CPT Codes and Fees, |
Surgery, Part 1 (10000-29999) |
Surgery, Part 2 (30000-49999) |
Surgery, Part 3 (50000-69999) |
Assistant Surgery Guide |
Radiology |
Pathology and Laboratory |
Evaluation & Management, Medicine, Physical Therapy |
Commission Assigned Codes |
N.C. Industrial Commission Assigned Codes |
Effective January 1, 2015ABBREVIATIONS: BR = by
report (i.e., report is needed to establish fee), CPT
= Current Procedural Terminology, FAC = services were
performed in a facility setting, FUD = follow-up days
(i.e., number of days in global period), NA = no
allowance, OFF = services were performed in physician
office setting, PC (26) = professional component,
PER AGM = per agreement, SC = special
consideration (see Guides or contact Industrial Commission),
TBA = to be assigned, TC (27) = technical
component, Total = total fee, and Units =
requires time or number of units. |
CPT Code |
Total |
OFF |
FAC |
TC (27) |
PC (26) |
FUD |
30000 |
$153.57 |
|
|
|
|
0 |
30020 |
$155.20 |
|
|
|
|
0 |
30100 |
$127.58 |
|
|
|
|
15 |
30110 |
$224.27 |
|
|
|
|
15 |
30115 |
$552.57 |
|
|
|
|
15 |
30117 |
$461.56 |
|
|
|
|
15 |
30118 |
$1,350.56 |
|
|
|
|
15 |
30120 |
$925.56 |
|
|
|
|
15 |
30124 |
$340.48 |
|
|
|
|
15 |
30125 |
$969.44 |
|
|
|
|
15 |
30130 |
$378.67 |
|
|
|
|
15 |
30140 |
$494.87 |
|
|
|
|
15 |
30150 |
$1,289.60 |
|
|
|
|
45 |
30160 |
$1,604.90 |
|
|
|
|
45 |
30200 |
$90.21 |
|
|
|
|
0 |
30210 |
$101.58 |
|
|
|
|
0 |
30220 |
$234.04 |
|
|
|
|
15 |
30300 |
$113.77 |
|
|
|
|
0 |
30310 |
$276.29 |
|
|
|
|
15 |
30320 |
$677.72 |
|
|
|
|
15 |
30400 |
$1,510.64 |
|
|
|
|
90 |
30410 |
$2,118.46 |
|
|
|
|
90 |
30420 |
$2,601.97 |
|
|
|
|
90 |
30430 |
$1,002.77 |
|
|
|
|
45 |
30435 |
$1,673.15 |
|
|
|
|
45 |
30450 |
$2,285.06 |
|
|
|
|
45 |
30460 |
$1,412.32 |
|
|
|
|
45 |
30462 |
$2,827.06 |
|
|
|
|
45 |
30465 |
$1,591.43 |
|
|
|
|
45 |
30520 |
$996.26 |
|
|
|
|
45 |
30540 |
$1,101.09 |
|
|
|
|
15 |
30545 |
$1,690.23 |
|
|
|
|
15 |
30560 |
$138.14 |
|
|
|
|
0 |
30580 |
$992.20 |
|
|
|
|
45 |
30600 |
$753.28 |
|
|
|
|
