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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule 93620-94005
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
93620-94005
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
93620
003
0
2
X
3,410.89
X
93620
26
003
0
2
X
2,785.12
X
93620
TC
003
0
2
X
874.26
X
93620
002
0
2
X
3,634.92
X
93620
26
002
0
2
X
2,847.22
X
93620
TC
002
0
2
X
950.18
X
93620
001
0
2
X
3,688.44
X
93620
26
001
0
2
X
2,862.15
X
93620
TC
001
0
2
X
968.22
X
93620
004
0
2
X
3,364.74
X
93620
26
004
0
2
X
2,771.57
X
93620
TC
004
0
2
X
860.52
X
93621
26
002
ZZZ
0
X
2,959.30
X
93621
26
003
ZZZ
0
X
2,793.38
X
93621
26
004
ZZZ
0
X
2,757.84
X
93621
26
001
ZZZ
0
X
2,999.10
X
93622
26
004
ZZZ
0
X
2,742.20
X
93622
26
003
ZZZ
0
X
2,777.50
X
93622
26
002
ZZZ
0
X
2,940.62
X
93622
26
001
ZZZ
0
X
2,979.79
X
93623
26
001
ZZZ
0
X
607.03
X
93623
26
002
ZZZ
0
X
599.49
X
93623
26
003
ZZZ
0
X
567.76
X
93623
26
004
ZZZ
0
X
560.65
X
93624
001
0
2
X
1,045.39
X
93624
26
001
0
2
X
893.56
X
93624
TC
001
0
2
X
215.09
X
93624
004
0
2
X
964.86
X
93624
26
004
0
2
X
870.20
X
93624
TC
004
0
2
X
191.00
X
93624
003
0
2
X
977.02
X
93624
26
003
0
2
X
783.06
X
93624
TC
003
0
2
X
194.00
X
93624
002
0
2
X
1,032.16
X
93624
26
002
0
2
X
889.78
X
93624
TC
002
0
2
X
211.03
X
93631
002
0
0
X
2,147.06
X
93631
26
002
0
0
X
1,452.34
X
93631
TC
002
0
0
X
694.72
X
93631
001
0
0
X
2,182.49
X
93631
26
001
0
0
X
2,877.43
X
93631
TC
001
0
0
X
710.37
X
93631
004
0
0
X
1,974.29
X
93631
26
004
0
0
X
2,833.68
X
93631
TC
004
0
0
X
619.89
X
93631
003
0
0
X
1,999.93
X
93631
26
003
0
0
X
1,370.60
X
93631
TC
003
0
0
X
629.42
X
93640
001
0
2
X
1,451.48
X
93640
26
001
0
2
X
913.09
X
93640
TC
001
0
2
X
776.46
X
93640
004
0
2
X
1,750.67
X
93640
26
004
0
2
X
860.53
X
93640
TC
004
0
2
X
690.10
X
93640
003
0
2
X
1,776.09
X
93640
26
003
0
2
X
1,074.99
X
93640
TC
003
0
2
X
701.15
X
93640
002
0
2
X
1,913.05
X
93640
26
002
0
2
X
904.27
X
93640
TC
002
0
2
X
762.03
X
93641
004
0
2
X
1,988.81
X
93641
26
004
0
2
X
939.14
X
93641
001
0
2
X
1,533.97
X
93641
26
001
0
2
X
995.60
X
93641
003
0
2
X
2,016.85
X
93641
26
003
0
2
X
1,315.75
X
93641
002
0
2
X
2,161.29
X
93641
26
002
0
2
X
986.20
X
93641
TC
001
0
2
X
776.46
X
93641
TC
002
0
2
X
762.03
X
93641
TC
003
0
2
X
701.15
X
93641
TC
004
0
2
X
690.10
X
93642
002
0
2
X
2,085.91
X
93642
26
002
0
2
X
961.36
X
93642
TC
002
0
2
X
762.03
X
93642
003
0
2
X
1,943.79
X
93642
26
003
0
2
X
1,242.69
X
93642
TC
003
0
2
X
701.15
X
93642
004
0
2
X
1,916.49
X
93642
26
004
0
2
X
915.26
X
93642
TC
004
