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2024 Workers' Compensation Part B Fee Schedule

95807-95933

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CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
95807   001 XXX 0 X 1,103.59 X
95807 26 001 XXX 0 X 371.66 X
95807 TC 001 XXX 0 X 731.92 X
95807   004 XXX 0 X 931.76 X
95807 26 004 XXX 0 X 326.75 X
95807 TC 004 XXX 0 X 604.96 X
95807   003 XXX 0 X 931.76 X
95807 26 003 XXX 0 X 326.75 X
95807 TC 003 XXX 0 X 604.96 X
95807   002 XXX 0 X 931.76 X
95807 26 002 XXX 0 X 326.75 X
95807 TC 002 XXX 0 X 604.96 X
95808   004 XXX 0 X 953.30 X
95808 26 004 XXX 0 X 462.66 X
95808 TC 004 XXX 0 X 501.16 X
95808   002 XXX 0 X 1,222.32 X
95808 26 002 XXX 0 X 535.86 X
95808 TC 002 XXX 0 X 1,029.18 X
95808   003 XXX 0 X 1,106.81 X
95808 26 003 XXX 0 X 526.33 X
95808 TC 003 XXX 0 X 509.10 X
95808   001 XXX 0 X 1,145.00 X
95808 26 001 XXX 0 X 548.88 X
95808 TC 001 XXX 0 X 565.04 X
95810   004 XXX 0 X 953.30 X
95810 26 004 XXX 0 X 462.66 X
95810 TC 004 XXX 0 X 501.16 X
95810   003 XXX 0 X 1,106.81 X
95810 26 003 XXX 0 X 526.33 X
95810 TC 003 XXX 0 X 509.10 X
95810   002 XXX 0 X 1,222.32 X
95810 26 002 XXX 0 X 535.86 X
95810 TC 002 XXX 0 X 1,029.18 X
95810   001 XXX 0 X 1,145.00 X
95810 26 001 XXX 0 X 548.88 X
95810 TC 001 XXX 0 X 565.04 X
95811   004 XXX 0 X 1,220.38 X
95811 26 004 XXX 0 X 584.96 X
95811 TC 004 XXX 0 X 635.41 X
95811   002 XXX 0 X 1,220.38 X
95811 26 002 XXX 0 X 584.96 X
95811 TC 002 XXX 0 X 635.41 X
95811   003 XXX 0 X 1,220.38 X
95811 26 003 XXX 0 X 584.96 X
95811 TC 003 XXX 0 X 635.41 X
95811   001 XXX 0 X 1,417.52 X
95811 26 001 XXX 0 X 648.96 X
95811 TC 001 XXX 0 X 768.56 X
95812   002 XXX 0 X 310.68 X
95812 26 002 XXX 0 X 175.04 X
95812 TC 002 XXX 0 X 150.98 X
95812   001 XXX 0 X 335.17 X
95812 26 001 XXX 0 X 180.49 X
95812 TC 001 XXX 0 X 156.58 X
95812   004 XXX 0 X 292.15 X
95812 26 004 XXX 0 X 159.06 X
95812 TC 004 XXX 0 X 135.11 X
95812   003 XXX 0 X 287.35 X
95812 26 003 XXX 0 X 172.36 X
95812 TC 003 XXX 0 X 120.52 X
95813   004 XXX 0 X 356.57 X
95813 26 004 XXX 0 X 221.48 X
95813 TC 004 XXX 0 X 135.11 X
95813   003 XXX 0 X 361.67 X
95813 26 003 XXX 0 X 224.12 X
95813 TC 003 XXX 0 X 137.54 X
95813   001 XXX 0 X 394.06 X
95813 26 001 XXX 0 X 237.43 X
95813 TC 001 XXX 0 X 156.58 X
95813   002 XXX 0 X 384.06 X
95813 26 002 XXX 0 X 233.16 X
95813 TC 002 XXX 0 X 150.98 X
95816   001 XXX 0 X 323.24 X
95816 26 001 XXX 0 X 176.14 X
95816 TC 001 XXX 0 X 144.09 X
95816   004 XXX 0 X 238.19 X
