Schedule of Benefits - nib · This Schedule of Benefits applies to services performed on and from 1...

Effective 1 July 2015

Schedule of Benefits

2

Section 1 About MediGap 3

Section 2 How to interpret this schedule 4

Section 3 Schedule of Benefits 5

Section 4 Items which will receive lower or no MediGap benefits from August 17 31

Disclaimer

This Schedule of Benefits applies to services performed on and from 1 July 2015, and is subject to change without notice. Please always refer to www.nib.com.au/providers/medigap to ensure you have the most up to date Schedule.

MediGap Benefits are paid on the MediGap Terms and Conditions, which sets out the agreement between you and nib and which you agree to each time you submit a MediGap claim to nib. A copy of the Terms and Conditions is also available at www.nib.com.au/providers/medigap

Please note that some services will have reduced Benefits for services performed on and from 17 August 2015. Please check the Schedule of Benefits for more information.

Contents

3

About MediGap

MediGap is nib’s medical gap scheme. It aims to eliminate the medical gap for nib customers for inpatient hospital services. The benefits paid to practitioners under the MediGap Scheme are outlined in this schedule of benefits.

MediGap is a no-gap scheme. As a registered MediGap practitioner you still have the right to decide on a case-by-case basis if you wish to participate. However each time you accept the MediGap rate as payment for service you are agreeing not to charge the nib customer any out-of-pocket costs.

To claim MediGap benefits you must first be a registered practitioner and you, the patient and the claim must meet the eligibility criteria set out in the MediGap Terms and Conditions, a copy of which is available at www.nib.com.au/providers/medigap

Practitioners employed by public hospitals and pathologists or radiologists are not eligible for MediGap. These practitioners can register with nib to claim the 25% portion of the Medicare Benefits Schedule Fee.

More information about MediGap, including how to register and claim is available at www.nib.com.au/providers/medigap

01SECTION

4

The Medigap benefits set out in this schedule are the total amount payable to the practitioner for the corresponding Medicare Benefits Schedule item number. The benefit includes 100% of the Medicare benefit payable for the service and the MediGap component payable by nib.

Benefits for MediGap are paid on the basis of the MediGap Terms and Conditions a copy of which is available at www.nib.com.au/providers/medigap

How to interpret this schedule02

SECTION

5

DERIVED* - Please refer to ‘Consultations – DERIVED Fees Per Patient’ table on page 30.DERIVED# - Calculate as per MBS method using MediGap Schedule of Benefits.4 to 11315