0
2
X
690.10
X
93642
001
0
2
X
1,508.96
X
93642
26
001
0
2
X
970.59
X
93642
TC
001
0
2
X
776.46
X
93644
001
0
2
X
531.98
X
93644
26
001
0
2
X
350.92
X
93644
TC
001
0
2
X
181.07
X
93644
002
0
2
X
473.12
X
93644
26
002
0
2
X
318.49
X
93644
TC
002
0
2
X
154.60
X
93644
003
0
2
X
473.12
X
93644
26
003
0
2
X
318.49
X
93644
TC
003
0
2
X
154.60
X
93644
004
0
2
X
473.12
X
93644
26
004
0
2
X
318.49
X
93644
TC
004
0
2
X
154.60
X
93650
004
0
2
X
2,668.39
X
93650
003
0
2
X
2,703.74
X
93650
002
0
2
X
2,880.86
X
93650
001
0
2
X
2,923.40
X
93653
003
0
2
X
1,336.26
X
93653
004
0
2
X
1,336.26
X
93653
002
0
2
X
1,336.26
X
93653
001
0
2
X
1,486.77
X
93654
001
0
2
X
1,984.13
X
93654
002
0
2
X
1,783.18
X
93654
003
0
2
X
1,783.18
X
93654
004
0
2
X
1,783.18
X
93655
004
ZZZ
0
X
668.08
X
93655
003
ZZZ
0
X
668.08
X
93655
002
ZZZ
0
X
668.08
X
93655
001
ZZZ
0
X
743.23
X
93656
004
0
2
X
1,783.80
X
93656
002
0
2
X
1,783.80
X
93656
003
0
2
X
1,783.80
X
93656
001
0
2
X
1,984.66
X
93657
001
ZZZ
0
X
744.12
X
93657
003
ZZZ
0
X
668.70
X
93657
002
ZZZ
0
X
668.70
X
93657
004
ZZZ
0
X
668.70
X
93660
0
2
X
*
X
93662
002
ZZZ
0
X
684.38
X
93662
26
002
ZZZ
0
X
354.33
X
93662
TC
002
ZZZ
0
X
330.05
X
93662
003
ZZZ
0
X
684.38
X
93662
26
003
ZZZ
0
X
354.33
X
93662
TC
003
ZZZ
0
X
330.05
X
93662
004
ZZZ
0
X
684.38
X
93662
26
004
ZZZ
0
X
354.33
X
93662
TC
004
ZZZ
0
X
330.05
X
93662
001
ZZZ
0
X
785.92
X
93662
26
001
ZZZ
0
X
386.14
X
93662
TC
001
ZZZ
0
X
399.78
X
93668
XXX
0
X
*
X
93701
003
XXX
6
X
74.38
X
93701
26
003
XXX
6
X
19.73
X
93701
TC
003
XXX
6
X
54.68
X
93701
002
XXX
6
X
74.38
X
93701
26
002
XXX
6
X
19.73
X
93701
TC
002
XXX
6
X
54.68
X
93701
001
XXX
6
X
86.36
X
93701
26
001
XXX
6
X
21.64
X
93701
TC
001
XXX
6
X
64.71
X
93701
004
XXX
6
X
74.38
X
93701
26
004
XXX
6
X
19.73
X
93701
TC
004
XXX
6
X
54.68
X
93702
001
XXX
6
X
196.80
X
93702
003
XXX
6
X
168.14
X
93702
004
XXX
6
X
168.14
X
93702
002
XXX
6
X
168.14
X
93724
001
0
6
X
1,258.93
X
93724
26
001
0
6
X
828.81
X
93724
TC
001
0
6
X
430.15
X
93724
004
0
6
X
1,154.36
X
93724
26
004
0
6
X
772.47
X
93724
TC
004
0
6
X
381.89
X
93724
003
0
6
X
1,169.52
X
93724
26
003
0
6
X
781.51
X
93724
TC
003
0
6
X
387.92
X
93724
002
0
6
X
1,241.65
X
93724
26
002
0
6
X
819.64
X
93724
TC
002
0
6
X
422.04
X
93740
003
XXX
9
X
62.11
X
93740
26
003
XXX
9
X
46.95
X
93740
TC
003
XXX
9
X
15.16
X
93740
004
XXX
9
X
61.25
X
93740
26
004
XXX
9
X
46.31
X
93740
TC
004
XXX
9
X
14.92
X
93740
001
XXX
9
X
97.53
X
93740
26
001
XXX
9
X
51.18
X
93740
TC
001
XXX
9
X
46.34
X
93740
002
XXX
9
X
66.73
X
93740
26
002
XXX
9
X
50.37