95816 26 004 XXX 0 X 149.55 X
95816 TC 004 XXX 0 X 127.63 X
95816   003 XXX 0 X 257.73 X
95816 26 003 XXX 0 X 172.08 X
95816 TC 003 XXX 0 X 87.07 X
95816   002 XXX 0 X 282.16 X
95816 26 002 XXX 0 X 169.25 X
95816 TC 002 XXX 0 X 141.21 X
95819   003 XXX 0 X 267.34 X
95819 26 003 XXX 0 X 181.70 X
95819 TC 003 XXX 0 X 87.07 X
95819   002 XXX 0 X 292.55 X
95819 26 002 XXX 0 X 179.63 X
95819 TC 002 XXX 0 X 141.21 X
95819   004 XXX 0 X 285.00 X
95819 26 004 XXX 0 X 159.04 X
95819 TC 004 XXX 0 X 127.63 X
95819   001 XXX 0 X 333.79 X
95819 26 001 XXX 0 X 186.63 X
95819 TC 001 XXX 0 X 144.09 X
95822   004 XXX 0 X 338.14 X
95822 26 004 XXX 0 X 162.87 X
95822 TC 004 XXX 0 X 175.17 X
95822   003 XXX 0 X 342.72 X
95822 26 003 XXX 0 X 202.73 X
95822 TC 003 XXX 0 X 177.92 X
95822   002 XXX 0 X 331.27 X
95822 26 002 XXX 0 X 157.14 X
95822 TC 002 XXX 0 X 186.44 X
95822   001 XXX 0 X 372.08 X
95822 26 001 XXX 0 X 205.15 X
95822 TC 001 XXX 0 X 197.86 X
95824     XXX 0 X * X
95829   003 XXX 0 X 468.24 X
95829 26 003 XXX 0 X 662.36 X
95829 TC 003 XXX 0 X 15.17 X
95829   004 XXX 0 X 670.96 X
95829 26 004 XXX 0 X 656.04 X
95829 TC 004 XXX 0 X 14.99 X
95829   002 XXX 0 X 477.81 X
95829 26 002 XXX 0 X 470.69 X
95829 TC 002 XXX 0 X 16.86 X
95829   001 XXX 0 X 480.23 X
95829 26 001 XXX 0 X 472.90 X
95829 TC 001 XXX 0 X 17.27 X
95830   002 XXX 0 X 297.72 X
95830   001 XXX 0 X 274.39 X
95830   004 XXX 0 X 247.56 X
95830   003 XXX 0 X 250.39 X
95836   003 XXX 0 X 154.60 X
95836   002 XXX 0 X 154.60 X
95836   004 XXX 0 X 154.60 X
95836   001 XXX 0 X 168.06 X
95851   004 XXX 0 X 51.49 40.34
95851   002 XXX 0 X 55.10 43.05
95851   003 XXX 0 X 52.07 40.78
95851   001 XXX 0 X 55.72 43.62
95852   004 XXX 0 X 34.36 27.44
95852   003 XXX 0 X 34.80 27.75
95852   002 XXX 0 X 36.97 29.43
95852   001 XXX 0 X 37.58 29.90
95857   001 XXX 0 X 109.50 84.46
95857   002 XXX 0 X 108.41 83.81
95857   003 XXX 0 X 105.26 81.09
95857   004 XXX 0 X 104.53 80.59
95860   001 XXX 0 X 229.58 X
95860 26 001 XXX 0 X 184.96 X
95860 TC 001 XXX 0 X 41.11 X
95860   003 XXX 0 X 223.78 X
95860 26 003 XXX 0 X 180.82 X
95860 TC 003 XXX 0 X 36.94 X
95860   002 XXX 0 X 227.61 X
95860 26 002 XXX 0 X 183.96 X
95860 TC 002 XXX 0 X 44.02 X
95860   004 XXX 0 X 223.86 X
95860 26 004 XXX 0 X 175.29 X
95860 TC 004 XXX 0 X 36.37 X
95861   002 XXX 0 X 378.93 X
95861 26 002 XXX 0 X 299.29 X
95861 TC 002 XXX 0 X 79.58 X
95861   004 XXX 0 X 352.24 X
95861 26 004 XXX 0 X 281.11 X
95861 TC 004 XXX 0 X 71.77 X
