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2024 Workers' Compensation Part B Fee Schedule

36580-38564

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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
36580   001 0 0 X 725.09 163.10
36580   004 0 0 X 625.45 147.30
36580   003 0 0 X 625.45 147.30
36580   002 0 0 X 625.45 147.30
36581   004 10 2 X 1,315.04 454.31
36581   001 10 2 X 1,525.87 514.23
36581   003 10 2 X 1,315.04 454.31
36581   002 10 2 X 1,315.04 454.31
36582   004 10 2 X 2,463.62 666.28
36582   003 10 2 X 2,463.62 666.28
36582   002 10 2 X 2,463.62 666.28
36582   001 10 2 X 2,854.31 741.57
36583   002 10 2 X 1,451.17 671.02
36583   003 10 2 X 1,451.17 671.02
36583   001 10 2 X 1,663.57 746.64
36583   004 10 2 X 1,451.17 671.02
36584   002 0 0 X 651.93 148.19
36584   003 0 0 X 651.93 148.19
36584   004 0 0 X 651.93 148.19
36584   001 0 0 X 757.59 165.45
36585   004 10 2 X 3,096.11 623.32
36585   001 10 2 X 3,602.72 696.00
36585   003 10 2 X 3,096.11 623.32
36585   002 10 2 X 3,096.11 623.32
36589   004 10 2 X 365.67 306.20
36589   001 10 2 X 411.34 341.37
36589   003 10 2 X 365.67 306.20
36589   002 10 2 X 365.67 306.20
36590   001 10 2 X 887.52 465.31
36590   004 10 2 X 776.41 417.20
36590   002 10 2 X 776.41 417.20
36590   003 10 2 X 776.41 417.20
36591   001 XXX 0 X 43.12 X
36591   004 XXX 0 X 35.54 X
36591   002 XXX 0 X 35.54 X
36591   003 XXX 0 X 35.54 X
36592   003 XXX 0 X 43.92 X
36592   002 XXX 0 X 43.92 X
36592   001 XXX 0 X 53.25 X
36592   004 XXX 0 X 43.92 X
36593   001 XXX 0 X 85.74 X
36593   004 XXX 0 X 63.26 X
36593   002 XXX 0 X 63.26 X
36593   003 XXX 0 X 63.26 X
36595   001 0 2 X 2,073.99 458.66
36595   004 0 2 X 1,793.10 418.85
36595   003 0 2 X 1,793.10 418.85
36595   002 0 2 X 1,793.10 418.85
36596   003 0 2 X 394.53 100.91
36596   002 0 2 X 394.53 100.91
36596   004 0 2 X 394.53 100.91
36596   001 0 2 X 456.44 111.21
36597   004 0 2 X 341.97 134.95
36597   001 0 2 X 389.74 146.34
36597   002 0 2 X 341.97 134.95
36597   003 0 2 X 341.97 134.95
36598   002 0 2 X 230.53 X
36598   003 0 2 X 230.53 X
36598   001 0 2 X 272.48 X
36598   004 0 2 X 230.53 X
36600   004 XXX 2 X 38.38 X
36600   001 XXX 2 X 41.13 X
36600   002 XXX 2 X 40.65 X
36600   003 XXX 2 X 38.81 X
36620   001 0 0 X 206.96 X
36620   004 0 0 X 188.85 X
36620   003 0 0 X 191.04 X
36620   002 0 0 X 203.83 X
36625   003 0 0 X 309.05 X
36625   002 0 0 X 327.20 X
36625   001 0 0 X 350.56 X
36625   004 0 0 X 305.75 X
36640   003 0 2 X 548.44 X
36640   002 0 2 X 553.57 X
36640   001 0 2 X 526.91 X
36640   004 0 2 X 489.07 X
36660   004 0 2 X 188.56 X
