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Health Care Services Review
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Fee Schedule
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Fee Schedule 63287-64766
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Part B Fee Schedule
63287-64766
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
63287
001
90
2
X
7,337.17
X
63287
004
90
2
X
6,680.00
X
63287
002
90
2
X
6,231.87
X
63287
003
90
2
X
6,757.80
X
63290
001
90
2
X
7,581.00
X
63290
004
90
2
X
6,900.82
X
63290
003
90
2
X
6,981.74
X
63290
002
90
2
X
7,464.12
X
63295
004
ZZZ
0
X
637.26
X
63295
001
ZZZ
0
X
723.81
X
63295
003
ZZZ
0
X
637.26
X
63295
002
ZZZ
0
X
637.26
X
63300
002
90
2
X
6,585.33
X
63300
003
90
2
X
6,475.89
X
63300
004
90
2
X
4,340.21
X
63300
001
90
2
X
6,611.81
X
63301
004
90
2
X
4,867.74
X
63301
001
90
2
X
5,360.99
X
63301
003
90
2
X
4,923.87
X
63301
002
90
2
X
5,275.67
X
63302
003
90
2
X
6,784.75
X
63302
002
90
2
X
6,928.66
X
63302
004
90
2
X
5,153.24
X
63302
001
90
2
X
5,640.88
X
63303
001
90
2
X
7,793.04
X
63303
002
90
2
X
5,620.56
X
63303
003
90
2
X
5,268.98
X
63303
004
90
2
X
5,209.43
X
63304
001
90
2
X
5,821.48
X
63304
003
90
2
X
5,419.78
X
63304
002
90
2
X
5,743.23
X
63304
004
90
2
X
5,355.65
X
63305
001
90
2
X
6,305.32
X
63305
002
90
2
X
7,989.04
X
63305
003
90
2
X
5,813.92
X
63305
004
90
2
X
5,746.57
X
63306
004
90
2
X
5,717.93
X
63306
001
90
2
X
6,214.58
X
63306
002
90
2
X
6,131.24
X
63306
003
90
2
X
5,786.32
X
63307
001
90
2
X
6,387.18
X
63307
004
90
2
X
5,857.73
X
63307
003
90
2
X
5,928.46
X
63307
002
90
2
X
6,297.95
X
63308
001
ZZZ
0
X
1,140.42
X
63308
004
ZZZ
0
X
1,036.42
X
63308
002
ZZZ
0
X
1,122.46
X
63308
003
ZZZ
0
X
1,048.54
X
63600
001
90
2
X
2,846.99
X
63600
002
90
2
X
2,950.74
X
63600
003
90
2
X
2,770.21
X
63600
004
90
2
X
2,553.34
X
63610
0
2
X
*
X
63620
004
90
0
X
1,290.15
X
63620
001
90
0
X
1,468.75
X
63620
003
90
0
X
1,290.15
X
63620
002
90
0
X
1,290.15
X
63621
002
ZZZ
0
X
408.17
X
63621
003
ZZZ
0
X
408.17
X
63621
004
ZZZ
0
X
408.17
X
63621
001
ZZZ
0
X
458.20
X
63650
002
10
2
X
2,128.42
X
63650
003
10
2
X
1,788.71
X
63650
004
10
2
X
1,767.14
X
63650
001
10
2
X
2,146.31
X
63655
002
90
2
X
3,469.14
X
63655
003
90
2
X
3,159.70
X
63655
001
90
2
X
3,543.91
X
63655
004
90
2
X
3,120.10
X
63661
001
10
2
X
1,012.92
554.46
63661
004
10
2
X
898.16
511.61
63661
002
10
2
X
898.16
511.61
63661
003
10
2
X
898.16
511.61
63662
004
90
2
X
1,183.50
X
63662
001
90
