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Health Care Services Review
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>
Fee Schedule
>
Fee Schedule 76529-76941
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
76529-76941
View the PDF
CPT/HCPC Code
Modifier
Medicare Location
Global Surgery Indicator
Multiple Surgery Indicator
Prevailing Charge Amount
Fee Schedule Amount
Site of Service Amount
76529
001
XXX
0
X
237.75
X
76529
26
001
XXX
0
X
100.69
X
76529
TC
001
XXX
0
X
146.54
X
76529
004
XXX
0
X
219.68
X
76529
26
004
XXX
0
X
93.58
X
76529
TC
004
XXX
0
X
130.36
X
76529
003
XXX
0
X
225.51
X
76529
26
003
XXX
0
X
96.04
X
76529
TC
003
XXX
0
X
132.44
X
76529
002
XXX
0
X
237.73
X
76529
26
002
XXX
0
X
100.43
X
76529
TC
002
XXX
0
X
143.85
X
76536
001
XXX
0
X
241.80
X
76536
26
001
XXX
0
X
98.85
X
76536
TC
001
XXX
0
X
151.63
X
76536
004
XXX
0
X
222.47
X
76536
26
004
XXX
0
X
91.96
X
76536
TC
004
XXX
0
X
134.98
X
76536
003
XXX
0
X
228.52
X
76536
26
003
XXX
0
X
94.22
X
76536
TC
003
XXX
0
X
137.14
X
76536
002
XXX
0
X
242.77
X
76536
26
002
XXX
0
X
98.51
X
76536
TC
002
XXX
0
X
148.81
X
76604
001
XXX
4
X
228.17
X
76604
26
001
XXX
4
X
97.84
X
76604
TC
001
XXX
4
X
138.94
X
76604
004
XXX
4
X
211.40
X
76604
26
004
XXX
4
X
91.20
X
76604
TC
004
XXX
4
X
123.86
X
76604
003
XXX
4
X
217.11
X
76604
26
003
XXX
4
X
93.34
X
76604
TC
003
XXX
4
X
125.78
X
76604
002
XXX
4
X
228.70
X
76604
26
002
XXX
4
X
97.50
X
76604
TC
002
XXX
4
X
136.46
X
76641
001
XXX
0
X
182.63
X
76641
26
001
XXX
0
X
59.99
X
76641
TC
001
XXX
0
X
122.66
X
76641
002
XXX
0
X
161.18
X
76641
26
002
XXX
0
X
56.40
X
76641
TC
002
XXX
0
X
104.77
X
76641
003
XXX
0
X
161.18
X
76641
26
003
XXX
0
X
56.40
X
76641
TC
003
XXX
0
X
104.77
X
76641
004
XXX
0
X
161.18
X
76641
26
004
XXX
0
X
56.40
X
76641
TC
004
XXX
0
X
104.77
X
76642
002
XXX
0
X
132.70
X
76642
26
002
XXX
0
X
52.53
X
76642
TC
002
XXX
0
X
80.19
X
76642
003
XXX
0
X
132.70
X
76642
26
003
XXX
0
X
52.53
X
76642
TC
003
XXX
0
X
80.19
X
76642
004
XXX
0
X
132.70
X
76642
26
004
XXX
0
X
52.53
X
76642
TC
004
XXX
0
X
80.19
X
76642
001
XXX
0
X
149.73
X
76642
26
001
XXX
0
X
55.88
X
76642
TC
001
XXX
0
X
93.85
X
76700
001
XXX
4
X
339.15
X
76700
26
001
XXX
4
X
140.22
X
76700
TC
001
XXX
4
X
210.97
X
76700
004
XXX
4
X
312.16
X
76700
26
004
XXX
4
X
130.79
X
76700
TC
004
XXX
4
X
188.05
X
76700
002
XXX
4
X
337.60