45 |
30620 |
$1,036.88 |
|
|
|
|
45 |
30630 |
$1,023.08 |
|
|
|
|
45 |
30801 |
$117.01 |
|
|
|
|
0 |
30802 |
$229.15 |
|
|
|
|
15 |
30901 |
$138.95 |
|
|
|
|
0 |
30903 |
$186.90 |
|
|
|
|
0 |
30905 |
$293.34 |
|
|
|
|
0 |
30906 |
$276.29 |
|
|
|
|
0 |
30915 |
$912.56 |
|
|
|
|
15 |
30920 |
$1,360.30 |
|
|
|
|
15 |
30930 |
$150.34 |
|
|
|
|
15 |
30999 |
BR |
|
|
|
|
0 |
31000 |
$120.26 |
|
|
|
|
0 |
31002 |
$182.02 |
|
|
|
|
0 |
31020 |
$427.43 |
|
|
|
|
45 |
31030 |
$999.51 |
|
|
|
|
45 |
31032 |
$1,111.64 |
|
|
|
|
45 |
31040 |
$1,314.80 |
|
|
|
|
90 |
31050 |
$861.37 |
|
|
|
|
45 |
31051 |
$1,168.54 |
|
|
|
|
45 |
31070 |
$681.78 |
|
|
|
|
45 |
31075 |
$1,488.70 |
|
|
|
|
90 |
31080 |
$1,563.46 |
|
|
|
|
90 |
31081 |
$1,746.30 |
|
|
|
|
90 |
31084 |
$2,147.71 |
|
|
|
|
90 |
31085 |
$2,269.61 |
|
|
|
|
90 |
31086 |
$1,786.12 |
|
|
|
|
90 |
31087 |
$1,769.05 |
|
|
|
|
90 |
31090 |
$1,785.30 |
|
|
|
|
90 |
31200 |
$726.48 |
|
|
|
|
45 |
31201 |
$1,166.91 |
|
|
|
|
45 |
31205 |
$1,381.44 |
|
|
|
|
45 |
31225 |
$2,713.31 |
|
|
|
|
90 |
31230 |
$3,349.58 |
|
|
|
|
90 |
31231 |
$192.59 |
|
|
|
|
0 |
31233 |
$388.43 |
|
|
|
|
15 |
31235 |
$393.30 |
|
|
|
|
15 |
31237 |
$496.50 |
|
|
|
|
15 |
31238 |
$580.20 |
|
|
|
|
15 |
31239 |
$1,513.07 |
|
|
|
|
15 |
31240 |
$464.82 |
|
|
|
|
15 |
31254 |
$829.67 |
|
|
|
|
45 |
31255 |
$1,244.92 |
|
|
|
|
45 |
31256 |
$551.77 |
|
|
|
|
45 |
31267 |
$843.49 |
|
|
|
|
15 |
31276 |
$1,105.95 |
|
|
|
|
15 |
31287 |
$701.29 |
|
|
|
|
15 |
31288 |
$819.92 |
|
|
|
|
15 |
31290 |
$2,291.56 |
|
|
|
|
45 |
31291 |
$2,407.75 |
|
|
|
|
45 |
31292 |
$1,860.88 |
|
|
|
|
45 |
31293 |
$2,036.39 |
|
|
|
|
45 |
31294 |
$2,326.50 |
|
|
|
|
45 |
31295 |
|
$4,020.40 |
$347.01 |
|
|
0 |
31296 |
|
$7,527.32 |
$414.41 |
|
|
0 |
31297 |
|
$7,456.62 |
$339.67 |
|
|
0 |
31299 |
BR |
|
|
|
|
0 |
31300 |
$1,945.38 |
|
|
|
|
90 |
31320 |
$659.84 |
|
|
|
|
45 |
31360 |
$2,701.11 |
|
|
|
|
90 |
31365 |
$3,829.83 |
|
|
|
|
90 |
31367 |
$2,831.12 |
|
|
|
|
90 |
31368 |
$3,949.27 |
|
|
|
|
90 |
31370 |
$2,790.50 |
|
|
