2018 Workers' Compensation Part B Fee Schedule

95937-97016

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"Effective Jan. 1, 2017, CMS (Medicare) has deleted the PT and OT evaluation and re-evaluation HCPCS codes as follows:

97001 PT Evaluation
97002 PT Re-evaluation
97003 OT Evaluation
97004 OT Re-evaluation

CMS has added the following new HCPCS codes for these services:

97161 PT Eval Low Complex 20 min
97162 PT Eval Mod Complex 30 min
97163 PT Eval High Complex 45 min

97165 OT Eval Low Complex 30 min
97166 OT Eval Mod Complex 45 min
97167 OT Eval High Complex 60 min

97164 PT Re-eval Est Plan Care
97168 OT Re-eval Est Plan Care

The Pennsylvania Workers’ Compensation Part B Fee Schedule reimbursement for all new HCPCS codes have been calculated in compliance with 34 Pa. Code Section 127.153(c), which states on or after Jan. 1, 1995, payment rates under the act for new HCPCS codes will be based on the rates allowed in the Medicare fee schedule on the effective date of the new codes, and 34 Pa. Code Section 127.104, which requires payments to outpatient providers for services rendered under the act be calculated by multiplying the Medicare Part B reimbursement for the services by 113%. Furthermore, CMS has determined that the 2017 Medicare fee schedule reimbursement amounts will remain the same for all three levels of the physical and occupational evaluation services regardless of the time indicator or acuity of services rendered. The re-evaluation codes are not impacted by the newly-introduced tier complexity stratification."

CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
Implied Decimal 2 (in dollars)
95937   1 XXX 0 0 11645 0
95937 26 1 XXX 0 0 13677 0
95937 TC 1 XXX 0 0 2864 0
95937   2 XXX 0 0 12700 0
95937 26 2 XXX 0 0 13639 0
95937 TC 2 XXX 0 0 2806 0
95937   3 XXX 0 0 11194 0
95937 26 3 XXX 0 0 10418 0
95937 TC 3 XXX 0 0 2564 0
95937   4 XXX 0 0 11151 0
95937 26 4 XXX 0 0 11700 0
95937 TC 4 XXX 0 0 2526 0
95938   1 XXX 0 0 40848 0
95938 26 1 XXX 0 0 5944 0
95938 TC 1 XXX 0 0 34903 0
95938   2 XXX 0 0 35609 0
95938 26 2 XXX 0 0 5556 0
95938 TC 2 XXX 0 0 30053 0
95938   3 XXX 0 0 35609 0
95938 26 3 XXX 0 0 5556 0
95938 TC 3 XXX 0 0 30053 0
95938   4 XXX 0 0 35609 0
95938 26 4 XXX 0 0 5556 0
95938 TC 4 XXX 0 0 30053 0
95939   1 XXX 0 0 63848 0
95939 26 1 XXX 0 0 15664 0
95939 TC 1 XXX 0 0 48181 0
95939   2 XXX 0 0 56117 0
95939 26 2 XXX 0 0 14627 0
95939 TC 2 XXX 0 0 41490 0
95939   3 XXX 0 0 56117 0
95939 26 3 XXX 0 0 14627 0
95939 TC 3 XXX 0 0 41490 0
95939   4 XXX 0 0 56117 0
95939 26 4 XXX 0 0 14627 0
