Part B Fee Schedules

Fee Schedule 50553-51784

CPT/HCPC Code	Modifier	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
50553		002	0	2	X	895.88	X
50553		003	0	2	X	823.41	X
50553		001	0	2	X	865.40	X
50553		004	0	2	X	878.10	X
50555		003	0	3	X	1,220.07	X
50555		002	0	3	X	1,287.61	X
50555		001	0	3	X	1,303.87	X
50555		004	0	3	X	1,205.59	X
50557		001	0	3	X	1,224.34	X
50557		004	0	3	X	1,220.17	X
50557		002	0	3	X	1,195.63	X
50557		003	0	3	X	1,129.68	X
50561		004	0	3	X	1,363.69	X
50561		001	0	3	X	1,574.74	X
50561		003	0	3	X	1,535.65	X
50561		002	0	3	X	1,567.07	X
50562		004	90	2	X	1,239.27	X
50562		001	90	2	X	1,366.84	X
50562		003	90	2	X	1,239.27	X
50562		002	90	2	X	1,239.27	X
50570		002	0	2	X	1,216.17	X
50570		003	0	2	X	1,259.60	X
50570		004	0	2	X	1,254.70	X
50570		001	0	2	X	1,280.64	X
50572		002	0	3	X	2,025.33	X
50572		003	0	3	X	1,867.58	X
50572		004	0	3	X	1,895.41	X
50572		001	0	3	X	2,051.28	X
50574		001	0	3	X	2,087.14	X
50574		003	0	3	X	1,959.57	X
50574		002	0	3	X	1,950.34	X
50574		004	0	3	X	1,936.62	X
50575		001	0	3	X	2,777.84	X
50575		004	0	3	X	2,568.74	X
50575		002	0	3	X	2,743.16	X
50575		003	0	3	X	2,599.45	X
50576		004	0	3	X	2,108.72	X
50576		001	0	3	X	2,281.68	X
50576		003	0	3	X	2,134.40	X
50576		002	0	3	X	2,253.14	X
50580		004	0	3	X	1,642.68	X
50580		002	0	3	X	1,729.66	X
50580		003	0	3	X	1,660.31	X
50580		001	0	3	X	1,746.50	X
50590		001	90	2	X	2,320.30	X
50590		002	90	2	X	2,288.12	X
50590		003	90	2	X	2,154.70	X
50590		004	90	2	X	2,127.90	X
50592		004	10	2	X	10,318.16	712.14
50592		001	10	2	X	12,539.34	782.03
50592		003	10	2	X	10,318.16	712.14
50592		002	10	2	X	10,318.16	712.14
50593		003	10	2	X	8,004.35	826.35
50593		002	10	2	X	8,004.35	826.35
50593		001	10	2	X	9,558.40	903.88
50593		004	10	2	X	8,004.35	826.35
50600		001	90	2	X	2,783.42	X
50600		004	90	2	X	2,647.42	X
50600		003	90	2	X	2,624.94	X
50600		002	90	2	X	2,811.34	X
50605		001	90	2	X	2,344.44	X
50605		003	90	2	X	2,215.52	X
50605		002	90	2	X	2,319.26	X
50605		004	90	2	X	2,190.99	X
50606		004	ZZZ	0	X	777.93	245.51
50606		001	ZZZ	0	X	886.52	263.56
50606		003	ZZZ	0	X	777.93	245.51
50606		002	ZZZ	0	X	777.93	245.51
50610		002	90	2	X	3,068.11	X
50610		003	90	2	X	2,901.45	X
50610		004	90	2	X	2,866.69	X
50610		001	90	2	X	3,108.40	X
50620		004	90	2	X	2,765.15	X
50620		002	90	2	X	2,961.44	X
50620		003	90	2	X	2,798.70	X
50620		001	90	2	X	3,000.65	X
50630		001	90	2	X	3,124.87	X
50630		004	90	2	X	2,873.62	X
50630		002	90	2	X	3,082.98	X
50630		003	90	2	X	2,909.04	X
50650		001	90	2	X	3,311.85	X
50650		004	90	2	X	3,058.71	X
50650		003	90	2	X	3,095.47	X
50650		002	90	2	X	3,269.79	X
50660		001	90	2	X	3,640.16	X
