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2024 Workers' Compensation Part B Fee Schedule

93313-93619

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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
93313   004 XXX 0 X 162.43 X
93313   001 XXX 0 X 175.30 X
93313   002 XXX 0 X 173.19 X
93313   003 XXX 0 X 164.36 X
93314   001 XXX 6 X 595.02 X
93314 26 001 XXX 6 X 175.30 X
93314 TC 001 XXX 6 X 419.58 X
93314   002 XXX 6 X 584.43 X
93314 26 002 XXX 6 X 173.19 X
93314 TC 002 XXX 6 X 411.25 X
93314   003 XXX 6 X 540.30 X
93314 26 003 XXX 6 X 164.36 X
93314 TC 003 XXX 6 X 375.94 X
93314   004 XXX 6 X 532.50 X
93314 26 004 XXX 6 X 162.43 X
93314 TC 004 XXX 6 X 370.15 X
93315   004 XXX 0 X 683.50 X
93315 26 004 XXX 0 X 355.12 X
93315 TC 004 XXX 0 X 328.37 X
93315   002 XXX 0 X 702.32 X
93315 26 002 XXX 0 X 364.85 X
93315 TC 002 XXX 0 X 337.39 X
93315   003 XXX 0 X 683.50 X
93315 26 003 XXX 0 X 355.12 X
93315 TC 003 XXX 0 X 328.37 X
93315   001 XXX 0 X 792.21 X
93315 26 001 XXX 0 X 390.67 X
93315 TC 001 XXX 0 X 401.52 X
93316   001 XXX 0 X 156.76 X
93316   003 XXX 0 X 140.33 X
93316   002 XXX 0 X 144.24 X
93316   004 XXX 0 X 140.33 X
93317   003 XXX 0 X 542.29 X
93317 26 003 XXX 0 X 213.88 X
93317 TC 003 XXX 0 X 328.37 X
93317   004 XXX 0 X 542.29 X
93317 26 004 XXX 0 X 213.88 X
93317 TC 004 XXX 0 X 328.37 X
93317   001 XXX 0 X 634.43 X
93317 26 001 XXX 0 X 232.92 X
93317 TC 001 XXX 0 X 401.52 X
93317   002 XXX 0 X 557.17 X
93317 26 002 XXX 0 X 219.79 X
93317 TC 002 XXX 0 X 337.39 X
93318     XXX 6 X * X
93319   002 ZZZ 0 X 71.31 29.78
93319   004 ZZZ 0 X 71.31 29.78
93319   003 ZZZ 0 X 71.31 29.78
93319   001 ZZZ 0 X 79.87 31.96
93320   001 ZZZ 0 X 276.11 X
93320 26 001 ZZZ 0 X 86.00 X
93320 TC 001 ZZZ 0 X 190.13 X
93320   003 ZZZ 0 X 232.24 X
93320 26 003 ZZZ 0 X 75.34 X
93320 TC 003 ZZZ 0 X 156.93 X
93320   002 ZZZ 0 X 232.24 X
93320 26 002 ZZZ 0 X 75.34 X
93320 TC 002 ZZZ 0 X 156.93 X
93320   004 ZZZ 0 X 232.24 X
93320 26 004 ZZZ 0 X 75.34 X
93320 TC 004 ZZZ 0 X 156.93 X
93321   003 ZZZ 0 X 193.38 X
93321 26 003 ZZZ 0 X 90.86 X
93321 TC 003 ZZZ 0 X 109.76 X
93321   004 ZZZ 0 X 147.87 X
93321 26 004 ZZZ 0 X 111.33 X
93321 TC 004 ZZZ 0 X 108.12 X
93321   001 ZZZ 0 X 218.05 X
93321 26 001 ZZZ 0 X 83.30 X