Item No Benefit

4 DERIVED*

24 DERIVED*

37 DERIVED*

47 DERIVED*

58 DERIVED*

59 DERIVED*

60 DERIVED*

65 DERIVED*

104 102.25

105 51.85

106 84.85

107 150.00

108 94.95

109 230.45

110 174.80

112 DERIVED#

116 87.45

119 49.80

132 306.35

133 153.35

135 306.35

137 306.35

139 153.80

141 525.45

143 328.45

160 260.80

161 434.65

162 608.35

163 782.50

164 869.45

173 26.85

195 DERIVED*

289 305.90

297 302.55

320 50.30

322 100.35

324 154.50

326 213.15

328 247.40

Item No Benefit

342 57.15

344 75.85

346 112.20

385 99.20

386 49.85

597 138.85

598 112.00

599 183.60

600 133.15

721 166.40

723 131.85

729 81.20

731 81.20

732 83.10

735 81.75

739 139.95

743 233.35

747 60.05

750 102.95

758 171.45

825 115.55

826 184.30

828 253.05

830 160.90

832 241.45

834 321.80

835 115.55

837 184.30

838 253.05

855 160.90

857 241.45

858 321.80

861 160.90

864 241.45

866 321.80

871 92.90

872 43.25

880 56.25

2801 167.55

Item No Benefit

2806 83.85

2814 47.75

2820 DERIVED#

2824 203.35

2832 122.95

2840 88.55

2946 154.45

2949 231.75

2954 308.90

2958 110.90

2972 176.90

2974 242.90

2978 154.45

2984 231.75

2988 308.90

2992 110.90

2996 176.90

3000 242.90

3005 167.55

3010 83.85

3014 47.75

3015 DERIVED#

3018 203.35

3023 122.95

3028 88.55

3032 154.45

3040 231.75

3044 308.90

3051 110.90

3055 176.90

3062 242.90

3069 154.45

3074 231.75

3078 308.90

3083 110.90

3088 176.90

3093 242.90

6007 155.95

6009 52.20

Item No Benefit

6011 103.85

6013 143.85

6015 183.20

11000 147.85

11003 391.25

11004 391.25

11005 391.25

11006 200.60

11009 273.55

11012 134.50

11015 180.05

11018 269.00

11021 180.05

11024 136.75

11027 202.85

11200 48.75

11204 129.35

11205 129.35

11210 129.35

11211 129.35

11215 146.95

11218 181.55

11221 80.95

11222 80.95

11224 48.80

11225 48.80

11235 146.65

11237 97.30

11240 97.30

11241 123.85

11242 95.70

11243 95.70

11300 234.65

11303 234.65

11304 386.45

11306 26.70

11309 32.05

11312 45.25

11315 59.95

Schedule of Benefits03

SECTION

6



Item No Benefit

11318 74.05

11321 140.60

11324 40.05

11327 24.05

11330 9.60

11332 71.35

11333 54.35

11336 54.35

11339 54.35

11500 206.10

11503 171.10

11506 25.35

11509 43.95

11512 76.20

11600 87.80

11612 142.50

11615 96.25

11627 288.80

11700 37.85

11701 18.85

11702 18.85

11708 155.10

11709 203.05

11710 62.90

11711 34.30

11712 184.50

11713 84.55

11715 146.40

11718 42.10

11721 84.55

11722 42.10

11724 204.80

11727 114.90

11800 210.10

11810 210.10

11820 2448.25

11823 2448.25

11830 225.00

11833 300.80

11900 33.20

11903 134.00

11906 134.00

Item No Benefit

11909 199.20

11912 199.20

11915 199.20

11917 516.65

11919 516.65

11921 90.50

12000 46.85

12003 70.80

12012 25.00

12015 75.15

12018 96.65

12021 141.80

12200 45.15

12201 2907.10

12203 714.35

12207 716.85

12210 852.65

12213 768.15

12215 852.65

12217 768.15

12250 407.35

12500 250.05

12503 490.25

12506 350.05

12509 250.05

12512 121.25

12515 265.30

12518 121.25

12521 146.15

12524 182.75

12527 98.05

12530 146.15

12533 97.95

13015 279.35

13020 283.85

13025 126.85

13030 179.25

13100 156.85

13103 81.70

13104 169.85

13106 139.30

13109 261.45

Item No Benefit

13110 262.30

13112 156.85

13200 4093.70

13201 3829.20

13202 612.65

13203 640.55

13206 612.65

13209 111.45

13212 466.45

13215 146.20

13218 1044.30

13221 66.85

13251 550.00

13290 268.75

13292 537.80

13300 66.10

13303 98.00

13306 387.95

13309 330.75

13312 33.00

13318 264.10

13319 264.10

13400 119.70

13500 221.85

13503 443.85

13506 227.00

13700 402.35

13703 144.25

13706 100.60

13709 58.45

13750 164.95

13755 164.95

13757 88.05

13760 920.75

13815 103.20

13818 137.65

13830 91.20

13839 27.90

13842 83.90

13847 188.95

13848 158.65

13851 597.65

Item No Benefit

13854 139.00

13857 177.20

13870 419.35

13873 311.05

13876 89.05

13881 169.55

13882 133.45

13885 177.95

13888 89.05

13915 73.70

13918 111.00

13921 125.60

13924 73.95

13927 95.65

13930 133.50

13933 148.15

13936 96.50

13939 111.00

13942 73.95

13945 59.50

13948 73.95

14050 62.60

14053 62.60

14100 181.00

14106 181.00

14109 222.40

14112 263.20

14115 304.45

14118 386.65

14124 181.00

14200 69.10

14201 273.75

14202 138.55

14203 59.10

14206 41.10

14209 102.50

14212 214.15

14218 113.20

14221 60.65

14224 81.30

14227 113.20

14230 344.45

7



Item No Benefit

14233 418.25

14236 762.75

14239 184.20

14242 547.40

14245 113.20

15000 53.50

15003 DERIVED#

15006 118.70

15009 DERIVED#

15012 67.25

15100 60.00

15103 DERIVED#

15106 70.80

15109 DERIVED#

15112 151.30

15115 DERIVED#

15211 68.80

15214 DERIVED#

15215 75.05

15218 75.05

15221 75.05

15224 75.05

15227 75.05

15230 DERIVED#

15233 DERIVED#

15236 DERIVED#

15239 DERIVED#

15242 DERIVED#

15245 75.05

15248 75.05

15251 75.05

15254 75.05

15257 75.05

15260 DERIVED#

15263 DERIVED#

15266 DERIVED#

15269 DERIVED#

15272 DERIVED#

15303 449.20

15304 449.20

15307 851.60

15308 851.60

Item No Benefit

15311 419.25

15312 416.20

15315 823.20

15316 823.20

15319 510.90

15320 510.90

15323 908.45

15324 908.45

15327 988.30

15328 988.30

15331 938.40

15332 938.40

15335 851.60

15336 851.60

15338 1177.25

15339 95.85

15342 239.45

15345 638.95

15348 73.45

15351 146.70

15354 178.00

15357 50.35

15500 292.70

15503 375.80

15506 561.25

15509 253.65

15512 327.00

15513 369.75

15515 473.45

15518 92.85

15521 410.00

15524 768.80

15527 95.20

15530 424.75

15533 805.40

15536 321.95

15539 756.70

15550 794.45

15553 857.10

15556 801.45

15559 1045.30

15562 1351.95

Item No Benefit

15600 2050.05

15700 57.95

15705 96.60

15710 96.60

15800 121.50

15850 251.75

16003 730.25

16006 561.10

16009 382.95

16012 331.30

16015 4586.60

16018 2741.85

16401 112.90

16404 56.75

16406 176.80

16500 62.20

16501 185.50

16502 62.20

16504 62.20

16505 62.20

16508 62.20

16509 62.20

16511 290.30

16512 83.80

16514 48.35

16515 1006.90

16518 513.40

16519 1550.60

16520 1812.25

16522 2280.10

16525 858.80

16527 1006.95

16528 1812.25

16564 294.85

16567 431.20

16570 562.75

16571 431.20

16573 351.40

16600 85.35

16603 163.85

16606 327.05

16609 666.95

Item No Benefit

16612 524.75

16615 279.45

16618 279.45

16621 279.45

16624 402.15

16627 818.85

16633 DERIVED#

16636 DERIVED#

17610 65.95

17615 131.25

17620 181.80

17625 231.50

17640 65.95

17645 131.25

17650 181.80

17655 231.50

17680 131.25

18213 135.95

18216 291.25

18219 DERIVED#

18222 57.70

18225 76.75

18226 436.80

18227 DERIVED#

18228 95.85

18230 365.70

18232 291.25

18233 291.25

18234 191.45

18236 95.85

18238 57.70

18240 143.55

18242 57.70

18244 154.60

18246 154.60

18248 135.95

18250 95.85

18252 154.60

18254 154.60

18256 95.85

18258 95.85

18260 135.95

8



Item No Benefit

18262 95.85

18264 154.60

18266 95.85

18268 135.95

18270 135.95

18272 95.85

18274 135.95

18276 191.45

18278 135.95

18280 191.45

18282 154.60

18284 226.45

18286 226.45

18288 226.45

18290 383.05

18292 191.45

18294 269.90

18296 230.90

18298 269.90

18350 191.40

18351 191.40

18353 382.95

18354 191.40

18360 191.40

18361 191.40

18362 378.25

18365 191.40

18366 239.80

18368 409.45

18369 69.05

18370 69.05

18372 191.40

18374 191.40

18375 352.45

18377 191.40

18379 352.45

20100 157.55

20102 189.05

20104 126.05

20120 157.55

20124 126.05

20140 157.55

Item No Benefit

20142 189.05

20143 189.05

20144 252.10

20145 252.10

20146 157.55

20147 189.05

20148 126.05

20160 189.05

20162 220.60

20164 126.05

20170 189.05

20172 220.60

20174 283.60

20176 315.15

20190 157.55

20192 315.15

20210 472.70

20212 157.55

20214 283.60

20216 630.30

20220 315.15

20222 189.05

20225 378.15

20230 378.15

20300 157.55

20305 472.70

20320 189.05

20321 315.15

20330 252.10

20350 315.15

20352 157.55

20355 378.15

20400 94.50

20401 126.05

20402 157.55

20403 157.55

20404 189.05

20405 252.10

20406 409.70

20410 157.55

20420 157.55

20440 126.05

Item No Benefit

20450 157.55

20452 189.05

20470 189.05

20472 315.15

20474 409.70

20475 315.15

20500 472.70

20520 189.05

20522 126.05

20524 126.05

20526 315.15

20528 252.10

20540 409.70

20542 472.70

20546 472.70

20548 472.70

20560 630.30

20600 315.15

20604 409.70

20620 315.15

20622 409.70

20630 252.10

20632 220.60

20634 315.15

20670 409.70

20680 94.50

20690 157.55

20700 94.50

20702 126.05

20703 126.05

20704 315.15

20705 189.05

20706 220.60

20730 157.55

20740 157.55

20745 189.05

20750 126.05

20752 189.05

20754 220.60

20756 283.60

20770 472.70

20790 252.10

Item No Benefit

20791 315.15

20792 409.70

20793 472.70

20794 378.15

20798 315.15

20799 189.05

20800 94.50

20802 157.55

20803 126.05

20804 317.85

20805 189.00

20806 220.50

20810 126.00

20815 189.00

20820 157.50

20830 126.00

20832 189.00

20840 189.00

20841 252.00

20842 126.00

20844 315.00

20845 315.00

20846 315.00

20847 315.00

20848 315.00

20850 378.00

20855 472.50

20860 189.00

20862 220.50

20863 315.00

20864 315.00

20866 315.00

20867 315.00

20868 315.00

20880 472.50

20882 315.00

20884 157.50

20886 189.00

20900 94.50

20902 126.00

20904 220.50

20905 315.00

9



Item No Benefit

20906 126.00

20910 126.00

20911 157.50

20912 157.50

20914 220.50

20916 220.50

20920 126.00

20924 126.00

20926 126.00

20928 189.00

20930 126.00

20932 126.00

20934 189.00

20936 252.00

20938 126.00

20940 126.00

20942 157.50

20943 126.00

20944 189.00

20946 252.00

20948 126.00

20950 157.50

20952 126.00

20953 157.50

20954 315.00

20956 126.00

20958 157.50

20960 220.50

21100 94.50

21110 157.50

21112 126.00

21114 157.50

21116 189.00

21120 189.00