50660		004	90	2	X	3,354.50	X
50660		002	90	2	X	5,046.77	X
50660		003	90	2	X	4,963.54	X
50684		002	0	2	X	188.67	X
50684		003	0	2	X	136.50	X
50684		001	0	2	X	193.61	X
50684		004	0	2	X	189.11	X
50686		003	0	2	X	202.10	X
50686		002	0	2	X	210.23	X
50686		004	0	2	X	200.00	X
50686		001	0	2	X	212.15	X
50688		004	10	2	X	162.49	X
50688		002	10	2	X	177.26	X
50688		003	10	2	X	164.24	X
50688		001	10	2	X	173.19	X
50690		002	0	2	X	174.32	X
50690		003	0	2	X	171.64	X
50690		001	0	2	X	169.44	X
50690		004	0	2	X	170.96	X
50693		002	0	2	X	1,549.64	339.73
50693		003	0	2	X	1,549.64	339.73
50693		001	0	2	X	1,781.04	365.37
50693		004	0	2	X	1,549.64	339.73
50694		003	0	2	X	1,710.28	439.32
50694		002	0	2	X	1,710.28	439.32
50694		004	0	2	X	1,710.28	439.32
50694		001	0	2	X	1,959.19	472.07
50695		003	0	2	X	2,086.78	557.73
50695		002	0	2	X	2,086.78	557.73
50695		004	0	2	X	2,086.78	557.73
50695		001	0	2	X	2,387.82	598.73
50700		004	90	2	X	2,879.52	X
50700		002	90	2	X	3,090.28	X
50700		003	90	2	X	2,914.94	X
50700		001	90	2	X	3,132.55	X
50705		002	ZZZ	0	X	2,483.79	314.41
50705		003	ZZZ	0	X	2,483.79	314.41
50705		001	ZZZ	0	X	2,876.11	337.81
50705		004	ZZZ	0	X	2,483.79	314.41
50706		004	ZZZ	0	X	1,122.50	292.31
50706		001	ZZZ	0	X	1,284.54	313.13
50706		003	ZZZ	0	X	1,122.50	292.31
50706		002	ZZZ	0	X	1,122.50	292.31
50715		004	90	2	X	3,137.02	X
50715		001	90	2	X	3,405.38	X
50715		003	90	2	X	3,173.51	X
50715		002	90	2	X	3,360.13	X
50722		001	90	2	X	3,110.53	X
50722		004	90	2	X	2,832.26	X
50722		003	90	2	X	2,864.74	X
50722		002	90	2	X	3,062.56	X
50725		002	90	2	X	3,433.84	X
50725		003	90	2	X	3,231.11	X
50725		004	90	2	X	3,193.64	X
50725		001	90	2	X	3,753.71	X
50727		004	90	2	X	1,388.56	X
50727		001	90	2	X	1,500.99	X
50727		003	90	2	X	1,405.12	X
50727		002	90	2	X	1,482.33	X
50728		003	90	2	X	2,068.44	X
50728		002	90	2	X	2,182.69	X
50728		004	90	2	X	2,043.96	X
50728		001	90	2	X	2,210.34	X
50740		003	90	2	X	3,344.59	X
50740		002	90	2	X	3,530.01	X
50740		004	90	2	X	3,342.88	X
50740		001	90	2	X	3,599.35	X
50750		001	90	2	X	3,730.18	X
50750		002	90	2	X	3,683.56	X
50750		003	90	2	X	3,490.23	X
50750		004	90	2	X	3,448.40	X
50760		002	90	2	X	3,546.18	X
50760		003	90	2	X	3,347.81	X
50760		001	90	2	X	3,594.07	X
50760		004	90	2	X	3,307.96	X
50770		004	90	2	X	3,596.76	X
50770		002	90	2	X	3,854.67	X
50770		003	90	2	X	3,640.68	X
50770		001	90	2	X	3,906.29	X
50780		004	90	2	X	3,336.58	X
50780		001	90	2	X	3,624.29	X
50780		002	90	2	X	3,576.18	X
50780		003	90	2	X	3,377.02	X
50782		004	90	2	X	3,453.07	X
50782		002	90	2	X	3,696.67	X
50782		003	90	2	X	3,494.52	X
50782		001	90	2	X	3,745.44	X