93321 TC 001 ZZZ 0 X 122.27 X
93321   002 ZZZ 0 X 211.47 X
93321 26 002 ZZZ 0 X 84.23 X
93321 TC 002 ZZZ 0 X 119.91 X
93325   003 ZZZ 0 X 277.57 X
93325 26 003 ZZZ 0 X 10.55 X
93325 TC 003 ZZZ 0 X 267.04 X
93325   002 ZZZ 0 X 277.57 X
93325 26 002 ZZZ 0 X 10.55 X
93325 TC 002 ZZZ 0 X 267.04 X
93325   001 ZZZ 0 X 336.28 X
93325 26 001 ZZZ 0 X 11.92 X
93325 TC 001 ZZZ 0 X 324.27 X
93325   004 ZZZ 0 X 277.57 X
93325 26 004 ZZZ 0 X 10.55 X
93325 TC 004 ZZZ 0 X 267.04 X
93350   001 XXX 6 X 1,100.58 X
93350 26 001 XXX 6 X 574.68 X
93350 TC 001 XXX 6 X 376.43 X
93350   004 XXX 6 X 1,067.64 X
93350 26 004 XXX 6 X 559.74 X
93350 TC 004 XXX 6 X 333.54 X
93350   003 XXX 6 X 1,072.02 X
93350 26 003 XXX 6 X 561.90 X
93350 TC 003 XXX 6 X 338.78 X
93350   002 XXX 6 X 1,095.05 X
93350 26 002 XXX 6 X 572.19 X
93350 TC 002 XXX 6 X 727.99 X
93351   002 XXX 6 X 470.53 X
93351   003 XXX 6 X 470.53 X
93351   004 XXX 6 X 470.53 X
93351   001 XXX 6 X 545.95 X
93352   004 ZZZ 0 X 65.23 X
93352   003 ZZZ 0 X 65.23 X
93352   002 ZZZ 0 X 65.23 X
93352   001 ZZZ 0 X 76.15 X
93355   002 XXX 0 X 354.43 X
93355   004 XXX 0 X 354.43 X
93355   003 XXX 0 X 354.43 X
93355   001 XXX 0 X 376.64 X
93356   004 ZZZ 0 X 53.61 16.62
93356   003 ZZZ 0 X 53.61 16.62
93356   002 ZZZ 0 X 53.61 16.62
93356   001 ZZZ 0 X 60.49 17.88
93451   004 0 2 X 1,288.08 X
93451 26 004 0 2 X 259.95 X
93451 TC 004 0 2 X 1,028.13 X
93451   002 0 2 X 1,288.08 X
93451 26 002 0 2 X 259.95 X
93451 TC 002 0 2 X 1,028.13 X
93451   003 0 2 X 1,288.08 X
93451 26 003 0 2 X 259.95 X
93451 TC 003 0 2 X 1,028.13 X
93451   001 0 2 X 1,452.40 X
93451 26 001 0 2 X 288.39 X
93451 TC 001 0 2 X 1,164.01 X
93452   004 0 2 X 1,437.92 X
93452 26 004 0 2 X 455.80 X
93452 TC 004 0 2 X 982.13 X
93452   002 0 2 X 1,437.92 X
93452 26 002 0 2 X 455.80 X
93452 TC 002 0 2 X 982.13 X
93452   003 0 2 X 1,437.92 X
93452 26 003 0 2 X 455.80 X
93452 TC 003 0 2 X 982.13 X
93452   001 0 2 X 1,618.39 X
93452 26 001 0 2 X 506.40 X
93452 TC 001 0 2 X 1,111.97 X
93453   001 0 2 X 2,117.22 X
93453 26 001 0 2 X 663.08 X
93453 TC 001 0 2 X 1,454.12 X
93453   002 0 2 X 1,881.63 X
93453 26 002 0 2 X 597.31 X
93453 TC 002 0 2 X 1,284.35 X
93453   003 0 2 X 1,881.63 X
93453 26 003 0 2 X 597.31 X
93453 TC 003 0 2 X 1,284.35 X
93453   004 0 2 X 1,881.63 X