95939 TC 4 XXX 0 0 41490 0
95940   1 XXX 0 0 4233 0
95940   2 XXX 0 0 3937 0
95940   3 XXX 0 0 3937 0
95940   4 XXX 0 0 3937 0
95941     XXX 9 0 0 0
95943     XXX 0 0 0 0
95950   1 XXX 0 0 74648 0
95950 26 1 XXX 0 0 23257 0
95950 TC 1 XXX 0 0 53961 0
95950   2 XXX 0 0 70374 0
95950 26 2 XXX 0 0 22454 0
95950 TC 2 XXX 0 0 52906 0
95950   3 XXX 0 0 69766 0
95950 26 3 XXX 0 0 21789 0
95950 TC 3 XXX 0 0 48475 0
95950   4 XXX 0 0 69147 0
95950 26 4 XXX 0 0 22545 0
95950 TC 4 XXX 0 0 47716 0
95951   1 XXX 0 0 93883 0
95951 26 1 XXX 0 0 43293 0
95951 TC 1 XXX 0 0 64504 0
95951   2 XXX 0 0 88615 0
95951 26 2 XXX 0 0 42863 0
95951 TC 2 XXX 0 0 63797 0
95951   3 XXX 0 0 99302 0
95951 26 3 XXX 0 0 41113 0
95951 TC 3 XXX 0 0 58192 0
95951   4 XXX 0 0 97929 0
95951 26 4 XXX 0 0 40658 0
95951 TC 4 XXX 0 0 57273 0
95953   1 XXX 0 0 80795 0
95953 26 1 XXX 0 0 29405 0
95953 TC 1 XXX 0 0 53961 0
95953   2 XXX 0 0 76488 0
95953 26 2 XXX 0 0 34751 0
95953 TC 2 XXX 0 0 52906 0
95953   3 XXX 0 0 81776 0
95953 26 3 XXX 0 0 27755 0
95953 TC 3 XXX 0 0 48475 0
95953   4 XXX 0 0 75057 0
95953 26 4 XXX 0 0 28456 0
95953 TC 4 XXX 0 0 47716 0
95954   1 XXX 0 0 41184 0
95954 26 1 XXX 0 0 21927 0
95954 TC 1 XXX 0 0 4322 0
95954   2 XXX 0 0 40586 0
95954 26 2 XXX 0 0 36361 0
95954 TC 2 XXX 0 0 4223 0
95954   3 XXX 0 0 38126 0
95954 26 3 XXX 0 0 34317 0
95954 TC 3 XXX 0 0 3814 0
95954   4 XXX 0 0 37663 0
95954 26 4 XXX 0 0 33909 0
95954 TC 4 XXX 0 0 3760 0
95955   1 XXX 0 0 34526 0
95955 26 1 XXX 0 0 17449 0
95955 TC 1 XXX 0 0 17076 0
95955   2 XXX 0 0 38382 0
95955 26 2 XXX 0 0 17204 0
95955 TC 2 XXX 0 0 16724 0
95955   3 XXX 0 0 41757 0
95955 26 3 XXX 0 0 16177 0
95955 TC 3 XXX 0 0 15241 0
95955   4 XXX 0 0 30985 0
95955 26 4 XXX 0 0 15978 0
95955 TC 4 XXX 0 0 15009 0
95956   1 XXX 0 0 87564 0
95956 26 1 XXX 0 0 37574 0
95956 TC 1 XXX 0 0 53961 0
95956   2 XXX 0 0 82361 0
95956 26 2 XXX 0 0 37184 0
95956 TC 2 XXX 0 0 52906 0
95956   3 XXX 0 0 84039 0
95956 26 3 XXX 0 0 35561 0
95956 TC 3 XXX 0 0 48475 0
95956   4 XXX 0 0 82881 0
95956 26 4 XXX 0 0 35159 0
95956 TC 4 XXX 0 0 47716 0
95957   1 XXX 0 0 42877 0
95957 26 1 XXX 0 0 23421 0
95957 TC 1 XXX 0 0 14397 0
95957   2 XXX 0 0 26954 0
95957 26 2 XXX 0 0 22573 0
95957 TC 2 XXX 0 0 14123 0
95957   3 XXX 0 0 40200 0
95957 26 3 XXX 0 0 27244 0
95957 TC 3 XXX 0 0 12959 0
95957   4 XXX 0 0 39717 0
95957 26 4 XXX 0 0 26957 0
95957 TC 4 XXX 0 0 12760 0
95958   1 XXX 0 0 63407 0
95958 26 1 XXX 0 0 40929 0
95958 TC 1 XXX 0 0 14838 0
95958   2 XXX 0 0 77521 0
95958 26 2 XXX 0 0 62978 0