|
|
90 |
31375 |
$2,606.85 |
|
|
|
|
90 |
31380 |
$2,797.01 |
|
|
|
|
90 |
31382 |
$2,704.37 |
|
|
|
|
90 |
31390 |
$3,872.08 |
|
|
|
|
90 |
31395 |
$4,688.75 |
|
|
|
|
90 |
31400 |
$1,321.30 |
|
|
|
|
90 |
31420 |
$1,339.19 |
|
|
|
|
90 |
31500 |
$238.88 |
|
|
|
|
0 |
31502 |
$96.70 |
|
|
|
|
0 |
31505 |
$81.27 |
|
|
|
|
0 |
31510 |
$194.22 |
|
|
|
|
15 |
31511 |
$244.60 |
|
|
|
|
0 |
31512 |
$302.28 |
|
|
|
|
0 |
31513 |
$383.55 |
|
|
|
|
0 |
31515 |
$229.98 |
|
|
|
|
0 |
31520 |
$329.11 |
|
|
|
|
0 |
31525 |
$377.87 |
|
|
|
|
0 |
31526 |
$458.31 |
|
|
|
|
0 |
31527 |
$488.38 |
|
|
|
|
15 |
31528 |
$393.30 |
|
|
|
|
0 |
31529 |
$401.43 |
|
|
|
|
0 |
31530 |
$548.52 |
|
|
|
|
0 |
31531 |
$667.15 |
|
|
|
|
0 |
31535 |
$560.69 |
|
|
|
|
15 |
31536 |
$592.39 |
|
|
|
|
15 |
31540 |
$737.03 |
|
|
|
|
15 |
31541 |
$693.15 |
|
|
|
|
15 |
31545 |
$760.90 |
|
|
|
|
0 |
31546 |
$1,157.49 |
|
|
|
|
0 |
31560 |
$815.86 |
|
|
|
|
45 |
31561 |
$975.12 |
|
|
|
|
45 |
31570 |
$690.72 |
|
|
|
|
15 |
31571 |
$667.15 |
|
|
|
|
15 |
31575 |
$208.02 |
|
|
|
|
0 |
31576 |
$352.67 |
|
|
|
|
15 |
31577 |
$440.43 |
|
|
|
|
0 |
31578 |
$515.19 |
|
|
|
|
0 |
31579 |
$359.18 |
|
|
|
|
0 |
31580 |
$1,963.26 |
|
|
|
|
90 |
31582 |
$2,940.84 |
|
|
|
|
90 |
31584 |
$2,442.71 |
|
|
|
|
90 |
31587 |
$1,188.04 |
|
|
|
|
90 |
31588 |
$1,760.93 |
|
|
|
|
90 |
31590 |
$947.50 |
|
|
|
|
90 |
31595 |
$1,127.89 |
|
|
|
|
90 |
31599 |
BR |
|
|
|
|
0 |
31600 |
$605.39 |
|
|
|
|
15 |
31601 |
$744.34 |
|
|
|
|
15 |
31603 |
$661.47 |
|
|
|
|
15 |
31605 |
$608.65 |
|
|
|
|
15 |
31610 |
$1,144.14 |
|
|
|
|
15 |
31611 |
$965.38 |
|
|
|
|
15 |
31612 |
$162.51 |
|
|
|
|
0 |
31613 |
$507.07 |
|
|
|
|
45 |
31614 |
$1,004.37 |
|
|
|
|
45 |
31615 |
$316.11 |
|
|
|
|
0 |
31620 |
$522.08 |
$154.50 |
|
|
0 |
|
31622 |
$434.99 |
|
|
|
|
0 |
31623 |
$442.80 |
|
|
|
|
0 |
31624 |
$446.90 |
|
|
|
|
0 |
31625 |
$492.03 |
|
|
|
|
15 |
31626 |
|
$814.94 |
$411.32 |
|
|
0 |
31627 |
|
$2,224.84 |
$199.88 |
|
|
|
31628 |
$591.16 |
|
|
|
|
15 |
31629 |
$522.70 |
|
|
|
|
15 |
31630 |