95861   003 XXX 0 X 356.81 X
95861 26 003 XXX 0 X 283.91 X
95861 TC 003 XXX 0 X 72.19 X
95861   001 XXX 0 X 384.25 X
95861 26 001 XXX 0 X 303.04 X
95861 TC 001 XXX 0 X 81.18 X
95863   002 XXX 0 X 448.96 X
95863 26 002 XXX 0 X 348.94 X
95863 TC 002 XXX 0 X 100.02 X
95863   003 XXX 0 X 423.25 X
95863 26 003 XXX 0 X 331.44 X
95863 TC 003 XXX 0 X 91.81 X
95863   004 XXX 0 X 417.84 X
95863 26 004 XXX 0 X 327.45 X
95863 TC 004 XXX 0 X 90.37 X
95863   001 XXX 0 X 455.14 X
95863 26 001 XXX 0 X 353.16 X
95863 TC 001 XXX 0 X 101.98 X
95864   001 XXX 0 X 598.68 X
95864 26 001 XXX 0 X 358.73 X
95864 TC 001 XXX 0 X 194.27 X
95864   004 XXX 0 X 545.97 X
95864 26 004 XXX 0 X 373.64 X
95864 TC 004 XXX 0 X 172.37 X
95864   002 XXX 0 X 589.95 X
95864 26 002 XXX 0 X 399.32 X
95864 TC 002 XXX 0 X 190.56 X
95864   003 XXX 0 X 553.36 X
95864 26 003 XXX 0 X 378.28 X
95864 TC 003 XXX 0 X 175.07 X
95865   002 XXX 0 X 215.73 X
95865 26 002 XXX 0 X 169.36 X
95865 TC 002 XXX 0 X 46.33 X
95865   001 XXX 0 X 243.50 X
95865 26 001 XXX 0 X 185.88 X
95865 TC 001 XXX 0 X 57.60 X
95865   004 XXX 0 X 215.73 X
95865 26 004 XXX 0 X 169.36 X
95865 TC 004 XXX 0 X 46.33 X
95865   003 XXX 0 X 215.73 X
95865 26 003 XXX 0 X 169.36 X
95865 TC 003 XXX 0 X 46.33 X
95866   001 XXX 0 X 163.39 X
95866 26 001 XXX 0 X 144.34 X
95866 TC 001 XXX 0 X 19.06 X
95866   003 XXX 0 X 146.59 X
95866 26 003 XXX 0 X 131.72 X
95866 TC 003 XXX 0 X 14.85 X
95866   002 XXX 0 X 146.59 X
95866 26 002 XXX 0 X 131.72 X
95866 TC 002 XXX 0 X 14.85 X
95866   004 XXX 0 X 146.59 X
95866 26 004 XXX 0 X 131.72 X
95866 TC 004 XXX 0 X 14.85 X
95867   002 XXX 0 X 191.29 X
95867 26 002 XXX 0 X 134.10 X
95867 TC 002 XXX 0 X 61.71 X
95867   001 XXX 0 X 158.27 X
95867 26 001 XXX 0 X 134.86 X
95867 TC 001 XXX 0 X 62.93 X
95867   003 XXX 0 X 179.30 X
95867 26 003 XXX 0 X 131.18 X
95867 TC 003 XXX 0 X 56.75 X
95867   004 XXX 0 X 176.86 X
95867 26 004 XXX 0 X 121.00 X
95867 TC 004 XXX 0 X 55.92 X
95868   004 XXX 0 X 340.18 X
95868 26 004 XXX 0 X 275.59 X
95868 TC 004 XXX 0 X 67.05 X
95868   002 XXX 0 X 354.59 X
95868 26 002 XXX 0 X 294.28 X
95868 TC 002 XXX 0 X 74.17 X
95868   003 XXX 0 X 342.76 X
95868 26 003 XXX 0 X 278.98 X
95868 TC 003 XXX 0 X 68.14 X
95868   001 XXX 0 X 357.92 X
95868 26 001 XXX 0 X 297.95 X
95868 TC 001 XXX 0 X 75.61 X
95869   004 XXX 0 X 192.43 X
95869 26 004 XXX 0 X 183.58 X
95869 TC 004 XXX 0 X 20.53 X
95869   003 XXX 0 X 201.16 X
95869 26 003 XXX 0 X 162.49 X
95869 TC 003 XXX 0 X 20.82 X
95869   002 XXX 0 X 188.60 X