X
76700
26
002
XXX
4
X
139.86
X
76700
TC
002
XXX
4
X
207.21
X
76700
003
XXX
4
X
320.50
X
76700
26
003
XXX
4
X
133.93
X
76700
TC
003
XXX
4
X
191.09
X
76705
004
XXX
4
X
226.94
X
76705
26
004
XXX
4
X
96.57
X
76705
TC
004
XXX
4
X
134.98
X
76705
003
XXX
4
X
233.13
X
76705
26
003
XXX
4
X
99.12
X
76705
TC
003
XXX
4
X
137.14
X
76705
002
XXX
4
X
250.66
X
76705
26
002
XXX
4
X
103.43
X
76705
TC
002
XXX
4
X
148.81
X
76705
001
XXX
4
X
245.90
X
76705
26
001
XXX
4
X
103.77
X
76705
TC
001
XXX
4
X
151.63
X
76706
001
XXX
0
X
154.06
X
76706
26
001
XXX
0
X
44.76
X
76706
TC
001
XXX
0
X
109.27
X
76706
003
XXX
0
X
136.17
X
76706
26
003
XXX
0
X
41.91
X
76706
TC
003
XXX
0
X
94.26
X
76706
002
XXX
0
X
136.17
X
76706
26
002
XXX
0
X
41.91
X
76706
TC
002
XXX
0
X
94.26
X
76706
004
XXX
0
X
136.17
X
76706
26
004
XXX
0
X
41.91
X
76706
TC
004
XXX
0
X
94.26
X
76770
003
XXX
4
X
309.72
X
76770
26
003
XXX
4
X
123.21
X
76770
TC
003
XXX
4
X
191.09
X
76770
001
XXX
4
X
329.14
X
76770
26
001
XXX
4
X
129.16
X
76770
TC
001
XXX
4
X
210.97
X
76770
002
XXX
4
X
326.45
X
76770
26
002
XXX
4
X
128.70
X
76770
TC
002
XXX
4
X
207.21
X
76770
004
XXX
4
X
301.64
X
76770
26
004
XXX
4
X
120.48
X
76770
TC
004
XXX
4
X
188.05
X
76775
001
XXX
4
X
244.87
X
76775
26
001
XXX
4
X
102.71
X
76775
TC
001
XXX
4
X
151.63
X
76775
004
XXX
4
X
226.19
X
76775
26
004
XXX
4
X
95.45
X
76775
TC
004
XXX
4
X
134.98
X
76775
002
XXX
4
X
275.51
X
76775
26
002
XXX
4
X
102.42
X
76775
TC
002
XXX
4
X
158.87
X
76775
003
XXX
4
X
232.24
X
76775
26
003
XXX
4
X
98.06
X
76775
TC
003
XXX
4
X
137.14
X
76776
002
XXX
4
X
207.48
X
76776
26
002
XXX
4
X
62.66
X
76776
TC
002
XXX
4
X
144.82
X
76776
003
XXX
4
X
207.48
X
76776
26
003
XXX
4
X
62.66
X
76776
TC
003
XXX
4
X
144.82
X
76776
004
XXX
4
X
207.48
X
76776
26
004
XXX
4
X
62.66
X
76776
TC
004
XXX
4
X
144.82
X
76776
001
XXX
4
X
248.35
X
76776
26
001
XXX
4
X
68.20
X
76776
TC
001
XXX
4
X
180.12
X
76800
004
XXX
0
X
329.14
X
76800
26
004
XXX
0
X
166.21
X
76800
TC
004
XXX
0
X
176.77
X
76800
003
XXX
0
X
338.06
X
76800
26
003
XXX
0
X
167.98
X
76800
TC
003
XXX
0
X
182.00
X
76800
002
XXX
0
X
355.24
X
76800
26
002
XXX
0
X
177.18
X
76800
TC
002
XXX
0
X
191.93
X
76800
001
XXX
0
X
356.81
X
76800
26
001
XXX
0
X
179.48
X
76800
TC
001
XXX
0
X
192.77
X
76801
002
XXX
0
X
194.94
X
76801
26
002
XXX
0
X
109.73
X
76801
TC
002
XXX
0
X
85.11
X
76801
003
XXX
0
X
194.94