95958 TC 2 XXX 0 0 14546 0
95958   3 XXX 0 0 72760 0
95958 26 3 XXX 0 0 59435 0
95958 TC 3 XXX 0 0 13328 0
95958   4 XXX 0 0 71853 0
95958 26 4 XXX 0 0 58732 0
95958 TC 4 XXX 0 0 13122 0
95961     XXX 0 0 0 0
95962     ZZZ 0 0 0 0
95965 26 1 XXX 0 0 75721 0
95965 26 2 XXX 0 0 69891 0
95965 26 3 XXX 0 0 69891 0
95965 26 4 XXX 0 0 69891 0
95966 26 1 XXX 0 0 38613 0
95966 26 2 XXX 0 0 35367 0
95966 26 3 XXX 0 0 35367 0
95966 26 4 XXX 0 0 35367 0
95967 26 1 ZZZ 0 0 33896 0
95967 26 2 ZZZ 0 0 31008 0
95967 26 3 ZZZ 0 0 31008 0
95967 26 4 ZZZ 0 0 31008 0
95970   1 XXX 0 0 4792 4641
95970   2 XXX 0 0 4200 4076
95970   3 XXX 0 0 4200 4076
95970   4 XXX 0 0 4200 4076
95971   1 XXX 0 0 7775 7551
95971   2 XXX 0 0 7010 6818
95971   3 XXX 0 0 7010 6818
95971   4 XXX 0 0 7010 6818
95972   1 XXX 0 0 14238 13867
95972   2 XXX 0 0 13093 12775
95972   3 XXX 0 0 13093 12775
95972   4 XXX 0 0 13093 12775
95974   1 XXX 0 0 28923 27286
95974   2 XXX 0 0 26818 25416
95974   3 XXX 0 0 26818 25416
95974   4 XXX 0 0 26818 25416
95975   1 ZZZ 0 0 17277 16310
95975   2 ZZZ 0 0 15850 15023
95975   3 ZZZ 0 0 15850 15023
95975   4 ZZZ 0 0 15850 15023
95978   1 XXX 0 0 36407 32166
95978   2 XXX 0 0 33188 29649
95978   3 XXX 0 0 33188 29649
95978   4 XXX 0 0 33188 29649
95979   1 ZZZ 0 0 16792 15581
95979   2 ZZZ 0 0 15338 14324
95979   3 ZZZ 0 0 15338 14324
95979   4 ZZZ 0 0 15338 14324
95980   1 XXX 0 0 5963 0
95980   2 XXX 0 0 5431 0
95980   3 XXX 0 0 5431 0
95980   4 XXX 0 0 5431 0
95981   1 XXX 0 0 4258 2329
95981   2 XXX 0 0 3718 2121
95981   3 XXX 0 0 3718 2121
95981   4 XXX 0 0 3718 2121
95982   1 XXX 0 0 6402 4657
95982   2 XXX 0 0 5720 4269
95982   3 XXX 0 0 5720 4269
95982   4 XXX 0 0 5720 4269
95990   1 ZZZ 0 0 10715 0
95990   2 ZZZ 0 0 8983 0
95990   3 ZZZ 0 0 8983 0
95990   4 ZZZ 0 0 8983 0
95991   1 XXX 0 0 15257 6765
95991   2 XXX 0 0 13454 6229
95991   3 XXX 0 0 13454 6229
95991   4 XXX 0 0 13454 6229
95992     XXX 0 0 0 0
95999     XXX 0 0 0 0
96000   1 XXX 0 0 16828 0
96000   2 XXX 0 0 15617 0
96000   3 XXX 0 0 15617 0
96000   4 XXX 0 0 15617 0
96001   1 XXX 0 0 20066 0
96001   2 XXX 0 0 18634 0
96001   3 XXX 0 0 18634 0
96001   4 XXX 0 0 18634 0
96002   1 XXX 0 0 3946 0
96002   2 XXX 0 0 3610 0
96002   3 XXX 0 0 3610 0
96002   4 XXX 0 0 3610 0
96003   1 XXX 0 0 3706 0
96003   2 XXX 0 0 3350 0
96003   3 XXX 0 0 3350 0
96003   4 XXX 0 0 3350 0
96004   1 XXX 0 0 17367 0
96004   2 XXX 0 0 15909 0
96004   3 XXX 0 0 15909 0
96004   4 XXX 0 0 15909 0
96020 26 1 XXX 0 0 23065 0
96020 26 2 XXX 0 0 21221 0
96020 26 3 XXX 0 0 21221 0
96020 26 4 XXX 0 0 21221 0