36660   001 0 2 X 200.57 X
36660   002 0 2 X 198.58 X
36660   003 0 2 X 190.56 X
36680   003 0 2 X 246.66 X
36680   002 0 2 X 261.06 X
36680   004 0 2 X 243.60 X
36680   001 0 2 X 264.54 X
36800   004 0 2 X 474.90 X
36800   001 0 2 X 545.16 X
36800   003 0 2 X 560.06 X
36800   002 0 2 X 600.05 X
36810   001 0 2 X 1,273.50 X
36810   004 0 2 X 981.61 X
36810   003 0 2 X 1,209.23 X
36810   002 0 2 X 1,098.64 X
36815   001 0 2 X 965.64 X
36815   002 0 2 X 965.75 X
36815   003 0 2 X 825.22 X
36815   004 0 2 X 688.23 X
36818   001 90 2 X 1,662.58 X
36818   004 90 2 X 1,470.90 X
36818   003 90 2 X 1,470.90 X
36818   002 90 2 X 1,470.90 X
36819   001 90 2 X 2,103.09 X
36819   003 90 2 X 1,885.67 X
36819   002 90 2 X 1,885.67 X
36819   004 90 2 X 1,885.67 X
36820   004 90 2 X 1,730.45 X
36820   001 90 2 X 1,937.14 X
36820   003 90 2 X 1,730.45 X
36820   002 90 2 X 1,730.45 X
36821   004 90 2 X 2,378.53 X
36821   002 90 2 X 2,436.18 X
36821   003 90 2 X 2,378.44 X
36821   001 90 2 X 2,458.65 X
36823     90 2 X * X
36825   004 90 2 X 2,833.40 X
36825   001 90 2 X 2,976.86 X
36825   003 90 2 X 2,916.54 X
36825   002 90 2 X 2,988.69 X
36830   002 90 2 X 2,947.58 X
36830   003 90 2 X 2,876.80 X
36830   001 90 2 X 2,963.77 X
36830   004 90 2 X 2,816.53 X
36831   001 90 2 X 1,091.99 1,149.72
36831   004 90 2 X 968.85 1,018.26
36831   002 90 2 X 968.85 1,018.26
36831   003 90 2 X 968.85 1,018.26
36832   002 90 2 X 2,843.72 X
36832   003 90 2 X 2,729.31 X
36832   001 90 2 X 2,801.90 X
36832   004 90 2 X 2,671.32 X
36833   003 90 2 X 1,490.78 1,488.30
36833   002 90 2 X 1,490.78 1,488.30
36833   004 90 2 X 1,490.78 1,488.30
36833   001 90 2 X 1,656.04 1,653.13
36835   002 90 2 X 3,377.83 X
36835   003 90 2 X 3,377.83 X
36835   004 90 2 X 3,377.83 X
36835   001 90 2 X 3,377.83 X
36836   003 0 2 X 7,826.88 403.10
36836   002 0 2 X 7,826.88 403.10
36836   004 0 2 X 7,826.88 403.10
36836   001 0 2 X 8,930.32 432.37
36837   001 0 2 X 12,711.62 565.69
36837   003 0 2 X 11,136.63 525.98
36837   002 0 2 X 11,136.63 525.98
36837   004 0 2 X 11,136.63 525.98
36838   002 90 2 X 2,565.95 X
36838   003 90 2 X 2,565.95 X
36838   001 90 2 X 2,875.85 X
36838   004 90 2 X 2,565.95 X
36860   003 0 2 X 389.68 X
36860   002 0 2 X 476.60 X
36860   004 0 2 X 368.41 X
36860   001 0 2 X 428.48 X
36861   001 0 2 X 672.19 X
36861   004 0 2 X 626.26 X
36861   002 0 2 X 694.72 X
36861   003 0 2 X 624.16 X
36901   001 0 2 X 941.67 242.87
36901   002 0 2 X 827.36 224.28
36901   003 0 2 X 827.36 224.28
36901   004 0 2 X 827.36 224.28
36902   004 0 2 X 1,751.94 334.17
36902   001 0 2 X 2,004.33 361.62
36902   002 0 2 X 1,751.94 334.17