$592.39 |
|
|
|
|
15 |
31631 |
$571.90 |
|
|
|
|
15 |
31632 |
|
$141.73 |
$110.21 |
|
|
0 |
31633 |
|
$174.77 |
$138.25 |
|
|
0 |
31634 |
|
$3,571.57 |
$412.89 |
|
|
0 |
31635 |
$642.78 |
|
|
|
|
0 |
31636 |
$478.29 |
|
|
|
|
0 |
31637 |
$170.27 |
|
|
|
|
0 |
31638 |
$534.21 |
|
|
|
|
0 |
31640 |
$782.53 |
|
|
|
|
15 |
31641 |
$793.68 |
|
|
|
|
15 |
31643 |
$380.75 |
|
|
|
|
0 |
31645 |
$462.08 |
|
|
|
|
0 |
31646 |
$394.35 |
|
|
|
|
0 |
31647 |
|
$444.65 | $444.65 |
|
|
0 |
31648 |
|
$463.27 |
$463.27 |
|
|
0 |
31649 |
$147.37 |
$147.37 |
|
|
0 |
|
31651 |
$156.37 | $156.37 |
|
|
0 |
|
31660 |
$445.52 |
$445.52 |
|
|
0 |
|
31661 |
$470.05 |
$470.05 |
|
|
0 |
|
31717 |
$196.09 |
|
|
|
|
0 |
31720 |
$124.07 |
|
|
|
|
0 |
31725 |
$231.75 |
|
|
|
|
0 |
31730 |
$364.39 |
|
|
|
|
0 |
31750 |
$1,405.81 |
|
|
|
|
45 |
31755 |
$2,189.16 |
|
|
|
|
45 |
31760 |
$2,538.58 |
|
|
|
|
45 |
31766 |
$3,668.92 |
|
|
|
|
45 |
31770 |
$2,849.82 |
|
|
|
|
45 |
31775 |
$3,019.65 |
|
|
|
|
45 |
31780 |
$2,622.28 |
|
|
|
|
45 |
31781 |
$3,062.73 |
|
|
|
|
45 |
31785 |
$1,970.58 |
|
|
|
|
45 |
31786 |
$2,834.37 |
|
|
|
|
45 |
31800 |
$920.68 |
|
|
|
|
15 |
31805 |
$1,764.99 |
|
|
|
|
15 |
31820 |
$602.96 |
|
|
|
|
15 |
31825 |
$886.56 |
|
|
|
|
15 |
31830 |
$620.02 |
|
|
|
|
15 |
31899 |
BR |
|
|
|
|
0 |
32035 |
$1,057.21 |
|
|
|
|
45 |
32036 |
$1,166.91 |
|
|
|
|
45 |
32096 | $1,594.21 |
90 |
||||
32097 | $1,594.21 |
90 |
||||
32098 | $1,498.44 |
90 |
||||
32100 |
$1,694.29 |
|
|
|
|
90 |
32110 |
$1,844.63 |
|
|
|
|
90 |
32120 |
$1,513.89 |
|
|
|
|
90 |
32124 |
$1,743.05 |
|
|
|
|
90 |
32140 |
$1,951.89 |
|
|
|
|
90 |
32141 |
$2,033.14 |
|
|
|
|
90 |
32150 |
$1,809.67 |
|
|
|
|
90 |
32151 |
$1,700.80 |
|
|
|
|
90 |
32160 |
$1,287.17 |
|
|
|
|
90 |
32200 |
$1,572.40 |
|
|
|
|
45 |
32215 |
$1,399.32 |
|
|
|
|
45 |
32220 |
$2,657.24 |
|
|
|
|
45 |
32225 |
$1,904.76 |
|
|
|
|
45 |
32310 |
$1,879.56 |
|
|
|
|
90 |
32320 |
$2,960.32 |
|
|
|
|
90 |
32400 |
$221.06 |
|
|
|
|
0 |
32405 |
$275.96 |
|
|
|
|
0 |
32440 |
$2,999.34 |
|
|
|
|
90 |
