214   003 90 2 X 3,750.54 X
22214   002 90 2 X 4,020.13 X
22214   001 90 2 X 4,085.32 X
22216   004 ZZZ 0 X 1,283.54 X
22216   001 ZZZ 0 X 1,455.15 X
22216   003 ZZZ 0 X 1,302.82 X
22216   002 ZZZ 0 X 1,389.58 X
22220   001 90 2 X 4,464.28 X
22220   002 90 2 X 4,396.18 X
22220   003 90 2 X 4,114.65 X
22220   004 90 2 X 4,066.37 X
22222   004 90 2 X 3,650.66 X
22222   002 90 2 X 4,668.90 X
22222   003 90 2 X 3,693.68 X
22222   001 90 2 X 5,079.71 X
22224   001 90 2 X 4,254.04 X
22224   004 90 2 X 3,872.32 X
22224   002 90 2 X 4,188.27 X
22224   003 90 2 X 3,917.15 X
22226   001 ZZZ 0 X 1,455.15 X
22226   004 ZZZ 0 X 1,283.54 X
22226   003 ZZZ 0 X 1,302.82 X
22226   002 ZZZ 0 X 1,389.58 X
22310   001 90 2 X 1,170.24 X
22310   004 90 2 X 1,009.48 X
22310   003 90 2 X 942.03 X
22310   002 90 2 X 1,156.29 X
22315   004 90 2 X 1,663.96 X
22315   002 90 2 X 1,711.05 X
22315   003 90 2 X 1,540.02 X
22315   001 90 2 X 1,660.65 X
22318   001 90 2 X 3,812.00 X
22318   002 90 2 X 3,340.14 X
22318   003 90 2 X 3,340.14 X
22318   004 90 2 X 3,340.14 X
22319   001 90 2 X 4,307.14 X
22319   004 90 2 X 3,772.91 X
22319   002 90 2 X 3,772.91 X
22319   003 90 2 X 3,772.91 X
22325   004 90 2 X 2,783.11 X
22325   003 90 2 X 2,814.19 X
22325   002 90 2 X 4,181.42 X
22325   001 90 2 X 4,197.74 X
22326   001 90 2 X 4,216.44 X
22326   004 90 2 X 3,825.58 X
22326   003 90 2 X 3,870.99 X
22326   002 90 2 X 4,149.07 X
22327   001 90 2 X 4,059.93 X
22327   003 90 2 X 4,194.42 X
22327   002 90 2 X 3,997.79 X
22327   004 90 2 X 3,696.14 X
22328   002 ZZZ 0 X 1,126.53 X
22328   003 ZZZ 0 X 1,054.22 X
22328   001 ZZZ 0 X 1,180.32 X
22328   004 ZZZ 0 X 1,038.27 X
22505   003 10 2 X 378.70 X
22505   002 10 2 X 247.72 X
22505   004 10 2 X 237.32 X
22505   001 10 2 X 253.30 X
22510   004 10 2 X 2,598.74 700.26
22510   001 10 2 X 2,975.98 754.61
22510   003 10 2 X 2,598.74 700.26
22510   002 10 2 X 2,598.74 700.26
22511   003 10 2 X 2,572.23 655.94
22511   002 10 2 X 2,572.23 655.94
22511   001 10 2 X 2,949.51 707.31
22511   004 10 2 X 2,572.23 655.94
22512   004 ZZZ 0 X 1,436.76 320.17
22512   002 ZZZ 0 X 1,436.76 320.17
22512   001 ZZZ 0 X 1,649.27 342.79
22512   003 ZZZ 0 X 1,436.76 320.17
22513   004 10 2 X 10,855.01 796.99
22513   002 10 2 X 10,855.01 796.99
22513   003 10 2 X 10,855.01 796.99
22513   001 10 2 X 12,630.04 861.43
22514   002 10 2 X 10,811.92 744.46
22514   003 10 2 X 10,811.92 744.46
22514   004 10 2 X 10,811.92 744.46
22514   001 10 2 X 12,585.05 805.36
22515   001 ZZZ 0 X 7,640.03 358.84
22515   004 ZZZ 0 X 6,556.68 333.84
22515   003 ZZZ 0 X 6,556.68 333.84
22515   002 ZZZ 0 X 6,556.68 333.84
22526   004 10 9 X 3,345.44 568.14