36902   003 0 2 X 1,751.94 334.17
36903   001 0 2 X 9,205.52 494.72
36903   003 0 2 X 7,975.64 457.44
36903   002 0 2 X 7,975.64 457.44
36903   004 0 2 X 7,975.64 457.44
36904   001 0 2 X 2,921.70 569.75
36904   002 0 2 X 2,556.70 526.75
36904   003 0 2 X 2,556.70 526.75
36904   004 0 2 X 2,556.70 526.75
36905   001 0 2 X 3,738.98 715.11
36905   004 0 2 X 3,271.04 661.17
36905   003 0 2 X 3,271.04 661.17
36905   002 0 2 X 3,271.04 661.17
36906   004 0 2 X 9,683.41 771.61
36906   002 0 2 X 9,683.41 771.61
36906   003 0 2 X 9,683.41 771.61
36906   001 0 2 X 11,160.03 834.55
36907   002 ZZZ 0 X 1,048.07 192.58
36907   003 ZZZ 0 X 1,048.07 192.58
36907   004 ZZZ 0 X 1,048.07 192.58
36907   001 ZZZ 0 X 1,199.38 208.17
36908   004 ZZZ 0 X 3,837.15 288.65
36908   003 ZZZ 0 X 3,837.15 288.65
36908   002 ZZZ 0 X 3,837.15 288.65
36908   001 ZZZ 0 X 4,423.38 312.00
36909   004 ZZZ 0 X 2,802.20 273.97
36909   003 ZZZ 0 X 2,802.20 273.97
36909   002 ZZZ 0 X 2,802.20 273.97
36909   001 ZZZ 0 X 3,225.80 296.52
37140   002 90 2 X 5,276.76 X
37140   003 90 2 X 4,668.35 X
37140   004 90 2 X 4,317.52 X
37140   001 90 2 X 5,309.32 X
37145   004 90 2 X 4,335.45 X
37145   001 90 2 X 4,695.00 X
37145   003 90 2 X 4,387.50 X
37145   002 90 2 X 4,635.13 X
37160   001 90 2 X 5,315.19 X
37160   004 90 2 X 4,299.52 X
37160   003 90 2 X 4,349.60 X
37160   002 90 2 X 5,280.12 X
37180   001 90 2 X 4,547.52 X
37180   004 90 2 X 4,151.54 X
37180   002 90 2 X 4,658.26 X
37180   003 90 2 X 4,198.46 X
37181   002 90 2 X 5,398.79 X
37181   003 90 2 X 5,257.49 X
37181   004 90 2 X 4,665.64 X
37181   001 90 2 X 5,433.15 X
37182   003 0 2 X 1,949.27 X
37182   002 0 2 X 1,949.27 X
37182   004 0 2 X 1,949.27 X
37182   001 0 2 X 2,158.85 X
37183   004 0 2 X 909.45 X
37183   001 0 2 X 995.56 X
37183   003 0 2 X 909.45 X
37183   002 0 2 X 909.45 X
37184   004 0 2 X 5,377.76 882.35
37184   001 0 2 X 6,467.08 964.93
37184   003 0 2 X 5,377.76 882.35
37184   002 0 2 X 5,377.76 882.35
37185   003 ZZZ 0 X 1,756.06 323.65
37185   002 ZZZ 0 X 1,756.06 323.65
37185   004 ZZZ 0 X 1,756.06 323.65
37185   001 ZZZ 0 X 2,105.82 352.57
37186   004 ZZZ 0 X 3,625.09 485.41
37186   001 ZZZ 0 X 4,371.81 528.96
37186   002 ZZZ 0 X 3,625.09 485.41
37186   003 ZZZ 0 X 3,625.09 485.41
37187   001 0 2 X 6,294.49 897.51
37187   004 0 2 X 5,229.88 820.39
37187   003 0 2 X 5,229.88 820.39
37187   002 0 2 X 5,229.88 820.39
37188   002 0 0 X 4,513.19 592.32
37188   003 0 0 X 4,513.19 592.32
37188   001 0 0 X 5,448.30 649.37
37188   004 0 0 X 4,513.19 592.32
37191   001 0 2 X 4,781.83 440.41
37191   003 0 2 X 4,145.61 402.71