96040     XXX 9 0 0 0
96101   1 XXX 0 0 15054 14931
96101   2 XXX 0 0 13986 13886
96101   3 XXX 0 0 13986 13886
96101   4 XXX 0 0 13986 13886
96102   1 XXX 0 0 7032 3990
96102   2 XXX 0 0 6209 3718
96102   3 XXX 0 0 6209 3718
96102   4 XXX 0 0 6209 3718
96103   1 XXX 0 0 4375 4126
96103   2 XXX 0 0 4025 3822
96103   3 XXX 0 0 4025 3822
96103   4 XXX 0 0 4025 3822
96105   1 XXX 0 0 15140 0
96105   2 XXX 0 0 14235 0
96105   3 XXX 0 0 12843 0
96105   4 XXX 0 0 12589 0
96110     XXX 0 0 0 0
96111   1 XXX 0 0 15140 0
96111   2 XXX 0 0 14235 0
96111   3 XXX 0 0 12843 0
96111   4 XXX 0 0 12589 0
96116   1 XXX 0 0 17187 16006
96116   2 XXX 0 0 15489 14525
96116   3 XXX 0 0 15489 14525
96116   4 XXX 0 0 15489 14525
96118   1 XXX 0 0 20665 15942
96118   2 XXX 0 0 18332 14473
96118   3 XXX 0 0 18332 14473
96118   4 XXX 0 0 18332 14473
96119   1 XXX 0 0 10883 5726
96119   2 XXX 0 0 9085 4874
96119   3 XXX 0 0 9085 4874
96119   4 XXX 0 0 9085 4874
96120   1 XXX 0 0 7664 4126
96120   2 XXX 0 0 6713 3822
96120   3 XXX 0 0 6713 3822
96120   4 XXX 0 0 6713 3822
96125   1 XXX 0 0 14211 11860
96125   2 XXX 0 0 12812 10864
96125   3 XXX 0 0 12812 10864
96125   4 XXX 0 0 12812 10864
96127   1 XXX 0 0 719 0
96127   2 XXX 0 0 610 0
96127   3 XXX 0 0 610 0
96127   4 XXX 0 0 610 0
96150   1 XXX 0 0 4874 4804
96150   2 XXX 0 0 4466 4410
96150   3 XXX 0 0 4466 4410
96150   4 XXX 0 0 4466 4410
96151   1 XXX 0 0 4744 4606
96151   2 XXX 0 0 4342 4227
96151   3 XXX 0 0 4342 4227
96151   4 XXX 0 0 4342 4227
96152   1 XXX 0 0 4544 4408
96152   2 XXX 0 0 4158 4042
96152   3 XXX 0 0 4158 4042
96152   4 XXX 0 0 4158 4042
96153   1 XXX 0 0 1018 0
96153   2 XXX 0 0 913 0
96153   3 XXX 0 0 913 0
96153   4 XXX 0 0 913 0
96154   1 XXX 0 0 4414 4340
96154   2 XXX 0 0 4033 3979
96154   3 XXX 0 0 4033 3979
96154   4 XXX 0 0 4033 3979
96155   1 XXX 0 0 4275 0
96155   2 XXX 0 0 3916 0
96155   3 XXX 0 0 3916 0
96155   4 XXX 0 0 3916 0
96160   1 ZZZ 9 0 587 0
96160   2 ZZZ 9 0 507 0
96160   3 ZZZ 9 0 507 0
96160   4 ZZZ 9 0 507 0
96161   1 ZZZ 9 0 587 0
96161   2 ZZZ 9 0 507 0
96161   3 ZZZ 9 0 507 0
96161   4 ZZZ 9 0 507 0
96360   1 XXX 0 0 8714 0
96360   2 XXX 0 0 7372 0
96360   3 XXX 0 0 7372 0
96360   4 XXX 0 0 7372 0
96361   1 ZZZ 0 0 2588 0
96361   2 ZZZ 0 0 2191 0
96361   3 ZZZ 0 0 2191 0
96361   4 ZZZ 0 0 2191 0
96365   1 XXX 0 0 10563 0
96365   2 XXX 0 0 8957 0
96365   3 XXX 0 0 8957 0
96365   4 XXX 0 0 8957 0
96366   1 ZZZ 0 0 3373 0
96366   2 ZZZ 0 0 2915 0
96366   3 ZZZ 0 0 2915 0
96366   4 ZZZ 0 0 2915 0
96367   1 ZZZ 0 0 5286 0
96367   2 ZZZ 0 0 4539 0