95869 26 002 XXX 0 X 166.31 X
95869 TC 002 XXX 0 X 22.89 X
95869   001 XXX 0 X 208.36 X
95869 26 001 XXX 0 X 170.88 X
95869 TC 001 XXX 0 X 23.31 X
95870   004 XXX 0 X 84.46 X
95870 26 004 XXX 0 X 64.91 X
95870 TC 004 XXX 0 X 19.55 X
95870   003 XXX 0 X 84.46 X
95870 26 003 XXX 0 X 64.91 X
95870 TC 003 XXX 0 X 19.55 X
95870   002 XXX 0 X 84.46 X
95870 26 002 XXX 0 X 64.91 X
95870 TC 002 XXX 0 X 19.55 X
95870   001 XXX 0 X 96.83 X
95870 26 001 XXX 0 X 73.05 X
95870 TC 001 XXX 0 X 23.83 X
95872   003 XXX 0 X 280.05 X
95872 26 003 XXX 0 X 220.32 X
95872 TC 003 XXX 0 X 59.63 X
95872   004 XXX 0 X 276.59 X
95872 26 004 XXX 0 X 220.57 X
95872 TC 004 XXX 0 X 58.72 X
95872   001 XXX 0 X 299.51 X
95872 26 001 XXX 0 X 233.04 X
95872 TC 001 XXX 0 X 66.45 X
95872   002 XXX 0 X 446.84 X
95872 26 002 XXX 0 X 230.57 X
95872 TC 002 XXX 0 X 65.19 X
95873   004 ZZZ 0 X 52.87 X
95873 26 004 ZZZ 0 X 38.57 X
95873 TC 004 ZZZ 0 X 14.28 X
95873   002 ZZZ 0 X 52.87 X
95873 26 002 ZZZ 0 X 38.57 X
95873 TC 002 ZZZ 0 X 14.28 X
95873   003 ZZZ 0 X 52.87 X
95873 26 003 ZZZ 0 X 38.57 X
95873 TC 003 ZZZ 0 X 14.28 X
95873   001 ZZZ 0 X 60.29 X
95873 26 001 ZZZ 0 X 42.18 X
95873 TC 001 ZZZ 0 X 18.09 X
95874   001 ZZZ 0 X 61.07 X
95874 26 001 ZZZ 0 X 42.96 X
95874 TC 001 ZZZ 0 X 18.09 X
95874   004 ZZZ 0 X 53.47 X
95874 26 004 ZZZ 0 X 39.22 X
95874 TC 004 ZZZ 0 X 14.28 X
95874   003 ZZZ 0 X 53.47 X
95874 26 003 ZZZ 0 X 39.22 X
95874 TC 003 ZZZ 0 X 14.28 X
95874   002 ZZZ 0 X 53.47 X
95874 26 002 ZZZ 0 X 39.22 X
95874 TC 002 ZZZ 0 X 14.28 X
95875   001 XXX 0 X 212.95 X
95875 26 001 XXX 0 X 165.15 X
95875 TC 001 XXX 0 X 47.79 X
95875   003 XXX 0 X 199.08 X
95875 26 003 XXX 0 X 157.30 X
95875 TC 003 XXX 0 X 41.77 X
95875   002 XXX 0 X 210.26 X
95875 26 002 XXX 0 X 163.57 X
95875 TC 002 XXX 0 X 46.65 X
95875   004 XXX 0 X 196.93 X
95875 26 004 XXX 0 X 155.78 X
95875 TC 004 XXX 0 X 41.14 X
95885   004 ZZZ 0 X 87.89 X
95885 26 004 ZZZ 0 X 29.12 X
95885 TC 004 ZZZ 0 X 58.79 X
95885   003 ZZZ 0 X 87.89 X
95885 26 003 ZZZ 0 X 29.12 X
95885 TC 003 ZZZ 0 X 58.79 X
95885   002 ZZZ 0 X 87.89 X
95885 26 002 ZZZ 0 X 29.12 X
95885 TC 002 ZZZ 0 X 58.79 X
95885   001 ZZZ 0 X 99.39 X
95885 26 001 ZZZ 0 X 31.02 X
95885 TC 001 ZZZ 0 X 68.38 X
95886   001 ZZZ 0 X 155.07 X
95886 26 001 ZZZ 0 X 83.08 X
95886 TC 001 ZZZ 0 X 72.01 X
95886   003 ZZZ 0 X 139.71 X
95886 26 003 ZZZ 0 X 77.76 X
95886 TC 003 ZZZ 0 X 61.94 X
95886   002 ZZZ 0 X 139.71 X
95886 26 002 ZZZ 0 X 77.76 X
95886 TC 002 ZZZ 0 X 61.94 X