37191   002 0 2 X 4,145.61 402.71
37191   004 0 2 X 4,145.61 402.71
37192   004 0 2 X 2,808.82 623.83
37192   001 0 2 X 3,216.40 681.97
37192   002 0 2 X 2,808.82 623.83
37192   003 0 2 X 2,808.82 623.83
37193   001 0 2 X 3,070.57 681.37
37193   004 0 2 X 2,683.09 623.31
37193   003 0 2 X 2,683.09 623.31
37193   002 0 2 X 2,683.09 623.31
37195   001 XXX 0 X 886.68 X
37195   003 XXX 0 X 734.45 X
37195   002 XXX 0 X 734.45 X
37195   004 XXX 0 X 734.45 X
37197   003 0 2 X 2,397.66 494.25
37197   002 0 2 X 2,397.66 494.25
37197   004 0 2 X 2,397.66 494.25
37197   001 0 2 X 2,740.29 532.48
37200   001 0 2 X 649.82 X
37200   004 0 2 X 610.84 X
37200   002 0 2 X 643.55 X
37200   003 0 2 X 617.64 X
37211   002 0 2 X 660.59 X
37211   003 0 2 X 660.59 X
37211   004 0 2 X 660.59 X
37211   001 0 2 X 726.21 X
37212   004 0 2 X 583.23 X
37212   002 0 2 X 583.23 X
37212   003 0 2 X 583.23 X
37212   001 0 2 X 641.23 X
37213   001 0 2 X 448.14 X
37213   004 0 2 X 407.89 X
37213   002 0 2 X 407.89 X
37213   003 0 2 X 407.89 X
37214   003 0 2 X 238.32 X
37214   002 0 2 X 238.32 X
37214   004 0 2 X 238.32 X
37214   001 0 2 X 262.81 X
37215   001 90 2 X 2,423.35 X
37215   002 90 2 X 2,212.46 X
37215   003 90 2 X 2,212.46 X
37215   004 90 2 X 2,212.46 X
37216   001 90 9 X 2,334.47 X
37216   004 90 9 X 2,131.10 X
37216   002 90 9 X 2,131.10 X
37216   003 90 9 X 2,131.10 X
37217   003 90 2 X 1,846.83 X
37217   002 90 2 X 1,846.83 X
37217   001 90 2 X 2,030.53 X
37217   004 90 2 X 1,846.83 X
37218   001 90 2 X 1,414.44 1,518.60
37218   004 90 2 X 1,295.18 1,384.24
37218   002 90 2 X 1,295.18 1,384.24
37218   003 90 2 X 1,295.18 1,384.24
37220   002 0 2 X 5,335.68 763.62
37220   003 0 2 X 5,335.68 763.62
37220   001 0 2 X 6,018.08 844.71
37220   004 0 2 X 5,335.68 763.62
37221   003 0 2 X 7,873.77 927.95
37221   002 0 2 X 7,873.77 927.95
37221   004 0 2 X 7,873.77 927.95
37221   001 0 2 X 8,882.11 1,022.73
37222   002 ZZZ 0 X 1,544.47 346.79
37222   003 ZZZ 0 X 1,544.47 346.79
37222   001 ZZZ 0 X 1,738.64 383.46
37222   004 ZZZ 0 X 1,544.47 346.79
37223   003 ZZZ 0 X 4,331.37 393.63
37223   002 ZZZ 0 X 4,331.37 393.63
37223   004 ZZZ 0 X 4,331.37 393.63
37223   001 ZZZ 0 X 4,890.26 434.65
37224   003 0 2 X 6,406.60 840.75
37224   002 0 2 X 6,406.60 840.75
37224   001 0 2 X 7,227.05 929.18
37224   004 0 2 X 6,406.60 840.75
37225   002 0 2 X 18,031.07 1,133.06
37225   003 0 2 X 18,031.07 1,133.06
37225   001 0 2 X 20,375.45 1,254.94
37225   004 0 2 X 18,031.07 1,133.06
37226   002 0 2 X 15,086.58 928.06
37226   003 0 2 X 15,086.58 928.06
37226   004 0 2 X 15,086.58 928.06
37226   001 0 2 X 17,026.92 1,006.20