21130 94.50

21140 472.50

21150 315.00

21155 315.00

21160 126.00

21170 252.00

21195 94.50

21199 126.00

Item No Benefit

21200 126.00

21202 126.00

21210 189.00

21212 315.00

21214 315.00

21216 441.00

21220 126.00

21230 189.00

21232 157.50

21234 252.00

21260 126.00

21270 252.00

21272 126.00

21274 189.00

21275 315.00

21280 472.50

21300 94.50

21321 126.00

21340 126.00

21360 157.50

21380 94.50

21382 126.00

21390 94.50

21392 126.00

21400 126.00

21402 220.50

21403 315.00

21404 157.50

21420 94.50

21430 126.00

21432 157.50

21440 252.00

21445 315.00

21460 94.50

21461 126.00

21462 94.50

21464 126.00

21472 157.50

21474 157.50

21480 126.00

21482 157.50

21484 157.50

Item No Benefit

21486 220.50

21490 94.50

21500 252.00

21502 189.00

21520 126.00

21522 157.50

21530 472.50

21532 252.00

21535 315.00

21600 94.50

21610 157.50

21620 126.00

21622 157.50

21630 157.50

21632 189.00

21634 283.50

21636 472.50

21638 315.00

21650 252.00

21652 315.00

21654 252.00

21656 315.00

21670 126.00

21680 94.50

21682 126.00

21685 315.00

21700 94.50

21710 126.00

21712 157.50

21714 157.50

21716 157.50

21730 94.50

21732 126.00

21740 157.50

21756 189.00

21760 220.50

21770 252.00

21772 189.00

21780 126.00

21785 315.00

21790 472.50

21800 94.50

Item No Benefit

21810 126.00

21820 94.50

21830 126.00

21832 220.50

21834 126.00

21840 252.00

21842 189.00

21850 126.00

21860 94.50

21865 315.00

21870 472.50

21872 252.00

21878 94.50

21879 157.50

21880 220.50

21881 283.50

21882 346.50

21883 409.50

21884 472.50

21885 535.50

21886 598.50

21887 661.50

21900 94.50

21906 157.50

21908 189.00

21910 283.50

21912 157.50

21914 189.00

21915 157.50

21916 157.50

21918 157.50

21922 220.50

21925 126.00

21926 157.50

21927 157.50

21930 189.00

21935 157.50

21936 189.00

21939 94.50

21941 220.50

21942 315.00

21943 157.50

10



Item No Benefit

21945 157.50

21949 157.50

21952 315.00

21955 157.50

21959 157.50

21962 157.50

21965 157.50

21969 252.00

21970 472.50

21973 157.50

21976 157.50

21980 157.50

21981 126.00

21990 94.50

21992 126.00

21997 126.00

22001 94.50

22002 126.00

22007 126.00

22008 126.00

22012 94.50

22014 94.50

22015 189.00

22018 220.50

22020 126.00

22025 126.00

22031 157.50

22036 94.50

22040 63.00

22045 94.50

22050 63.00

22051 286.10

22055 378.00

22060 630.00

22065 157.50

22070 315.00

22075 472.50

22900 189.00

22905 189.00

23010 31.50

23021 63.00

23022 63.00

Item No Benefit

23023 63.00

23031 94.50

23032 94.50

23033 94.50

23041 126.00

23042 126.00

23043 126.00

23051 157.50

23052 157.50

23053 157.50

23061 189.00

23062 189.00

23063 189.00

23071 220.50

23072 220.50

23073 220.50

23081 252.00

23082 252.00

23083 252.00

23091 283.50

23101 315.00

23111 346.50

23112 378.00

23113 409.50

23114 441.00

23115 472.50

23116 504.00

23117 535.50

23118 567.00

23119 598.50

23121 630.00

23170 661.50

23180 693.00

23190 724.50

23200 756.00

23210 787.50

23220 819.00

23230 850.50

23240 882.05

23250 913.55

23260 945.05

23270 976.55

Item No Benefit

23280 1008.05

23290 1039.55

23300 1071.05

23310 1102.55

23320 1134.05

23330 1165.55

23340 1197.05

23350 1228.55

23360 1260.05

23370 1291.55

23380 1323.05

23390 1354.55

23400 1386.05

23410 1417.55

23420 1449.05

23430 1480.55

23440 1512.05

23450 1543.55

23460 1575.05

23470 1606.55

23480 1638.05

23490 1669.55

23500 1701.05

23510 1732.55

23520 1764.10

23530 1795.60

23540 1827.10

23550 1858.60

23560 1890.10

23570 1921.60

23580 1953.10

23590 1984.60

23600 2016.10

23610 2047.60

23620 2079.10

23630 2110.60

23640 2142.10

23650 2173.60

23660 2205.10

23670 2236.60

23680 2268.10

23690 2299.60

Item No Benefit

23700 2331.10

23710 2362.60

23720 2394.10

23730 2425.60

23740 2457.10

23750 2488.60

23760 2520.10

23770 2551.60

23780 2583.10

23790 2614.60

23800 2646.15

23810 2677.65

23820 2709.15

23830 2740.65

23840 2772.15

23850 2803.65

23860 2835.15

23870 2866.65

23880 2898.15

23890 2929.65

23900 2961.15

23910 2992.65

23920 3024.15

23930 3055.65

23940 3087.15

23950 3118.65

23960 3150.15

23970 3181.65

23980 3213.15

23990 3244.65

24100 3276.15

24101 3307.65

24102 3339.15

24103 3370.65

24104 3402.15

24105 3433.65

24106 3465.15

24107 3496.65

24108 3528.20

24109 3559.70

24110 3591.20

24111 3622.70

11



Item No Benefit

24112 3654.20

24113 3685.70

24114 3717.20

24115 3748.70

24116 3780.20

24117 3811.70

24118 3843.20

24119 3874.70

24120 3906.20

24121 3937.70

24122 3969.20

24123 4000.70

24124 4032.20

24125 4063.70

24126 4095.20

24127 4126.70

24128 4158.20

24129 4189.70

24130 4221.20

24131 4252.70

24132 4284.20

24133 4315.70

24134 4347.20

24135 4378.75

24136 4410.25

25000 31.50

25005 63.00

25010 94.50

25015 31.50

25020 63.00

25025 DERIVED#

25030 DERIVED#

25050 DERIVED#

25200 DERIVED#

25205 DERIVED#

30001 DERIVED#

30003 48.50

30006 62.15

30009 81.20

30010 98.80

30013 175.00

30014 207.75

Item No Benefit

30017 435.95

30020 849.05

30023 435.95

30024 435.95

30026 69.75

30029 120.30

30032 110.30

30035 157.15

30038 120.30

30041 192.50

30042 248.15

30045 157.15

30048 200.20

30049 248.15

30052 339.60

30055 98.80

30058 193.00

30061 31.40

30062 81.20

30064 146.90

30067 298.95

30068 370.10

30071 69.75

30074 157.15

30075 200.20

30078 64.75

30081 146.90

30084 78.60

30087 39.35

30090 171.85

30093 229.35

30094 253.20

30096 245.85

30097 129.85

30099 120.30

30102 200.20

30103 245.85

30104 169.65

30106 207.75

30107 294.05

30110 380.20

30111 496.70

Item No Benefit

30114 496.70

30165 608.15

30168 608.15

30171 924.90

30174 924.90

30177 1317.95

30180 182.50

30183 329.55

30185 244.00

30186 63.40

30187 343.55

30189 196.95

30190 531.80

30192 52.85

30195 84.90

30196 168.85

30197 588.35

30202 64.60

30203 227.60

30205 168.85

30207 59.60

30210 217.85

30213 146.80

30214 146.80

30216 36.55

30223 217.85

30224 317.65

30225 357.85

30226 200.20

30229 364.95

30232 298.95

30235 395.35

30238 200.20

30241 476.45

30244 476.45

30246 922.30

30247 988.55

30250 1672.80

30251 2569.55

30253 1115.20

30255 1485.05

30256 595.50

Item No Benefit

30259 265.40

30262 78.60

30265 157.15

30266 200.20

30269 200.20

30272 395.35

30275 2356.95

30278 62.15

30281 159.75

30282 207.75

30283 273.70

30286 531.95

30289 671.55

30293 595.50

30294 2356.95

30296 1368.75

30297 1368.75

30299 852.30

30300 1022.70

30302 681.85

30303 818.10

30306 1067.85

30308 1067.85

30309 1368.75

30310 611.55

30313 364.95

30314 611.55

30315 1524.15

30317 1825.00

30318 1213.55

30320 1825.00

30321 1213.55

30323 1825.00

30324 1825.00

30329 330.15

30330 961.00

30332 389.40

30335 1167.20

30336 1400.65

30373 649.40

30375 700.50

30376 700.50

12



Item No Benefit

30378 703.80

30379 1247.30

30382 1756.30

30384 1477.45

30385 757.00

30387 853.35

30388 2146.90

30390 295.55

30391 382.10

30392 906.45

30393 703.80

30394 662.30

30396 1366.10

30397 312.25

30399 429.50

30400 850.00

30402 624.35

30403 700.50

30405 1229.60

30406 70.15

30408 526.90

30409 234.40

30411 119.30

30412 70.35

30414 927.00

30415 1853.90

30416 1006.50

30417 1509.70

30418 2146.90

30419 1098.10

30421 2683.15

30422 907.60

30425 1756.30

30427 2097.75

30428 2244.30

30430 3122.25

30431 700.50

30433 975.70

30434 790.40

30436 878.15

30437 1092.95

30438 1546.60

Item No Benefit

30439 249.40

30440 707.40

30441 183.10

30442 249.40

30443 993.60

30445 993.60

30446 993.60

30448 1307.45

30449 1453.85

30450 704.70

30451 359.65

30452 507.30

30454 1159.10

30455 1362.75

30457 1853.90

30458 1362.75

30460 1159.10

30461 1986.80

30463 2439.40

30464 2927.35

30466 1688.00

30467 2088.00

30469 2312.70

30472 1248.95

30473 208.60

30475 377.20

30476 289.20

30478 289.20

30479 560.75

30481 420.50

30482 299.00

30483 208.50

30484 429.80

30485 663.50

30487 213.05

30488 106.00

30490 620.00

30491 654.10

30492 927.35

30493 392.45

30494 495.30

30495 927.35

Item No Benefit

30496 788.90

30497 940.70

30499 1118.75

30500 1198.00

30502 1322.20

30503 1480.60

30505 740.25

30506 1295.45

30508 1363.60

30509 1363.60

30515 944.80

30517 1237.00

30518 1324.60

30520 905.90

30521 1938.15

30523 2025.60

30524 2230.25

30526 2892.50

30527 1168.75

30529 1753.05

30530 1051.90

30532 1207.85

30533 1436.60

30535 2275.85

30536 2308.40

30538 1597.30

30539 1168.75

30541 2035.55

30542 1383.10

30544 1013.00

30545 2464.25

30547 1694.65

30548 1266.00

30550 2766.20

30551 1909.00

30553 1412.00

30554 3077.75

30556 2123.15

30557 1568.05

30559 1139.55

30560 1266.00

30562 798.10

Item No Benefit

30563 798.10

30564 1035.95

30565 1168.75

30566 1298.25

30568 973.90

30569 496.55

30571 597.45

30572 597.45

30574 165.30

30575 687.70

30577 1460.95

30578 1538.85

30580 1402.25

30581 1022.60

30583 1601.95

30584 2364.55

30586 940.70

30587 973.90

30589 1678.20

30590 1850.45

30593 2532.20

30594 2921.90

30596 1203.60

30597 966.05

30599 1753.05

30600 1042.40

30601 1284.10

30602 2084.10

30603 2201.10

30605 2502.95

30606 1490.00

30609 623.05

30612 478.00

30614 623.05

30615 699.20

30616 355.85

30617 478.00

30620 401.65

30621 546.60

30628 47.75

30631 317.40

30634 315.25

13



Item No Benefit

30635 391.40

30638 401.65

30641 546.60

30644 699.20

30653 62.35

30656 145.05

30659 200.85

30660 248.95

30663 193.60

30666 63.60

30672 597.45

30675 401.65

30676 508.45

30679 129.15

30680 1569.40

30682 1569.40

30684 1931.40

30686 1931.40

30687 638.60

30688 489.45

30690 755.60

30692 489.45

30694 755.60

30696 755.60

30710 697.15

31000 779.20

31001 973.90

31002 1168.75