96367   3 ZZZ 0 0 4539 0
96367   4 ZZZ 0 0 4539 0
96368   1 ZZZ 0 0 3158 0
96368   2 ZZZ 0 0 2727 0
96368   3 ZZZ 0 0 2727 0
96368   4 ZZZ 0 0 2727 0
96369   1 XXX 0 0 22809 0
96369   2 XXX 0 0 19299 0
96369   3 XXX 0 0 19299 0
96369   4 XXX 0 0 19299 0
96370   1 ZZZ 0 0 2442 0
96370   2 ZZZ 0 0 2131 0
96370   3 ZZZ 0 0 2131 0
96370   4 ZZZ 0 0 2131 0
96371   1 ZZZ 0 0 11040 0
96371   2 ZZZ 0 0 9293 0
96371   3 ZZZ 0 0 9293 0
96371   4 ZZZ 0 0 9293 0
96372   1 XXX 0 0 3135 0
96372   2 XXX 0 0 2752 0
96372   3 XXX 0 0 2752 0
96372   4 XXX 0 0 2752 0
96373   1 XXX 0 0 2723 0
96373   2 XXX 0 0 2388 0
96373   3 XXX 0 0 2388 0
96373   4 XXX 0 0 2388 0
96374   1 XXX 0 0 8306 0
96374   2 XXX 0 0 7075 0
96374   3 XXX 0 0 7075 0
96374   4 XXX 0 0 7075 0
96375   1 ZZZ 0 0 3680 0
96375   2 ZZZ 0 0 3119 0
96375   3 ZZZ 0 0 3119 0
96375   4 ZZZ 0 0 3119 0
96376     ZZZ 9 0 0 0
96377         0 0 0
96379     XXX 0 0 0 0
96401   1 XXX 0 0 10778 0
96401   2 XXX 0 0 8991 0
96401   3 XXX 0 0 8991 0
96401   4 XXX 0 0 8991 0
96402   1 XXX 0 0 5761 0
96402   2 XXX 0 0 4869 0
96402   3 XXX 0 0 4869 0
96402   4 XXX 0 0 4869 0
96405   1 0 2 0 7999 6410
96405   2 0 2 0 7905 6333
96405   3 0 2 0 7511 6031
96405   4 0 2 0 7419 5967
96406   1 0 2 0 12059 9675
96406   2 0 2 0 11922 9565
96406   3 0 2 0 11349 9124
96406   4 0 2 0 11213 9028
96409   1 XXX 0 0 20032 0
96409   2 XXX 0 0 16486 0
96409   3 XXX 0 0 16486 0
96409   4 XXX 0 0 16486 0
96411   1 ZZZ 0 0 11607 0
96411   2 ZZZ 0 0 9565 0
96411   3 ZZZ 0 0 9565 0
96411   4 ZZZ 0 0 9565 0
96413   1 XXX 0 0 28304 0
96413   2 XXX 0 0 23246 0
96413   3 XXX 0 0 23246 0
96413   4 XXX 0 0 23246 0
96415   1 ZZZ 0 0 6414 0
96415   2 ZZZ 0 0 5293 0
96415   3 ZZZ 0 0 5293 0
96415   4 ZZZ 0 0 5293 0
96416   1 XXX 0 0 30448 0
96416   2 XXX 0 0 24934 0
96416   3 XXX 0 0 24934 0
96416   4 XXX 0 0 24934 0
96417   1 ZZZ 0 0 13852 0
96417   2 ZZZ 0 0 11393 0
96417   3 ZZZ 0 0 11393 0
96417   4 ZZZ 0 0 11393 0
96420   1 XXX 0 0 10475 0
96420   2 XXX 0 0 10278 0
96420   3 XXX 0 0 9442 0
96420   4 XXX 0 0 9295 0
96422   1 XXX 0 0 10320 0
96422   2 XXX 0 0 11275 0
96422   3 XXX 0 0 9296 0
96422   4 XXX 0 0 11071 0
96423   1 ZZZ 0 0 8250 0
96423   2 ZZZ 0 0 8222 0
96423   3 ZZZ 0 0 3660 0
96423   4 ZZZ 0 0 3603 0
96425   1 XXX 0 0 11884 0
96425   2 XXX 0 0 9663 0
96425   3 XXX 0 0 9142 0
96425   4 XXX 0 0 10586 0
96440   1 0 0 0 28574 24341
96440   2 0 0 0 24331 20795
96440   3 0 0 0 26806 22919
96440   4 0 0 0 24412 21470
96446   1 XXX 0 0 25951 3187
96446   2 XXX 0 0 23002 2885
96446   3 XXX 0 0 23002 2885