37227   001 0 2 X 27,541.62 1,516.01
37227   004 0 2 X 24,369.18 1,368.66
37227   002 0 2 X 24,369.18 1,368.66
37227   003 0 2 X 24,369.18 1,368.66
37228   004 0 2 X 9,112.28 1,027.85
37228   001 0 2 X 10,284.77 1,137.04
37228   003 0 2 X 9,112.28 1,027.85
37228   002 0 2 X 9,112.28 1,027.85
37229   002 0 2 X 17,886.74 1,327.21
37229   003 0 2 X 17,886.74 1,327.21
37229   001 0 2 X 20,208.16 1,470.63
37229   004 0 2 X 17,886.74 1,327.21
37230   004 0 2 X 14,062.24 1,278.58
37230   002 0 2 X 14,062.24 1,278.58
37230   003 0 2 X 14,062.24 1,278.58
37230   001 0 2 X 15,874.21 1,409.16
37231   003 0 2 X 22,533.76 1,389.69
37231   002 0 2 X 22,533.76 1,389.69
37231   004 0 2 X 22,533.76 1,389.69
37231   001 0 2 X 25,456.76 1,531.69
37232   004 ZZZ 0 X 2,053.34 371.86
37232   002 ZZZ 0 X 2,053.34 371.86
37232   003 ZZZ 0 X 2,053.34 371.86
37232   001 ZZZ 0 X 2,313.95 411.26
37233   003 ZZZ 0 X 2,516.82 611.02
37233   002 ZZZ 0 X 2,516.82 611.02
37233   004 ZZZ 0 X 2,516.82 611.02
37233   001 ZZZ 0 X 2,833.28 676.78
37234   004 ZZZ 0 X 6,506.50 509.04
37234   001 ZZZ 0 X 7,348.39 562.12
37234   003 ZZZ 0 X 6,506.50 509.04
37234   002 ZZZ 0 X 6,506.50 509.04
37235   004 ZZZ 0 X 6,959.66 722.56
37235   003 ZZZ 0 X 6,959.66 722.56
37235   002 ZZZ 0 X 6,959.66 722.56
37235   001 ZZZ 0 X 7,855.38 798.01
37236   004 0 2 X 4,287.95 766.65
37236   001 0 2 X 4,939.48 837.06
37236   003 0 2 X 4,287.95 766.65
37236   002 0 2 X 4,287.95 766.65
37237   002 ZZZ 0 X 1,864.80 358.78
37237   003 ZZZ 0 X 1,864.80 358.78
37237   004 ZZZ 0 X 1,864.80 358.78
37237   001 ZZZ 0 X 2,146.53 391.94
37238   004 0 2 X 6,229.31 537.02
37238   001 0 2 X 7,218.15 586.37
37238   002 0 2 X 6,229.31 537.02
37238   003 0 2 X 6,229.31 537.02
37239   004 ZZZ 0 X 3,095.55 250.43
37239   001 ZZZ 0 X 3,588.22 273.57
37239   003 ZZZ 0 X 3,095.55 250.43
37239   002 ZZZ 0 X 3,095.55 250.43
37241   002 0 2 X 6,903.94 735.24
37241   003 0 2 X 6,903.94 735.24
37241   001 0 2 X 7,980.18 793.43
37241   004 0 2 X 6,903.94 735.24
37242   003 0 2 X 11,601.02 821.03
37242   002 0 2 X 11,601.02 821.03
37242   004 0 2 X 11,601.02 821.03
37242   001 0 2 X 13,445.18 886.09
37243   004 0 2 X 14,641.10 978.93
37243   002 0 2 X 14,641.10 978.93
37243   003 0 2 X 14,641.10 978.93
37243   001 0 2 X 16,973.42 1,056.49
37244   001 0 2 X 11,880.55 1,232.22
37244   004 0 2 X 10,281.87 1,141.95
37244   003 0 2 X 10,281.87 1,141.95
37244   002 0 2 X 10,281.87 1,141.95
37246   004 0 2 X 3,083.55 548.75
37246   001 0 2 X 3,530.88 593.99
37246   003 0 2 X 3,083.55 548.75
37246   002 0 2 X 3,083.55 548.75
37247   002 ZZZ 0 X 1,250.55 272.11