31200 45.60

31205 128.00

31210 165.10

31215 192.55

31220 287.75

31225 511.45

31230 225.40

31235 192.55

31240 225.40

31245 494.95

31250 494.95

31255 296.90

31256 296.90

31257 296.90

Item No Benefit

31258 296.90

31260 423.40

31261 423.40

31262 423.40

31263 423.40

31265 247.45

31266 247.45

31267 247.45

31268 247.45

31270 346.40

31271 346.40

31272 346.40

31273 346.40

31275 401.40

31276 401.40

31277 401.40

31278 401.40

31280 209.05

31281 209.75

31282 209.75

31283 209.75

31285 285.65

31286 285.65

31287 285.65

31288 285.65

31290 329.85

31291 329.85

31292 329.85

31293 329.85

31295 392.80

31300 429.10

31305 527.80

31310 373.75

31315 472.80

31320 527.80

31325 362.90

31330 429.10

31335 494.95

31340 DERIVED#

31345 282.95

31346 282.95

31350 581.25

Item No Benefit

31355 958.35

31400 350.15

31403 404.20

31406 673.55

31409 2092.75

31412 2577.80

31420 246.65

31423 538.90

31426 1077.70

31429 1679.55

31432 1796.30

31435 1320.30

31438 2092.75

31450 545.45

31452 954.40

31454 755.60

31456 329.35

31458 395.20

31460 478.85

31462 699.20

31464 1168.75

31466 1753.10

31468 1926.00

31470 966.05

31472 1569.15

31500 348.80

31503 465.10

31506 523.25

31509 465.10

31512 872.10

31515 585.05

31519 987.30

31524 1395.35

31525 697.50

31530 799.00

31533 184.95

31536 254.05

31539 534.95

31542 264.15

31545 799.00

31548 184.95

31551 290.70

Item No Benefit

31554 581.45

31557 465.10

31560 465.10

31563 348.40

31566 174.30

31569 1139.55

31572 1402.25

31575 1139.55

31578 1139.55

31581 1402.25

31584 2064.50

31587 113.20

31590 337.60

32000 1325.90

32003 1386.90

32004 1478.85

32005 1670.70

32006 1478.85

32009 1754.30

32012 1937.90

32015 2381.55

32018 2019.45

32021 724.15

32023 713.95

32024 1754.30

32025 2346.60

32026 2527.00

32028 2707.70

32029 541.45

32030 1325.90

32033 1937.90

32036 2457.80

32039 1973.45

32042 1662.45

32045 622.15

32046 961.50

32047 1120.10

32051 2978.20

32054 2733.40

32057 724.15

32060 2978.20

32063 2733.40

14



Item No Benefit

32066 724.15

32069 2203.05

32072 61.50

32075 96.45

32078 216.65

32081 297.55

32084 143.15

32087 263.15

32090 429.80

32093 603.20

32094 709.45

32095 164.25

32096 330.30

32099 428.35

32102 815.95

32103 992.85

32104 1285.15

32105 622.15

32106 1754.30

32108 1285.15

32111 815.95

32112 992.85

32114 224.25

32115 163.05

32117 1285.15

32120 330.30

32123 428.35

32126 622.15

32129 815.95

32131 685.95

32132 57.95

32135 86.75

32138 472.75

32139 472.75

32142 86.75

32145 173.60

32147 57.95

32150 330.30

32153 90.10

32156 169.35

32159 428.35

32162 622.15

Item No Benefit

32165 815.95

32166 265.05

32168 169.35

32171 114.15

32174 114.15

32175 209.10

32177 224.00

32180 330.30

32183 722.05

32186 722.05

32200 380.15

32203 816.35

32206 737.50

32209 1185.25

32210 328.40

32212 175.15

32213 882.10

32214 445.75

32215 167.35

32216 792.15

32217 208.55

32218 208.55

32220 1206.30

32221 1206.30

32500 148.35

32501 148.35

32504 361.60

32507 721.00

32508 721.00

32511 1071.90

32514 1252.25

32517 1612.50

32520 721.00

32522 1071.90

32523 721.00

32526 1071.90

32700 1940.70

32703 1605.45

32708 1920.50

32710 2133.95

32711 2347.35

32712 1696.80

Item No Benefit

32715 1696.80

32718 1605.45

32721 2550.15

32724 2895.75

32730 2194.75

32733 2550.15

32736 558.75

32739 1747.60

32742 2001.80

32745 2286.15

32748 2479.15

32751 1605.45

32754 2001.80

32757 558.75

32760 548.65

32763 1605.45

32766 1066.95

32769 369.75

33050 1966.40

33055 1576.90

33070 1137.70

33075 1447.20

33080 1766.60

33100 1940.70

33103 2723.05

33109 3292.15

33112 2855.20

33115 1920.50

33116 1890.30

33118 2133.95

33119 2100.50

33121 2347.35

33124 1636.00

33127 2144.00

33130 1869.55

33133 1402.05

33136 3535.75

33139 2144.00

33142 2001.80

33145 3444.45

33148 4277.60

33151 4064.25

Item No Benefit

33154 3007.60

33157 3353.00

33160 3353.00

33163 2845.20

33166 2845.20

33169 2215.05

33172 1727.30

33175 1591.80

33178 2024.35

33181 2474.95

33500 1534.15

33506 1717.20

33509 1920.50

33512 2133.95

33515 2347.35

33518 1717.20

33521 1859.35

33524 2194.75

33527 2550.15

33530 2194.75

33533 2550.15

33536 1818.85

33539 1310.70

33542 1869.55

33545 369.75

33548 752.05

33551 369.75

33554 368.05

33800 1595.20

33803 1524.20

33806 1097.35

33810 800.50

33811 2383.20

33812 1259.90

33815 1158.35

33818 1351.40

33821 1544.40

33824 1473.25

33827 1727.30

33830 1981.25

33833 1798.60

33836 2144.00

15



Item No Benefit

33839 2509.70

33842 1239.55

33845 863.65

33848 863.65

34100 955.25

34103 558.75

34106 394.10

34109 457.15

34112 1158.35

34115 1310.70

34118 1869.55

34121 1493.50

34124 1636.00

34127 2144.00

34130 670.60

34133 752.05

34136 1208.95

34139 1208.95

34142 1493.50

34145 1087.20

34148 1940.70

34151 2651.90

34154 3160.10

34157 1605.45

34160 3007.60

34163 3861.10

34166 3861.10

34169 2144.00

34172 1747.60

34175 1605.45

34500 416.70

34503 558.75

34506 284.35

34509 1320.85

34512 1453.05

34515 1036.35

34518 1737.30

34521 1067.35

34524 558.75

34527 745.30

34528 368.05

34530 275.95

Item No Benefit

34533 1676.35

34538 368.05

34539 275.95

34800 1097.35

34803 2418.40

34806 1310.70

34809 1310.70

34812 1585.00

34815 1310.70

34818 1442.80

34821 1961.15

34824 670.60

34827 812.90

34830 955.25

34833 1239.55

35000 955.25

35003 1239.55

35006 1554.60

35009 1208.95

35012 955.25

35100 497.95

35103 316.90

35200 231.70

35202 1104.05

35300 694.80

35303 890.95

35306 822.30

35307 1511.60

35309 1027.85

35312 1164.95

35315 1164.95

35317 479.70

35319 859.90

35320 1155.05

35321 1096.55

35324 411.15

35327 551.05

35330 694.80

35331 798.80

35360 1116.65

35361 957.65

35362 798.80

Item No Benefit

35363 639.95

35404 467.30

35406 1096.55

35408 822.55

35410 1219.95

35412 3798.50

35500 121.95

35502 120.20

35503 80.30

35506 80.55

35507 261.65

35508 385.40

35509 134.15

35512 269.10

35513 332.55

35516 174.50

35517 219.00

35518 311.75

35520 87.45

35523 87.45

35526 174.50

35527 219.00

35530 404.75

35533 524.75

35534 524.75

35536 522.65

35539 409.40

35542 479.40

35545 275.40

35548 1251.05

35551 1025.85

35554 65.25

35557 321.75

35560 1025.85

35561 2069.25

35562 1698.90

35564 784.25

35565 1025.85

35566 595.85

35568 936.90

35569 241.25

35570 830.75

Item No Benefit

35571 830.75

35572 185.70

35573 1246.35

35577 1011.75

35578 1011.75

35595 1732.50

35596 1025.85

35597 2209.80

35599 1011.75

35602 1011.75

35605 548.90

35608 96.00

35611 96.00

35612 759.00

35613 607.20

35614 95.85

35615 80.55

35616 674.40

35617 260.55

35618 327.00

35620 80.00

35622 903.65

35623 1228.85

35626 124.20

35627 160.70

35630 274.50

35633 327.00

35634 1028.55

35635 449.15

35636 649.50

35637 609.95

35638 1067.25

35639 202.35

35640 274.50

35641 1863.95

35643 327.00

35644 305.45

35645 478.05

35646 305.45

35647 305.45

35648 478.05

35649 804.00

16



Item No Benefit

35653 1012.05

35657 1012.05

35658 624.05

35661 1306.95

35664 2178.30

35667 1851.35

35670 1524.45

35673 1136.70

35674 311.75

35676 637.50

35677 804.00

35678 969.35

35680 873.05

35683 526.95

35684 706.70

35687 487.80

35688 595.85

35691 238.05

35694 956.55

35697 1419.30

35700 1095.05

35703 101.25

35706 101.25

35709 65.25

35710 694.95

35712 543.20

35713 679.25

35716 651.50

35717 817.95

35720 1011.75

35723 724.65

35726 724.65

35729 326.70

35750 1176.90

35753 1301.40

35754 1637.85

35756 1176.90

35759 844.95

36500 1405.45

36502 1039.45

36503 2114.40

36506 1405.45

Item No Benefit

36509 1190.00

36516 1405.45

36519 1962.30

36522 1683.95

36525 2393.00

36526 1808.30

36527 2222.15

36528 1962.30

36529 2421.80

36531 1759.80

36532 2525.80

36533 2985.30

36537 1050.85

36540 1683.95

36543 1962.30

36546 1050.85

36549 1266.20

36552 1127.00

36558 987.60

36561 262.15

36564 1405.45

36567 1544.65

36570 1962.30

36573 1405.45

36576 1759.80

36579 1127.00

36585 1127.00

36588 1405.45

36591 1683.95

36594 1405.45

36597 1405.45

36600 1683.95

36603 1962.30

36604 406.80

36605 1049.75

36606 3519.75

36607 1049.75

36608 406.80

36609 1127.00

36612 987.60

36615 1127.00

36618 987.60

Item No Benefit

36621 705.95

36624 848.25

36627 1050.85

36630 519.00

36633 1127.00

36636 607.80

36639 1266.20

36642 632.95

36645 1620.65

36648 1443.25

36649 406.80

36650 227.50

36652 987.60

36654 1266.20

36656 1620.65

36658 730.05

36660 354.25

36662 846.40

36663 998.35

36664 896.55

36665 189.40

36666 504.50

36667 236.05

36668 236.05

36800 41.70

36803 708.80

36806 987.60

36809 1266.20

36811 491.50

36812 253.35

36815 361.55

36818 420.40

36821 491.20

36824 323.95

36825 883.50

36827 349.30

36830 308.90

36833 420.40

36836 349.30

36840 459.65

36842 494.30

36845 1050.90

Item No Benefit

36848 349.35

36851 349.35

36854 708.85

36857 557.00

36860 253.35

36863 708.85

37000 1127.05

37004 987.65

37008 633.00

37011 141.85

37014 1620.75

37020 1127.05

37023 633.00

37026 633.00

37029 1405.50

37038 1051.45

37041 70.80

37042 1385.15

37043 1025.20

37044 1051.45

37045 2171.70

37047 2532.35

37050 1127.05

37053 1302.15

37200 1544.75

37201 1209.60

37202 607.15

37203 1583.85

37206 848.20

37207 1316.80

37208 632.30

37209 1962.20

37210 2421.60

37211 2941.10

37212 420.35

37215 632.90

37217 192.80

37218 210.10

37219 426.65

37220 1544.85

37221 708.50

37223 313.35

17



Item No Benefit

37224 459.65

37227 871.25

37230 1579.45

37233 845.85

37245 1912.90

37300 70.80

37303 112.50

37306 987.55

37309 1405.35

37315 210.15

37318 420.35

37321 141.85

37324 349.30

37327 491.15