X
93740
TC
002
XXX
9
X
16.36
X
93745
XXX
0
X
*
X
93750
001
XXX
0
X
97.50
84.88
93750
004
XXX
0
X
89.51
78.85
93750
003
XXX
0
X
89.51
78.85
93750
002
XXX
0
X
89.51
78.85
93770
001
XXX
9
X
39.52
X
93770
26
001
XXX
9
X
36.46
X
93770
TC
001
XXX
9
X
3.01
X
93770
004
XXX
9
X
36.08
X
93770
26
004
XXX
9
X
33.34
X
93770
TC
004
XXX
9
X
2.82
X
93770
002
XXX
9
X
58.06
X
93770
26
002
XXX
9
X
91.77
X
93770
TC
002
XXX
9
X
3.00
X
93770
003
XXX
9
X
53.75
X
93770
26
003
XXX
9
X
90.88
X
93770
TC
003
XXX
9
X
2.83
X
93784
XXX
6
X
*
X
93786
XXX
6
X
*
X
93788
XXX
6
X
*
X
93790
XXX
0
X
*
X
93792
004
XXX
0
X
75.41
X
93792
003
XXX
0
X
75.41
X
93792
002
XXX
0
X
75.41
X
93792
001
XXX
0
X
86.73
X
93793
001
XXX
0
X
18.88
X
93793
002
XXX
0
X
17.40
X
93793
003
XXX
0
X
17.40
X
93793
004
XXX
0
X
17.40
X
93797
002
0
0
X
59.23
41.90
93797
004
0
0
X
47.32
33.37
93797
003
0
0
X
51.65
36.44
93797
001
0
0
X
59.98
42.31
93798
004
0
0
X
75.72
53.46
93798
002
0
0
X
83.24
58.67
93798
001
0
0
X
84.39
59.59
93798
003
0
0
X
78.90
55.67
93799
XXX
0
X
#
X
93880
004
XXX
6
X
628.05
X
93880
26
004
XXX
6
X
266.92
X
93880
TC
004
XXX
6
X
350.02
X
93880
003
XXX
6
X
642.73
X
93880
26
003
XXX
6
X
285.29
X
93880
TC
003
XXX
6
X
355.41
X
93880
002
XXX
6
X
657.91
X
93880
26
002
XXX
6
X
282.11
X
93880
TC
002
XXX
6
X
391.44
X
93880
001
XXX
6
X
660.57
X
93880
26
001
XXX
6
X
287.59
X
93880
TC
001
XXX
6
X
400.06
X
93882
003
XXX
6
X
619.88
X
93882
26
003
XXX
6
X
262.44
X
93882
TC
003
XXX
6
X
355.41
X
93882
002
XXX
6
X
633.83
X
93882
26
002
XXX
6
X
257.99
X
93882
TC
002
XXX
6
X
391.44
X
93882
001
XXX
6
X
636.18
X
93882
26
001
XXX
6
X
263.23
X
93882
TC
001
XXX
6
X
400.06
X
93882
004
XXX
6
X
605.46
X
93882
26
004
XXX
6
X
244.37
X
93882
TC
004
XXX
6
X
350.02
X
93886
002
XXX
6
X
564.53
X
93886
26
002
XXX
6
X
173.08
X
93886
TC
002
XXX
6
X
391.44
X
93886
003
XXX
6
X
518.68
X
93886
26
003
XXX
6
X
163.34
X
93886
TC
003
XXX
6
X
355.41
X
93886
004
XXX
6
X
511.44
X
93886
26
004
XXX
6
X
161.42
X
93886
TC
004
XXX
6
X
350.02
X
93886
001
XXX
6
X
575.46
X
93886
26
001
XXX
6
X
175.39
X
93886
TC
001
XXX
6
X
400.06
X
93888
004
XXX
6
X
459.38
X
93888
26
004
XXX
6
X
109.40
X
93888
TC
004
XXX
6
X
350.02
X
93888
003
XXX
6
X
466.01
X
93888
26
003
XXX
6
X
110.62
X
93888
TC
003
XXX
6
X
355.41
X
93888
002
XXX
6
X
507.62
X
93888
26
002
XXX
6
X
116.17
X
93888
TC
002
XXX
6
X
391.44
X
93888
001
XXX
6
X
517.63
X
93888
26
001
XXX
6
X
117.57
X
93888
TC
001
XXX
6
X
400.06
X
93890
001
XXX
6
X
556.72
X
93890
26
001
XXX
6
X
122.22
X
93890
TC
001
XXX
6
X
434.48
X
93890
004
XXX
6
X
463.76