37247   003 ZZZ 0 X 1,250.55 272.11
37247   001 ZZZ 0 X 1,428.03 294.37
37247   004 ZZZ 0 X 1,250.55 272.11
37248   004 0 2 X 2,141.08 471.90
37248   001 0 2 X 2,444.88 510.91
37248   003 0 2 X 2,141.08 471.90
37248   002 0 2 X 2,141.08 471.90
37249   001 ZZZ 0 X 1,047.36 250.54
37249   004 ZZZ 0 X 919.26 231.54
37249   002 ZZZ 0 X 919.26 231.54
37249   003 ZZZ 0 X 919.26 231.54
37252   002 ZZZ 0 X 2,035.13 145.69
37252   003 ZZZ 0 X 2,035.13 145.69
37252   004 ZZZ 0 X 2,035.13 145.69
37252   001 ZZZ 0 X 2,368.93 158.17
37253   001 ZZZ 0 X 366.64 126.63
37253   004 ZZZ 0 X 321.71 116.59
37253   002 ZZZ 0 X 321.71 116.59
37253   003 ZZZ 0 X 321.71 116.59
37500   001 90 2 X 1,739.87 X
37500   004 90 2 X 1,572.73 X
37500   003 90 2 X 1,572.73 X
37500   002 90 2 X 1,572.73 X
37501     YYY 2 X # X
37565   002 90 2 X 1,739.84 X
37565   003 90 2 X 1,648.80 X
37565   004 90 2 X 1,685.81 X
37565   001 90 2 X 1,602.28 X
37600   004 90 2 X 1,485.37 X
37600   001 90 2 X 1,535.25 X
37600   003 90 2 X 1,491.19 X
37600   002 90 2 X 1,526.70 X
37605   002 90 2 X 1,401.71 X
37605   003 90 2 X 1,325.25 X
37605   001 90 2 X 1,288.01 X
37605   004 90 2 X 1,154.16 X
37606   001 90 2 X 1,302.11 X
37606   004 90 2 X 1,181.96 X
37606   003 90 2 X 1,197.10 X
37606   002 90 2 X 1,281.69 X
37607   004 90 2 X 996.63 X
37607   003 90 2 X 1,007.59 X
37607   002 90 2 X 1,075.99 X
37607   001 90 2 X 1,092.75 X
37609   001 10 2 X 641.65 X
37609   004 10 2 X 618.81 X
37609   003 10 2 X 613.20 X
37609   002 10 2 X 632.96 X
37615   003 90 2 X 1,257.06 X
37615   002 90 2 X 1,307.50 X
37615   001 90 2 X 1,305.40 X
37615   004 90 2 X 1,207.91 X
37616   003 90 2 X 2,076.61 X
37616   002 90 2 X 2,180.78 X
37616   001 90 2 X 2,206.24 X
37616   004 90 2 X 2,055.07 X
37617   002 90 2 X 2,099.31 X
37617   003 90 2 X 2,013.75 X
37617   004 90 2 X 2,458.41 X
37617   001 90 2 X 2,112.53 X
37618   002 90 2 X 1,383.15 X
37618   003 90 2 X 1,344.36 X
37618   004 90 2 X 1,275.15 X
37618   001 90 2 X 1,392.55 X
37619   001 90 2 X 3,110.49 X
37619   004 90 2 X 2,788.65 X
37619   003 90 2 X 2,788.65 X
37619   002 90 2 X 2,788.65 X
37650   002 90 2 X 1,242.91 X
37650   003 90 2 X 970.14 X
37650   001 90 2 X 1,266.19 X
37650   004 90 2 X 1,203.99 X
37660   001 90 2 X 1,862.98 X
37660   004 90 2 X 1,704.53 X
37660   003 90 2 X 1,723.81 X
37660   002 90 2 X 1,835.85 X
37700   004 90 2 X 812.81 X
37700   002 90 2 X 1,080.25 X
37700   003 90 2 X 928.42 X
37700   001 90 2 X 905.64 X
37718   001 90 2 X 840.25 X
37718   004 90 2 X 766.69 X
37718   003 90 2 X 766.69 X
37718   002 90 2 X 766.69 X
37722   004 90 2 X 906.78 X
