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Worker
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Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
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Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
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Health Care Services Review
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Fee Schedule
>
Fee Schedule 88334-90847
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
88334-90847
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
88334
001
ZZZ
0
X
95.82
X
88334
26
001
ZZZ
0
X
66.49
X
88334
TC
001
ZZZ
0
X
29.30
X
88334
002
ZZZ
0
X
84.64
X
88334
26
002
ZZZ
0
X
61.10
X
88334
TC
002
ZZZ
0
X
23.48
X
88334
003
ZZZ
0
X
84.64
X
88334
26
003
ZZZ
0
X
61.10
X
88334
TC
003
ZZZ
0
X
23.48
X
88334
004
ZZZ
0
X
84.64
X
88334
26
004
ZZZ
0
X
61.10
X
88334
TC
004
ZZZ
0
X
23.48
X
88341
001
ZZZ
0
X
113.85
X
88341
26
001
ZZZ
0
X
35.92
X
88341
TC
001
ZZZ
0
X
77.93
X
88341
002
ZZZ
0
X
100.21
X
88341
26
002
ZZZ
0
X
33.68
X
88341
TC
002
ZZZ
0
X
66.54
X
88341
003
ZZZ
0
X
100.21
X
88341
26
003
ZZZ
0
X
33.68
X
88341
TC
003
ZZZ
0
X
66.54
X
88341
004
ZZZ
0
X
100.21
X
88341
26
004
ZZZ
0
X
33.68
X
88341
TC
004
ZZZ
0
X
66.54
X
88342
002
XXX
0
X
169.49
X
88342
26
002
XXX
0
X
91.20
X
88342
TC
002
XXX
0
X
33.89
X
88342
003
XXX
0
X
175.64
X
88342
26
003
XXX
0
X
90.10
X
88342
TC
003
XXX
0
X
31.22
X
88342
004
XXX
0
X
147.02
X
88342
26
004
XXX
0
X
89.52
X
88342
TC
004
XXX
0
X
30.71
X
88342
001
XXX
0
X
179.86
X
88342
26
001
XXX
0
X
92.76
X
88342
TC
001
XXX
0
X
34.43
X
88344
001
XXX
0
X
197.69
X
88344
26
001
XXX
0
X
65.87
X
88344
TC
001
XXX
0
X
131.84
X
88344
003
XXX
0
X
174.41
X
88344
26
003
XXX
0
X
61.79
X
88344
TC
003
XXX
0
X
112.62
X
88344
002
XXX
0
X
174.41
X
88344
26
002
XXX
0
X
61.79
X
88344
TC
002
XXX
0
X
112.62
X
88344
004
XXX
0
X
174.41
X
88344
26
004
XXX
0
X
61.79
X
88344
TC
004
XXX
0
X
112.62
X
88346
002
XXX
0
X
130.54
X
88346
26
002
XXX
0
X
121.39
X
88346
TC
002
XXX
0
X
29.85
X
88346
003
XXX
0
X
118.79
X
88346
26
003
XXX
0
X
116.71
X
88346
TC
003
XXX
0
X
27.44
X
88346
004
XXX
0
X
122.74
X
88346
26
004
XXX
0
X
115.41
X
88346
TC
004
XXX
0
X
27.00
X
88346
001
XXX
0
X
152.95
X
88346
26
001
XXX
0
X
122.53
X
88346
TC
001
XXX
0
X
30.42
X
88347
001
XXX
0
X
136.81
X
88347
26
001
XXX
0
X
106.35
X
88347
TC
001
XXX
0
X
30.42
X
88347
004
XXX
0
X
127.60
X