2
X
1,313.29
X
63662
003
90
2
X
1,183.50
X
63662
002
90
2
X
1,183.50
X
63663
002
10
2
X
1,338.77
797.33
63663
003
10
2
X
1,338.77
797.33
63663
004
10
2
X
1,338.77
797.33
63663
001
10
2
X
1,524.16
882.03
63664
003
90
2
X
1,233.06
X
63664
002
90
2
X
1,233.06
X
63664
004
90
2
X
1,233.06
X
63664
001
90
2
X
1,367.96
X
63685
001
10
2
X
1,742.06
X
63685
003
10
2
X
1,633.94
X
63685
002
10
2
X
1,710.00
X
63685
004
10
2
X
1,558.46
X
63688
004
10
2
X
1,263.19
X
63688
001
10
2
X
1,226.10
X
63688
003
10
2
X
1,278.69
X
63688
002
10
2
X
1,210.33
X
63700
004
90
2
X
3,187.03
X
63700
002
90
2
X
3,449.20
X
63700
003
90
2
X
3,229.89
X
63700
001
90
2
X
3,555.52
X
63702
001
90
2
X
3,999.88
X
63702
004
90
2
X
3,585.59
X
63702
002
90
2
X
3,880.30
X
63702
003
90
2
X
3,633.76
X
63704
001
90
2
X
4,443.38
X
63704
004
90
2
X
3,983.03
X
63704
002
90
2
X
4,310.49
X
63704
003
90
2
X
4,036.48
X
63706
004
90
2
X
4,581.35
X
63706
001
90
2
X
5,110.62
X
63706
003
90
2
X
4,642.86
X
63706
002
90
2
X
4,957.84
X
63707
004
90
2
X
4,467.49
X
63707
002
90
2
X
4,120.10
X
63707
003
90
2
X
4,416.46
X
63707
001
90
2
X
4,456.07
X
63709
001
90
2
X
4,503.27
X
63709
004
90
2
X
4,436.47
X
63709
002
90
2
X
4,627.08
X
63709
003
90
2
X
3,489.89
X
63710
001
90
2
X
2,753.91
X
63710
003
90
2
X
2,542.60
X
63710
002
90
2
X
2,712.63
X
63710
004
90
2
X
2,513.18
X
63740
001
90
2
X
3,478.42
X
63740
004
90
2
X
2,892.59
X
63740
002
90
2
X
3,451.55
X
63740
003
90
2
X
3,340.47
X
63741
002
90
2
X
2,368.62
X
63741
003
90
2
X
2,164.68
X
63741
001
90
2
X
2,418.00
X
63741
004
90
2
X
2,138.21
X
63744
001
90
2
X
3,136.47
X
63744
003
90
2
X
3,000.39
X
63744
002
90
2
X
2,990.29
X
63744
004
90
2
X
1,714.13
X
63746
001
90
2
X
1,396.26
X
63746
003
90
2
X
1,271.34
X
63746
002
90
2
X
2,703.00
X
63746
004
90
2
X
1,256.35
X
64400
004
0
2
X
154.26
134.38
64400
002
0
2
X
144.75
125.28
64400
003
0
2
X
151.21
131.57
64400
001
0
2
X
165.43
143.05
64405
004
0
2
X
200.25
170.55
64405
002
0
2
X
180.96
154.14
64405
003
0
2
X
205.65
175.14
64405
001
0
2
X
201.94
171.61
64408
002
0
2
X
228.52
X
64408
003
0
2
X
250.38
X
64408
001
0
2
X
231.58
X
64408
004
0
2
X
247.44
X
64415
004
0
2
X
167.84
X
64415
003
0
2
X
168.96
X
64415
002
0
2
X
170.55
X
64415
001
0
2
X
172.97
X
64416
004
0
2
X
344.44
X
64416
001
0
2
X
368.28
X
64416
003
0
2
X
344.44
X
64416
002
0
2
X
344.44
X
64417
003
0
2
X
201.38
X
64417
001
0
2
X
209.37
X
64417
002
0
2
X
214.56
X
64417
004
0
2
X
206.25
X
64418
003
0
2
X
193.28
160.09
64418