32442 |
$3,387.77 |
|
|
|
|
90 |
32445 |
$3,482.84 |
|
|
|
|
90 |
32480 |
$2,701.92 |
|
|
|
|
90 |
32482 |
$2,836.00 |
|
|
|
|
90 |
32484 |
$2,913.19 |
|
|
|
|
90 |
32486 |
$3,122.86 |
|
|
|
|
90 |
32488 |
$3,350.38 |
|
|
|
|
90 |
32491 |
BR |
|
|
|
|
0 |
32501 |
$740.86 |
|
|
|
|
0 |
32503 |
$3,645.66 |
|
|
|
|
90 |
32504 |
$4,171.01 |
|
|
|
|
90 |
32505 | $1,839.91 |
0 |
||||
32506 | $310.61 |
0 |
||||
32507 | $310.61 |
0 |
||||
32540 |
$1,979.52 |
|
|
|
|
90 |
32550 |
|
$1,573.90 |
$423.19 |
|
|
0 |
32551 |
|
|
$332.85 |
|
|
0 |
32552 |
|
$344.25 |
$305.04 |
|
|
10 |
32553 |
|
$1,107.15 |
$393.42 |
|
|
0 |
32554 |
|
$1,088.32 |
$178.07 |
|
|
0 |
32555 |
|
$1,255.32 |
$222.27 |
|
|
0 |
32556 |
|
$1,148.97 |
$243.92 |
|
|
0 |
32557 |
|
$1,855.77 |
$321.79 |
|
|
0 |
32560 |
|
$579.95 |
$209.17 |
|
|
0 |
32561 |
|
$180.41 |
$138.47 |
|
|
0 |
32562 |
|
$160.39 |
$123.95 |
|
|
0 |
32601 |
$706.15 |
|
|
|
|
0 |
32604 |
$999.51 |
|
|
|
|
15 |
32606 | $969.44 | 15 | ||||
32607 | $611.16 | 0 | ||||
32608 | $750.62 | 0 | ||||
32609 | $518.23 | 0 | ||||
32650 |
$1,399.32 |
|
|
|
|
15 |
32651 |
$1,904.76 |
|
|
|
|
15 |
32652 |
$2,657.24 |
|
|
|
|
15 |
32653 |
$1,809.67 |
|
|
|
|
15 |
32654 |
$1,844.63 |
|
|
|
|
15 |
32655 |
$2,055.08 |
|
|
|
|
15 |
32656 |
$2,019.34 |
|
|
|
|
15 |
32658 |
$1,937.27 |
|
|
|
|
15 |
32659 |
$1,978.69 |
|
|
|
|
15 |
32661 |
$1,733.28 |
|
|
|
|
15 |
32662 |
$2,408.57 |
|
|
|
|
15 |
32663 |
$2,748.25 |
|
|
|
|
15 |
32664 |
$1,923.44 |
|
|
|
|
15 |
32665 |
$2,307.80 |
|
|
|
|
15 |
32666 | $1,719.44 | 90 | ||||
32667 | $310.61 | 0 | ||||
32668 | $312.23 | 0 | ||||
32669 | $2,650.75 | 90 | ||||
32670 | $3,164.74 |
90 |
||||
32671 | $3,511.02 |
90 |
||||
32672 | $3,003.23 |
90 |
||||
32673 | $2,374.11 |
90 |
||||
32674 | $426.01 |
90 |
||||
32701 | $429.88 | $429.88 |
0 |
|||
32800 |
$1,617.90 |
|
|
|
|
45 |
32810 |
$1,433.45 |
|
|
|
|
45 |
32815 |
$2,895.33 |
|
|
|
|
45 |
32820 |
$3,071.67 |
|
|
|
|
45 |
32850 |
BR |
|
|
|
|
90 |
32851 |
$4,823.63 |
|
|
|
|
90 |
32852 |
$5,231.58 |
|
|
|
|
90 |
32853 |