X
76801
26
003
XXX
0
X
109.73
X
76801
TC
003
XXX
0
X
85.11
X
76801
004
XXX
0
X
194.94
X
76801
26
004
XXX
0
X
109.73
X
76801
TC
004
XXX
0
X
85.11
X
76801
001
XXX
0
X
223.57
X
76801
26
001
XXX
0
X
119.36
X
76801
TC
001
XXX
0
X
104.23
X
76802
004
ZZZ
0
X
152.40
X
76802
26
004
ZZZ
0
X
92.26
X
76802
TC
004
ZZZ
0
X
60.17
X
76802
003
ZZZ
0
X
152.40
X
76802
26
003
ZZZ
0
X
92.26
X
76802
TC
003
ZZZ
0
X
60.17
X
76802
002
ZZZ
0
X
152.40
X
76802
26
002
ZZZ
0
X
92.26
X
76802
TC
002
ZZZ
0
X
60.17
X
76802
001
ZZZ
0
X
175.44
X
76802
26
001
ZZZ
0
X
100.65
X
76802
TC
001
ZZZ
0
X
74.82
X
76805
002
XXX
0
X
382.55
X
76805
26
002
XXX
0
X
171.75
X
76805
TC
002
XXX
0
X
220.55
X
76805
003
XXX
0
X
363.14
X
76805
26
003
XXX
0
X
164.24
X
76805
TC
003
XXX
0
X
203.37
X
76805
004
XXX
0
X
353.63
X
76805
26
004
XXX
0
X
160.05
X
76805
TC
004
XXX
0
X
200.20
X
76805
001
XXX
0
X
382.30
X
76805
26
001
XXX
0
X
172.22
X
76805
TC
001
XXX
0
X
224.67
X
76810
003
ZZZ
0
X
698.07
X
76810
26
003
ZZZ
0
X
292.32
X
76810
TC
003
ZZZ
0
X
405.81
X
76810
002
ZZZ
0
X
747.65
X
76810
26
002
ZZZ
0
X
307.93
X
76810
TC
002
ZZZ
0
X
439.69
X
76810
004
ZZZ
0
X
688.37
X
76810
26
004
ZZZ
0
X
289.11
X
76810
TC
004
ZZZ
0
X
399.33
X
76810
001
ZZZ
0
X
759.46
X
76810
26
001
ZZZ
0
X
311.64
X
76810
TC
001
ZZZ
0
X
447.77
X
76811
001
XXX
0
X
590.86
X
76811
26
001
XXX
0
X
236.53
X
76811
TC
001
XXX
0
X
354.32
X
76811
002
XXX
0
X
503.22
X
76811
26
002
XXX
0
X
214.36
X
76811
TC
002
XXX
0
X
288.90
X
76811
003
XXX
0
X
503.22
X
76811
26
003
XXX
0
X
214.36
X
76811
TC
003
XXX
0
X
288.90
X
76811
004
XXX
0
X
503.22
X
76811
26
004
XXX
0
X
214.36
X
76811
TC
004
XXX
0
X
288.90
X
76812
001
ZZZ
0
X
352.29
X
76812
26
001
ZZZ
0
X
220.40
X
76812
TC
001
ZZZ
0
X
131.92
X
76812
002
ZZZ
0
X
300.85
X
76812
26
002
ZZZ
0
X
200.57
X
76812
TC
002
ZZZ
0
X
100.30
X
76812
003
ZZZ
0
X
300.85
X
76812
26
003
ZZZ
0
X
200.57
X
76812
TC
003
ZZZ
0
X
100.30
X
76812
004
ZZZ
0
X
300.85
X
76812
26
004
ZZZ
0
X
200.57
X
76812
TC
004
ZZZ
0
X
100.30
X
76813
004
XXX
0
X
211.90
X
76813
26
004
XXX
0
X
96.09
X
76813
TC
004
XXX
0
X
115.80
X
76813
002
XXX
0
X
211.90
X
76813
26
002
XXX
0
X
96.09
X
76813
TC
002
XXX
0
X
115.80
X
76813
003
XXX
0
X
211.90
X
76813
26
003
XXX
0
X
96.09
X
76813
TC
003
XXX
0
X
115.80
X
76813
001
XXX
0
X
249.95
X
76813
26
001
XXX
0
X
104.41
X
76813
TC
001
XXX
0
X
145.52
X
76814
001
XXX
0
X