002
0
2
X
200.06
165.45
64418
001
0
2
X
202.33
167.54
64418
004
0
2
X
191.83
158.44
64420
001
0
2
X
211.21
X
64420
003
0
2
X
185.12
X
64420
002
0
2
X
194.80
X
64420
004
0
2
X
202.87
X
64421
003
ZZZ
0
X
263.02
X
64421
002
ZZZ
0
X
279.50
X
64421
004
ZZZ
0
X
288.11
X
64421
001
ZZZ
0
X
283.50
X
64425
001
0
2
X
235.63
207.93
64425
004
0
2
X
185.14
164.04
64425
002
0
2
X
228.11
202.14
64425
003
0
2
X
238.47
211.13
64430
003
0
2
X
239.52
X
64430
002
0
2
X
272.57
X
64430
004
0
2
X
236.88
X
64430
001
0
2
X
279.13
X
64435
004
0
2
X
209.87
X
64435
002
0
2
X
199.36
X
64435
001
0
2
X
216.60
X
64435
003
0
2
X
192.93
X
64445
002
0
2
X
178.59
159.58
64445
003
0
2
X
187.40
167.23
64445
001
0
2
X
194.80
173.59
64445
004
0
2
X
189.88
169.90
64446
002
0
2
X
354.59
X
64446
003
0
2
X
354.59
X
64446
001
0
2
X
383.05
X
64446
004
0
2
X
354.59
X
64447
003
0
2
X
165.51
X
64447
001
0
2
X
180.82
X
64447
002
0
2
X
165.51
X
64447
004
0
2
X
165.51
X
64448
001
0
2
X
352.37
X
64448
003
0
2
X
325.99
X
64448
002
0
2
X
325.99
X
64448
004
0
2
X
325.99
X
64449
001
0
2
X
345.92
X
64449
004
0
2
X
322.61
X
64449
002
0
2
X
322.61
X
64449
003
0
2
X
322.61
X
64450
004
0
2
X
170.96
149.01
64450
002
0
2
X
192.08
167.71
64450
003
0
2
X
181.08
157.86
64450
001
0
2
X
184.63
160.50
64451
001
0
2
X
320.31
120.74
64451
004
0
2
X
284.99
111.68
64451
002
0
2
X
284.99
111.68
64451
003
0
2
X
284.99
111.68
64454
003
0
2
X
287.79
114.95
64454
002
0
2
X
287.79
114.95
64454
001
0
2
X
323.55
124.53
64454
004
0
2
X
287.79
114.95
64455
003
0
2
X
85.79
69.07
64455
002
0
2
X
85.79
69.07
64455
001
0
2
X
95.44
75.58
64455
004
0
2
X
85.79
69.07
64461
003
0
2
X
222.12
134.05
64461
002
0
2
X
222.12
134.05
64461
004
0
2
X
222.12
134.05
64461
001
0
2
X
246.58
143.51
64462
002
ZZZ
0
X
126.26
84.50
64462
003
ZZZ
0
X
126.26
84.50
64462
001
ZZZ
0
X
139.35
90.51
64462
004
ZZZ
0
X
126.26
84.50
64463
003
0
2
X
241.11
130.15
64463
002
0
2
X
241.11
130.15
64463
004
0
2
X
241.11
130.15
64463
001
0
2
X
268.17
138.34
64479
001
0
2
X
579.66
272.01
64479
004
0
2
X
512.66
249.64
64479
002
0
2
X
512.66
249.64
64479
003
0
2
X
512.66
249.64
64480
004
ZZZ
0
X
460.19
172.95
64480
001
ZZZ
0
X
524.44
188.45
64480
003
ZZZ
0
X
460.19
172.95
64480
002
ZZZ
0
X
460.19
172.95
64483
001
0
2
X
534.99
231.18
64483
004
0
2
X
473.23
213.45
64483
002
0
2
X
473.23
213.45
64483
003
0
2
X
473.23
213.45
64484
003
ZZZ
0
X
434.34
149.57
64484
002
ZZZ
0
X
434.34
149.57
64484
001
ZZZ
0
X
496.34
163.23
64484
004
ZZZ