X
93890
26
004
XXX
6
X
112.11
X
93890
TC
004
XXX
6
X
351.62
X
93890
002
XXX
6
X
463.76
X
93890
26
002
XXX
6
X
112.11
X
93890
TC
002
XXX
6
X
351.62
X
93890
003
XXX
6
X
463.76
X
93890
26
003
XXX
6
X
112.11
X
93890
TC
003
XXX
6
X
351.62
X
93892
004
XXX
6
X
494.51
X
93892
26
004
XXX
6
X
128.38
X
93892
TC
004
XXX
6
X
366.12
X
93892
003
XXX
6
X
494.51
X
93892
26
003
XXX
6
X
128.38
X
93892
TC
003
XXX
6
X
366.12
X
93892
002
XXX
6
X
494.51
X
93892
26
002
XXX
6
X
128.38
X
93892
TC
002
XXX
6
X
366.12
X
93892
001
XXX
6
X
591.46
X
93892
26
001
XXX
6
X
139.60
X
93892
TC
001
XXX
6
X
451.88
X
93893
001
XXX
6
X
580.11
X
93893
26
001
XXX
6
X
139.60
X
93893
TC
001
XXX
6
X
440.55
X
93893
003
XXX
6
X
485.06
X
93893
26
003
XXX
6
X
128.38
X
93893
TC
003
XXX
6
X
356.71
X
93893
004
XXX
6
X
485.06
X
93893
26
004
XXX
6
X
128.38
X
93893
TC
004
XXX
6
X
356.71
X
93893
002
XXX
6
X
485.06
X
93893
26
002
XXX
6
X
128.38
X
93893
TC
002
XXX
6
X
356.71
X
93895
XXX
6
X
*
X
93922
001
XXX
6
X
363.86
X
93922
26
001
XXX
6
X
196.07
X
93922
TC
001
XXX
6
X
240.34
X
93922
002
XXX
6
X
381.32
X
93922
26
002
XXX
6
X
176.48
X
93922
TC
002
XXX
6
X
233.91
X
93922
004
XXX
6
X
333.99
X
93922
26
004
XXX
6
X
182.95
X
93922
TC
004
XXX
6
X
116.72
X
93922
003
XXX
6
X
390.19
X
93922
26
003
XXX
6
X
194.17
X
93922
TC
003
XXX
6
X
118.50
X
93923
001
XXX
6
X
421.43
X
93923
26
001
XXX
6
X
214.47
X
93923
TC
001
XXX
6
X
279.53
X
93923
003
XXX
6
X
441.69
X
93923
26
003
XXX
6
X
211.00
X
93923
TC
003
XXX
6
X
223.77
X
93923
002
XXX
6
X
437.78
X
93923
26
002
XXX
6
X
194.58
X
93923
TC
002
XXX
6
X
272.23
X
93923
004
XXX
6
X
384.79
X
93923
26
004
XXX
6
X
199.50
X
93923
TC
004
XXX
6
X
220.40
X
93924
001
XXX
6
X
422.09
X
93924
26
001
XXX
6
X
208.97
X
93924
TC
001
XXX
6
X
276.74
X
93924
002
XXX
6
X
446.08
X
93924
26
002
XXX
6
X
203.41
X
93924
TC
002
XXX
6
X
270.55
X
93924
003
XXX
6
X
447.45
X
93924
26
003
XXX
6
X
211.84
X
93924
TC
003
XXX
6
X
244.62
X
93924
004
XXX
6
X
401.36
X
93924
26
004
XXX
6
X
188.96
X
93924
TC
004
XXX
6
X
240.92
X
93925
001
XXX
6
X
516.12
X
93925
26
001
XXX
6
X
116.11
X
93925
TC
001
XXX
6
X
400.06
X
93925
004
XXX
6
X
456.97
X
93925
26
004
XXX
6
X
106.91
X
93925
TC
004
XXX
6
X
350.02
X
93925
003
XXX
6
X
463.68
X
93925
26
003
XXX
6
X
108.25
X
93925
TC
003
XXX
6
X
355.41
X
93925
002
XXX
6
X
505.99
X
93925
26
002
XXX
6
X
114.57
X
93925
TC
002
XXX
6
X
391.44
X
93926
004
XXX
6
X
403.47
X
93926
26
004
XXX
6
X
53.47
X
93926
TC
004
XXX
6
X
350.02
X
93926
002
XXX
6
X
448.88
X
93926
26
002
XXX
6
X
57.50
X
93926
TC
002
XXX
6
X
391.44
X
93926
003
XXX
6
