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2024 Workers' Compensation Part B Fee Schedule

50553-51784

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