0
X
434.34
149.57
64486
002
0
2
X
188.22
100.74
64486
003
0
2
X
188.22
100.74
64486
004
0
2
X
188.22
100.74
64486
001
0
2
X
210.25
107.91
64487
004
0
2
X
229.94
115.76
64487
002
0
2
X
229.94
115.76
64487
003
0
2
X
229.94
115.76
64487
001
0
2
X
257.35
123.78
64488
001
0
2
X
258.02
133.65
64488
003
0
2
X
231.46
125.13
64488
002
0
2
X
231.46
125.13
64488
004
0
2
X
231.46
125.13
64489
004
0
2
X
320.27
139.56
64489
002
0
2
X
320.27
139.56
64489
003
0
2
X
320.27
139.56
64489
001
0
2
X
360.34
148.94
64490
002
0
2
X
307.21
185.42
64490
003
0
2
X
307.21
185.42
64490
004
0
2
X
307.21
185.42
64490
001
0
2
X
348.52
204.13
64491
001
ZZZ
0
X
175.03
116.86
64491
003
ZZZ
0
X
156.08
107.04
64491
002
ZZZ
0
X
156.08
107.04
64491
004
ZZZ
0
X
156.08
107.04
64492
001
ZZZ
0
X
177.15
118.97
64492
004
ZZZ
0
X
157.86
108.80
64492
003
ZZZ
0
X
157.86
108.80
64492
002
ZZZ
0
X
157.86
108.80
64493
004
0
2
X
274.28
157.24
64493
001
0
2
X
311.96
173.14
64493
003
0
2
X
274.28
157.24
64493
002
0
2
X
274.28
157.24
64494
002
ZZZ
0
X
141.58
91.36
64494
003
ZZZ
0
X
141.58
91.36
64494
001
ZZZ
0
X
159.08
99.48
64494
004
ZZZ
0
X
141.58
91.36
64495
001
ZZZ
0
X
161.18
101.60
64495
004
ZZZ
0
X
143.34
93.11
64495
003
ZZZ
0
X
143.34
93.11
64495
002
ZZZ
0
X
143.34
93.11
64505
002
0
2
X
183.13
157.45
64505
003
0
2
X
189.88
164.36
64505
004
0
2
X
200.02
172.95
64505
001
0
2
X
203.65
175.39
64510
004
0
2
X
268.14
X
64510
001
0
2
X
280.10
X
64510
003
0
2
X
265.45
X
64510
002
0
2
X
270.45
X
64517
001
0
2
X
436.18
274.16
64517
004
0
2
X
389.91
252.17
64517
003
0
2
X
389.91
252.17
64517
002
0
2
X
389.91
252.17
64520
003
0
2
X
274.12
X
64520
002
0
2
X
235.25
X
64520
004
0
2
X
274.02
X
64520
001
0
2
X
243.12
X
64530
002
0
2
X
340.84
X
64530
003
0
2
X
296.11
X
64530
004
0
2
X
292.77
X
64530
001
0
2
X
312.07
X
64553
10
2
X
*
X
64555
001
10
2
X
791.87
X
64555
004
10
2
X
266.82
X
64555
003
10
2
X
819.00
X
64555
002
10
2
X
757.00
X
64561
001
10
2
X
1,944.39
920.18
64561
004
10
2
X
1,715.85
844.45
64561
003
10
2
X
1,715.85
844.45
64561
002
10
2
X
1,715.85
844.45
64566
004
0
2
X
217.71
51.90
64566
001
0
2
X
243.31
55.68
64566
003
0
2
X
217.71
51.90
64566
002
0
2
X
217.71
51.90
64568
001
90
2
X
1,216.68
X
64568
004
90
2
X
1,105.73
X
64568
003
90
2
X
1,105.73
X
64568
002
90
2
X
1,105.73
X
64569
003
90
2
X
1,113.30
X
64569
002
90
2
X
1,113.30
X
64569
004
90
2
X
1,113.30
X
64569
001
90
2
X
1,253.63
X
64570
001
90
2
X
1,121.59
X
64570
004
90
2
X
982.82
X
64570
002
90
2