50783		004	90	2	X	3,551.91	X
50783		001	90	2	X	3,848.24	X
50783		003	90	2	X	3,594.28	X
50783		002	90	2	X	3,798.77	X
50785		001	90	2	X	4,081.91	X
50785		004	90	2	X	3,750.06	X
50785		003	90	2	X	3,795.27	X
50785		002	90	2	X	4,053.65	X
50800		004	90	2	X	3,008.76	X
50800		003	90	2	X	3,046.83	X
50800		002	90	2	X	3,351.80	X
50800		001	90	2	X	3,454.94	X
50810		001	90	2	X	3,651.73	X
50810		003	90	2	X	3,392.64	X
50810		002	90	2	X	3,601.16	X
50810		004	90	2	X	3,353.30	X
50815		004	90	2	X	4,180.04	X
50815		001	90	2	X	4,701.24	X
50815		003	90	2	X	4,231.74	X
50815		002	90	2	X	4,532.70	X
50820		004	90	2	X	4,285.57	X
50820		001	90	2	X	4,697.04	X
50820		003	90	2	X	4,337.95	X
50820		002	90	2	X	4,627.18	X
50825		001	90	2	X	6,762.64	X
50825		002	90	2	X	6,662.61	X
50825		003	90	2	X	6,247.03	X
50825		004	90	2	X	6,168.95	X
50830		004	90	2	X	5,419.78	X
50830		001	90	2	X	5,873.68	X
50830		002	90	2	X	5,797.92	X
50830		003	90	2	X	5,484.24	X
50840		003	90	2	X	3,747.56	X
50840		002	90	2	X	4,176.82	X
50840		004	90	2	X	3,386.60	X
50840		001	90	2	X	3,667.71	X
50845		003	90	2	X	3,629.61	X
50845		002	90	2	X	3,830.18	X
50845		001	90	2	X	3,878.66	X
50845		004	90	2	X	3,586.68	X
50860		002	90	2	X	2,880.16	X
50860		003	90	2	X	2,721.28	X
50860		001	90	2	X	2,918.52	X
50860		004	90	2	X	2,688.87	X
50900		004	90	2	X	2,751.30	X
50900		001	90	2	X	2,659.37	X
50900		002	90	2	X	2,872.58	X
50900		003	90	2	X	2,474.45	X
50920		001	90	2	X	2,959.13	X
50920		002	90	2	X	2,852.13	X
50920		003	90	2	X	2,479.43	X
50920		004	90	2	X	2,450.17	X
50930		001	90	2	X	3,497.43	X
50930		004	90	2	X	3,234.44	X
50930		002	90	2	X	3,453.84	X
50930		003	90	2	X	3,273.18	X
50940		001	90	2	X	2,715.00	X
50940		004	90	2	X	2,509.60	X
50940		003	90	2	X	2,539.73	X
50940		002	90	2	X	2,896.62	X
50945		001	90	2	X	2,345.22	X
50945		004	90	2	X	2,140.25	X
50945		002	90	2	X	2,140.25	X
50945		003	90	2	X	2,140.25	X
50947		004	90	2	X	3,233.79	X
50947		002	90	2	X	3,233.79	X
50947		003	90	2	X	3,233.79	X
50947		001	90	2	X	3,572.48	X
50948		002	90	2	X	2,957.06	X
50948		003	90	2	X	2,957.06	X
50948		004	90	2	X	2,957.06	X
50948		001	90	2	X	3,266.37	X
50949			YYY	2	X	#	X
50951		003	0	2	X	1,135.95	X
50951		001	0	2	X	849.17	X
50951		004	0	2	X	1,115.25	X
50951		002	0	2	X	1,149.96	X
50953		002	0	3	X	1,136.43	X
50953		003	0	3	X	1,122.12	X
50953		004	0	3	X	839.64	X
50953		001	0	3	X	890.80	X
50955		001	0	3	X	1,210.50	X
50955		004	0	3	X	992.39	X
50955		003	0	3	X	1,003.39	X
50955		002	0	3	X	1,205.92	X
50957		002	0	3	X	1,047.26	X
50957		003	0	3	X	1,186.69	X
50957		001	0	3	X	1,058.20	X
50957		004	0	3	X	991.54	X
50961		001	0	3	X	991.73	X
50961		004	0	3	X	1,297.38	X