88347
26
004
XXX
0
X
100.56
X
88347
TC
004
XXX
0
X
27.00
X
88347
003
XXX
0
X
129.13
X
88347
26
003
XXX
0
X
72.70
X
88347
TC
003
XXX
0
X
27.44
X
88347
002
XXX
0
X
135.34
X
88347
26
002
XXX
0
X
105.42
X
88347
TC
002
XXX
0
X
29.85
X
88348
004
XXX
0
X
378.06
X
88348
26
004
XXX
0
X
335.34
X
88348
TC
004
XXX
0
X
109.90
X
88348
002
XXX
0
X
406.84
X
88348
26
002
XXX
0
X
334.56
X
88348
TC
002
XXX
0
X
121.43
X
88348
003
XXX
0
X
383.08
X
88348
26
003
XXX
0
X
335.54
X
88348
TC
003
XXX
0
X
111.66
X
88348
001
XXX
0
X
674.30
X
88348
26
001
XXX
0
X
340.39
X
88348
TC
001
XXX
0
X
123.76
X
88350
004
ZZZ
0
X
105.04
X
88350
26
004
ZZZ
0
X
42.93
X
88350
TC
004
ZZZ
0
X
62.10
X
88350
003
ZZZ
0
X
105.04
X
88350
26
003
ZZZ
0
X
42.93
X
88350
TC
003
ZZZ
0
X
62.10
X
88350
002
ZZZ
0
X
105.04
X
88350
26
002
ZZZ
0
X
42.93
X
88350
TC
002
ZZZ
0
X
62.10
X
88350
001
ZZZ
0
X
118.39
X
88350
26
001
ZZZ
0
X
45.71
X
88350
TC
001
ZZZ
0
X
72.65
X
88355
001
XXX
0
X
387.69
X
88355
26
001
XXX
0
X
294.33
X
88355
TC
001
XXX
0
X
93.35
X
88355
003
XXX
0
X
362.56
X
88355
26
003
XXX
0
X
278.36
X
88355
TC
003
XXX
0
X
84.23
X
88355
002
XXX
0
X
382.81
X
88355
26
002
XXX
0
X
291.22
X
88355
TC
002
XXX
0
X
91.59
X
88355
004
XXX
0
X
438.74
X
88355
26
004
XXX
0
X
275.18
X
88355
TC
004
XXX
0
X
82.92
X
88356
003
XXX
0
X
571.16
X
88356
26
003
XXX
0
X
442.48
X
88356
TC
003
XXX
0
X
128.56
X
88356
004
XXX
0
X
564.11
X
88356
26
004
XXX
0
X
437.53
X
88356
TC
004
XXX
0
X
126.55
X
88356
002
XXX
0
X
601.68
X
88356
26
002
XXX
0
X
462.24
X
88356
TC
002
XXX
0
X
139.40
X
88356
001
XXX
0
X
608.98
X
88356
26
001
XXX
0
X
467.02
X
88356
TC
001
XXX
0
X
141.97
X
88358
XXX
0
X
*
X
88360
004
XXX
0
X
217.91
X
88360
26
004
XXX
0
X
125.18
X
88360
TC
004
XXX
0
X
92.75
X
88360
003
XXX
0
X
217.91
X
88360
26
003
XXX
0
X
125.18
X
88360
TC
003
XXX
0
X
92.75
X
88360
002
XXX
0
X
217.91
X
88360
26
002
XXX
0
X
125.18
X
88360
TC
002
XXX
0
X
92.75
X
88360
001
XXX
0
X
248.27
X
88360
26
001
XXX
0
X
136.43
X
88360
TC
001
XXX
0
X
111.84
X
88361
004
XXX
0
X
283.39
X
88361
26
004
XXX
0
X
114.76
X
88361
TC
004
XXX
0
X
168.64
X
88361
003
XXX
0
X
283.39
X
88361
26
003
XXX
0
X
114.76
X
88361
TC
003
XXX
0
X
168.64
X
88361
002
XXX
0
X
283.39
X
88361
26
002
XXX
0
X
114.76
X
88361
TC
002
XXX
0
X
168.64
X
88361
001
XXX
0
X
328.75
X
88361
26
001
XXX
0
X
127.87
X
88361
TC
001
XXX
0
X
200.89
X
88362
XXX
0
X
*
X
88363
004
XXX
0
X
64.78
29.59
88363
002
XXX
0
X
64.78