X
982.82
X
64570
003
90
2
X
982.82
X
64575
003
90
2
X
808.07
X
64575
002
90
2
X
857.03
X
64575
004
90
2
X
798.64
X
64575
001
90
2
X
868.90
X
64580
90
2
X
*
X
64581
001
90
2
X
1,775.28
X
64581
004
90
2
X
1,628.60
X
64581
002
90
2
X
1,628.60
X
64581
003
90
2
X
1,628.60
X
64582
002
90
2
X
1,034.80
X
64582
003
90
2
X
1,034.80
X
64582
004
90
2
X
1,034.80
X
64582
001
90
2
X
1,137.52
X
64583
001
90
2
X
1,023.40
X
64583
004
90
2
X
948.66
X
64583
003
90
2
X
948.66
X
64583
002
90
2
X
948.66
X
64584
004
90
2
X
798.92
X
64584
001
90
2
X
862.86
X
64584
002
90
2
X
798.92
X
64584
003
90
2
X
798.92
X
64585
002
10
2
X
336.75
X
64585
003
10
2
X
321.35
X
64585
004
10
2
X
317.70
X
64585
001
10
2
X
340.51
X
64590
001
10
2
X
516.56
X
64590
003
10
2
X
474.17
X
64590
002
10
2
X
508.34
X
64590
004
10
2
X
468.68
X
64595
004
10
2
X
310.88
X
64595
002
10
2
X
335.73
X
64595
003
10
2
X
314.43
X
64595
001
10
2
X
340.96
X
64596
10
2
X
#
X
64597
ZZZ
0
X
#
X
64598
10
2
X
#
X
64600
004
10
2
X
766.18
X
64600
001
10
2
X
781.88
X
64600
003
10
2
X
752.80
X
64600
002
10
2
X
649.47
X
64605
001
10
2
X
1,184.75
X
64605
004
10
2
X
726.12
X
64605
003
10
2
X
733.64
X
64605
002
10
2
X
770.95
X
64610
004
10
2
X
2,124.00
X
64610
001
10
2
X
2,194.29
X
64610
003
10
2
X
2,131.60
X
64610
002
10
2
X
2,148.46
X
64611
003
10
2
X
172.57
156.66
64611
002
10
2
X
172.57
156.66
64611
004
10
2
X
172.57
156.66
64611
001
10
2
X
194.55
176.54
64612
001
10
2
X
395.91
X
64612
004
10
2
X
364.30
X
64612
003
10
2
X
368.67
X
64612
002
10
2
X
390.64
X
64615
004
10
2
X
230.33
209.05
64615
003
10
2
X
230.33
209.05
64615
002
10
2
X
230.33
209.05
64615
001
10
2
X
262.90
238.22
64616
004
10
2
X
194.70
172.95
64616
001
10
2
X
219.17
193.87
64616
002
10
2
X
194.70
172.95
64616
003
10
2
X
194.70
172.95
64617
002
10
2
X
296.55
183.18
64617
003
10
2
X
296.55
183.18
64617
004
10
2
X
296.55
183.18
64617
001
10
2
X
332.28
200.16
64620
001
10
2
X
362.80
X
64620
004
10
2
X
386.90
X
64620
003
10
2
X
335.78
X
64620
002
10
2
X
330.39
X
64624
004
10
2
X
549.18
205.40
64624
002
10
2
X
549.18
205.40
64624
003
10
2
X
549.18
205.40
64624
001
10
2
X
619.44
223.55
64625
002
10
2
X
672.14
271.69
64625
003
10
2
X
672.14
271.69
64625
004
10
2
X
672.14
271.69
64625
001
10
2
X
756.35
295.21
64628
001
10
2
X
603.53
X
64628
004
10
2
X
546.92
X
64628
002
10
2
X
546.92
X
64628
003
10
2
X
546.92
X
64629
001
ZZZ
0
X
282.17
X
64629
004
ZZZ
0
X
256.94
X
64629
003
ZZZ
0
X
256.94
X
64629
002
ZZZ
0
X
256.94
X
64630