50961		003	0	3	X	1,349.43	X
50961		002	0	3	X	1,368.00	X
50970		003	0	2	X	1,340.87	X
50970		002	0	2	X	1,416.25	X
50970		004	0	2	X	1,324.96	X
50970		001	0	2	X	1,434.46	X
50972		003	0	2	X	905.73	X
50972		002	0	2	X	940.62	X
50972		004	0	2	X	896.32	X
50972		001	0	2	X	949.25	X
50974		004	0	3	X	1,736.25	X
50974		001	0	3	X	1,878.94	X
50974		002	0	3	X	1,855.32	X
50974		003	0	3	X	1,757.24	X
50976		002	0	3	X	1,771.55	X
50976		003	0	3	X	1,678.96	X
50976		004	0	3	X	1,659.15	X
50976		001	0	3	X	1,793.94	X
50980		004	0	2	X	1,065.53	X
50980		001	0	2	X	1,141.11	X
50980		003	0	2	X	872.66	X
50980		002	0	2	X	1,657.42	X
51020		001	90	2	X	1,669.78	X
51020		004	90	2	X	1,659.18	X
51020		003	90	2	X	1,666.55	X
51020		002	90	2	X	1,692.40	X
51030		003	90	2	X	1,637.95	X
51030		002	90	2	X	1,818.90	X
51030		004	90	2	X	1,134.58	X
51030		001	90	2	X	1,636.42	X
51040		001	90	2	X	1,598.76	X
51040		004	90	2	X	1,571.85	X
51040		002	90	2	X	1,613.06	X
51040		003	90	2	X	1,607.38	X
51045		002	90	2	X	1,430.33	X
51045		003	90	2	X	1,610.08	X
51045		001	90	2	X	1,634.42	X
51045		004	90	2	X	1,604.05	X
51050		002	90	2	X	1,701.89	X
51050		003	90	2	X	1,665.38	X
51050		001	90	2	X	1,713.84	X
51050		004	90	2	X	1,657.79	X
51060		002	90	2	X	2,263.09	X
51060		003	90	2	X	2,116.80	X
51060		004	90	2	X	2,089.72	X
51060		001	90	2	X	2,298.29	X
51065		001	90	2	X	1,774.19	X
51065		004	90	2	X	1,631.93	X
51065		002	90	2	X	2,064.71	X
51065		003	90	2	X	1,849.27	X
51080		001	90	2	X	1,254.54	X
51080		003	90	2	X	1,163.47	X
51080		002	90	2	X	1,321.94	X
51080		004	90	2	X	1,271.50	X
51100		002	0	2	X	111.45	69.53
51100		003	0	2	X	111.45	69.53
51100		004	0	2	X	111.45	69.53
51100		001	0	2	X	126.43	75.83
51101		002	0	2	X	225.84	92.18
51101		003	0	2	X	225.84	92.18
51101		004	0	2	X	225.84	92.18
51101		001	0	2	X	262.75	101.61
51102		003	0	2	X	590.87	437.18
51102		002	0	2	X	590.87	437.18
51102		004	0	2	X	590.87	437.18
51102		001	0	2	X	669.20	483.86
51500		002	90	2	X	1,966.14	X
51500		003	90	2	X	1,840.89	X
51500		004	90	2	X	1,819.79	X
51500		001	90	2	X	1,996.53	X
51520		002	90	2	X	2,076.64	X
51520		003	90	2	X	2,027.80	X
51520		001	90	2	X	2,028.94	X
51520		004	90	2	X	1,861.07	X
51525		003	90	2	X	2,556.48	X
51525		002	90	2	X	2,705.88	X
51525		004	90	2	X	2,525.65	X
51525		001	90	2	X	2,741.85	X
51530		001	90	2	X	2,420.45	X
51530		004	90	2	X	2,665.92	X
51530		002	90	2	X	2,649.55	X
51530		003	90	2	X	2,682.32	X
51535		001	90	2	X	2,290.00	X
51535		004	90	2	X	2,101.66	X
51535		003	90	2	X	2,126.08	X
51535		002	90	2	X	2,257.99	X
51550		003	90	2	X	2,737.99	X
51550		002	90	2	X	2,896.93	X
51550		004	90	2	X	2,705.52	X
51550		001	90	2	X	2,935.29	X