29.59
88363
003
XXX
0
X
64.78
29.59
88363
001
XXX
0
X
71.41
31.56
88364
003
ZZZ
0
X
144.64
X
88364
26
003
ZZZ
0
X
41.97
X
88364
TC
003
ZZZ
0
X
102.68
X
88364
004
ZZZ
0
X
144.64
X
88364
26
004
ZZZ
0
X
41.97
X
88364
TC
004
ZZZ
0
X
102.68
X
88364
001
ZZZ
0
X
164.91
X
88364
26
001
ZZZ
0
X
44.72
X
88364
TC
001
ZZZ
0
X
120.20
X
88364
002
ZZZ
0
X
144.64
X
88364
26
002
ZZZ
0
X
41.97
X
88364
TC
002
ZZZ
0
X
102.68
X
88365
001
XXX
0
X
178.81
X
88365
26
001
XXX
0
X
138.28
X
88365
TC
001
XXX
0
X
40.54
X
88365
002
XXX
0
X
182.66
X
88365
26
002
XXX
0
X
145.17
X
88365
TC
002
XXX
0
X
39.84
X
88365
003
XXX
0
X
168.05
X
88365
26
003
XXX
0
X
131.16
X
88365
TC
003
XXX
0
X
36.88
X
88365
004
XXX
0
X
165.98
X
88365
26
004
XXX
0
X
129.77
X
88365
TC
004
XXX
0
X
36.28
X
88366
003
XXX
0
X
223.40
X
88366
26
003
XXX
0
X
97.17
X
88366
TC
003
XXX
0
X
126.26
X
88366
002
XXX
0
X
223.40
X
88366
26
002
XXX
0
X
97.17
X
88366
TC
002
XXX
0
X
126.26
X
88366
004
XXX
0
X
223.40
X
88366
26
004
XXX
0
X
97.17
X
88366
TC
004
XXX
0
X
126.26
X
88366
001
XXX
0
X
251.12
X
88366
26
001
XXX
0
X
103.36
X
88366
TC
001
XXX
0
X
147.79
X
88367
004
XXX
0
X
409.09
X
88367
26
004
XXX
0
X
146.07
X
88367
TC
004
XXX
0
X
263.02
X
88367
003
XXX
0
X
409.09
X
88367
26
003
XXX
0
X
146.07
X
88367
TC
003
XXX
0
X
263.02
X
88367
002
XXX
0
X
409.09
X
88367
26
002
XXX
0
X
146.07
X
88367
TC
002
XXX
0
X
263.02
X
88367
001
XXX
0
X
475.99
X
88367
26
001
XXX
0
X
158.65
X
88367
TC
001
XXX
0
X
317.25
X
88368
26
001
XXX
0
X
171.98
X
88368
TC
001
XXX
0
X
258.97
X
88368
26
002
XXX
0
X
158.36
X
88368
TC
002
XXX
0
X
214.33
X
88368
26
003
XXX
0
X
158.36
X
88368
TC
003
XXX
0
X
214.33
X
88368
26
004
XXX
0
X
158.36
X
88368
TC
004
XXX
0
X
214.33
X
88368
001
XXX
0
X
430.91
X
88368
004
XXX
0
X
372.74
X
88368
003
XXX
0
X
372.74
X
88368
002
XXX
0
X
372.74
X
88369
003
ZZZ
0
X
110.07
X
88369
26
003
ZZZ
0
X
38.81
X
88369
TC
003
ZZZ
0
X
71.24
X
88369
001
ZZZ
0
X
124.45
X
88369
26
001
ZZZ
0
X
41.02
X
88369
TC
001
ZZZ
0
X
83.45
X
88369
002
ZZZ
0
X
110.07
X
88369
26
002
ZZZ
0
X
38.81
X
88369
TC
002
ZZZ
0
X
71.24
X
88369
004
ZZZ
0
X
110.07
X
88369
26
004
ZZZ
0
X
38.81
X
88369
TC
004
ZZZ
0
X
71.24
X
88371
XXX
9
X
25.12
X
88372
XXX
9
X
29.63
X
88373
002
ZZZ
0
X
89.78
X
88373
26
002
ZZZ
0
X
32.67
X
88373
TC
002
ZZZ
0
X
57.13
X
88373
004
ZZZ
0
X
89.78
X
88373
26
004
ZZZ
0
X
32.67
X
88373
TC
004
ZZZ
0
X
57.13
X
88373
003
ZZZ
0
X
89.78
X
88373
26
003