37722   001 90 2 X 1,017.00 X
37722   003 90 2 X 906.78 X
37722   002 90 2 X 906.78 X
37735   001 90 2 X 2,276.12 X
37735   002 90 2 X 2,237.70 X
37735   003 90 2 X 2,079.37 X
37735   004 90 2 X 2,055.35 X
37760   004 90 2 X 1,982.78 X
37760   002 90 2 X 2,120.24 X
37760   003 90 2 X 1,974.86 X
37760   001 90 2 X 2,155.51 X
37761   002 90 2 X 993.44 X
37761   003 90 2 X 993.44 X
37761   004 90 2 X 993.44 X
37761   001 90 2 X 1,113.82 X
37765   004 10 2 X 968.30 X
37765   003 10 2 X 968.30 X
37765   002 10 2 X 968.30 X
37765   001 10 2 X 1,065.80 X
37766   002 10 2 X 1,179.79 X
37766   003 10 2 X 1,179.79 X
37766   004 10 2 X 1,179.79 X
37766   001 10 2 X 1,290.34 X
37780   002 90 2 X 663.08 X
37780   003 90 2 X 603.08 X
37780   004 90 2 X 596.39 X
37780   001 90 2 X 649.68 X
37785   003 90 2 X 496.62 X
37785   002 90 2 X 520.45 X
37785   004 90 2 X 491.44 X
37785   001 90 2 X 526.30 X
37788   004 90 2 X 4,160.69 X
37788   001 90 2 X 4,563.90 X
37788   002 90 2 X 4,454.49 X
37788   003 90 2 X 4,216.84 X
37790   003 90 2 X 1,270.78 X
37790   002 90 2 X 1,341.07 X
37790   004 90 2 X 1,255.77 X
37790   001 90 2 X 1,358.08 X
37799     YYY 2 X # X
38100   001 90 2 X 2,626.11 X
38100   004 90 2 X 2,439.55 X
38100   002 90 2 X 2,703.14 X
38100   003 90 2 X 2,491.66 X
38101   001 90 2 X 2,395.11 X
38101   004 90 2 X 2,185.63 X
38101   003 90 2 X 2,209.92 X
38101   002 90 2 X 2,725.60 X
38102   002 ZZZ 0 X 883.34 X
38102   003 ZZZ 0 X 827.18 X
38102   004 ZZZ 0 X 818.23 X
38102   001 ZZZ 0 X 897.02 X
38115   001 90 2 X 2,463.13 X
38115   003 90 2 X 2,621.65 X
38115   002 90 2 X 2,757.21 X
38115   004 90 2 X 2,248.91 X
38120     90 2 X * X
38129     YYY 2 X # X
38200   001 0 2 X 468.42 X
38200   002 0 2 X 494.87 X
38200   003 0 2 X 470.51 X
38200   004 0 2 X 464.89 X
38204     XXX 9 X * X
38205   002 0 2 X 170.47 X
38205   003 0 2 X 170.47 X
38205   004 0 2 X 170.47 X
38205   001 0 2 X 185.38 X
38206   001 0 2 X 185.38 X
38206   004 0 2 X 170.47 X
38206   002 0 2 X 170.47 X
38206   003 0 2 X 170.47 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   001 XXX 2 X 509.02 133.33
38220   004 XXX 2 X 442.48 122.91
38220   002 XXX 2 X 442.48 122.91
38220   003 XXX 2 X 442.48 122.91
38221   004 XXX 2 X 474.22 156.17
38221   001 XXX 2 X 543.43 169.54
38221   003 XXX 2 X 474.22 156.17
38221   002 XXX 2 X 474.22 156.17
38222   003 XXX 2 X 243.60 115.64
38222   002 XXX 2 X 243.60 115.64
38222   004 XXX 2 X 243.60 115.64
38222   001 XXX 2 X 271.03 124.19
38230   004 0 2 X 592.80 X
38230   001 0 2 X 2,171.73 X
38230   003 0 2 X 600.09 X
38230   002 0 2 X 633.01 X
38232   001 0 2 X 345.85 X