22526   001 10 9 X 4,049.93 652.03
22526   002 10 9 X 3,345.44 568.14
22526   003 10 9 X 3,345.44 568.14
22527   001 ZZZ 9 X 3,297.13 300.03
22527   003 ZZZ 9 X 2,712.55 262.81
22527   002 ZZZ 9 X 2,712.55 262.81
22527   004 ZZZ 9 X 2,712.55 262.81
22532   002 90 2 X 3,349.95 X
22532   003 90 2 X 3,349.95 X
22532   004 90 2 X 3,349.95 X
22532   001 90 2 X 3,815.83 X
22533   002 90 2 X 3,132.41 X
22533   003 90 2 X 3,132.41 X
22533   004 90 2 X 3,132.41 X
22533   001 90 2 X 3,543.44 X
22534   004 ZZZ 0 X 789.98 X
22534   001 ZZZ 0 X 899.65 X
22534   003 ZZZ 0 X 789.98 X
22534   002 ZZZ 0 X 789.98 X
22548   004 90 2 X 5,217.07 X
22548   001 90 2 X 5,582.00 X
22548   003 90 2 X 5,279.68 X
22548   002 90 2 X 5,666.29 X
22551   004 90 2 X 3,030.57 X
22551   003 90 2 X 3,030.57 X
22551   002 90 2 X 3,030.57 X
22551   001 90 2 X 3,423.98 X
22552   001 ZZZ 0 X 795.83 X
22552   004 ZZZ 0 X 708.21 X
22552   003 ZZZ 0 X 708.21 X
22552   002 ZZZ 0 X 708.21 X
22554   002 90 2 X 4,615.46 X
22554   003 90 2 X 4,247.33 X
22554   001 90 2 X 4,739.90 X
22554   004 90 2 X 4,217.54 X
22556   001 90 2 X 5,504.84 X
22556   003 90 2 X 5,049.98 X
22556   002 90 2 X 5,416.24 X
22556   004 90 2 X 4,990.10 X
22558   001 90 2 X 5,191.57 X
22558   004 90 2 X 4,707.16 X
22558   003 90 2 X 4,763.44 X
22558   002 90 2 X 5,108.12 X
22585   002 ZZZ 0 X 1,328.56 X
22585   003 ZZZ 0 X 1,236.07 X
22585   004 ZZZ 0 X 1,221.41 X
22585   001 ZZZ 0 X 1,350.93 X
22586   004 90 2 X 2,508.36 X
22586   001 90 2 X 2,802.33 X
22586   003 90 2 X 2,508.36 X
22586   002 90 2 X 2,508.36 X
22590   003 90 2 X 4,466.45 X
22590   002 90 2 X 4,681.48 X
22590   001 90 2 X 5,008.98 X
22590   004 90 2 X 4,368.61 X
22595   001 90 2 X 5,207.80 X
22595   004 90 2 X 4,684.91 X
22595   002 90 2 X 5,117.16 X
22595   003 90 2 X 4,742.30 X
22600   003 90 2 X 4,242.99 X
22600   002 90 2 X 4,507.42 X
22600   004 90 2 X 4,192.03 X
22600   001 90 2 X 4,704.52 X
22610   002 90 2 X 3,999.76 X
22610   003 90 2 X 4,149.46 X
22610   001 90 2 X 4,095.83 X
22610   004 90 2 X 3,672.49 X
22612   002 90 2 X 4,709.17 X
22612   003 90 2 X 4,648.73 X
22612   001 90 2 X 4,614.13 X
22612   004 90 2 X 4,594.01 X
22614   001 ZZZ 0 X 1,576.91 X
22614   004 ZZZ 0 X 1,391.59 X
22614   003 ZZZ 0 X 1,412.62 X
22614   002 ZZZ 0 X 1,506.79 X
22630   002 90 2 X 5,133.17 X
22630   003 90 2 X 4,435.78 X
22630   001 90 2 X 5,211.61 X
22630   004 90 2 X 4,882.32 X
22632   004 ZZZ 0 X 1,178.02 X
22632   002 ZZZ 0 X 1,278.19 X
22632   003 ZZZ 0 X 1,196.08 X
22632   001 ZZZ 0 X 1,339.28 X
22633   001 90 2 X 3,495.76 X
22633   004 90 2 X 3,097.27 X
22633   002 90 2 X 3,097.27 X
22633   003 90 2 X 3,097.27 X
22634   001 ZZZ 0 X 949.93 X