ZZZ
0
X
32.67
X
88373
TC
003
ZZZ
0
X
57.13
X
88373
001
ZZZ
0
X
101.55
X
88373
26
001
ZZZ
0
X
34.66
X
88373
TC
001
ZZZ
0
X
66.89
X
88374
002
XXX
0
X
303.87
X
88374
26
002
XXX
0
X
69.75
X
88374
TC
002
XXX
0
X
234.14
X
88374
001
XXX
0
X
347.88
X
88374
26
001
XXX
0
X
73.85
X
88374
TC
001
XXX
0
X
274.00
X
88374
004
XXX
0
X
303.87
X
88374
26
004
XXX
0
X
69.75
X
88374
TC
004
XXX
0
X
234.14
X
88374
003
XXX
0
X
303.87
X
88374
26
003
XXX
0
X
69.75
X
88374
TC
003
XXX
0
X
234.14
X
88375
XXX
0
X
*
X
88377
001
XXX
0
X
362.04
X
88377
26
001
XXX
0
X
107.04
X
88377
TC
001
XXX
0
X
255.02
X
88377
003
XXX
0
X
319.38
X
88377
26
003
XXX
0
X
101.48
X
88377
TC
003
XXX
0
X
217.91
X
88377
004
XXX
0
X
319.38
X
88377
26
004
XXX
0
X
101.48
X
88377
TC
004
XXX
0
X
217.91
X
88377
002
XXX
0
X
319.38
X
88377
26
002
XXX
0
X
101.48
X
88377
TC
002
XXX
0
X
217.91
X
88380
XXX
0
X
*
X
88381
004
XXX
0
X
367.41
X
88381
26
004
XXX
0
X
98.11
X
88381
TC
004
XXX
0
X
269.29
X
88381
002
XXX
0
X
367.41
X
88381
26
002
XXX
0
X
98.11
X
88381
TC
002
XXX
0
X
269.29
X
88381
003
XXX
0
X
367.41
X
88381
26
003
XXX
0
X
98.11
X
88381
TC
003
XXX
0
X
269.29
X
88381
001
XXX
0
X
431.06
X
88381
26
001
XXX
0
X
105.86
X
88381
TC
001
XXX
0
X
325.19
X
88387
003
XXX
0
X
67.34
X
88387
26
003
XXX
0
X
54.20
X
88387
TC
003
XXX
0
X
13.10
X
88387
004
XXX
0
X
67.34
X
88387
26
004
XXX
0
X
54.20
X
88387
TC
004
XXX
0
X
13.10
X
88387
001
XXX
0
X
73.85
X
88387
26
001
XXX
0
X
58.12
X
88387
TC
001
XXX
0
X
15.78
X
88387
002
XXX
0
X
67.34
X
88387
26
002
XXX
0
X
54.20
X
88387
TC
002
XXX
0
X
13.10
X
88388
002
XXX
0
X
40.56
X
88388
26
002
XXX
0
X
33.98
X
88388
TC
002
XXX
0
X
6.59
X
88388
001
XXX
0
X
43.91
X
88388
26
001
XXX
0
X
35.86
X
88388
TC
001
XXX
0
X
8.04
X
88388
003
XXX
0
X
40.56
X
88388
26
003
XXX
0
X
33.98
X
88388
TC
003
XXX
0
X
6.59
X
88388
004
XXX
0
X
40.56
X
88388
26
004
XXX
0
X
33.98
X
88388
TC
004
XXX
0
X
6.59
X
88399
XXX
0
X
#
X
88720
XXX
9
X
5.67
X
88738
XXX
9
X
5.67
X
88740
XXX
9
X
10.59
X
88741
XXX
9
X
10.59
X
88749
XXX
9
X
#
X
89049
004
XXX
0
X
338.78
123.02
89049
002
XXX
0
X
338.78
123.02
89049
003
XXX
0
X
338.78
123.02
89049
001
XXX
0
X
395.23
131.16
89050
XXX
9
X
5.33
X
89051
XXX
9
X
6.33
X
89055
XXX
9
X
4.83
X
89060
26
001
XXX
9
X
59.23
X
89060
26
004
XXX
9
X
55.61
X
89060
26
003
XXX
9
X
56.18
X
89060
26
002
XXX
9
X
58.66
X
89060
XXX
9
X
8.28
X
89125
XXX
9
X
6.64
X
89160
XXX
9
X
5.48
X
89190
XXX
9
X
6.54
X
89220