003
10
2
X
496.20
X
64630
002
10
2
X
530.44
X
64630
001
10
2
X
538.77
X
64630
004
10
2
X
490.79
X
64632
002
10
2
X
137.74
118.60
64632
003
10
2
X
137.74
118.60
64632
004
10
2
X
137.74
118.60
64632
001
10
2
X
151.27
128.55
64633
003
10
2
X
719.34
385.65
64633
002
10
2
X
719.34
385.65
64633
004
10
2
X
719.34
385.65
64633
001
10
2
X
808.31
421.26
64634
003
ZZZ
0
X
326.92
116.33
64634
002
ZZZ
0
X
326.92
116.33
64634
004
ZZZ
0
X
326.92
116.33
64634
001
ZZZ
0
X
370.20
125.94
64635
002
10
2
X
706.88
377.87
64635
003
10
2
X
706.88
377.87
64635
004
10
2
X
706.88
377.87
64635
001
10
2
X
794.16
412.59
64636
002
ZZZ
0
X
293.96
101.18
64636
003
ZZZ
0
X
293.96
101.18
64636
004
ZZZ
0
X
293.96
101.18
64636
001
ZZZ
0
X
332.89
109.29
64640
004
10
2
X
289.37
256.43
64640
001
10
2
X
303.02
267.75
64640
003
10
2
X
289.57
257.08
64640
002
10
2
X
298.53
263.29
64642
004
0
2
X
219.21
172.06
64642
002
0
2
X
219.21
172.06
64642
003
0
2
X
219.21
172.06
64642
001
0
2
X
245.25
190.32
64643
001
ZZZ
0
X
161.38
127.41
64643
004
ZZZ
0
X
145.03
115.87
64643
002
ZZZ
0
X
145.03
115.87
64643
003
ZZZ
0
X
145.03
115.87
64644
001
0
2
X
279.71
207.48
64644
003
0
2
X
249.82
187.81
64644
002
0
2
X
249.82
187.81
64644
004
0
2
X
249.82
187.81
64645
002
ZZZ
0
X
176.84
132.84
64645
003
ZZZ
0
X
176.84
132.84
64645
004
ZZZ
0
X
176.84
132.84
64645
001
ZZZ
0
X
197.46
146.24
64646
001
0
2
X
263.72
205.69
64646
004
0
2
X
235.97
186.11
64646
003
0
2
X
235.97
186.11
64646
002
0
2
X
235.97
186.11
64647
002
0
2
X
273.24
214.95
64647
003
0
2
X
273.24
214.95
64647
004
0
2
X
273.24
214.95
64647
001
0
2
X
305.18
237.27
64650
002
0
2
X
111.47
74.09
64650
003
0
2
X
111.47
74.09
64650
004
0
2
X
111.47
74.09
64650
001
0
2
X
127.60
81.84
64653
003
0
2
X
129.01
93.61
64653
001
0
2
X
146.91
103.57
64653
004
0
2
X
129.01
93.61
64653
002
0
2
X
129.01
93.61
64680
002
10
2
X
644.66
X
64680
003
10
2
X
637.96
X
64680
001
10
2
X
630.95
X
64680
004
10
2
X
439.03
X
64681
002
10
2
X
954.29
456.56
64681
003
10
2
X
954.29
456.56
64681
004
10
2
X
954.29
456.56
64681
001
10
2
X
1,084.87
499.82
64702
001
90
2
X
1,153.84
X
64702
004
90
2
X
1,052.27
X
64702
002
90
2
X
1,084.45
X
64702
003
90
2
X
1,043.97
X
64704
001
90
2
X
1,322.19
X
64704
004
90
2
X
1,167.09
X
64704
002
90
2
X
1,226.15
X
64704
003
90
2
X
1,098.57
X
64708
004
90
2
X
1,466.04
X
64708
002
90
2
X
1,604.65
X
64708
003
90
2
X
1,484.22
X
64708
001
90
2
X
1,633.80
X
64712
004
90
2
X
1,854.56
X
64712
002
90
2
X
2,041.04
X
64712