165.36
X
76814
26
001
XXX
0
X
87.89
X
76814
TC
001
XXX
0
X
77.45
X
76814
002
XXX
0
X
140.86
X
76814
26
002
XXX
0
X
80.67
X
76814
TC
002
XXX
0
X
60.20
X
76814
003
XXX
0
X
140.86
X
76814
26
003
XXX
0
X
80.67
X
76814
TC
003
XXX
0
X
60.20
X
76814
004
XXX
0
X
140.86
X
76814
26
004
XXX
0
X
80.67
X
76814
TC
004
XXX
0
X
60.20
X
76815
001
XXX
0
X
252.06
X
76815
26
001
XXX
0
X
96.83
X
76815
TC
001
XXX
0
X
155.24
X
76815
004
XXX
0
X
216.52
X
76815
26
004
XXX
0
X
87.74
X
76815
TC
004
XXX
0
X
128.77
X
76815
003
XXX
0
X
216.52
X
76815
26
003
XXX
0
X
87.74
X
76815
TC
003
XXX
0
X
128.77
X
76815
002
XXX
0
X
216.52
X
76815
26
002
XXX
0
X
87.74
X
76815
TC
002
XXX
0
X
128.77
X
76816
004
XXX
0
X
195.70
X
76816
26
004
XXX
0
X
93.58
X
76816
TC
004
XXX
0
X
106.13
X
76816
003
XXX
0
X
201.01
X
76816
26
003
XXX
0
X
96.04
X
76816
TC
003
XXX
0
X
107.84
X
76816
002
XXX
0
X
211.64
X
76816
26
002
XXX
0
X
100.43
X
76816
TC
002
XXX
0
X
116.99
X
76816
001
XXX
0
X
212.68
X
76816
26
001
XXX
0
X
100.69
X
76816
TC
001
XXX
0
X
119.18
X
76817
004
XXX
0
X
200.66
X
76817
26
004
XXX
0
X
83.04
X
76817
TC
004
XXX
0
X
117.67
X
76817
001
XXX
0
X
230.22
X
76817
26
001
XXX
0
X
89.89
X
76817
TC
001
XXX
0
X
140.32
X
76817
003
XXX
0
X
200.66
X
76817
26
003
XXX
0
X
83.04
X
76817
TC
003
XXX
0
X
117.67
X
76817
002
XXX
0
X
200.66
X
76817
26
002
XXX
0
X
83.04
X
76817
TC
002
XXX
0
X
117.67
X
76818
001
XXX
0
X
295.56
X
76818
26
001
XXX
0
X
133.54
X
76818
TC
001
XXX
0
X
173.40
X
76818
002
XXX
0
X
296.08
X
76818
26
002
XXX
0
X
133.04
X
76818
TC
002
XXX
0
X
170.32
X
76818
003
XXX
0
X
281.12
X
76818
26
003
XXX
0
X
127.35
X
76818
TC
003
XXX
0
X
157.02
X
76818
004
XXX
0
X
273.80
X
76818
26
004
XXX
0
X
124.16
X
76818
TC
004
XXX
0
X
154.51
X
76819
001
XXX
0
X
248.67
X
76819
26
001
XXX
0
X
84.14
X
76819
TC
001
XXX
0
X
164.48
X
76819
004
XXX
0
X
214.68
X
76819
26
004
XXX
0
X
77.22
X
76819
TC
004
XXX
0
X
137.46
X
76819
003
XXX
0
X
214.68
X
76819
26
003
XXX
0
X
77.22
X
76819
TC
003
XXX
0
X
137.46
X
76819
002
XXX
0
X
214.68
X
76819
26
002
XXX
0
X
77.22
X
76819
TC
002
XXX
0
X
137.46
X
76820
001
XXX
0
X
213.51
X
76820
26
001
XXX
0
X
60.29
X
76820
TC
001
XXX
0
X
153.28
X
76820
004
XXX
0
X
179.89
X
76820
26
004
XXX
0
X
55.32
X
76820
TC
004
XXX
0
X
124.56
X
76820
002
XXX
0
X
179.89
X
76820
26
002
XXX
0
X
55.32
X
76820
TC
002
XXX
0
X
124.56
X
76820
003
XXX
0
X
179.89
X