93453 26 004 0 2 X 597.31 X
93453 TC 004 0 2 X 1,284.35 X
93454   003 0 2 X 1,482.33 X
93454 26 003 0 2 X 459.34 X
93454 TC 003 0 2 X 1,023.00 X
93454   004 0 2 X 1,482.33 X
93454 26 004 0 2 X 459.34 X
93454 TC 004 0 2 X 1,023.00 X
93454   001 0 2 X 1,668.32 X
93454 26 001 0 2 X 510.08 X
93454 TC 001 0 2 X 1,158.23 X
93454   002 0 2 X 1,482.33 X
93454 26 002 0 2 X 459.34 X
93454 TC 002 0 2 X 1,023.00 X
93455   001 0 2 X 1,945.99 X
93455 26 001 0 2 X 588.26 X
93455 TC 001 0 2 X 1,357.77 X
93455   003 0 2 X 1,729.18 X
93455 26 003 0 2 X 530.03 X
93455 TC 003 0 2 X 1,199.15 X
93455   002 0 2 X 1,729.18 X
93455 26 002 0 2 X 530.03 X
93455 TC 002 0 2 X 1,199.15 X
93455   004 0 2 X 1,729.18 X
93455 26 004 0 2 X 530.03 X
93455 TC 004 0 2 X 1,199.15 X
93456   001 0 2 X 2,087.39 X
93456 26 001 0 2 X 651.88 X
93456 TC 001 0 2 X 1,435.48 X
93456   004 0 2 X 1,855.52 X
93456 26 004 0 2 X 587.67 X
93456 TC 004 0 2 X 1,267.87 X
93456   003 0 2 X 1,855.52 X
93456 26 003 0 2 X 587.67 X
93456 TC 003 0 2 X 1,267.87 X
93456   002 0 2 X 1,855.52 X
93456 26 002 0 2 X 587.67 X
93456 TC 002 0 2 X 1,267.87 X
93457   004 0 2 X 2,102.40 X
93457 26 004 0 2 X 659.08 X
93457 TC 004 0 2 X 1,443.35 X
93457   003 0 2 X 2,102.40 X
93457 26 003 0 2 X 659.08 X
93457 TC 003 0 2 X 1,443.35 X
93457   002 0 2 X 2,102.40 X
93457 26 002 0 2 X 659.08 X
93457 TC 002 0 2 X 1,443.35 X
93457   001 0 2 X 2,365.40 X
93457 26 001 0 2 X 731.35 X
93457 TC 001 0 2 X 1,634.04 X
93458   001 0 2 X 2,013.45 X
93458 26 001 0 2 X 622.30 X
93458 TC 001 0 2 X 1,391.16 X
93458   002 0 2 X 1,789.12 X
93458 26 002 0 2 X 560.46 X
93458 TC 002 0 2 X 1,228.67 X
93458   003 0 2 X 1,789.12 X
93458 26 003 0 2 X 560.46 X
93458 TC 003 0 2 X 1,228.67 X
93458   004 0 2 X 1,789.12 X
93458 26 004 0 2 X 560.46 X
93458 TC 004 0 2 X 1,228.67 X
93459   001 0 2 X 2,223.01 X
93459 26 001 0 2 X 699.48 X
93459 TC 001 0 2 X 1,523.55 X
93459   004 0 2 X 1,976.20 X
93459 26 004 0 2 X 630.52 X
93459 TC 004 0 2 X 1,345.65 X
93459   003 0 2 X 1,976.20 X
93459 26 003 0 2 X 630.52 X
93459 TC 003 0 2 X 1,345.65 X
93459   002 0 2 X 1,976.20 X
93459 26 002 0 2 X 630.52 X
93459 TC 002 0 2 X 1,345.65 X
93460   001 0 2 X 2,379.89 X
93460 26 001 0 2 X 779.22 X
93460 TC 001 0 2 X 1,600.63 X
93460   004 0 2 X 2,116.25 X