22634   004 ZZZ 0 X 842.08 X
22634   002 ZZZ 0 X 842.08 X
22634   003 ZZZ 0 X 842.08 X
22800   002 90 2 X 4,734.48 X
22800   003 90 2 X 4,384.50 X
22800   004 90 2 X 4,330.76 X
22800   001 90 2 X 4,819.02 X
22802   004 90 2 X 6,621.46 X
22802   001 90 2 X 6,973.30 X
22802   002 90 2 X 6,885.39 X
22802   003 90 2 X 6,682.86 X
22804   002 90 2 X 7,869.54 X
22804   003 90 2 X 7,390.47 X
22804   004 90 2 X 7,281.73 X
22804   001 90 2 X 8,227.47 X
22808   002 90 2 X 5,394.45 X
22808   003 90 2 X 5,073.40 X
22808   004 90 2 X 4,999.82 X
22808   001 90 2 X 5,637.47 X
22810   003 90 2 X 5,289.36 X
22810   001 90 2 X 5,712.73 X
22810   002 90 2 X 5,630.10 X
22810   004 90 2 X 5,229.41 X
22812   001 90 2 X 6,521.17 X
22812   004 90 2 X 5,909.97 X
22812   002 90 2 X 6,415.96 X
22812   003 90 2 X 5,981.12 X
22818   004 90 2 X 5,724.69 X
22818   003 90 2 X 5,724.69 X
22818   002 90 2 X 5,724.69 X
22818   001 90 2 X 6,545.68 X
22819   004 90 2 X 6,134.62 X
22819   001 90 2 X 6,970.12 X
22819   003 90 2 X 6,134.62 X
22819   002 90 2 X 6,134.62 X
22830   001 90 2 X 2,911.67 X
22830   004 90 2 X 2,616.01 X
22830   003 90 2 X 2,648.48 X
22830   002 90 2 X 2,860.42 X
22836   003 90 2 X 1,833.63 X
22836   002 90 2 X 1,833.63 X
22836   001 90 2 X 1,981.85 X
22836   004 90 2 X 1,833.63 X
22837   003 90 2 X 2,020.20 X
22837   002 90 2 X 2,020.20 X
22837   004 90 2 X 2,020.20 X
22837   001 90 2 X 2,182.69 X
22838   001 90 2 X 2,211.65 X
22838   004 90 2 X 2,047.05 X
22838   002 90 2 X 2,047.05 X
22838   003 90 2 X 2,047.05 X
22840   002 ZZZ 0 X 4,779.06 X
22840   003 ZZZ 0 X 4,031.81 X
22840   004 ZZZ 0 X 3,724.60 X
22840   001 ZZZ 0 X 4,844.03 X
22841     XXX 9 X * X
22842   004 ZZZ 0 X 4,171.35 X
22842   001 ZZZ 0 X 4,680.99 X
22842   002 ZZZ 0 X 4,899.19 X
22842   003 ZZZ 0 X 4,223.74 X
22843   002 ZZZ 0 X 2,190.62 X
22843   003 ZZZ 0 X 2,050.01 X
22843   001 ZZZ 0 X 2,295.04 X
22843   004 ZZZ 0 X 2,019.04 X
22844   001 ZZZ 0 X 2,804.46 X
22844   004 ZZZ 0 X 2,467.24 X
22844   003 ZZZ 0 X 2,505.11 X
22844   002 ZZZ 0 X 2,676.90 X
22845   004 ZZZ 0 X 3,406.98 X
22845   002 ZZZ 0 X 3,746.98 X
22845   003 ZZZ 0 X 3,449.19 X
22845   001 ZZZ 0 X 3,819.05 X
22846   001 ZZZ 0 X 2,119.10 X
22846   004 ZZZ 0 X 1,864.32 X
22846   003 ZZZ 0 X 1,892.90 X
22846   002 ZZZ 0 X 2,022.71 X
22847   002 ZZZ 0 X 2,247.27 X
22847   003 ZZZ 0 X 2,102.97 X
22847   004 ZZZ 0 X 2,071.23 X
22847   001 ZZZ 0 X 2,354.54 X
22848   002 ZZZ 0 X 1,465.84 X
22848   003 ZZZ 0 X 1,371.66 X
22848   001 ZZZ 0 X 1,535.76 X
22848   004 ZZZ 0 X 1,350.91 X
22849   001 90 2 X 3,021.83 X
22849   003 90 2 X 2,772.56 X
22849   002 90 2 X 2,973.24 X
22849   004 90 2 X 2,739.72 X