$6,030.36 |
|
|
|
|
90 |
32854 |
$6,438.30 |
|
|
|
|
90 |
32855 |
BR |
|
|
|
|
0 |
32856 |
BR |
|
|
|
|
0 |
32900 |
$2,110.35 |
|
|
|
|
90 |
32905 |
$2,536.97 |
|
|
|
|
90 |
32906 |
$3,220.36 |
|
|
|
|
90 |
32940 |
$2,328.13 |
|
|
|
|
90 |
32960 |
$191.11 |
|
|
|
|
0 |
32997 |
$619.61 |
|
|
|
|
0 |
32998 | $5,357.32 | $544.05 | 0 | |||
32999 |
BR |
|
|
|
|
0 |
33010 |
$258.86 |
|
|
|
|
0 |
33011 |
$230.33 |
|
|
|
|
0 |
33015 |
$780.10 |
|
|
|
|
15 |
33020 |
$1,937.27 |
|
|
|
|
90 |
33025 |
$1,978.69 |
|
|
|
|
90 |
33030 |
$2,993.65 |
|
|
|
|
90 |
33031 |
$2,610.10 |
|
|
|
|
90 |
33050 |
$1,733.28 |
|
|
|
|
90 |
33120 |
$4,085.80 |
|
|
|
|
90 |
33130 |
$2,610.91 |
|
|
|
|
90 |
33140 |
$2,475.65 |
|
|
|
|
90 |
33141 |
$539.74 |
|
|
|
|
0 |
33202 | $1,455.37 |
90 |
||||
33203 | $1,498.55 |
90 |
||||
33206 |
$1,092.15 |
|
|
|
|
45 |
33207 |
$1,283.92 |
|
|
|
|
45 |
33208 |
$1,164.48 |
|
|
|
|
45 |
33210 |
$449.97 |
|
|
|
|
15 |
33211 |
$457.09 |
|
|
|
|
15 |
33212 |
$837.80 |
|
|
|
|
15 |
33213 |
$800.08 |
|
|
|
|
15 |
33214 |
$894.93 |
|
|
|
|
15 |
33215 |
$588.36 |
|
|
|
|
90 |
33216 |
$692.41 |
|
|
|
|
15 |
33217 |
$717.37 |
|
|
|
|
15 |
33218 |
$755.73 |
|
|
|
|
15 |
33220 |
$668.88 |
|
|
|
|
15 |
33221 | $692.49 | 90 | ||||
33222 |
$816.67 |
|
|
|
|
15 |
33223 |
$938.56 |
|
|
|
|
15 |
33224 |
$958.00 |
|
|
|
|
0 |
33225 |
$848.68 |
|
|
|
|
0 |
33226 |
$922.37 |
|
|
|
|
0 |
33227 | $660.72 |
90 |
||||
33228 | $689.09 |
90 |
||||
33229 | $717.44 |
90 |
||||
33230 | $745.21 |
90 |
||||
33231 | $773.55 |
90 |
||||
33233 |
$377.93 |
|
|
|
|
15 |
33234 |
$1,048.27 |
|
|
|
|
15 |
33235 |
$1,041.10 |
|
|
|
|
15 |
33236 |
$1,237.61 |
|
|
|
|
45 |
33237 |
$1,747.11 |
|
|
|
|
45 |
33238 |
$1,942.95 |
|
|
|
|
45 |
33240 |
$994.63 |
|
|
|
|
15 |
33241 |
|
|
$441.44 |
|
|
90 |
33243 |
$2,410.20 |
|
|
|
|
45 |
33244 |
$1,374.93 |
|
|
|
|
45 |
33249 |
$2,359.81 |
|
|
|
|
45 |
33250 |
$2,423.20 |
|
|
|
|
45 |
33251 |
$3,098.47 |
|
|
|
|
90 |
33254 | $2,536.09 |
90 |
||||
33255 | $3,056.38 | 90 | ||||
33256 | $3,647.04 | 90 | ||||