X
409.50
X
93926
26
003
XXX
6
X
54.15
X
93926
TC
003
XXX
6
X
355.41
X
93926
001
XXX
6
X
458.36
X
93926
26
001
XXX
6
X
58.28
X
93926
TC
001
XXX
6
X
400.06
X
93930
001
XXX
6
X
496.39
X
93930
26
001
XXX
6
X
96.36
X
93930
TC
001
XXX
6
X
400.06
X
93930
004
XXX
6
X
438.82
X
93930
26
004
XXX
6
X
88.92
X
93930
TC
004
XXX
6
X
350.02
X
93930
003
XXX
6
X
445.30
X
93930
26
003
XXX
6
X
89.95
X
93930
TC
003
XXX
6
X
355.41
X
93930
002
XXX
6
X
486.47
X
93930
26
002
XXX
6
X
95.04
X
93930
TC
002
XXX
6
X
391.44
X
93931
002
XXX
6
X
438.44
X
93931
26
002
XXX
6
X
47.05
X
93931
TC
002
XXX
6
X
391.44
X
93931
001
XXX
6
X
447.75
X
93931
26
001
XXX
6
X
47.63
X
93931
TC
001
XXX
6
X
400.06
X
93931
004
XXX
6
X
393.87
X
93931
26
004
XXX
6
X
43.92
X
93931
TC
004
XXX
6
X
350.02
X
93931
003
XXX
6
X
399.80
X
93931
26
003
XXX
6
X
44.46
X
93931
TC
003
XXX
6
X
355.41
X
93970
004
XXX
6
X
476.06
X
93970
26
004
XXX
6
X
126.06
X
93970
TC
004
XXX
6
X
350.02
X
93970
003
XXX
6
X
482.93
X
93970
26
003
XXX
6
X
127.60
X
93970
TC
003
XXX
6
X
355.41
X
93970
002
XXX
6
X
526.91
X
93970
26
002
XXX
6
X
135.44
X
93970
TC
002
XXX
6
X
391.44
X
93970
001
XXX
6
X
537.46
X
93970
26
001
XXX
6
X
137.42
X
93970
TC
001
XXX
6
X
400.06
X
93971
002
XXX
6
X
458.92
X
93971
26
002
XXX
6
X
67.55
X
93971
TC
002
XXX
6
X
391.44
X
93971
003
XXX
6
X
419.16
X
93971
26
003
XXX
6
X
63.85
X
93971
TC
003
XXX
6
X
355.41
X
93971
004
XXX
6
X
413.06
X
93971
26
004
XXX
6
X
63.04
X
93971
TC
004
XXX
6
X
350.02
X
93971
001
XXX
6
X
468.44
X
93971
26
001
XXX
6
X
68.40
X
93971
TC
001
XXX
6
X
400.06
X
93975
002
XXX
6
X
671.50
X
93975
26
002
XXX
6
X
280.09
X
93975
TC
002
XXX
6
X
391.44
X
93975
001
XXX
6
X
683.29
X
93975
26
001
XXX
6
X
283.30
X
93975
TC
001
XXX
6
X
400.06
X
93975
004
XXX
6
X
614.17
X
93975
26
004
XXX
6
X
264.19
X
93975
TC
004
XXX
6
X
350.02
X
93975
003
XXX
6
X
622.52
X
93975
26
003
XXX
6
X
267.16
X
93975
TC
003
XXX
6
X
355.41
X
93976
002
XXX
6
X
531.74
X
93976
26
002
XXX
6
X
140.30
X
93976
TC
002
XXX
6
X
391.44
X
93976
001
XXX
6
X
541.94
X
93976
26
001
XXX
6
X
141.87
X
93976
TC
001
XXX
6
X
400.06
X
93976
004
XXX
6
X
482.63
X
93976
26
004
XXX
6
X
132.61
X
93976
TC
004
XXX
6
X
350.02
X
93976
003
XXX
6
X
489.47
X
93976
26
003
XXX
6
X
134.09
X
93976
TC
003
XXX
6
X
355.41
X
93978
002
XXX
6
X
519.51
X
93978
26
002
XXX
6
X
128.02
X
93978
TC
002
XXX
6
X
391.44
X
93978
001
XXX
6
X
529.83
X
93978
26
001
XXX
6
X
129.80
X
93978
TC
001
XXX
6
X
400.06
X
93978
004
XXX
6
X
469.35
X
93978
26
004
XXX
6
X
119.41
X
93978
TC
004
XXX
6
X
350.02
X
93978
003
XXX
6
X
476.21
X
93978
26