51555		001	90	2	X	3,540.79	X
51555		004	90	2	X	3,383.05	X
51555		003	90	2	X	3,406.11	X
51555		002	90	2	X	3,691.16	X
51565		001	90	2	X	4,200.99	X
51565		004	90	2	X	3,869.52	X
51565		003	90	2	X	3,916.26	X
51565		002	90	2	X	4,145.60	X
51570		004	90	2	X	4,072.17	X
51570		001	90	2	X	4,407.94	X
51570		003	90	2	X	4,120.73	X
51570		002	90	2	X	4,352.07	X
51575		004	90	2	X	5,467.24	X
51575		002	90	2	X	5,854.21	X
51575		001	90	2	X	5,931.47	X
51575		003	90	2	X	5,533.88	X
51580		004	90	2	X	5,180.92	X
51580		001	90	2	X	5,606.83	X
51580		002	90	2	X	5,535.97	X
51580		003	90	2	X	5,242.74	X
51585		002	90	2	X	6,592.04	X
51585		003	90	2	X	6,238.15	X
51585		004	90	2	X	6,163.62	X
51585		001	90	2	X	6,677.33	X
51590		001	90	2	X	6,673.79	X
51590		004	90	2	X	6,366.78	X
51590		002	90	2	X	6,330.04	X
51590		003	90	2	X	6,466.10	X
51595		004	90	2	X	7,542.59	X
51595		002	90	2	X	7,892.86	X
51595		003	90	2	X	7,543.96	X
51595		001	90	2	X	8,002.79	X
51596		002	90	2	X	7,414.62	X
51596		003	90	2	X	7,276.91	X
51596		004	90	2	X	7,677.48	X
51596		001	90	2	X	7,454.32	X
51597		002	90	2	X	7,811.38	X
51597		003	90	2	X	7,323.90	X
51597		004	90	2	X	7,236.82	X
51597		001	90	2	X	7,929.30	X
51600		002	0	2	X	109.08	X
51600		003	0	2	X	106.37	X
51600		001	0	2	X	110.85	X
51600		004	0	2	X	105.82	X
51605		004	0	2	X	151.51	X
51605		003	0	2	X	153.10	X
51605		002	0	2	X	159.19	X
51605		001	0	2	X	160.76	X
51610		003	0	2	X	163.39	X
51610		002	0	2	X	174.03	X
51610		004	0	2	X	162.62	X
51610		001	0	2	X	171.81	X
51700		003	0	2	X	110.80	100.28
51700		002	0	2	X	118.18	106.77
51700		001	0	2	X	122.19	110.58
51700		004	0	2	X	103.41	93.82
51701		003	0	2	X	122.63	57.43
51701		002	0	2	X	122.63	57.43
51701		001	0	2	X	139.70	63.03
51701		004	0	2	X	122.63	57.43
51702		004	0	2	X	191.63	62.73
51702		001	0	2	X	220.75	69.26
51702		003	0	2	X	191.63	62.73
51702		002	0	2	X	191.63	62.73
51703		001	0	2	X	303.32	185.67
51703		004	0	2	X	269.14	169.06
51703		002	0	2	X	269.14	169.06
51703		003	0	2	X	269.14	169.06
51705		001	0	2	X	144.53	125.36
51705		004	0	2	X	138.89	121.02
51705		002	0	2	X	142.36	123.44
51705		003	0	2	X	137.53	119.53
51710		004	0	2	X	180.37	X
51710		001	0	2	X	189.02	X
51710		003	0	2	X	181.76	X
51710		002	0	2	X	187.56	X
51715		002	0	2	X	734.17	X
51715		003	0	2	X	695.32	X
51715		001	0	2	X	743.46	X
51715		004	0	2	X	687.15	X
51720		004	0	2	X	202.14	184.07
51720		001	0	2	X	213.21	193.23
51720		003	0	2	X	204.56	185.84
51720		002	0	2	X	210.80	191.56
51725		001	0	2	X	288.05	X
51725	26	001	0	2	X	246.29	X
51725	TC	001	0	2	X	47.70	X
51725		004	0	2	X	236.40	X
51725	26	004	0	2	X	202.84	X
51725	TC	004	0	2	X	41.87	X