93460 26 004 0 2 X 702.44 X
93460 TC 004 0 2 X 1,413.81 X
93460   003 0 2 X 2,116.25 X
93460 26 003 0 2 X 702.44 X
93460 TC 003 0 2 X 1,413.81 X
93460   002 0 2 X 2,116.25 X
93460 26 002 0 2 X 702.44 X
93460 TC 002 0 2 X 1,413.81 X
93461   002 0 2 X 2,423.54 X
93461 26 002 0 2 X 775.13 X
93461 TC 002 0 2 X 1,648.45 X
93461   003 0 2 X 2,423.54 X
93461 26 003 0 2 X 775.13 X
93461 TC 003 0 2 X 1,648.45 X
93461   004 0 2 X 2,423.54 X
93461 26 004 0 2 X 775.13 X
93461 TC 004 0 2 X 1,648.45 X
93461   001 0 2 X 2,726.64 X
93461 26 001 0 2 X 860.25 X
93461 TC 001 0 2 X 1,866.34 X
93462   001 ZZZ 0 X 395.66 X
93462   002 ZZZ 0 X 356.81 X
93462   003 ZZZ 0 X 356.81 X
93462   004 ZZZ 0 X 356.81 X
93463   004 ZZZ 0 X 188.87 X
93463   003 ZZZ 0 X 188.87 X
93463   002 ZZZ 0 X 188.87 X
93463   001 ZZZ 0 X 208.54 X
93464   004 ZZZ 0 X 428.91 X
93464 26 004 ZZZ 0 X 166.43 X
93464 TC 004 ZZZ 0 X 262.45 X
93464   003 ZZZ 0 X 428.91 X
93464 26 003 ZZZ 0 X 166.43 X
93464 TC 003 ZZZ 0 X 262.45 X
93464   002 ZZZ 0 X 428.91 X
93464 26 002 ZZZ 0 X 166.43 X
93464 TC 002 ZZZ 0 X 262.45 X
93464   001 ZZZ 0 X 480.88 X
93464 26 001 ZZZ 0 X 183.65 X
93464 TC 001 ZZZ 0 X 297.18 X
93503   002 0 0 X 694.02 X
93503   003 0 0 X 623.37 X
93503   004 0 0 X 636.24 X
93503   001 0 0 X 667.91 X
93505   002 0 2 X 1,026.80 X
93505 26 002 0 2 X 874.72 X
93505 TC 002 0 2 X 216.74 X
93505   003 0 2 X 967.09 X
93505 26 003 0 2 X 819.99 X
93505 TC 003 0 2 X 197.89 X
93505   004 0 2 X 955.05 X
93505 26 004 0 2 X 855.72 X
93505 TC 004 0 2 X 194.88 X
93505   001 0 2 X 1,041.15 X
93505 26 001 0 2 X 880.83 X
93505 TC 001 0 2 X 221.31 X
93563   001 ZZZ 0 X 104.68 X
93563   002 ZZZ 0 X 97.32 X
93563   003 ZZZ 0 X 97.32 X
93563   004 ZZZ 0 X 97.32 X
93564   003 ZZZ 0 X 99.13 X
93564   001 ZZZ 0 X 106.82 X
93564   002 ZZZ 0 X 99.13 X
93564   004 ZZZ 0 X 99.13 X
93565   001 ZZZ 0 X 80.62 X
93565   002 ZZZ 0 X 74.93 X
93565   003 ZZZ 0 X 74.93 X
93565   004 ZZZ 0 X 74.93 X
93566   002 ZZZ 0 X 285.62 74.93
93566   003 ZZZ 0 X 285.62 74.93
93566   004 ZZZ 0 X 285.62 74.93
93566   001 ZZZ 0 X 319.02 80.62
93567   004 ZZZ 0 X 236.50 84.29
93567   003 ZZZ 0 X 236.50 84.29
93567   002 ZZZ 0 X 236.50 84.29
93567   001 ZZZ 0 X 262.66 90.45
93568   001 ZZZ 0 X 288.11 82.49
93568   004 ZZZ 0 X 258.44 76.70