37330 987.55

37333 848.20

37336 1126.90

37339 364.50

37340 645.90

37341 1384.95

37342 1266.10

37343 2114.25

37345 1050.75

37348 1050.75

37351 420.35

37354 491.15

37369 283.55

37372 708.75

37375 1759.70

37381 1126.90

37384 1759.70

37387 491.15

37390 1405.35

37393 349.30

37396 1126.90

37402 708.75

37405 1405.35

37408 708.75

37411 1405.35

37415 70.80

37417 848.20

37418 1126.90

Item No Benefit

37420 556.90

37423 1405.35

37426 1481.10

37429 491.15

37432 1405.35

37435 141.85

37438 420.35

37444 1519.25

37601 420.20

37604 420.20

37605 575.00

37606 853.85

37607 1405.35

37610 2114.25

37613 420.35

37616 1050.75

37619 420.35

37622 293.60

37623 349.30

37800 669.20

37803 669.20

37806 773.20

37809 773.20

37812 713.80

37815 119.05

37818 630.95

37821 1069.60

37824 1487.10

37827 685.05

37830 887.65

37833 423.60

37836 892.30

37839 1011.15

37842 1963.20

37845 892.30

37848 1606.20

37851 1189.90

37854 470.45

38200 551.25

38203 657.85

38206 795.40

38209 1021.25

Item No Benefit

38212 1698.65

38213 505.80

38215 439.25

38218 708.75

38220 219.55

38222 439.25

38225 658.90

38228 878.70

38231 1098.20

38234 878.50

38237 1098.15

38240 1317.75

38241 581.35

38243 549.05

38246 1098.15

38256 330.80

38270 1129.20

38272 1271.10

38273 1271.10

38274 1271.10

38275 368.80

38285 238.55

38286 214.90

38287 2595.55

38290 3304.90

38293 3547.45

38300 689.75

38303 884.45

38306 1020.40

38309 1185.15

38312 1515.65

38315 1627.40

38318 2123.30

38350 854.80

38353 341.90

38356 1120.75

38358 3838.85

38359 178.75

38362 536.20

38365 355.80

38368 1705.85

38371 400.95

Item No Benefit

38384 1466.30

38387 400.95

38390 1466.30

38393 400.95

38415 536.00

38418 1286.35

38421 2056.25

38424 1286.35

38427 1588.35

38430 818.60

38436 335.20

38438 2056.25

38440 1539.75

38441 2436.35

38446 1588.35

38447 2056.25

38448 487.25

38449 2876.60

38450 1149.75

38452 770.00

38453 2309.75

38455 3124.20

38456 2056.25

38457 1919.65

38458 1023.20

38460 369.60

38462 438.15

38464 476.20

38466 1285.80

38468 1981.25

38469 2309.75

38470 1282.70

38473 767.80

38475 1158.60

38477 2790.65

38478 1351.75

38480 2790.65

38481 3176.90

38483 2397.20

38485 1138.20

38487 2397.20

38488 2660.05

18



Item No Benefit

38489 3163.55

38490 772.45

38493 2726.90

38496 869.15

38497 2852.50

38498 2852.50

38500 3064.80

38501 3064.80

38503 3327.65

38504 3327.65

38505 386.20

38506 2265.35

38507 2659.50

38508 3327.45

38509 3327.45

38512 2923.35

38515 3722.25

38518 3995.45

38550 2989.55

38553 3788.60

38556 4324.80

38559 3525.65

38562 4324.80

38565 4850.75

38568 2595.05

38571 2858.05

38572 2767.95

38577 772.45

38588 579.55

38600 2134.05

38603 1335.05

38609 667.45

38612 748.15

38613 938.95

38615 2134.05

38618 2660.05

38621 1061.95

38624 1193.30

38627 932.75

38637 772.45

38640 1335.05

38643 1486.85

Item No Benefit

38647 2973.35

38650 2660.05

38653 2660.05

38654 1705.85

38656 1335.05

38670 2659.50

38673 2993.30

38677 2800.40

38680 3321.65

38700 1486.85

38703 2680.25

38706 2538.60

38709 2973.35

38712 3570.45

38715 2376.85

38718 2973.35

38721 2083.60

38724 2973.35

38727 2083.60

38730 2973.35

38733 2083.60

38736 2973.35

38739 2680.25

38742 2680.25

38745 2973.35

38748 2973.35

38751 2973.35

38754 3722.00

38757 2973.35

38760 2973.35

38763 2973.35

38766 2973.35

38800 51.45

38803 102.80

38806 178.50

38809 219.95

38812 279.60

39000 113.55

39003 129.20

39006 240.45

39009 89.50

39012 358.40

Item No Benefit

39013 164.65

39015 567.15

39018 567.15

39100 358.40

39106 1792.35

39109 669.30

39112 2325.35

39115 113.55

39118 449.30

39121 952.95

39124 2438.90

39125 449.60

39126 545.90

39127 714.50

39128 995.50

39130 1016.95

39131 192.75

39133 240.45

39134 513.75

39135 240.45

39136 240.45

39137 913.15

39138 1016.95

39139 1365.30

39140 441.75

39300 533.00

39303 703.10

39306 1020.95

39309 1077.55

39312 601.20

39315 1554.05

39318 964.20

39321 714.50

39323 417.55

39324 417.55

39327 714.65

39330 417.55

39331 417.55

39333 601.20

39500 1917.15

39503 1440.60

39600 714.50

Item No Benefit

39603 1803.70

39606 1202.40

39609 1440.60

39612 1690.15

39615 1803.70

39640 4573.20

39642 4807.95

39646 5511.45

39650 3986.85

39653 7094.70

39654 5159.80

39656 3869.75

39658 4573.20

39660 4573.20

39662 4573.20

39700 839.60

39703 782.90

39706 1678.70

39709 2393.60

39712 4321.85

39715 2994.80

39718 1315.85

39721 1202.40

39800 4310.60

39803 4310.60

39806 1939.55

39812 952.95

39815 2756.40

39818 2756.40

39821 3273.05

39900 782.90

39903 2393.60

39906 1202.40

40000 1383.85

40003 1383.85

40006 1089.05

40009 794.05

40012 1554.05

40015 963.40

40018 240.45

40100 1043.50

40103 1531.50

19



Item No Benefit

40106 1554.05

40109 1678.70

40112 2155.25

40115 1089.05

40118 1440.60

40300 1440.60

40301 1445.10

40303 1644.75

40306 2166.65

40309 1644.75

40312 2211.90

40315 2393.60

40316 3137.30

40318 2994.80

40321 1644.75

40324 964.20

40327 964.20

40330 1440.60

40331 1440.60

40332 2350.65

40333 1202.40

40334 1589.80

40335 2919.85

40336 476.50

40339 2393.60

40342 2211.90

40345 2059.10

40348 2614.35

40351 2614.35

40600 1440.60

40700 2631.80

40703 2211.90

40706 3232.85

40709 782.90

40712 1576.65

40800 963.40

40801 2633.50

40803 1803.70

40850 3415.90

40851 5978.15

40852 513.75

40854 794.05

Item No Benefit

40856 385.30

40858 794.05

40860 3051.20

40862 286.15

40903 836.50

40905 907.65

41500 123.50

41503 357.45

41506 215.55

41509 243.90

41512 877.05

41515 575.65

41518 1390.30

41521 1480.30

41524 427.65

41527 879.60

41530 1433.05

41533 1713.00

41536 1918.70

41539 1631.55

41542 1787.75

41545 780.30

41548 1035.50

41551 2384.75

41554 2809.75

41557 1631.55

41560 1787.75

41563 2213.15

41564 2861.95

41566 1631.55

41569 1787.75

41572 1546.70

41575 3646.20

41576 5469.40

41578 3646.20

41579 2734.60

41581 4193.90

41584 2878.20

41587 3920.00

41590 1787.75

41593 2330.05

41596 2604.00

Item No Benefit

41599 2604.00

41603 754.25

41604 279.15

41608 1631.55

41611 1049.80

41614 1631.55

41615 1631.55

41617 2837.10

41620 1234.35

41623 1787.75

41626 215.55

41629 780.30

41632 357.45

41635 1713.00

41638 2138.20

41641 71.00

41644 213.75

41647 164.50

41650 164.50

41653 107.70

41656 183.90

41659 116.05

41662 123.50

41665 258.20

41668 329.25

41671 723.40

41672 902.45

41674 150.40

41677 134.70

41680 243.90

41683 175.40

41686 107.70

41689 204.30

41692 266.50

41695 149.70

41698 48.70

41701 137.55

41704 54.30

41707 671.45

41710 780.30

41713 907.90

41716 442.65

Item No Benefit

41719 175.95

41722 879.60

41725 671.45

41728 1343.25

41729 851.25

41731 1163.30

41734 1518.00

41737 723.40

41740 88.00

41743 505.15

41746 1163.30

41749 907.90

41752 442.65

41755 69.60

41758 175.95

41761 183.90

41764 183.90

41767 1103.25

41770 1049.80

41773 879.60

41776 877.05

41779 1049.80

41782 1425.25

41785 1768.15

41786 1103.25

41787 851.25

41788 329.25

41789 442.65

41792 414.35

41793 556.10

41796 170.20

41797 215.55

41800 175.95

41801 243.90

41804 134.70

41807 104.90

41810 53.25

41813 533.45

41816 277.80

41819 522.35

41820 626.85

41822 357.45

20



Item No Benefit

41825 533.45

41828 78.10

41831 534.40

41832 342.05

41834 1929.85

41837 1850.35

41840 2275.10

41843 2000.65

41846 277.80

41849 408.50

41852 442.65

41855 431.40

41858 739.70

41861 904.60

41864 610.00

41867 918.25

41868 581.85

41870 680.90

41873 879.60

41876 879.60

41879 1425.25

41880 380.45

41881 601.40

41884 136.30

41885 430.95

41886 266.50

41889 266.50

41892 351.85

41895 550.50

41898 384.65

41901 904.60

41904 369.00

41905 678.65

41907 183.90

41910 584.20

42503 152.75

42506 721.00

42509 912.45

42510 1051.80

42512 721.00

42515 912.45

42518 529.35

Item No Benefit

42521 1802.60

42524 306.50

42527 608.30

42530 946.45

42533 608.30

42536 1250.35

42539 1780.15

42542 754.85

42543 1324.15

42545 1915.20

42548 1137.70

42551 946.45

42554 1104.15

42557 1543.40

42563 777.55

42569 1543.40

42572 175.80

42573 340.75

42574 724.00

42575 123.95

42581 175.80

42584 414.70

42587 77.80

42590 506.90

42593 306.50

42596 754.85

42599 946.45

42602 946.45

42605 698.30

42608 450.55

42610 144.20

42611 216.25

42614 72.40

42615 108.00

42617 204.70

42620 78.90

42622 123.80

42623 1046.70

42626 1688.10

42629 1271.55

42632 175.60

42635 450.05

Item No Benefit

42638 562.65

42641 731.40

42644 107.95

42647 306.15

42650 107.95

42651 240.60

42653 1957.00

42656 2498.30

42662 1350.25

42665 900.35

42667 212.40

42668 112.65

42672 1341.80

42673 670.80

42676 173.45

42677 91.10

42680 449.70

42683 179.45

42686 409.50

42689 175.60

42692 414.20

42695 675.05

42698 892.10

42701 499.25

42702 1144.90

42703 856.80

42704 698.10

42707 1193.85

42710 1351.45

42713 563.15

42716 1790.90

42719 777.35

42725 2004.70

42731 2275.15

42734 450.45

42738 447.50

42739 447.50

42740 447.50

42741 450.45

42743 946.20

42744 450.15

42746 1430.35

Item No Benefit

42749 1790.90

42752 2004.70

42755 247.80

42758 1047.60

42761 777.35

42764 777.35

42767 1633.10

42770 441.55

42773 1351.45

42776 2004.70

42779 2500.50

42782 675.65

42783 675.65

42785 529.20

42786 529.20

42788 529.20

42789 529.20

42791 529.20

42792 529.20

42794 101.30

42801 1572.20

42802 785.85

42805 878.45

42806 529.20

42807 532.90

42808 532.90

42809 675.65

42810 850.30

42811 675.65

42812 247.80

42815 946.20

42818 878.45

42821 135.30

42824 104.65

42833 878.45

42836 1092.55

42839 1047.60

42842 1306.50

42845 283.65

42848 1047.60

42851 1306.50

42854 608.15