96446   4 XXX 0 0 23002 2885
96450   1 0 0 0 15156 0
96450   2 0 0 0 15975 0
96450   3 0 0 0 17980 0
96450   4 0 0 0 14358 0
96521   1 XXX 0 0 25076 0
96521   2 XXX 0 0 20581 0
96521   3 XXX 0 0 20581 0
96521   4 XXX 0 0 20581 0
96522   1 XXX 0 0 18124 0
96522   2 XXX 0 0 14898 0
96522   3 XXX 0 0 14898 0
96522   4 XXX 0 0 14898 0
96523   1 XXX 0 0 4594 0
96523   2 XXX 0 0 3770 0
96523   3 XXX 0 0 3770 0
96523   4 XXX 0 0 3770 0
96542   1 XXX 0 0 21448 0
96542   2 XXX 0 0 21159 0
96542   3 XXX 0 0 19960 0
96542   4 XXX 0 0 19725 0
96549     XXX 0 0 0 0
96567   1 XXX 0 0 11546 0
96567   2 XXX 0 0 9745 0
96567   3 XXX 0 0 9745 0
96567   4 XXX 0 0 9745 0
96570   1 ZZZ 0 0 15522 13408
96570   2 ZZZ 0 0 13370 11561
96570   3 ZZZ 0 0 13370 11561
96570   4 ZZZ 0 0 13370 11561
96571   1 ZZZ 0 0 8594 7839
96571   2 ZZZ 0 0 7014 6366
96571   3 ZZZ 0 0 7014 6366
96571   4 ZZZ 0 0 7014 6366
96573   1 0 0 0 23397 0
96573   2 0 0 0 20564 0
96573   3 0 0 0 20564 0
96573   4 0 0 0 20564 0
96574   1 0 0 0 30082 0
96574   2 0 0 0 26590 0
96574   3 0 0 0 26590 0
96574   4 0 0 0 26590 0
96900   1 XXX 0 0 3665 0
96900   2 XXX 0 0 3272 0
96900   3 XXX 0 0 3002 0
96900   4 XXX 0 0 3584 0
96902     XXX 9 0 0 0
96904   1 XXX 0 0 10957 0
96904   2 XXX 0 0 8940 0
96904   3 XXX 0 0 8940 0
96904   4 XXX 0 0 8940 0
96910   1 XXX 0 0 4869 0
96910   2 XXX 0 0 4781 0
96910   3 XXX 0 0 4390 0
96910   4 XXX 0 0 4326 0
96912   1 XXX 0 0 5475 0
96912   2 XXX 0 0 5294 0
96912   3 XXX 0 0 5051 0
96912   4 XXX 0 0 4973 0
96913   1 XXX 0 0 7911 0
96913   2 XXX 0 0 7818 0
96913   3 XXX 0 0 7440 0
96913   4 XXX 0 0 7348 0
96920   1 XXX 0 0 28082 11331
96920   2 XXX 0 0 24509 10259
96920   3 XXX 0 0 24509 10259
96920   4 XXX 0 0 24509 10259
96921   1 0 2 0 28766 11530
96921   2 0 2 0 25104 10442
96921   3 0 2 0 25104 10442
96921   4 0 2 0 25104 10442
96922   1 0 2 0 39533 20640
96922   2 0 2 0 34772 18702
96922   3 0 2 0 34772 18702
96922   4 0 2 0 34772 18702
96931     YYY 0 0 0 0
96932     YYY 0 0 0 0
96933     YYY 0 0 0 0
96934     YYY 0 0 0 0
96935     YYY 0 0 0 0
96936     YYY 0 0 0 0
96999   1 XXX 0 0 0 0
96999   2 XXX 0 0 0 0
96999   3 XXX 0 0 0 0
96999   4 XXX 0 0 0 0
97010   1 XXX 9 0 3610 0
97010   2 XXX 9 0 3560 0
97010   3 XXX 9 0 3356 0
97010   4 XXX 9 0 3362 0
97012   1 XXX 0 0 3716 0
97012   2 XXX 0 0 3731 0
97012   3 XXX 0 0 3490 0
97012   4 XXX 0 0 3860 0
97014   1 XXX 0 0 3469 0
97014   2 XXX 0 0 3323 0
97014   3 XXX 0 0 3371 0
97014   4 XXX 0 0 3603 0
97016   1 XXX 0 0 3917 0
97016   2 XXX 0 0 3871 0
97016   3 XXX 0 0 4153 0
97016   4 XXX 0 0 3582 0