XXX
0
X
*
X
89230
XXX
0
X
*
X
89240
XXX
0
X
#
X
89250
XXX
9
X
*
X
89251
XXX
9
X
*
X
89253
XXX
9
X
*
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89254
XXX
9
X
*
X
89255
XXX
9
X
*
X
89257
XXX
9
X
*
X
89258
XXX
9
X
*
X
89259
XXX
9
X
*
X
89260
XXX
9
X
*
X
89261
XXX
9
X
*
X
89264
XXX
9
X
*
X
89268
XXX
9
X
*
X
89272
XXX
9
X
*
X
89280
XXX
9
X
*
X
89281
XXX
9
X
*
X
89290
XXX
9
X
*
X
89291
XXX
9
X
*
X
89300
XXX
9
X
11.12
X
89310
XXX
9
X
9.73
X
89320
XXX
9
X
13.91
X
89321
XXX
9
X
13.62
X
89322
XXX
9
X
17.51
X
89325
XXX
9
X
12.06
X
89329
XXX
9
X
22.14
X
89330
XXX
9
X
11.73
X
89331
XXX
9
X
22.14
X
89335
XXX
9
X
*
X
89337
XXX
9
X
*
X
89342
XXX
9
X
*
X
89343
XXX
9
X
*
X
89344
XXX
9
X
*
X
89346
XXX
9
X
*
X
89352
XXX
9
X
*
X
89353
XXX
9
X
*
X
89354
XXX
9
X
*
X
89356
XXX
9
X
*
X
89398
XXX
9
X
#
X
90281
XXX
9
X
*
X
90283
XXX
9
X
*
X
90284
XXX
9
X
*
X
90287
XXX
9
X
*
X
90288
XXX
9
X
*
X
90291
XXX
9
X
*
X
90296
XXX
9
X
*
X
90371
XXX
9
X
*
X
90375
XXX
9
X
*
X
90376
XXX
9
X
*
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90377
XXX
9
X
*
X
90378
XXX
9
X
*
X
90380
XXX
9
X
#
X
90381
XXX
9
X
#
X
90384
XXX
9
X
*
X
90385
XXX
9
X
*
X
90386
XXX
9
X
*
X
90389
XXX
9
X
*
X
90393
XXX
9
X
*
X
90396
XXX
9
X
*
X
90399
XXX
9
X
#
X
90460
004
XXX
0
X
39.11
X
90460
002
XXX
0
X
39.11
X
90460
003
XXX
0
X
39.11
X
90460
001
XXX
0
X
43.33
X
90461
004
ZZZ
0
X
19.78
X
90461
002
ZZZ
0
X
19.78
X
90461
003
ZZZ
0
X
19.78
X
90461
001
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0
X
21.56
X
90471
XXX
0
X
*
X
90472
ZZZ
0
X
*
X
90473
XXX
0
X
*
X
90474
ZZZ
0
X
*
X
90476
XXX
9
X
*
X
90477
XXX
9
X
*
X
90581
XXX
9
X
*
X
90584
X
#
X
90585
XXX
9
X
*
X
90586
XXX
9
X
*
X
90587
XXX
9
X
#
X
90589
XXX
9
X
#
X
90611
XXX
9
X
#
X
90619
XXX
9
X
*
X
90620
XXX
9
X
*
X
90621
XXX
9
X
*
X
90622
XXX
9
X
#
X
90623
XXX
9
X
#
X
90625
XXX
9
X
*
X
90626
XXX
9
X
#
X
90627
XXX
9
X
#
X
90630
XXX
9
X
*
X
90632
XXX
9
X
*
X
90633
XXX
9
X
*
X
90634
XXX
9
X
*
X
90636
XXX
9
X
*
X
90644
XXX
9
X
*
X
90647
XXX
9
X
*
X
90648
XXX
9
X
*
X
90649
XXX
9
X
*
X
90650
XXX
9
X
*
X
90651
XXX
9
X
*
X
90653
XXX
9
X
*
X
90654
XXX
9
X
30.99
X
90655
XXX
9
X
*
X
90656
XXX
9
X
*
X
90657
XXX
9
X
*
X
90658
XXX
9
X
*
X
90660
XXX
9
X
*
X
90661
XXX
9
X
*
X
90662
XXX
9
X
*
X
90664
XXX
9
X
*
X
90666
XXX
9
X
*
X
90667
XXX
9
X
*
X
90668
XXX
9
X
*
X
90670
XXX
9
X
*
X
90671
XXX
9
X
*
X
90672
XXX
9
X
*
X
90673
XXX
9
X
58.59
X
90674
XXX
9
X
*