93568   003 ZZZ 0 X 258.44 76.70
93568   002 ZZZ 0 X 258.44 76.70
93569   003 ZZZ 0 X 43.26 X
93569   002 ZZZ 0 X 43.26 X
93569   004 ZZZ 0 X 43.26 X
93569   001 ZZZ 0 X 46.10 X
93571   004 ZZZ 0 X 618.92 X
93571 26 004 ZZZ 0 X 216.92 X
93571 TC 004 ZZZ 0 X 402.05 X
93571   003 ZZZ 0 X 618.92 X
93571 26 003 ZZZ 0 X 216.92 X
93571 TC 003 ZZZ 0 X 402.05 X
93571   002 ZZZ 0 X 618.92 X
93571 26 002 ZZZ 0 X 216.92 X
93571 TC 002 ZZZ 0 X 402.05 X
93571   001 ZZZ 0 X 714.27 X
93571 26 001 ZZZ 0 X 235.04 X
93571 TC 001 ZZZ 0 X 479.27 X
93572   004 ZZZ 0 X 569.94 X
93572 26 004 ZZZ 0 X 174.15 X
93572 TC 004 ZZZ 0 X 395.87 X
93572   001 ZZZ 0 X 656.29 X
93572 26 001 ZZZ 0 X 188.83 X
93572 TC 001 ZZZ 0 X 467.52 X
93572   002 ZZZ 0 X 569.94 X
93572 26 002 ZZZ 0 X 174.15 X
93572 TC 002 ZZZ 0 X 395.87 X
93572   003 ZZZ 0 X 569.94 X
93572 26 003 ZZZ 0 X 174.15 X
93572 TC 003 ZZZ 0 X 395.87 X
93573   001 ZZZ 0 X 76.84 X
93573   002 ZZZ 0 X 72.10 X
93573   003 ZZZ 0 X 72.10 X
93573   004 ZZZ 0 X 72.10 X
93574   004 ZZZ 0 X 79.54 X
93574   003 ZZZ 0 X 79.54 X
93574   002 ZZZ 0 X 79.54 X
93574   001 ZZZ 0 X 84.67 X
93575   004 ZZZ 0 X 106.40 X
93575   001 ZZZ 0 X 113.34 X
93575   002 ZZZ 0 X 106.40 X
93575   003 ZZZ 0 X 106.40 X
93580   004 0 2 X 2,081.37 X
93580   002 0 2 X 2,081.37 X
93580   003 0 2 X 2,081.37 X
93580   001 0 2 X 2,288.42 X
93581   003 0 2 X 2,789.90 X
93581   002 0 2 X 2,789.90 X
93581   001 0 2 X 3,048.04 X
93581   004 0 2 X 2,789.90 X
93582   004 0 2 X 1,109.02 X
93582   003 0 2 X 1,109.02 X
93582   002 0 2 X 1,109.02 X
93582   001 0 2 X 1,218.19 X
93583   001 0 2 X 1,355.85 X
93583   002 0 2 X 1,234.47 X
93583   003 0 2 X 1,234.47 X
93583   004 0 2 X 1,234.47 X
93584   001 ZZZ 0 X 66.58 X
93584   002 ZZZ 0 X 62.04 X
93584   003 ZZZ 0 X 62.04 X
93584   004 ZZZ 0 X 62.04 X
93585   001 ZZZ 0 X 62.75 X
93585   002 ZZZ 0 X 58.45 X
93585   003 ZZZ 0 X 58.45 X
93585   004 ZZZ 0 X 58.45 X
93586   003 ZZZ 0 X 73.88 X
93586   002 ZZZ 0 X 73.88 X
93586   001 ZZZ 0 X 79.28 X
93586   004 ZZZ 0 X 73.88 X
93587   004 ZZZ 0 X 109.02 X
93587   003 ZZZ 0 X 109.02 X
93587   002 ZZZ 0 X 109.02 X
93587   001 ZZZ 0 X 117.01 X
93588   001 ZZZ 0 X 118.15 X
93588   004 ZZZ 0 X 110.10 X
93588   003 ZZZ 0 X 110.10 X
93588   002 ZZZ 0 X 110.10 X