76820
26
003
XXX
0
X
55.32
X
76820
TC
003
XXX
0
X
124.56
X
76821
004
XXX
0
X
201.54
X
76821
26
004
XXX
0
X
77.00
X
76821
TC
004
XXX
0
X
124.56
X
76821
003
XXX
0
X
201.54
X
76821
26
003
XXX
0
X
77.00
X
76821
TC
003
XXX
0
X
124.56
X
76821
002
XXX
0
X
201.54
X
76821
26
002
XXX
0
X
77.00
X
76821
TC
002
XXX
0
X
124.56
X
76821
001
XXX
0
X
236.68
X
76821
26
001
XXX
0
X
83.39
X
76821
TC
001
XXX
0
X
153.28
X
76825
003
XXX
0
X
320.13
X
76825
26
003
XXX
0
X
133.55
X
76825
TC
003
XXX
0
X
191.09
X
76825
004
XXX
0
X
311.80
X
76825
26
004
XXX
0
X
130.21
X
76825
TC
004
XXX
0
X
188.05
X
76825
002
XXX
0
X
337.13
X
76825
26
002
XXX
0
X
139.35
X
76825
TC
002
XXX
0
X
207.21
X
76825
001
XXX
0
X
354.34
X
76825
26
001
XXX
0
X
139.86
X
76825
TC
001
XXX
0
X
210.97
X
76826
001
XXX
0
X
303.00
X
76826
26
001
XXX
0
X
153.71
X
76826
TC
001
XXX
0
X
76.56
X
76826
004
XXX
0
X
218.72
X
76826
26
004
XXX
0
X
168.25
X
76826
TC
004
XXX
0
X
67.95
X
76826
003
XXX
0
X
269.07
X
76826
26
003
XXX
0
X
157.33
X
76826
TC
003
XXX
0
X
69.11
X
76826
002
XXX
0
X
295.98
X
76826
26
002
XXX
0
X
157.02
X
76826
TC
002
XXX
0
X
218.44
X
76827
004
XXX
0
X
342.63
X
76827
26
004
XXX
0
X
184.95
X
76827
TC
004
XXX
0
X
166.80
X
76827
003
XXX
0
X
340.06
X
76827
26
003
XXX
0
X
183.59
X
76827
TC
003
XXX
0
X
169.46
X
76827
002
XXX
0
X
353.40
X
76827
26
002
XXX
0
X
186.11
X
76827
TC
002
XXX
0
X
184.60
X
76827
001
XXX
0
X
356.12
X
76827
26
001
XXX
0
X
189.04
X
76827
TC
001
XXX
0
X
188.21
X
76828
002
XXX
0
X
214.93
X
76828
26
002
XXX
0
X
104.79
X
76828
TC
002
XXX
0
X
119.91
X
76828
003
XXX
0
X
197.86
X
76828
26
003
XXX
0
X
110.90
X
76828
TC
003
XXX
0
X
109.76
X
76828
004
XXX
0
X
191.51
X
76828
26
004
XXX
0
X
131.18
X
76828
TC
004
XXX
0
X
108.12
X
76828
001
XXX
0
X
221.37
X
76828
26
001
XXX
0
X
104.05
X
76828
TC
001
XXX
0
X
122.27
X
76830
004
XXX
0
X
253.55
X
76830
26
004
XXX
0
X
113.76
X
76830
TC
004
XXX
0
X
146.16
X
76830
003
XXX
0
X
260.36
X
76830
26
003
XXX
0
X
115.72
X
76830
TC
003
XXX
0
X
148.51
X
76830
002
XXX
0
X
274.39
X
76830
26
002
XXX
0
X
120.98
X
76830
TC
002
XXX
0
X
161.28
X
76830
001
XXX
0
X
275.31
X
76830
26
001
XXX
0
X
121.34
X
76830
TC
001
XXX
0
X
164.29
X
76831
001
XXX
4
X
273.80
X
76831
004
XXX
4
X
235.01
X
76831
002
XXX
4
X
235.01
X
76831
003
XXX
4
X
235.01
X
76856
003
XXX
4
X
260.36
X
76856
26
003
XXX
4
X
115.74
X
76856
TC
003
XXX
4
X
148.51