95886   004 ZZZ 0 X 139.71 X
95886 26 004 ZZZ 0 X 77.76 X
95886 TC 004 ZZZ 0 X 61.94 X
95887   002 ZZZ 0 X 123.96 X
95887 26 002 ZZZ 0 X 61.01 X
95887 TC 002 ZZZ 0 X 62.99 X
95887   003 ZZZ 0 X 123.96 X
95887 26 003 ZZZ 0 X 61.01 X
95887 TC 003 ZZZ 0 X 62.99 X
95887   004 ZZZ 0 X 123.96 X
95887 26 004 ZZZ 0 X 61.01 X
95887 TC 004 ZZZ 0 X 62.99 X
95887   001 ZZZ 0 X 138.25 X
95887 26 001 ZZZ 0 X 64.99 X
95887 TC 001 ZZZ 0 X 73.25 X
95905   001 XXX 0 X 148.31 X
95905 26 001 XXX 0 X 5.68 X
95905 TC 001 XXX 0 X 142.64 X
95905   002 XXX 0 X 125.15 X
95905 26 002 XXX 0 X 5.02 X
95905 TC 002 XXX 0 X 120.12 X
95905   003 XXX 0 X 125.15 X
95905 26 003 XXX 0 X 5.02 X
95905 TC 003 XXX 0 X 120.12 X
95905   004 XXX 0 X 125.15 X
95905 26 004 XXX 0 X 5.02 X
95905 TC 004 XXX 0 X 120.12 X
95907   001 XXX 0 X 162.82 X
95907 26 001 XXX 0 X 87.82 X
95907 TC 001 XXX 0 X 75.03 X
95907   002 XXX 0 X 146.45 X
95907 26 002 XXX 0 X 82.22 X
95907 TC 002 XXX 0 X 64.23 X
95907   004 XXX 0 X 146.45 X
95907 26 004 XXX 0 X 82.22 X
95907 TC 004 XXX 0 X 64.23 X
95907   003 XXX 0 X 146.45 X
95907 26 003 XXX 0 X 82.22 X
95907 TC 003 XXX 0 X 64.23 X
95908   002 XXX 0 X 180.72 X
95908 26 002 XXX 0 X 103.32 X
95908 TC 002 XXX 0 X 77.40 X
95908   001 XXX 0 X 200.73 X
95908 26 001 XXX 0 X 110.43 X
95908 TC 001 XXX 0 X 90.29 X
95908   004 XXX 0 X 180.72 X
95908 26 004 XXX 0 X 103.32 X
95908 TC 004 XXX 0 X 77.40 X
95908   003 XXX 0 X 180.72 X
95908 26 003 XXX 0 X 103.32 X
95908 TC 003 XXX 0 X 77.40 X
95909   003 XXX 0 X 216.62 X
95909 26 003 XXX 0 X 123.28 X
95909 TC 003 XXX 0 X 93.33 X
95909   002 XXX 0 X 216.62 X
95909 26 002 XXX 0 X 123.28 X
95909 TC 002 XXX 0 X 93.33 X
95909   001 XXX 0 X 240.73 X
95909 26 001 XXX 0 X 131.56 X
95909 TC 001 XXX 0 X 109.18 X
95909   004 XXX 0 X 216.62 X
95909 26 004 XXX 0 X 123.28 X
95909 TC 004 XXX 0 X 93.33 X
95910   001 XXX 0 X 316.86 X
95910 26 001 XXX 0 X 176.20 X
95910 TC 001 XXX 0 X 140.65 X
95910   004 XXX 0 X 285.30 X
95910 26 004 XXX 0 X 164.95 X
95910 TC 004 XXX 0 X 120.33 X
95910   003 XXX 0 X 285.30 X
95910 26 003 XXX 0 X 164.95 X
95910 TC 003 XXX 0 X 120.33 X
95910   002 XXX 0 X 285.30 X
95910 26 002 XXX 0 X 164.95 X
95910 TC 002 XXX 0 X 120.33 X
95911   004 XXX 0 X 345.83 X
95911 26 004 XXX 0 X 206.01 X
95911 TC 004 XXX 0 X 139.84 X
95911   003 XXX 0 X 345.83 X
95911 26 003 XXX 0 X 206.01 X
95911 TC 003 XXX 0 X 139.84 X
95911   002 XXX 0 X 345.83 X
95911 26 002 XXX 0 X 206.01 X
95911 TC 002 XXX 0 X 139.84 X
95911   001 XXX 0 X 383.56 X