21



Item No Benefit

42857 608.15

42860 1351.45

42863 1160.10

42866 1126.10

42869 822.25

42872 360.50

43021 651.75

43022 782.25

43023 126.75

43500 155.15

43503 257.45

43506 448.25

43509 448.25

43512 448.25

43515 448.25

43518 739.10

43521 584.25

43524 739.10

43801 1310.05

43804 1394.80

43807 1521.75

43810 1775.40

43813 1775.40

43816 1648.45

43819 1331.45

43822 1331.45

43825 1521.75

43828 1681.25

43831 1310.05

43834 1521.75

43837 1902.05

43840 1648.45

43843 2536.30

43846 2726.45

43849 697.45

43852 2219.05

43855 2346.05

43858 824.15

43861 2282.70

43864 1712.05

43867 951.10

43870 1331.45

Item No Benefit

43873 1775.40

43876 1521.75

43879 1775.40

43882 2282.70

43900 1521.95

43903 2536.65

43906 2219.40

43909 2219.40

43912 2096.80

43915 1585.35

43930 608.10

43933 711.90

43936 1328.45

43939 1012.15

43942 316.35

43945 1328.45

43948 189.90

43951 1189.65

43954 1455.15

43957 1581.50

43960 556.40

43963 2214.05

43966 2530.55

43969 3479.50

43972 2530.55

43975 2973.40

43978 2530.55

43981 695.85

43984 1771.40

43987 1961.25

43990 2404.10

43993 2593.75

43996 2910.10

43999 363.90

44102 350.80

44105 61.55

44108 671.00

44111 785.95

44114 785.95

44130 632.55

44133 502.10

44136 231.40

Item No Benefit

44325 419.80

44328 505.90

44331 834.25

44334 1695.55

44338 204.45

44342 312.25

44346 360.60

44350 409.15

44354 468.25

44358 261.10

44359 374.75

44361 505.90

44364 419.80

44367 741.05

44370 1022.50

44373 2099.00

44376 DERIVED#

45000 793.75

45003 882.15

45006 1521.50

45009 555.80

45012 931.10

45015 440.95

45018 694.50

45019 581.65

45020 581.65

45021 260.00

45024 584.35

45025 260.00

45026 584.35

45027 176.45

45030 189.50

45033 352.90

45035 1029.40

45036 1654.05

45039 352.90

45042 452.20

45045 452.20

45048 1135.70

45051 694.65

45054 360.85

45200 416.90

Item No Benefit

45203 595.35

45206 562.35

45207 562.35

45209 694.65

45212 344.65

45215 1486.90

45218 666.90

45221 383.50

45224 172.35

45227 653.05

45230 326.60

45233 694.65

45236 544.70

45239 383.50

45240 383.50

45400 300.15

45403 597.50

45406 661.40

45409 882.15

45412 1213.05

45415 1323.00

45418 1433.35

45439 416.90

45442 859.95

45445 816.10

45448 551.30

45451 694.65

45460 1837.70

45461 1309.75

45462 988.35

45464 2805.15

45465 1998.55

45466 1507.25

45468 2687.20

45469 2027.45

45471 3377.80

45472 2547.80

45474 4066.45

45475 3068.15

45477 4755.20

45478 3586.60

45480 5443.75

22



Item No Benefit

45481 4107.25

45483 6202.35

45484 4679.65

45485 773.75

45486 661.40

45487 595.35

45488 661.40

45489 992.35

45490 1323.30

45491 1654.05

45492 1984.75

45493 595.35

45494 2402.80

45496 610.05

45497 476.45

45498 383.50

45499 285.90

45500 1598.75

45501 2602.20

45502 2602.20

45503 2977.10

45504 2602.20

45505 2602.20

45506 322.50

45512 433.55

45515 273.45

45518 330.90

45519 629.10

45520 1320.30

45522 926.30

45524 1087.45

45527 1087.45

45528 1631.00

45530 1612.05

45533 1825.65

45536 671.30

45539 1570.70

45542 899.40

45545 912.80

45546 290.10

45548 405.85

45551 650.55

Item No Benefit

45552 936.45

45553 936.45

45554 1025.60

45555 936.45

45556 1123.25

45557 1123.25

45558 1684.70

45559 1666.85

45560 694.50

45561 2602.20

45562 1612.05

45563 1612.05

45564 3733.60

45565 2800.30

45566 1570.70

45568 650.55

45569 993.55

45570 1341.55

45572 427.70

45575 1056.00

45578 1222.95

45581 405.85

45584 926.30

45585 926.30

45586 926.30

45587 1306.25

45588 1959.55

45590 708.55

45593 832.30

45596 1320.30

45597 1767.45

45599 1373.25

45602 1025.60

45605 861.55

45608 1213.05

45611 694.65

45614 861.55

45617 344.65

45620 478.05

45623 1060.20

45624 1374.50

45625 275.00

Item No Benefit

45626 478.05

45629 694.65

45632 750.65

45635 861.55

45638 1486.90

45639 1486.90

45641 1587.85

45644 1876.05

45645 327.85

45646 1320.30

45647 1876.05

45650 216.70

45652 522.50

45653 522.50

45656 736.40

45659 764.30

45660 4221.10

45661 1876.05

45662 1028.30

45665 478.05

45668 478.05

45669 478.05

45671 1222.95

45674 355.65

45675 708.55

45676 843.55

45677 793.75

45680 992.35

45683 1102.40

45686 1301.30

45689 383.80

45692 440.95

45695 716.65

45698 672.65

45701 1213.05

45704 440.95

45707 1146.55

45710 716.65

45713 816.10

45714 1146.55

45716 1146.55

45720 1417.60

Item No Benefit

45723 1598.75

45726 1806.55

45729 2028.80

45731 2056.75

45732 2315.55

45735 2362.25

45738 2657.50

45741 2598.70

45744 2921.85

45747 2835.15

45752 3175.60

45753 3194.45

45754 3829.35

45755 539.20

45758 964.85

45761 1097.70

45767 3682.80

45770 2821.00

45773 2571.00

45776 2571.00

45779 1890.25

45782 1445.30

45785 2445.90

45788 2418.05

45791 1306.25

45794 738.75

45797 273.45

45799 43.15

45801 186.05

45803 478.05

45805 252.90

45807 361.40

45809 544.70

45811 736.40

45813 861.55

45815 522.50

45817 681.05

45819 861.50

45821 558.35

45823 159.65

45825 496.10

45827 474.20

23



Item No Benefit

45829 361.70

45831 474.20

45833 595.35

45835 738.75

45837 859.95

45839 859.95

45841 694.50

45843 425.95

45845 738.75

45847 273.45

45849 851.75

45851 209.60

45853 1306.25

45855 599.25

45857 958.65

45859 483.25

45861 1279.05

45863 1417.90

45865 425.95

45867 457.90

45869 1742.25

45871 1962.55

45873 2205.35

45875 690.15

45877 690.15

45879 457.90

45882 63.05

45885 650.55

45888 606.35

45891 883.35

45894 300.15

45897 1567.60

45900 353.55

45939 656.50

45945 174.25

45975 189.70

45978 231.75

45981 125.75

45984 905.45

45987 905.45

45990 1236.75

45993 1236.75

Item No Benefit

45996 350.65

46300 509.45

46303 566.20

46306 792.60

46307 792.60

46309 792.60

46312 1019.10

46315 1358.75

46318 1698.55

46321 2038.25

46324 1215.45

46325 1268.35

46327 305.80

46330 521.05

46333 849.15

46336 396.35

46339 701.85

46342 701.85

46345 849.15

46348 368.00

46351 549.20

46354 735.95

46357 917.15

46360 1104.05

46363 317.05

46366 192.55

46369 317.05

46372 644.25

46375 764.30

46378 1019.10

46381 452.85

46384 452.85

46387 934.30

46390 1245.80

46393 1443.75

46396 496.20

46399 779.50

46402 779.50

46405 951.30

46408 1041.80

46411 611.45

46414 792.45

Item No Benefit

46417 735.95

46420 308.00

46423 492.50

46426 509.45

46429 622.75

46432 679.50

46435 792.60

46438 203.90

46441 492.50

46442 422.80

46444 735.95

46447 917.15

46450 339.75

46453 566.20

46456 147.20

46459 283.10

46462 452.85

46464 339.75

46465 339.75

46468 594.50

46471 849.15

46474 1104.05

46477 1358.75

46480 566.20

46483 452.85

46486 339.75

46489 396.35

46492 543.55

46494 331.10

46495 305.80

46498 331.10

46500 396.35

46501 495.60

46502 456.05

46503 569.65

46504 1664.40

46507 1936.35

46510 528.40

46513 85.05

46516 169.85

46519 212.65

46522 634.10

Item No Benefit

46525 85.05

46528 255.15

46531 128.15

46534 354.50

47000 107.65

47003 129.25

47006 260.20

47009 259.05

47012 517.85

47015 129.25

47018 298.30

47021 402.75

47024 301.90

47027 402.75

47030 301.90

47033 402.75

47036 129.55

47039 172.40

47042 172.40

47045 230.30

47048 496.25

47051 661.50

47054 496.25

47057 194.00

47060 258.95

47063 388.35

47066 517.70

47069 107.90

47072 143.60

47300 129.55

47303 151.10

47306 172.40

47309 215.80

47312 194.00

47315 222.95

47318 258.95

47321 323.50

47324 258.95

47327 301.90

47330 345.30

47333 431.40

47336 258.95

24



Item No Benefit

47339 301.90

47342 345.30

47345 431.40

47348 143.60

47351 359.80

47354 258.95

47357 575.30

47360 201.45

47363 301.90

47366 402.75

47369 258.95

47372 431.40

47375 575.30

47378 258.95

47381 388.35

47384 517.70

47385 445.75

47386 719.15

47387 417.00

47390 625.75

47393 834.20

47396 287.55

47399 575.30

47402 431.40

47405 287.55

47408 575.30

47411 172.40

47414 345.30

47417 402.75

47420 791.10

47423 330.75

47426 490.40

47429 661.60

47432 827.20

47435 633.05

47438 1007.30

47441 1258.85

47444 345.35

47447 517.80

47450 690.65

47451 832.55

47453 402.80

Item No Benefit

47456 604.40

47459 805.70

47462 172.45

47465 345.35

47466 172.45

47467 345.35

47468 661.60

47471 65.70

47474 287.60

47477 359.85

47480 719.30

47483 863.20

47486 1438.70

47489 2158.10

47492 359.85

47495 719.30

47498 1078.95

47501 1438.70

47504 2158.10

47507 2158.10

47510 2158.10

47513 575.40

47516 661.60

47519 1323.70

47522 1151.10

47525 1323.70

47528 1151.10

47531 1467.45

47534 1654.55

47537 661.60

47540 330.85

47543 345.35

47546 517.80

47549 690.65

47552 575.40

47555 863.20

47558 1151.10

47561 417.10

47564 625.85

47565 1088.65

47566 1387.65

47567 726.40

Item No Benefit

47570 834.35

47573 1043.05

47576 172.45

47579 244.55

47582 503.65

47585 647.55

47588 2013.85

47591 2446.10

47594 330.85

47597 496.35

47600 661.60

47603 863.20

47606 359.85

47609 539.50

47612 625.85

47615 719.30

47618 899.25

47621 625.85

47624 863.20

47627 244.55

47630 517.80

47633 172.45

47636 259.00

47639 345.35

47642 230.35

47645 345.35

47648 460.05

47651 359.85

47654 539.50

47657 719.30

47663 215.85

47666 359.85

47672 172.45

47678 259.00

47681 65.70

47684 1151.10

47687 2013.85

47690 1582.50

47693 2013.85

47696 575.40

47699 2302.15

47702 2877.50

Item No Benefit

47703 65.70

47705 431.45

47708 330.85

47711 489.25

47714 366.80

47717 647.55

47720 647.55

47723 647.55

47726 215.85

47729 359.85

47732 575.40

47735 65.75

47738 359.85

47741 734.05

47753 621.40

47756 621.40

47762 364.90

47765 599.20

47768 734.05

47771 843.30

47774 665.75

47777 665.75

47780 865.45

47783 865.45

47786 1098.35

47789 1098.35

47900 259.00

47903 359.85

47904 86.30

47906 172.45

47912 86.30

47915 259.00

47916 130.10