X
76856
004
XXX
4
X
253.55
X
76856
26
004
XXX
4
X
112.77
X
76856
TC
004
XXX
4
X
146.16
X
76856
002
XXX
4
X
277.75
X
76856
26
002
XXX
4
X
120.98
X
76856
TC
002
XXX
4
X
161.28
X
76856
001
XXX
4
X
275.31
X
76856
26
001
XXX
4
X
121.34
X
76856
TC
001
XXX
4
X
164.29
X
76857
002
XXX
4
X
170.51
X
76857
26
002
XXX
4
X
64.76
X
76857
TC
002
XXX
4
X
111.00
X
76857
003
XXX
4
X
161.56
X
76857
26
003
XXX
4
X
61.89
X
76857
TC
003
XXX
4
X
102.21
X
76857
004
XXX
4
X
157.36
X
76857
26
004
XXX
4
X
60.30
X
76857
TC
004
XXX
4
X
100.56
X
76857
001
XXX
4
X
173.40
X
76857
26
001
XXX
4
X
65.04
X
76857
TC
001
XXX
4
X
113.15
X
76870
002
XXX
4
X
266.09
X
76870
26
002
XXX
4
X
111.03
X
76870
TC
002
XXX
4
X
161.28
X
76870
004
XXX
4
X
244.55
X
76870
26
004
XXX
4
X
103.90
X
76870
TC
004
XXX
4
X
146.16
X
76870
003
XXX
4
X
251.12
X
76870
26
003
XXX
4
X
106.39
X
76870
TC
003
XXX
4
X
148.51
X
76870
001
XXX
4
X
265.67
X
76870
26
001
XXX
4
X
111.33
X
76870
TC
001
XXX
4
X
164.29
X
76872
002
XXX
0
X
270.92
X
76872
26
002
XXX
0
X
109.69
X
76872
TC
002
XXX
0
X
161.28
X
76872
003
XXX
0
X
252.41
X
76872
26
003
XXX
0
X
103.90
X
76872
TC
003
XXX
0
X
148.51
X
76872
001
XXX
0
X
275.31
X
76872
26
001
XXX
0
X
111.03
X
76872
TC
001
XXX
0
X
164.29
X
76872
004
XXX
0
X
248.97
X
76872
26
004
XXX
0
X
102.71
X
76872
TC
004
XXX
0
X
146.16
X
76873
004
XXX
0
X
345.94
X
76873
26
004
XXX
0
X
162.32
X
76873
TC
004
XXX
0
X
183.60
X
76873
002
XXX
0
X
345.94
X
76873
26
002
XXX
0
X
162.32
X
76873
TC
002
XXX
0
X
183.60
X
76873
001
XXX
0
X
396.46
X
76873
26
001
XXX
0
X
176.33
X
76873
TC
001
XXX
0
X
220.16
X
76873
003
XXX
0
X
345.94
X
76873
26
003
XXX
0
X
162.32
X
76873
TC
003
XXX
0
X
183.60
X
76881
001
XXX
0
X
216.99
X
76881
004
XXX
0
X
194.43
X
76881
003
XXX
0
X
194.43
X
76881
002
XXX
0
X
194.43
X
76881
26
001
XXX
0
X
53.45
X
76881
TC
001
XXX
0
X
163.52
X
76881
26
002
XXX
0
X
50.08
X
76881
TC
002
XXX
0
X
144.31
X
76881
26
003
XXX
0
X
50.08
X
76881
TC
003
XXX
0
X
144.31
X
76881
26
004
XXX
0
X
50.08
X
76881
TC
004
XXX
0
X
144.31
X
76882
001
XXX
0
X
56.77
X
76882
26
001
XXX
0
X
37.16
X
76882
TC
001
XXX
0
X
19.60
X
76882
002
XXX
0
X
51.91
X
76882
26
002
XXX
0
X
34.78
X
76882
TC
002
XXX
0
X
17.13
X
76882
003
XXX
0
X
51.91
X
76882
26
003
XXX
0
X
34.78
X
76882
TC
003
XXX
0
X
17.13
X
76882
004
XXX
0
X
51.91
X
76882
26
004
XXX
0
X
34.78
X
76882
TC
004
XXX
0
X
17.13
X