95911 26 001 XXX 0 X 219.98 X
95911 TC 001 XXX 0 X 163.58 X
95912   002 XXX 0 X 405.36 X
95912 26 002 XXX 0 X 247.19 X
95912 TC 002 XXX 0 X 158.18 X
95912   003 XXX 0 X 405.36 X
95912 26 003 XXX 0 X 247.19 X
95912 TC 003 XXX 0 X 158.18 X
95912   004 XXX 0 X 405.36 X
95912 26 004 XXX 0 X 247.19 X
95912 TC 004 XXX 0 X 158.18 X
95912   001 XXX 0 X 449.14 X
95912 26 001 XXX 0 X 264.04 X
95912 TC 001 XXX 0 X 185.07 X
95913   001 XXX 0 X 520.40 X
95913 26 001 XXX 0 X 312.93 X
95913 TC 001 XXX 0 X 207.48 X
95913   002 XXX 0 X 470.30 X
95913 26 002 XXX 0 X 293.09 X
95913 TC 002 XXX 0 X 177.16 X
95913   003 XXX 0 X 470.30 X
95913 26 003 XXX 0 X 293.09 X
95913 TC 003 XXX 0 X 177.16 X
95913   004 XXX 0 X 470.30 X
95913 26 004 XXX 0 X 293.09 X
95913 TC 004 XXX 0 X 177.16 X
95919   002 XXX 0 X 17.54 X
95919 26 002 XXX 0 X 11.24 X
95919 TC 002 XXX 0 X 6.31 X
95919   003 XXX 0 X 17.54 X
95919 26 003 XXX 0 X 11.24 X
95919 TC 003 XXX 0 X 6.31 X
95919   004 XXX 0 X 17.54 X
95919 26 004 XXX 0 X 11.24 X
95919 TC 004 XXX 0 X 6.31 X
95919   001 XXX 0 X 19.33 X
95919 26 001 XXX 0 X 12.05 X
95919 TC 001 XXX 0 X 7.27 X
95921   001 XXX 0 X 113.29 X
95921 26 001 XXX 0 X 73.49 X
95921 TC 001 XXX 0 X 39.80 X
95921   003 XXX 0 X 98.81 X
95921 26 003 XXX 0 X 66.14 X
95921 TC 003 XXX 0 X 32.66 X
95921   002 XXX 0 X 101.46 X
95921 26 002 XXX 0 X 67.95 X
95921 TC 002 XXX 0 X 33.53 X
95921   004 XXX 0 X 98.81 X
95921 26 004 XXX 0 X 66.14 X
95921 TC 004 XXX 0 X 32.66 X
95922   003 XXX 0 X 103.65 X
95922 26 003 XXX 0 X 71.03 X
95922 TC 003 XXX 0 X 32.66 X
95922   004 XXX 0 X 103.65 X
95922 26 004 XXX 0 X 71.03 X
95922 TC 004 XXX 0 X 32.66 X
95922   002 XXX 0 X 106.50 X
95922 26 002 XXX 0 X 72.96 X
95922 TC 002 XXX 0 X 33.53 X
95922   001 XXX 0 X 119.08 X
95922 26 001 XXX 0 X 79.34 X
95922 TC 001 XXX 0 X 39.80 X
95923   004 XXX 0 X 98.81 X
95923 26 004 XXX 0 X 66.14 X
95923 TC 004 XXX 0 X 32.66 X
95923   001 XXX 0 X 113.29 X
95923 26 001 XXX 0 X 73.49 X
95923 TC 001 XXX 0 X 39.80 X
95923   002 XXX 0 X 101.46 X
95923 26 002 XXX 0 X 67.95 X
95923 TC 002 XXX 0 X 33.53 X
95923   003 XXX 0 X 98.81 X
95923 26 003 XXX 0 X 66.14 X
95923 TC 003 XXX 0 X 32.66 X
95924   001 XXX 0 X 253.67 X
95924 26 001 XXX 0 X 148.12 X
95924 TC 001 XXX 0 X 105.58 X
95924   002 XXX 0 X 229.41 X
95924 26 002 XXX 0 X 138.54 X
95924 TC 002 XXX 0 X 90.86 X
95924   003 XXX 0 X 229.41 X
95924 26 003 XXX 0 X 138.54 X
95924 TC 003 XXX 0 X 90.86 X
95924   004 XXX 0 X 229.41 X
95924 26 004 XXX 0 X 138.54 X