47918 359.85

47920 581.90

47921 172.45

47924 57.50

47927 215.85

47930 402.80

47933 316.30

47936 388.45

47948 244.55

25



Item No Benefit

47951 287.60

47954 575.40

47957 431.45

47960 201.45

47963 330.85

47966 661.60

47969 402.80

47972 321.80

47975 564.10

47978 342.60

47981 230.05

47982 557.60

48200 1151.10

48203 1395.60

48206 864.10

48209 1107.85

48212 864.10

48215 1107.85

48218 864.10

48221 1151.10

48224 575.40

48227 748.10

48230 647.55

48233 935.10

48236 1222.85

48239 676.15

48242 935.10

48400 503.65

48403 791.30

48406 503.65

48409 791.30

48412 963.75

48415 1222.85

48418 963.75

48421 1222.85

48424 1151.10

48427 1395.60

48500 503.65

48503 503.65

48506 748.10

48509 359.85

48512 1366.80

Item No Benefit

48600 143.65

48603 215.85

48606 2013.85

48612 3740.80

48613 5320.85

48615 676.15

48618 3740.80

48621 2446.10

48624 3021.55

48627 3884.45

48630 4316.15

48632 2385.95

48636 1237.15

48639 2085.95

48640 5320.85

48642 1222.85

48645 1654.55

48648 1654.55

48651 2302.15

48654 1654.55

48657 2302.15

48660 1654.55

48663 1237.15

48666 748.10

48669 2229.90

48672 1669.15

48675 1007.30

48678 853.80

48681 1438.70

48684 1438.70

48687 2013.85

48690 2302.15

48691 2771.70

48692 1868.15

48693 903.50

48694 1673.05

48900 431.45

48903 863.20

48906 863.20

48909 1151.10

48912 503.65

48915 1151.10

Item No Benefit

48918 2302.15

48921 2373.90

48924 2733.70

48927 560.90

48930 1151.10

48933 1510.70

48936 1151.10

48939 1654.55

48942 2158.10

48945 417.10

48948 935.10

48951 1366.80

48954 1438.70

48957 1654.55

48960 1438.70

49100 503.65

49103 1078.95

49106 1438.70

49109 1078.95

49112 1078.95

49115 1726.30

49116 2304.10

49117 2764.90

49118 417.05

49121 934.95

49200 1251.35

49203 934.95

49206 863.05

49209 1150.95

49210 1536.35

49211 1843.65

49212 359.85

49215 992.85

49218 417.10

49221 935.10

49224 1078.95

49227 1078.95

49300 796.55

49303 834.35

49306 1654.55

49309 1151.10

49312 1438.70

Item No Benefit

49315 1294.90

49318 2013.85

49319 3538.20

49321 2446.10

49324 2877.50

49327 3309.05

49330 3309.05

49333 3740.80

49336 546.60

49339 4244.25

49342 4244.25

49345 5035.55

49346 1294.90

49360 525.60

49363 632.95

49366 935.10

49500 575.40

49503 748.10

49506 1122.30

49509 1151.10

49512 1654.55

49515 1294.90

49517 1843.50

49518 2013.85

49519 3538.20

49521 2446.10

49524 2877.50

49527 2446.10

49530 3021.55

49533 3453.15

49534 687.00

49536 1438.70

49539 1438.70

49542 2013.85

49545 1151.10

49548 1438.70

49551 2013.85

49554 2877.50

49557 417.10

49558 417.10

49559 624.55

49560 842.95

26



Item No Benefit

49561 1030.00

49562 1123.95

49563 1217.50

49564 1387.75

49566 1151.10

49569 1151.10

49700 417.10

49703 935.10

49706 503.65

49709 1078.95

49712 1151.10

49715 1726.30

49716 2304.10

49717 2764.90

49718 575.30

49721 359.80

49724 1007.10

49727 431.40

49728 872.45

49800 201.45

49803 258.95

49806 201.45

49809 330.75

49812 661.50

49815 1150.85

49818 417.00

49821 661.50

49824 1158.05

49827 719.15

49830 1258.60

49833 791.10

49836 1366.55

49837 977.30

49838 1687.80

49839 791.10

49842 1366.55

49845 719.15

49848 244.50

49851 316.25

49854 575.30

49857 532.20

49860 431.40

Item No Benefit

49863 647.40

49866 459.95

49878 86.30

50100 417.00

50102 934.90

50103 503.55

50104 477.15

50106 719.15

50109 719.15

50112 551.60

50115 217.20

50118 661.50

50121 1294.75

50127 1073.40

50130 477.15

50200 287.55

50201 497.50

50203 633.05

50206 935.10

50209 1151.10

50212 2517.75

50215 3165.20

50218 4172.40

50221 3884.45

50224 4316.15

50227 5035.55

50230 2589.65

50233 3309.05

50236 2589.65

50239 1726.30

50300 1769.15

50303 2415.45

50306 3771.40

50309 466.15

50312 1069.85

50315 1059.50

50318 1059.50

50321 1419.45

50324 2023.55

50327 2468.25

50330 349.45

50333 942.65

Item No Benefit

50336 1409.05

50339 858.15

50342 995.75

50345 529.75

50348 349.45

50349 483.40

50351 2411.80

50352 86.30

50353 542.20

50354 2002.30

50357 858.20

50360 995.80

50363 762.65

50366 1334.85

50369 995.80

50372 1748.05

50375 762.65

50378 1334.85

50381 995.80

50384 1748.05

50387 995.80

50390 349.50

50393 1292.30

50394 4244.50

50396 709.95

50399 1409.15

50402 646.35

50405 879.35

50408 1525.60

50411 2002.30

50414 2701.40

50417 2002.30

50420 1652.60

50423 1525.60

50426 709.95

50450 1896.25

50451 1896.25

50455 2147.45

50456 2147.45

50460 3206.25

50461 3206.25

50465 4515.90

Item No Benefit

50466 4515.90

50470 5727.25

50471 5727.25

50475 6608.75

50476 6608.75

50500 427.55

50504 570.40

50508 610.85

50512 814.95

50516 550.00

50520 733.20

50524 631.35

50528 1018.55

50532 886.20

50536 1181.45

50540 814.95

50544 407.40

50548 814.95

50552 702.85

50556 936.90

50560 733.20

50564 977.80

50568 855.60

50572 1140.80

50576 936.90

50580 977.80

50584 936.90

50588 1222.10

50600 671.85

50604 2851.70

50608 5296.65

50612 7534.00

50616 957.25

50620 5296.65

50624 5296.65

50628 6542.80

50632 5500.20

50636 6111.45

50640 3378.35

50644 3259.55

50650 641.00

50654 767.60

27



Item No Benefit

50658 305.60

51300 128.35

51303 DERIVED#

51306 185.40

51309 DERIVED#

51312 DERIVED#

51315 405.20

51318 267.35

51700 97.05

51703 48.80

51800 127.95

51803 DERIVED#

51900 438.40

51902 99.35

51904 611.55

51906 930.10

52000 110.90

52003 158.05

52006 158.05

52009 249.55

52010 341.50

52012 31.55

52015 147.75

52018 372.15

52021 39.55

52024 70.15

52025 247.25

52027 201.35

52030 121.00

52033 247.25

52034 57.80

52035 640.15

52036 170.60

52039 438.40

52042 231.90

52045 331.40

52048 499.50

52051 675.30

52054 790.05

52056 36.75

52057 219.10

52058 319.45

Item No Benefit

52059 359.85

52060 254.65

52061 300.65

52062 397.55

52063 479.10

52064 227.90

52066 598.85

52069 266.90

52072 79.05

52073 201.35

52075 201.35

52078 397.55

52081 62.50

52084 160.65

52087 275.20

52090 479.10

52092 624.55

52094 790.00

52095 512.00

52096 151.70

52097 215.20

52098 253.05

52099 189.90

52102 189.90

52105 354.40

52106 146.40

52108 438.40

52111 438.40

52114 790.05

52117 940.45

52120 1112.35

52122 1112.35

52123 1259.25

52126 1210.70

52129 1620.75

52130 594.90

52131 822.75

52132 334.70

52133 122.40

52135 194.05

52138 603.10

52141 596.55

Item No Benefit

52144 556.05

52147 524.70

52148 927.50

52158 1493.35

52180 253.05

52182 557.00

52184 822.75

52186 1012.80

52300 429.75

52303 613.70

52306 910.50

52309 309.35

52312 429.75

52315 716.00

52318 213.45

52319 355.90

52321 716.00

52324 716.00

52327 355.25

52330 1181.80

52333 1181.80

52336 738.65

52337 1615.80

52339 841.20

52342 1461.20

52345 1647.95

52348 1862.10

52351 2091.20

52354 2120.00

52357 2386.80

52360 2434.90

52363 2739.25

52366 2678.65

52369 3011.75

52372 2922.35

52375 3273.30

52378 1131.50

52379 1933.75

52380 3292.70

52382 3947.15

52420 364.45

52424 715.85

Item No Benefit

52430 1647.95

52440 818.15

52442 1022.90

52444 1136.30

52446 1341.35

52450 454.55

52452 738.65

52456 1250.35

52458 454.55

52460 1181.80

52480 759.10

52482 730.35

52484 869.50

52600 476.40

52603 455.35

52606 347.35

52609 455.35

52612 571.75

52615 709.45

52618 825.85

52621 825.85

52624 666.90

52626 409.05

52627 709.45

52630 262.60

52633 709.45

52636 262.60

52800 358.35

52803 516.00

52806 358.35

52809 613.35

52812 876.25

52815 924.85

52818 613.35

52821 1333.75

52824 574.45

52826 307.60

52828 457.45

52830 603.45

52832 827.55

53000 42.05

53003 118.70

28



Item No Benefit

53004 45.95

53006 673.50

53009 382.05

53012 151.85

53015 759.20

53016 624.40

53017 778.90

53019 750.55

53052 158.70

53054 158.70

53056 92.95

53058 158.70

53060 129.85

53062 116.25

53064 210.50

53068 176.35

53070 230.05

53200 77.05

53203 153.60

53206 185.00

53209 2134.55

53212 1153.10

53215 529.00

53218 846.25

53220 426.60

53221 1129.10

53224 1251.65

53225 376.00

53226 404.20

53227 1538.00

53230 1732.45

53233 1946.80

53236 609.25

53239 609.25

53242 404.20

53400 174.10

53403 212.75

53406 548.05

53409 548.05

53410 115.40

53411 321.85

53412 528.45

Item No Benefit

53413 647.40

53414 743.75

53415 587.15

53416 587.15

53418 763.30

53419 763.30

53422 968.70

53423 968.70

53424 831.10

53425 831.10

53427 1135.15

53429 1135.15

53439 321.85

53453 651.30

53455 765.05

53458 58.00

53459 317.40

53460 647.40

53600 52.45

53700 168.25

53702 84.20

53704 50.70

53706 168.25

55026 67.70

55028 135.40

55029 46.95

55030 135.40

55031 46.95

55032 135.40

55033 46.95

55036 138.15

55037 46.95

55038 135.40

55039 46.95

55048 135.90

55049 46.95

55054 135.40

55065 124.05

55070 121.95

55073 42.25

55076 135.40

55079 46.95

Item No Benefit

55084 121.95

55085 42.25

55113 299.20

55114 299.20

55115 299.20

55116 331.95

55117 331.95

55118 308.10

55130 216.60

55131 108.30

55135 450.55

55136 225.25

55238 228.90

55244 228.90

55246 228.90

55248 228.90

55252 228.90

55274 228.90

55276 228.90

55278 228.90

55280 228.90

55282 228.90

55284 228.90

55292 228.90

55294 228.90

55296 149.95

55600 135.15

55601 67.55

55603 135.15

55700 75.75

55701 37.85

55702 22.10

55703 44.20

55704 88.40

55705 44.20

55706 126.25

55707 88.40

55708 44.20

55709 47.95

55710 44.20

55711 22.10

55712 145.20

Item No Benefit

55713 63.10

55714 44.20

55715 50.50

55716 22.10

55717 23.95

55718 126.25

55719 72.60

55720 25.25

55721 145.20

55722 63.10

55723 47.95

55724 72.60

55725 50.50

55726 23.95

55727 25.25

55729 34.40

55730 17.20

55735 80.15

55736 160.35

55737 35.95

55739 71.95

55759 189.40

55760 94.70

55762 75.75

55763 37.85

55764 202.05

55765 101.00