003
90
2
X
1,877.42
X
64712
001
90
2
X
2,071.68
X
64713
004
90
2
X
2,211.42
X
64713
002
90
2
X
2,405.45
X
64713
003
90
2
X
2,334.89
X
64713
001
90
2
X
2,446.06
X
64714
001
90
2
X
2,605.42
X
64714
002
90
2
X
1,954.86
X
64714
003
90
2
X
1,823.09
X
64714
004
90
2
X
1,802.88
X
64716
004
90
2
X
1,164.66
X
64716
002
90
2
X
1,255.66
X
64716
001
90
2
X
1,274.38
X
64716
003
90
2
X
1,178.60
X
64718
004
90
2
X
1,406.38
X
64718
001
90
2
X
1,522.47
X
64718
003
90
2
X
1,411.14
X
64718
002
90
2
X
1,495.90
X
64719
001
90
2
X
1,238.49
X
64719
004
90
2
X
1,130.03
X
64719
003
90
2
X
1,132.27
X
64719
002
90
2
X
1,214.97
X
64721
001
90
2
X
1,152.17
X
64721
004
90
2
X
1,053.21
X
64721
003
90
2
X
1,056.72
X
64721
002
90
2
X
1,141.08
X
64722
002
90
2
X
1,754.43
X
64722
003
90
2
X
1,587.86
X
64722
001
90
2
X
1,752.42
X
64722
004
90
2
X
1,497.71
X
64726
003
90
2
X
501.85
X
64726
002
90
2
X
519.92
X
64726
004
90
2
X
496.79
X
64726
001
90
2
X
524.30
X
64727
001
ZZZ
0
X
1,439.12
X
64727
004
ZZZ
0
X
1,407.04
X
64727
003
ZZZ
0
X
1,410.67
X
64727
002
ZZZ
0
X
1,433.55
X
64732
002
90
2
X
1,029.33
X
64732
003
90
2
X
1,012.64
X
64732
001
90
2
X
1,066.02
X
64732
004
90
2
X
945.70
X
64734
002
90
2
X
1,364.59
X
64734
003
90
2
X
1,334.10
X
64734
001
90
2
X
1,121.82
X
64734
004
90
2
X
1,019.04
X
64736
001
90
2
X
1,038.73
X
64736
003
90
2
X
965.99
X
64736
002
90
2
X
1,024.61
X
64736
004
90
2
X
953.97
X
64738
002
90
2
X
1,343.32
X
64738
003
90
2
X
1,157.63
X
64738
004
90
2
X
1,143.58
X
64738
001
90
2
X
1,660.08
X
64740
001
90
2
X
1,248.75
X
64740
004
90
2
X
1,141.06
X
64740
002
90
2
X
1,230.49
X
64740
003
90
2
X
1,155.07
X
64742
004
90
2
X
1,169.71
X
64742
002
90
2
X
1,250.87
X
64742
003
90
2
X
1,184.11
X
64742
001
90
2
X
1,267.05
X
64744
001
90
2
X
1,383.41
X
64744
003
90
2
X
1,255.17
X
64744
002
90
2
X
1,371.06
X
64744
004
90
2
X
1,240.01
X
64746
003
90
2
X
1,055.44
X
64746
002
90
2
X
1,137.49
X
64746
004
90
2
X
1,050.44
X
64746
001
90
2
X
1,155.67
X
64755
004
90
2
X
2,669.51
X
64755
002
90
2
X
2,908.95
X
64755
003
90
2
X
2,700.38
X
64755
001
90
2
X
3,234.03
X
64760
001
90
2
X
1,693.54
X
64760
002
90
2
X
1,661.89
X
64760
003
90
2
X
2,102.44
X
64760
004
90
2
X
1,513.37
X
64763
003
90
2
X
1,299.51
X
64763
002
90
2
X
1,390.94
X
64763
004
90
2
X
1,284.69
X
64763
001
90
2
X
1,413.06
X
64766
003
90
2
X
1,688.49
X
64766
001
90
2
X
1,838.02
X
64766
002
90
2
X
1,808.81
X
64766
004
90
2
X
1,668.90
X
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