38232   004 0 2 X 309.35 X
38232   002 0 2 X 309.35 X
38232   003 0 2 X 309.35 X
38240   002 XXX 2 X 457.44 X
38240   003 XXX 2 X 433.96 X
38240   001 XXX 2 X 463.10 X
38240   004 XXX 2 X 428.53 X
38241   001 XXX 2 X 457.51 X
38241   004 XXX 2 X 423.85 X
38241   003 XXX 2 X 429.19 X
38241   002 XXX 2 X 552.53 X
38242   003 0 2 X 194.25 X
38242   002 0 2 X 194.25 X
38242   004 0 2 X 194.25 X
38242   001 0 2 X 210.93 X
38243   003 0 2 X 185.03 X
38243   002 0 2 X 185.03 X
38243   004 0 2 X 185.03 X
38243   001 0 2 X 199.53 X
38300   002 10 2 X 239.66 X
38300   003 10 2 X 227.46 X
38300   004 10 2 X 220.51 X
38300   001 10 2 X 242.63 X
38305   003 90 2 X 687.77 X
38305   001 90 2 X 737.80 X
38305   002 90 2 X 728.01 X
38305   004 90 2 X 680.31 X
38308   003 90 2 X 873.96 X
38308   002 90 2 X 927.91 X
38308   004 90 2 X 863.77 X
38308   001 90 2 X 940.91 X
38380   004 90 2 X 1,212.42 X
38380   001 90 2 X 1,327.08 X
38380   003 90 2 X 1,226.48 X
38380   002 90 2 X 1,429.68 X
38381   004 90 2 X 2,189.03 X
38381   003 90 2 X 2,213.88 X
38381   002 90 2 X 2,364.44 X
38381   001 90 2 X 2,401.00 X
38382   001 90 2 X 1,728.02 X
38382   004 90 2 X 1,575.95 X
38382   002 90 2 X 1,701.60 X
38382   003 90 2 X 1,593.29 X
38500   004 10 2 X 512.48 X
38500   003 10 2 X 495.06 X
38500   002 10 2 X 562.91 X
38500   001 10 2 X 534.81 X
38505   003 0 2 X 357.01 X
38505   002 0 2 X 411.72 X
38505   004 0 2 X 353.14 X
38505   001 0 2 X 350.45 X
38510   003 10 2 X 710.43 X
38510   002 10 2 X 805.36 X
38510   001 10 2 X 778.71 X
38510   004 10 2 X 717.98 X
38520   001 90 2 X 920.64 X
38520   004 90 2 X 853.00 X
38520   003 90 2 X 879.77 X
38520   002 90 2 X 921.59 X
38525   002 90 2 X 856.56 X
38525   003 90 2 X 749.06 X
38525   004 90 2 X 724.09 X
38525   001 90 2 X 853.26 X
38530   002 90 2 X 883.31 X
38530   003 90 2 X 1,010.22 X
38530   001 90 2 X 1,092.54 X
38530   004 90 2 X 838.91 X
38531   004 90 2 X 616.34 X
38531   001 90 2 X 677.18 X
38531   002 90 2 X 616.34 X
38531   003 90 2 X 616.34 X
38542   002 90 2 X 1,049.44 X
38542   003 90 2 X 969.11 X
38542   001 90 2 X 1,106.56 X
38542   004 90 2 X 961.94 X
38550   004 90 2 X 1,066.42 X
38550   001 90 2 X 1,161.71 X
38550   003 90 2 X 1,078.21 X
38550   002 90 2 X 1,145.36 X
38555   001 90 2 X 2,454.66 X
38555   003 90 2 X 2,273.80 X
38555   002 90 2 X 2,419.35 X
38555   004 90 2 X 2,248.63 X
38562   001 90 2 X 1,950.85 X
38562   004 90 2 X 1,849.27 X
38562   002 90 2 X 1,933.40 X
38562   003 90 2 X 1,861.49 X
38564   001 90 2 X 2,034.51 X
38564   004 90 2 X 1,952.78 X
38564   003 90 2 X 1,931.33 X
38564   002 90 2 X 2,014.32 X