X
90675
XXX
9
X
*
X
90676
XXX
9
X
*
X
90677
XXX
9
X
*
X
90678
X
#
X
90679
XXX
9
X
#
X
90680
XXX
9
X
*
X
90681
XXX
9
X
*
X
90682
XXX
9
X
67.65
X
90683
XXX
9
X
#
X
90685
XXX
9
X
37.33
X
90686
XXX
9
X
31.16
X
90687
XXX
9
X
*
X
90688
XXX
9
X
*
X
90689
XXX
9
X
*
X
90690
XXX
9
X
*
X
90691
XXX
9
X
*
X
90694
XXX
9
X
*
X
90696
XXX
9
X
*
X
90697
XXX
9
X
*
X
90698
XXX
9
X
*
X
90700
XXX
9
X
*
X
90702
XXX
9
X
*
X
90707
XXX
9
X
*
X
90710
XXX
9
X
*
X
90713
XXX
9
X
*
X
90714
XXX
9
X
*
X
90715
XXX
9
X
*
X
90716
XXX
9
X
*
X
90717
XXX
9
X
*
X
90723
XXX
9
X
*
X
90732
XXX
9
X
37.92
X
90733
XXX
9
X
*
X
90734
XXX
9
X
*
X
90736
XXX
9
X
*
X
90738
XXX
9
X
*
X
90739
XXX
9
X
*
X
90740
XXX
9
X
418.17
X
90743
XXX
9
X
95.74
X
90744
XXX
9
X
62.20
X
90746
XXX
9
X
163.80
X
90747
XXX
9
X
459.08
X
90748
XXX
9
X
*
X
90749
XXX
9
X
#
X
90750
XXX
9
X
*
X
90756
XXX
9
X
33.30
X
90758
XXX
9
X
#
X
90759
XXX
9
X
*
X
90785
002
ZZZ
0
X
7.76
X
90785
003
ZZZ
0
X
7.76
X
90785
004
ZZZ
0
X
7.76
X
90785
001
ZZZ
0
X
8.28
X
90791
001
XXX
0
X
256.93
198.71
90791
004
XXX
0
X
239.35
189.19
90791
003
XXX
0
X
239.35
189.19
90791
002
XXX
0
X
239.35
189.19
90792
004
XXX
0
X
200.60
195.54
90792
001
XXX
0
X
210.64
204.76
90792
003
XXX
0
X
200.60
195.54
90792
002
XXX
0
X
200.60
195.54
90832
002
XXX
0
X
99.90
79.61
90832
003
XXX
0
X
99.90
79.61
90832
004
XXX
0
X
99.90
79.61
90832
001
XXX
0
X
106.63
83.11
90833
002
ZZZ
0
X
67.00
66.54
90833
003
ZZZ
0
X
67.00
66.54
90833
004
ZZZ
0
X
67.00
66.54
90833
001
ZZZ
0
X
70.55
69.97
90834
003
XXX
0
X
130.06
119.42
90834
002
XXX
0
X
130.06
119.42
90834
004
XXX
0
X
130.06
119.42
90834
001
XXX
0
X
136.82
124.46
90836
004
ZZZ
0
X
108.80
X
90836
003
ZZZ
0
X
108.80
X
90836
002
ZZZ
0
X
108.80
X
90836
001
ZZZ
0
X
114.31
X
90837
004
XXX
0
X
190.85
180.21
90837
003
XXX
0
X
190.85
180.21
90837
002
XXX
0
X
190.85
180.21
90837
001
XXX
0
X
200.43
188.05
90838
002
ZZZ
0
X
175.75
174.74
90838
003
ZZZ
0
X
175.75
174.74
90838
004
ZZZ
0
X
175.75
174.74
90838
001
ZZZ
0
X
184.90
183.75
90839
XXX
0
X
*
X
90840
ZZZ
0
X
*
X
90845
004
XXX
0
X
199.83
X
90845
003
XXX
0
X
199.83
X
90845
002
XXX
0
X
199.83
X
90845
001
XXX
0
X
214.77
X
90846
001
XXX
0
X
244.57
X
90846
002
XXX
0
X
224.46
X
90846
004
XXX
0
X
224.46
X
90846
003
XXX
0
X
224.46
X
90847
004
XXX
0
X
254.62
X
90847
003
XXX
0
X
254.62
X
90847
002
XXX
0
X
254.62
X
90847
001
XXX
0
X
275.24
X
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