76883
001
XXX
0
X
89.61
X
76883
26
001
XXX
0
X
70.86
X
76883
TC
001
XXX
0
X
18.75
X
76883
004
XXX
0
X
83.04
X
76883
26
004
XXX
0
X
66.71
X
76883
TC
004
XXX
0
X
16.34
X
76883
003
XXX
0
X
83.04
X
76883
26
003
XXX
0
X
66.71
X
76883
TC
003
XXX
0
X
16.34
X
76883
002
XXX
0
X
83.04
X
76883
26
002
XXX
0
X
66.71
X
76883
TC
002
XXX
0
X
16.34
X
76885
001
XXX
0
X
275.63
X
76885
002
XXX
0
X
236.75
X
76885
003
XXX
0
X
236.75
X
76885
004
XXX
0
X
236.75
X
76886
004
XXX
0
X
211.15
X
76886
001
XXX
0
X
246.16
X
76886
002
XXX
0
X
211.15
X
76886
003
XXX
0
X
211.15
X
76932
001
YYY
0
X
272.29
X
76932
26
001
YYY
0
X
117.43
X
76932
TC
001
YYY
0
X
164.29
X
76932
004
YYY
0
X
249.93
X
76932
26
004
YYY
0
X
109.00
X
76932
TC
004
YYY
0
X
146.16
X
76932
003
YYY
0
X
256.51
X
76932
26
003
YYY
0
X
111.88
X
76932
TC
003
YYY
0
X
148.51
X
76932
002
YYY
0
X
270.45
X
76932
26
002
YYY
0
X
117.02
X
76932
TC
002
YYY
0
X
161.28
X
76936
004
XXX
0
X
802.36
X
76936
26
004
XXX
0
X
211.23
X
76936
TC
004
XXX
0
X
591.08
X
76936
003
XXX
0
X
815.96
X
76936
26
003
XXX
0
X
214.05
X
76936
TC
003
XXX
0
X
601.79
X
76936
002
XXX
0
X
883.17
X
76936
26
002
XXX
0
X
225.33
X
76936
TC
002
XXX
0
X
657.85
X
76936
001
XXX
0
X
911.07
X
76936
26
001
XXX
0
X
230.50
X
76936
TC
001
XXX
0
X
680.59
X
76937
001
ZZZ
0
X
83.51
X
76937
26
001
ZZZ
0
X
39.38
X
76937
TC
001
ZZZ
0
X
44.08
X
76937
002
ZZZ
0
X
69.30
X
76937
26
002
ZZZ
0
X
35.05
X
76937
TC
002
ZZZ
0
X
34.28
X
76937
003
ZZZ
0
X
69.30
X
76937
26
003
ZZZ
0
X
35.05
X
76937
TC
003
ZZZ
0
X
34.28
X
76937
004
ZZZ
0
X
69.30
X
76937
26
004
ZZZ
0
X
35.05
X
76937
TC
004
ZZZ
0
X
34.28
X
76940
002
YYY
0
X
352.37
X
76940
26
002
YYY
0
X
219.35
X
76940
TC
002
YYY
0
X
133.03
X
76940
003
YYY
0
X
352.37
X
76940
26
003
YYY
0
X
219.35
X
76940
TC
003
YYY
0
X
133.03
X
76940
001
YYY
0
X
405.56
X
76940
26
001
YYY
0
X
238.13
X
76940
TC
001
YYY
0
X
167.41
X
76940
004
YYY
0
X
352.37
X
76940
26
004
YYY
0
X
219.35
X
76940
TC
004
YYY
0
X
133.03
X
76941
004
XXX
0
X
341.87
X
76941
26
004
XXX
0
X
198.33
X
76941
TC
004
XXX
0
X
143.62
X
76941
003
XXX
0
X
346.99
X
76941
26
003
XXX
0
X
200.73
X
76941
TC
003
XXX
0
X
146.17
X
76941
002
XXX
0
X
371.46
X
76941
26
002
XXX
0
X
211.64
X
76941
TC
002
XXX
0
X
159.76
X
76941
001
XXX
0
X
382.14
X
76941
26
001
XXX
0
X
216.93
X
76941
TC
001
XXX
0
X
165.27
X
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