93590   004 0 2 X 1,847.80 X
93590   002 0 2 X 1,847.80 X
93590   003 0 2 X 1,847.80 X
93590   001 0 2 X 2,022.23 X
93591   001 0 2 X 1,678.50 X
93591   004 0 2 X 1,533.48 X
93591   003 0 2 X 1,533.48 X
93591   002 0 2 X 1,533.48 X
93592   004 ZZZ 0 X 676.08 X
93592   003 ZZZ 0 X 676.08 X
93592   002 ZZZ 0 X 676.08 X
93592   001 ZZZ 0 X 739.63 X
93593 26 001 0 2 X 240.38 X
93593 26 002 0 2 X 226.63 X
93593 26 003 0 2 X 226.63 X
93593 26 004 0 2 X 226.63 X
93594 26 004 0 2 X 356.68 X
93594 26 003 0 2 X 356.68 X
93594 26 002 0 2 X 356.68 X
93594 26 001 0 2 X 379.91 X
93595 26 001 0 2 X 342.93 X
93595 26 003 0 2 X 321.89 X
93595 26 002 0 2 X 321.89 X
93595 26 004 0 2 X 321.89 X
93596 26 002 0 2 X 389.64 X
93596 26 001 0 2 X 413.49 X
93596 26 004 0 2 X 389.64 X
93596 26 003 0 2 X 389.64 X
93597 26 001 0 2 X 553.35 X
93597 26 002 0 2 X 519.45 X
93597 26 003 0 2 X 519.45 X
93597 26 004 0 2 X 519.45 X
93598 26 002 ZZZ 0 X 85.02 X
93598 26 001 ZZZ 0 X 90.75 X
93598 26 003 ZZZ 0 X 85.02 X
93598 26 004 ZZZ 0 X 85.02 X
93600   001 0 0 X 769.53 X
93600 26 001 0 0 X 700.76 X
93600 TC 001 0 0 X 212.00 X
93600   003 0 0 X 708.03 X
93600 26 003 0 0 X 665.61 X
93600 TC 003 0 0 X 191.15 X
93600   004 0 0 X 698.32 X
93600 26 004 0 0 X 664.94 X
93600 TC 004 0 0 X 188.18 X
93600   002 0 0 X 757.66 X
93600 26 002 0 0 X 680.87 X
93600 TC 002 0 0 X 208.04 X
93602   001 0 0 X 540.28 X
93602 26 001 0 0 X 419.53 X
93602 TC 001 0 0 X 120.73 X
93602   003 0 0 X 501.73 X
93602 26 003 0 0 X 423.49 X
93602 TC 003 0 0 X 108.83 X
93602   004 0 0 X 495.31 X
93602 26 004 0 0 X 421.43 X
93602 TC 004 0 0 X 107.12 X
93602   002 0 0 X 532.84 X
93602 26 002 0 0 X 423.85 X
93602 TC 002 0 0 X 118.39 X
93603   003 0 0 X 599.12 X
93603 26 003 0 0 X 719.13 X
93603 TC 003 0 0 X 164.69 X
93603   004 0 0 X 591.09 X
93603 26 004 0 0 X 693.75 X
93603 TC 004 0 0 X 161.98 X
93603   001 0 0 X 647.73 X
93603 26 001 0 0 X 680.27 X
93603 TC 001 0 0 X 182.58 X
93603   002 0 0 X 749.50 X
93603 26 002 0 0 X 674.35 X
93603 TC 002 0 0 X 179.15 X
93609   004 ZZZ 0 X 1,640.11 X
93609 26 004 ZZZ 0 X 1,866.61 X
93609 TC 004 ZZZ 0 X 261.73 X
93609   001 ZZZ 0 X 1,761.51 X
93609 26 001 ZZZ 0 X 1,903.65 X
93609 TC 001 ZZZ 0 X 294.68 X
93609   002 ZZZ 0 X 1,741.69 X
93609 26 002 ZZZ 0 X 1,452.53 X