33257 |
|
|
$1,105.58 |
|
|
|
33258 |
|
|
$1,248.09 |
|
|
|
33259 |
|
|
$1,629.93 |
|
|
|
33261 |
$2,901.02 |
|
|
|
|
90 |
33262 | $718.20 | 90 | ||||
33263 | $746.54 | 90 | ||||
33264 | $774.91 | 0 | ||||
33265 | $2,536.09 |
90 |
||||
33266 | $3,468.26 |
90 |
||||
33270 |
|
$1,190.68 |
|
|
|
90 |
33271 |
|
$1,001.22 |
$1,001.22 |
|
|
90 |
33272 |
|
$736.37 |
$736.37 |
|
|
90 |
33273 |
|
$811.68 |
$811.68 |
|
|
90 |
33282 |
$742.40 |
|
|
|
|
90 |
33284 |
$575.79 |
|
|
|
|
90 |
33300 |
$2,424.00 |
|
|
|
|
90 |
33305 |
$2,902.64 |
|
|
|
|
90 |
33310 |
$2,246.86 |
|
|
|
|
90 |
33315 |
$2,744.19 |
|
|
|
|
90 |
33320 |
$2,341.13 |
|
|
|
|
90 |
33321 |
$3,204.93 |
|
|
|
|
90 |
33322 |
$3,178.11 |
|
|
|
|
90 |
33330 |
$2,510.15 |
|
|
|
|
90 |
33335 |
$3,373.13 |
|
|
|
|
90 |
33361 |
|
$2,619.95 | $2,619.95 |
|
|
0 |
33362 |
$2,866.55 | $2,866.55 |
|
|
0 |
|
33363 |
|
$2,968.05 | $2,968.05 |
|
|
0 |
33364 |
$3,157.30 | $3,157.30 |
|
|
0 |
|
33365 |
$3,454.08 | $3,454.08 |
|
|
0 |
|
33366 |
$3,886.50 | $3,886.50 |
|
|
0 |
|
33367 |
$1,213.32 | $1,213.32 |
|
|
0 |
|
33368 |
$1,470.28 | $1,470.28 |
|
|
0 |
|
33369 |
$1,941.18 | $1,941.18 |
|
|
0 |
|
33400 |
$3,857.45 |
|
|
|
|
90 |
33401 |
$3,801.38 |
|
|
|
|
90 |
33403 |
$3,878.59 |
|
|
|
|
90 |
33404 |
$4,593.68 |
|
|
|
|
90 |
33405 |
$4,674.12 |
|
|
|
|
90 |
33406 |
$5,565.56 |
|
|
|
|
90 |
33410 |
$4,154.36 |
|
|
|
|
90 |
33411 |
$5,498.10 |
|
|
|
|
90 |
33412 |
$5,646.81 |
|
|
|
|
90 |
33413 |
$5,970.23 |
|
|
|
|
90 |
33414 |
$5,411.97 |
|
|
|
|
90 |
33415 |
$4,401.89 |
|
|
|
|
90 |
33416 |
$4,468.53 |
|
|
|
|
90 |
33417 |
$4,925.21 |
|
|
|
|
90 |
33418 |
|
$3,780.86 |
$3,780.86 |
|
|
90 |
33419 |
|
$889.49 |
$889.49 |
|
|
90 |
33420 |
$3,177.30 |
|
|
|
|
90 |
33422 |
$4,327.13 |
|
|
|
|
90 |
33425 |
$4,506.72 |
|
|
|
|
90 |
33426 |
$4,609.93 |
|
|
|
|
90 |
33427 |
$5,302.28 |
|
|
|
|
90 |
33430 |
$5,097.49 |
|
|
|
|
90 |
33460 |
$3,786.75 |
|
|
|
|
90 |
33463 |
$4,516.47 |
|
|
|
|
90 |
33464 |
$4,651.38 |
|
|
|
|
90 |
33465 |
$4,706.63 |
|
|
|
|
90 |
33468 |
$4,997 |