003
XXX
6
X
120.81
X
93978
TC
003
XXX
6
X
355.41
X
93979
001
XXX
6
X
466.47
X
93979
26
001
XXX
6
X
66.40
X
93979
TC
001
XXX
6
X
400.06
X
93979
002
XXX
6
X
456.97
X
93979
26
002
XXX
6
X
65.51
X
93979
TC
002
XXX
6
X
391.44
X
93979
003
XXX
6
X
417.22
X
93979
26
003
XXX
6
X
61.87
X
93979
TC
003
XXX
6
X
355.41
X
93979
004
XXX
6
X
411.14
X
93979
26
004
XXX
6
X
61.10
X
93979
TC
004
XXX
6
X
350.02
X
93980
001
XXX
6
X
681.25
X
93980
26
001
XXX
6
X
281.12
X
93980
TC
001
XXX
6
X
400.06
X
93980
004
XXX
6
X
613.03
X
93980
26
004
XXX
6
X
263.01
X
93980
TC
004
XXX
6
X
350.02
X
93980
003
XXX
6
X
621.31
X
93980
26
003
XXX
6
X
265.98
X
93980
TC
003
XXX
6
X
355.41
X
93980
002
XXX
6
X
669.65
X
93980
26
002
XXX
6
X
278.17
X
93980
TC
002
XXX
6
X
391.44
X
93981
001
XXX
6
X
480.56
X
93981
26
001
XXX
6
X
110.92
X
93981
TC
001
XXX
6
X
369.68
X
93981
004
XXX
6
X
426.28
X
93981
26
004
XXX
6
X
103.33
X
93981
TC
004
XXX
6
X
322.96
X
93981
003
XXX
6
X
432.44
X
93981
26
003
XXX
6
X
104.55
X
93981
TC
003
XXX
6
X
327.91
X
93981
002
XXX
6
X
471.29
X
93981
26
002
XXX
6
X
109.73
X
93981
TC
002
XXX
6
X
361.62
X
93985
003
XXX
6
X
355.08
X
93985
26
003
XXX
6
X
53.86
X
93985
TC
003
XXX
6
X
301.19
X
93985
004
XXX
6
X
355.08
X
93985
26
004
XXX
6
X
53.86
X
93985
TC
004
XXX
6
X
301.19
X
93985
001
XXX
6
X
405.12
X
93985
26
001
XXX
6
X
58.00
X
93985
TC
001
XXX
6
X
347.13
X
93985
002
XXX
6
X
355.08
X
93985
26
002
XXX
6
X
53.86
X
93985
TC
002
XXX
6
X
301.19
X
93986
002
XXX
6
X
180.44
X
93986
26
002
XXX
6
X
34.75
X
93986
TC
002
XXX
6
X
145.68
X
93986
004
XXX
6
X
180.44
X
93986
26
004
XXX
6
X
34.75
X
93986
TC
004
XXX
6
X
145.68
X
93986
003
XXX
6
X
180.44
X
93986
26
003
XXX
6
X
34.75
X
93986
TC
003
XXX
6
X
145.68
X
93986
001
XXX
6
X
205.65
X
93986
26
001
XXX
6
X
37.72
X
93986
TC
001
XXX
6
X
167.95
X
93990
002
XXX
6
X
438.44
X
93990
26
002
XXX
6
X
47.05
X
93990
TC
002
XXX
6
X
391.44
X
93990
003
XXX
6
X
399.80
X
93990
26
003
XXX
6
X
44.46
X
93990
TC
003
XXX
6
X
355.41
X
93990
004
XXX
6
X
393.87
X
93990
26
004
XXX
6
X
43.92
X
93990
TC
004
XXX
6
X
350.02
X
93990
001
XXX
6
X
447.75
X
93990
26
001
XXX
6
X
47.63
X
93990
TC
001
XXX
6
X
400.06
X
93998
XXX
0
X
#
X
94002
001
XXX
0
X
160.20
X
94002
002
XXX
0
X
148.99
X
94002
003
XXX
0
X
148.99
X
94002
004
XXX
0
X
148.99
X
94003
002
XXX
0
X
108.27
X
94003
003
XXX
0
X
108.27
X
94003
004
XXX
0
X
108.27
X
94003
001
XXX
0
X
117.29
X
94004
001
XXX
0
X
85.35
X
94004
002
XXX
0
X
78.94
X
94004
003
XXX
0
X
78.94
X
94004
004
XXX
0
X
78.94
X
94005
XXX
9
X
*
X
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