55766 82.05

55767 41.00

55768 189.40

55769 94.70

55770 75.75

55771 37.85

55772 202.05

55773 101.00

55774 82.05

55848 136.00

55849 68.00

55850 190.55

55851 95.30

57341 544.75

57345 280.00

29



Item No Benefit

59312 108.90

59313 54.45

59314 65.70

59315 32.85

59318 58.85

59700 120.40

59701 60.20

59703 94.65

59704 47.30

59712 141.75

59713 70.85

59715 179.00

59716 89.50

59718 167.90

59719 83.95

59724 282.40

59725 141.20

59733 134.30

59734 67.15

59736 77.30

59737 38.65

59739 91.95

59740 46.00

59751 173.50

59752 86.75

59754 273.55

59755 136.80

59760 143.60

59761 71.80

59763 166.95

59903 145.35

59912 387.25

59925 459.90

59970 210.80

59971 72.70

59972 193.60

59973 229.95

59974 105.00

60000 691.55

60001 345.75

60003 1014.15

60004 507.05

60006 1442.10

Item No Benefit

60007 723.70

60009 1693.80

60010 846.90

60012 694.10

60013 347.05

60015 1017.90

60016 508.95

60018 1447.40

60019 723.70

60021 1693.80

60022 846.90

60024 694.10

60025 347.05

60027 1017.90

60028 508.95

60030 1447.40

60031 723.70

60033 1693.80

60034 846.90

60036 694.10

60037 347.05

60039 1017.90

60040 508.95

60042 1447.40

60043 723.70

60045 1693.80

60046 846.90

60048 694.10

60049 347.05

60051 1017.90

60052 508.95

60054 1447.40

60055 723.70

60057 1693.80

60058 846.90

60060 694.10

60061 347.05

60063 1017.90

60064 508.95

60066 1447.40

60067 723.70

60069 1693.80

60070 846.90

Item No Benefit

60072 59.15

60073 29.55

60075 118.25

60076 59.10

60078 177.50

60079 88.75

60500 54.30

60506 79.75

60507 39.90

60509 123.75

60510 61.85

61109 324.30

61110 162.15

61302 490.10

61303 617.30

61306 774.95

61307 911.70

61310 401.05

61313 331.25

61314 458.60

61316 416.20

61317 537.70

61320 249.95

61328 248.55

61340 276.25

61348 484.10

61352 283.20

61353 422.15

61356 428.90

61360 440.45

61361 503.80

61364 542.65

61368 243.60

61369 2201.15

61372 243.60

61373 534.75

61376 156.50

61381 627.15

61383 682.40

61384 750.95

61386 363.05

61387 470.35

61389 404.60

Item No Benefit

61390 447.65

61393 661.20

61397 269.55

61401 177.20

61402 660.70

61405 377.80

61409 953.85

61413 246.70

61417 129.75

61421 523.90

61425 655.95

61426 605.80

61429 592.95

61430 720.10

61433 542.65

61434 672.00

61437 592.65

61438 734.85

61441 534.75

61442 821.55

61445 313.15

61446 364.20

61449 498.15

61450 434.10

61453 562.05

61454 380.10

61457 513.70

61458 433.45

61461 576.40

61462 140.85

61465 289.90

61469 380.10

61473 191.50

61480 422.40

61484 961.85

61485 1091.10

61495 243.60

61499 276.25

61505 109.20

61523 1040.65

30


Consultations – Derived Fees

MBS ItemNumber of Patients

1 2 3 4 5 6 7+

00004 $46.45 $33.50 $29.15 $27.00 $25.70 $24.85 $22.50

00024 $70.85 $57.85 $53.55 $51.35 $50.05 $49.20 $46.90

00037 $112.80 $99.85 $95.50 $93.35 $92.05 $91.20 $88.85

00047 $153.80 $140.85 $136.50 $134.35 $133.05 $132.20 $129.85

00058 $25.85 $18.10 $15.50 $14.20 $13.45 $12.90 $11.05

00059 $36.95 $28.20 $25.30 $23.85 $22.95 $22.40 $20.15

00060 $58.70 $50.95 $48.35 $47.10 $46.30 $45.80 $43.90

00065 $85.50 $77.75 $75.15 $73.85 $73.10 $72.60 $70.70

00195 $70.65 $57.70 $53.35 $51.20 $49.90 $49.05 $46.70

31

The following item numbers will have either reduced MediGap benefits or no MediGap benefits for services performed on and from 17 August 2015.

The benefit listed here includes 100% of the Medicare benefit payable for the service and the MediGap component payable by nib for services performed on and after August 17.

If the item will be removed from the MediGap Schedule it is noted as being removed.

Please ensure you take note of the changes to provide nib customers with accurate Informed Financial Consent.

More information about the changes is available at www.nib.com.au/providers/medigap

DERIVED* - Please refer to ‘Consultations – DERIVED Fees Per Patient’ table on page 30.DERIVED# - Calculate as per MBS method using MediGap Schedule of Benefits.

Items which will receive lower or no MediGap benefits from August 17

04SECTION

Item No Benefit

11820 REMOVED

11823 REMOVED

12200 44.85

12201 2887.00

12203 709.40

12210 846.85

12213 762.85

12215 846.75

12217 762.85

12250 404.50

12500 REMOVED

12503 REMOVED

12506 REMOVED

12509 REMOVED

12512 REMOVED

12515 REMOVED

12518 REMOVED

12521 REMOVED

12524 REMOVED

12527 REMOVED

12530 REMOVED

13015 REMOVED

13020 REMOVED

13025 REMOVED

13030 REMOVED

13100 REMOVED

13103 81.30

13104 168.90

13106 REMOVED

Item No Benefit

13109 245.55

13110 246.30

13112 147.30

16003 REMOVED

16006 REMOVED

16009 REMOVED

16012 REMOVED

16015 REMOVED

16018 REMOVED

42738 REMOVED

42739 REMOVED

42740 REMOVED

46300 507.60

46303 564.15

46306 789.75

46307 789.75

46309 789.75

46312 1015.40

46315 1353.80

46318 1692.35

46321 2030.85

46324 1211.00

46325 1263.75

46327 304.70

46330 519.15

46333 846.05

46336 394.95

46339 699.30

46342 699.30

Item No Benefit

46345 846.05

46348 366.65

46351 547.20

46354 733.25

46357 913.80

46360 1100.00

46363 315.90

46366 191.85

46369 315.90

46372 641.90

46375 761.55

46378 1015.40

46381 451.20

46384 451.20

46387 930.90

46390 1241.25

46393 1438.50

46396 494.40

46399 776.70

46402 776.70

46405 947.85

46408 1038.00

46411 609.20

46414 789.60

46417 733.25

46420 306.90

46423 490.70

46426 507.60

46429 620.45

Item No Benefit

46432 677.00

46435 789.75

46438 203.15

46441 490.70

46442 421.25

46444 733.25

46447 913.80

46450 338.55

46453 564.15

46456 146.70

46459 282.05

46462 451.20

46464 338.55

46465 338.55

46468 592.35

46471 846.05

46474 1100.00

46477 1353.80

46480 564.15

46483 451.20

46486 338.55

46489 394.95

46492 541.55

46494 329.90

46495 304.70

46498 329.90

46500 394.95

46501 493.80

46502 454.40

11820 to 46502

32



Item No Benefit

46503 567.60

46504 1658.30

46507 1929.30

46510 526.50

46513 84.75

46516 169.25

46519 211.85

46522 631.80

46525 84.75

46528 254.25

46531 127.70

46534 353.25

47000 105.95

47003 127.20

51300 107.85

51303 DERIVED#

51306 155.80

51309 DERIVED#

51312 DERIVED#

51315 340.50

51318 224.65

55026 REMOVED

55028 REMOVED

55029 REMOVED

55030 REMOVED

55031 REMOVED

55032 REMOVED

55033 REMOVED

55036 REMOVED

55037 REMOVED

55038 REMOVED

55039 REMOVED

55048 REMOVED

55049 REMOVED

55054 REMOVED

55065 REMOVED

55070 REMOVED

55073 REMOVED

55076 REMOVED

55079 REMOVED

55084 REMOVED

55085 REMOVED

Item No Benefit

55113 REMOVED

55114 REMOVED

55115 REMOVED

55116 REMOVED

55117 REMOVED

55118 REMOVED

55238 REMOVED

55244 REMOVED

55246 REMOVED

55248 REMOVED

55252 REMOVED

55274 REMOVED

55276 REMOVED

55278 REMOVED

55280 REMOVED

55282 REMOVED

55284 REMOVED

55292 REMOVED

55294 REMOVED

55296 REMOVED

55600 REMOVED

55601 REMOVED

55603 REMOVED

55700 REMOVED

55701 REMOVED

55702 REMOVED

55703 REMOVED

55704 REMOVED

55705 REMOVED

55706 REMOVED

55707 REMOVED

55708 REMOVED

55709 REMOVED

55710 REMOVED

55711 REMOVED

55712 REMOVED

55713 REMOVED

55714 REMOVED

55715 REMOVED

55716 REMOVED

55717 REMOVED

55718 REMOVED

Item No Benefit

55719 REMOVED

55720 REMOVED

55721 REMOVED

55722 REMOVED

55723 REMOVED

55724 REMOVED

55725 REMOVED

55726 REMOVED

55727 REMOVED

55729 REMOVED

55730 REMOVED

55735 REMOVED

55736 REMOVED

55737 REMOVED

55739 REMOVED

55759 REMOVED

55760 REMOVED

55762 REMOVED

55763 REMOVED

55764 REMOVED

55765 REMOVED

55766 REMOVED

55767 REMOVED

55768 REMOVED

55769 REMOVED

55770 REMOVED

55771 REMOVED

55772 REMOVED

55773 REMOVED

55774 REMOVED

55848 REMOVED

55849 REMOVED

55850 REMOVED

55851 REMOVED

59700 REMOVED

59701 REMOVED

59703 REMOVED

59704 REMOVED

59712 REMOVED

59713 REMOVED

59715 REMOVED

59716 REMOVED

Item No Benefit

59718 REMOVED

59719 REMOVED

59724 REMOVED

59725 REMOVED

59733 REMOVED

59734 REMOVED

59736 REMOVED

59737 REMOVED

59739 REMOVED

59740 REMOVED

59751 REMOVED

59752 REMOVED

59754 REMOVED

59755 REMOVED

59760 REMOVED

59761 REMOVED

59763 REMOVED

60000 REMOVED

60001 REMOVED

60003 REMOVED

60004 REMOVED

60006 REMOVED

61302 REMOVED

61303 REMOVED

61306 REMOVED

61307 REMOVED

61310 REMOVED

61313 REMOVED

61314 REMOVED

61316 REMOVED

61317 REMOVED

61320 REMOVED

61328 REMOVED

61340 REMOVED

61348 REMOVED

61352 REMOVED

61353 REMOVED

61356 REMOVED

61360 REMOVED

61361 REMOVED

61364 REMOVED

61368 REMOVED

33



Item No Benefit

61369 REMOVED

61372 REMOVED

61373 REMOVED

61376 REMOVED

61381 REMOVED

61383 REMOVED

61384 REMOVED

61386 REMOVED

61387 REMOVED

61389 REMOVED

61390 REMOVED

61393 REMOVED

61397 REMOVED

61401 REMOVED

61402 REMOVED

61405 REMOVED

61409 REMOVED

61413 REMOVED

61417 REMOVED

61421 REMOVED

61425 REMOVED

61426 REMOVED

61429 REMOVED

61430 REMOVED

61433 REMOVED

Item No Benefit

61434 REMOVED

61437 REMOVED

61438 REMOVED

61441 REMOVED

61442 REMOVED

61445 REMOVED

61446 REMOVED

61449 REMOVED

61450 REMOVED

61453 REMOVED

61454 REMOVED

61457 REMOVED

61458 REMOVED

61461 REMOVED

61462 REMOVED

61465 REMOVED

61469 REMOVED

61473 REMOVED

61480 REMOVED

61484 REMOVED

61485 REMOVED

61495 REMOVED

61499 REMOVED

61505 REMOVED

61523 REMOVED

nib275803_Schedbenefits_0615

Contact nib Register for MediGap Email [email protected] Phone 1800 175 377, Mon to Fri: 9am – 5pm (AEST)

MediGap claim enquiries Email [email protected] Phone 1300 853 530, Mon to Fri: 9am – 5pm (AEST)

nib.com.au/providers/medigapnib health funds limited abn 83 000 124 381. Head Office 22 Honeysuckle Drive Newcastle NSW 2300

Date post:	24-Jun-2018
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Schedule of Benefits - nib · This Schedule of Benefits applies to services performed on and from 1...

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