51725		003	0	2	X	241.76	X
51725	26	003	0	2	X	206.90	X
51725	TC	003	0	2	X	42.48	X
51725		002	0	2	X	290.36	X
51725	26	002	0	2	X	243.61	X
51725	TC	002	0	2	X	46.72	X
51726		003	0	2	X	271.58	X
51726	26	003	0	2	X	229.93	X
51726	TC	003	0	2	X	54.66	X
51726		002	0	2	X	336.29	X
51726	26	002	0	2	X	266.73	X
51726	TC	002	0	2	X	60.04	X
51726		004	0	2	X	273.89	X
51726	26	004	0	2	X	225.46	X
51726	TC	004	0	2	X	53.81	X
51726		001	0	2	X	319.24	X
51726	26	001	0	2	X	285.29	X
51726	TC	001	0	2	X	61.31	X
51727		002	0	2	X	488.33	X
51727	26	002	0	2	X	188.56	X
51727	TC	002	0	2	X	299.76	X
51727		003	0	2	X	488.33	X
51727	26	003	0	2	X	188.56	X
51727	TC	003	0	2	X	299.76	X
51727		001	0	2	X	560.81	X
51727	26	001	0	2	X	205.07	X
51727	TC	001	0	2	X	355.71	X
51727		004	0	2	X	488.33	X
51727	26	004	0	2	X	188.56	X
51727	TC	004	0	2	X	299.76	X
51728		001	0	2	X	559.42	X
51728	26	001	0	2	X	201.61	X
51728	TC	001	0	2	X	357.86	X
51728		004	0	2	X	487.56	X
51728	26	004	0	2	X	186.04	X
51728	TC	004	0	2	X	301.59	X
51728		002	0	2	X	487.56	X
51728	26	002	0	2	X	186.04	X
51728	TC	002	0	2	X	301.59	X
51728		003	0	2	X	487.56	X
51728	26	003	0	2	X	186.04	X
51728	TC	003	0	2	X	301.59	X
51729		004	0	2	X	525.37	X
51729	26	004	0	2	X	220.24	X
51729	TC	004	0	2	X	305.09	X
51729		001	0	2	X	600.12	X
51729	26	001	0	2	X	238.10	X
51729	TC	001	0	2	X	362.04	X
51729		002	0	2	X	525.37	X
51729	26	002	0	2	X	220.24	X
51729	TC	002	0	2	X	305.09	X
51729		003	0	2	X	525.37	X
51729	26	003	0	2	X	220.24	X
51729	TC	003	0	2	X	305.09	X
51736		004	XXX	2	X	119.91	X
51736	26	004	XXX	2	X	96.70	X
51736	TC	004	XXX	2	X	15.93	X
51736		001	XXX	2	X	130.79	X
51736	26	001	XXX	2	X	110.92	X
51736	TC	001	XXX	2	X	17.87	X
51736		002	XXX	2	X	125.98	X
51736	26	002	XXX	2	X	110.24	X
51736	TC	002	XXX	2	X	17.62	X
51736		003	XXX	2	X	123.22	X
51736	26	003	XXX	2	X	118.55	X
51736	TC	003	XXX	2	X	16.17	X
51741		002	XXX	2	X	192.78	X
51741	26	002	XXX	2	X	162.36	X
51741	TC	002	XXX	2	X	125.30	X
51741		003	XXX	2	X	176.79	X
51741	26	003	XXX	2	X	157.46	X
51741	TC	003	XXX	2	X	23.23	X
51741		001	XXX	2	X	184.70	X
51741	26	001	XXX	2	X	163.47	X
51741	TC	001	XXX	2	X	26.04	X
51741		004	XXX	2	X	175.93	X
51741	26	004	XXX	2	X	156.57	X
51741	TC	004	XXX	2	X	22.93	X
51784		003	XXX	2	X	297.90	X
51784	26	003	XXX	2	X	251.76	X
51784	TC	003	XXX	2	X	46.12	X
51784		002	XXX	2	X	314.68	X
51784	26	002	XXX	2	X	263.87	X
51784	TC	002	XXX	2	X	50.84	X
51784		001	XXX	2	X	322.49	X
51784	26	001	XXX	2	X	269.59	X
51784	TC	001	XXX	2	X	52.88	X
51784		004	XXX	2	X	293.95	X
51784	26	004	XXX	2	X	248.61	X
51784	TC	004	XXX	2	X	45.29	X

Fee Schedule 50553-51784

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