93609 TC 002 ZZZ 0 X 289.17 X
93609   003 ZZZ 0 X 1,659.70 X
93609 26 003 ZZZ 0 X 1,873.02 X
93609 TC 003 ZZZ 0 X 265.93 X
93610   004 0 0 X 829.47 X
93610 26 004 0 0 X 774.71 X
93610 TC 004 0 0 X 130.37 X
93610   001 0 0 X 853.74 X
93610 26 001 0 0 X 791.95 X
93610 TC 001 0 0 X 147.10 X
93610   002 0 0 X 849.80 X
93610 26 002 0 0 X 789.15 X
93610 TC 002 0 0 X 144.28 X
93610   003 0 0 X 669.66 X
93610 26 003 0 0 X 770.99 X
93610 TC 003 0 0 X 132.51 X
93612   001 0 0 X 867.35 X
93612 26 001 0 0 X 793.27 X
93612 TC 001 0 0 X 176.54 X
93612   002 0 0 X 857.69 X
93612 26 002 0 0 X 784.99 X
93612 TC 002 0 0 X 173.18 X
93612   003 0 0 X 827.54 X
93612 26 003 0 0 X 760.86 X
93612 TC 003 0 0 X 158.98 X
93612   004 0 0 X 689.92 X
93612 26 004 0 0 X 775.92 X
93612 TC 004 0 0 X 156.56 X
93613 26 001 ZZZ 0 X 896.34 X
93613 26 004 ZZZ 0 X 812.42 X
93613 26 003 ZZZ 0 X 812.42 X
93613 26 002 ZZZ 0 X 812.42 X
93615   004 0 0 X 161.55 X
93615 26 004 0 0 X 131.79 X
93615 TC 004 0 0 X 29.83 X
93615   003 0 0 X 163.52 X
93615 26 003 0 0 X 133.27 X
93615 TC 003 0 0 X 30.30 X
93615   002 0 0 X 137.38 X
93615 26 002 0 0 X 138.47 X
93615 TC 002 0 0 X 32.85 X
93615   001 0 0 X 141.19 X
93615 26 001 0 0 X 139.85 X
93615 TC 001 0 0 X 33.42 X
93616   001 0 0 X 338.40 X
93616 26 001 0 0 X 305.01 X
93616 TC 001 0 0 X 33.42 X
93616   003 0 0 X 316.71 X
93616 26 003 0 0 X 286.43 X
93616 TC 003 0 0 X 30.30 X
93616   002 0 0 X 334.25 X
93616 26 002 0 0 X 301.36 X
93616 TC 002 0 0 X 32.85 X
93616   004 0 0 X 312.64 X
93616 26 004 0 0 X 282.87 X
93616 TC 004 0 0 X 29.83 X
93618   004 0 0 X 2,309.96 X
93618 26 004 0 0 X 2,149.79 X
93618 TC 004 0 0 X 381.89 X
93618   003 0 0 X 1,391.59 X
93618 26 003 0 0 X 2,155.40 X
93618 TC 003 0 0 X 387.92 X
93618   002 0 0 X 2,358.96 X
93618 26 002 0 0 X 2,181.93 X
93618 TC 002 0 0 X 422.04 X
93618   001 0 0 X 2,368.75 X
93618 26 001 0 0 X 2,188.33 X
93618 TC 001 0 0 X 430.15 X
93619   002 0 2 X 2,773.82 X
93619 26 002 0 2 X 2,605.81 X
93619 TC 002 0 2 X 820.63 X
93619   003 0 2 X 2,589.57 X
93619 26 003 0 2 X 2,553.64 X
93619 TC 003 0 2 X 754.21 X
93619   004 0 2 X 2,553.73 X
93619 26 004 0 2 X 2,542.88 X
93619 TC 004 0 2 X 742.39 X
93619   001 0 2 X 2,817.74 X
93619 26 001 0 2 X 2,618.30 X
93619 TC 001 0 2 X 836.42 X