95924 TC 004 XXX 0 X 90.86 X
95925   001 XXX 0 X 307.98 X
95925 26 001 XXX 0 X 195.73 X
95925 TC 001 XXX 0 X 151.66 X
95925   003 XXX 0 X 296.47 X
95925 26 003 XXX 0 X 176.83 X
95925 TC 003 XXX 0 X 136.32 X
95925   004 XXX 0 X 289.22 X
95925 26 004 XXX 0 X 174.75 X
95925 TC 004 XXX 0 X 134.19 X
95925   002 XXX 0 X 301.59 X
95925 26 002 XXX 0 X 189.34 X
95925 TC 002 XXX 0 X 148.74 X
95926   004 XXX 0 X 193.69 X
95926 26 004 XXX 0 X 111.81 X
95926 TC 004 XXX 0 X 81.88 X
95926   003 XXX 0 X 197.11 X
95926 26 003 XXX 0 X 113.63 X
95926 TC 003 XXX 0 X 83.56 X
95926   002 XXX 0 X 213.35 X
95926 26 002 XXX 0 X 121.12 X
95926 TC 002 XXX 0 X 92.19 X
95926   001 XXX 0 X 223.35 X
95926 26 001 XXX 0 X 126.00 X
95926 TC 001 XXX 0 X 97.35 X
95927   004 XXX 0 X 193.69 X
95927 26 004 XXX 0 X 111.81 X
95927 TC 004 XXX 0 X 81.88 X
95927   003 XXX 0 X 197.11 X
95927 26 003 XXX 0 X 113.63 X
95927 TC 003 XXX 0 X 83.56 X
95927   001 XXX 0 X 223.35 X
95927 26 001 XXX 0 X 126.00 X
95927 TC 001 XXX 0 X 97.35 X
95927   002 XXX 0 X 213.35 X
95927 26 002 XXX 0 X 121.12 X
95927 TC 002 XXX 0 X 92.19 X
95928   002 XXX 0 X 343.92 X
95928 26 002 XXX 0 X 169.92 X
95928 TC 002 XXX 0 X 173.99 X
95928   004 XXX 0 X 343.92 X
95928 26 004 XXX 0 X 169.92 X
95928 TC 004 XXX 0 X 173.99 X
95928   003 XXX 0 X 343.92 X
95928 26 003 XXX 0 X 169.92 X
95928 TC 003 XXX 0 X 173.99 X
95928   001 XXX 0 X 393.99 X
95928 26 001 XXX 0 X 184.39 X
95928 TC 001 XXX 0 X 209.55 X
95929   004 XXX 0 X 357.64 X
95929 26 004 XXX 0 X 169.92 X
95929 TC 004 XXX 0 X 187.79 X
95929   003 XXX 0 X 357.64 X
95929 26 003 XXX 0 X 169.92 X
95929 TC 003 XXX 0 X 187.79 X
95929   002 XXX 0 X 357.64 X
95929 26 002 XXX 0 X 169.92 X
95929 TC 002 XXX 0 X 187.79 X
95929   001 XXX 0 X 410.51 X
95929 26 001 XXX 0 X 184.39 X
95929 TC 001 XXX 0 X 226.06 X
95930   003 XXX 0 X 112.37 X
95930 26 003 XXX 0 X 89.06 X
95930 TC 003 XXX 0 X 23.22 X
95930   004 XXX 0 X 110.43 X
95930 26 004 XXX 0 X 87.63 X
95930 TC 004 XXX 0 X 22.82 X
95930   001 XXX 0 X 126.25 X
95930 26 001 XXX 0 X 99.44 X
95930 TC 001 XXX 0 X 26.77 X
95930   002 XXX 0 X 121.06 X
95930 26 002 XXX 0 X 95.45 X
95930 TC 002 XXX 0 X 25.57 X
95933   003 XXX 0 X 188.64 X
95933 26 003 XXX 0 X 130.21 X
95933 TC 003 XXX 0 X 77.64 X
95933   004 XXX 0 X 186.05 X
95933 26 004 XXX 0 X 127.93 X
95933 TC 004 XXX 0 X 76.41 X
95933   001 XXX 0 X 203.81 X
95933 26 001 XXX 0 X 133.75 X
95933 TC 001 XXX 0 X 86.26 X
95933   002 XXX 0 X 203.33 X
95933 26 002 XXX 0 X 136.69 X
95933 TC 002 XXX 0 X 84.62 X