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2021 Workers' Compensation Part B Fee Schedule

47135-49423

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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
47135   1 90 2 X 21,019.88 X
47135   2 90 2 X 21,019.88 X
47135   3 90 2 X 21,019.88 X
47135   4 90 2 X 21,019.88 X
47140   2 90 2 X 5,522.19 X
47140   3 90 2 X 5,522.19 X
47140   4 90 2 X 5,522.19 X
47140   1 90 2 X 6,068.46 X
47141   2 90 2 X 6,684.19 X
47141   3 90 2 X 6,684.19 X
47141   4 90 2 X 6,684.19 X
47141   1 90 2 X 7,302.75 X
47142   2 90 2 X 7,368.06 X
47142   3 90 2 X 7,368.06 X
47142   4 90 2 X 7,368.06 X
47142   1 90 2 X 8,027.63 X
47143     XXX 2 X * X
47144     90 2 X * X
47145     90 2 X * X
47146   2 XXX 2 X 578.06 X
47146   3 XXX 2 X 578.06 X
47146   4 XXX 2 X 578.06 X
47146   1 XXX 2 X 643.97 X
47147   2 XXX 2 X 674.39 X
47147   3 XXX 2 X 674.39 X
47147   4 XXX 2 X 674.39 X
47147   1 XXX 2 X 751.35 X
47300   4 90 2 X 1,586.28 X
47300   1 90 2 X 1,760.70 X
47300   3 90 2 X 1,960.84 X
47300   2 90 2 X 2,068.82 X
47350   4 90 2 X 1,786.83 X
47350   3 90 2 X 1,807.18 X
47350   2 90 2 X 1,933.00 X
47350   1 90 2 X 1,963.46 X
47360   4 90 2 X 2,508.60 X
47360   3 90 2 X 2,537.49 X
47360   2 90 2 X 2,718.61 X
47360   1 90 2 X 2,762.55 X
47361   4 90 2 X 4,238.70 X
47361   3 90 2 X 4,298.17 X
47361   2 90 2 X 4,552.42 X
47361   1 90 2 X 4,758.95 X
47362   4 90 2 X 1,514.07 X
47362   3 90 2 X 1,535.35 X
47362   2 90 2 X 1,626.15 X
47362   1 90 2 X 1,700.06 X
47370   2 90 2 X 1,757.43 X
47370   3 90 2 X 1,757.43 X
47370   4 90 2 X 1,757.43 X
47370   1 90 2 X 1,920.09 X
47371   2 90 2 X 1,656.17 X
47371   3 90 2 X 1,656.17 X
47371   4 90 2 X 1,656.17 X
47371   1 90 2 X 1,811.47 X
47379     YYY 2 X # X
47380   2 90 2 X 2,065.87 X
47380   3 90 2 X 2,065.87 X
47380   4 90 2 X 2,065.87 X
47380   1 90 2 X 2,250.94 X
47381   2 90 2 X 2,042.02 X
47381   3 90 2 X 2,042.02 X
47381   4 90 2 X 2,042.02 X
47381   1 90 2 X 2,225.43 X
47382   2 10 2 X 1,224.37 X
47382   3 10 2 X 1,224.37 X
47382   4 10 2 X 1,224.37 X
47382   1 10 2 X 1,352.02 X
47383   2 10 2 X 9,697.72 680.15
47383   3 10 2 X 9,697.72 680.15
47383   4 10 2 X 9,697.72 680.15
47383   1 10 2 X 11,289.17 737.94
47399     YYY 2 X # X
47400   2 90 2 X 2,162.37 X
47400   1 90 2 X 2,232.56 X
47400   4 90 2 X 2,549.06 X
47400   3 90 2 X 2,577.28 X
47420   4 90 2 X 2,365.38 X
47420   3 90 2 X 2,392.09 X
47420   2 90 2 X 2,557.88 X
47420   1 90 2 X 2,598.20 X
47425   4 90 2 X 2,550.82 X
47425   3 90 2 X 2,580.38 X
47425   2 90 2 X 2,775.87 X
47425   1 90 2 X 2,823.32 X
47460   4 90 2 X 2,743.69 X
47460   3 90 2 X 2,757.36 X
47460   2 90 2 X 2,816.92 X
47460   1 90 2 X 2,859.29 X
47480   4 90 2 X 1,664.33 X
47480   3 90 2 X 1,699.51 X
47480   2 90 2 X 1,758.84 X
47480   1 90 2 X 1,843.74 X
47490   3 90 2 X 808.88 X
47490   2 90 2 X 814.36 X
47490   4 90 2 X 825.22 X
47490   1 90 2 X 878.05 X
47531   2 0 2 X 466.42 127.19
47531   3 0 2 X 466.42 127.19
47531   4 0 2 X 466.42 127.19
47531   1 0 2 X 534.08 137.14
47532   2 0 2 X 1,027.82 287.65
47532   3 0 2 X 1,027.82 287.65
47532   4 0 2 X 1,027.82 287.65
47532   1 0 2 X 1,175.22 309.20
47533   2 0 2 X 1,673.73 407.57
47533   3 0 2 X 1,673.73 407.57
47533   4 0 2 X 1,673.73 407.57
47533   1 0 2 X 1,920.18 438.67
47534   2 0 2 X 2,065.07 540.89
47534   3 0 2 X 2,065.07 540.89
47534   4 0 2 X 2,065.07 540.89
47534   1 0 2 X 2,365.12 581.71
47535   2 0 2 X 1,382.14 311.01
47535   3 0 2 X 1,382.14 311.01
47535   4 0 2 X 1,382.14 311.01
47535   1 0 2 X 1,588.81 335.49
47536   2 0 2 X 1,017.98 196.18
47536   3 0 2 X 1,017.98 196.18
47536   4 0 2 X 1,017.98 196.18
47536   1 0 2 X 1,172.38 210.79
47537   2 0 2 X 504.96 132.27
47537   3 0 2 X 504.96 132.27
47537   4 0 2 X 504.96 132.27
47537   1 0 2 X 579.29 143.23
47538   2 0 2 X 5,584.64 438.31
47538   3 0 2 X 5,584.64 438.31
47538   4 0 2 X 5,584.64 438.31
47538   1 0 2 X 6,491.40 469.79
47539   2 0 2 X 6,109.19 592.78
47539   3 0 2 X 6,109.19 592.78
47539   4 0 2 X 6,109.19 592.78
47539   1 0 2 X 7,089.52 634.90
47540   2 0 2 X 6,356.50 707.59
47540   3 0 2 X 6,356.50 707.59
47540   4 0 2 X 6,356.50 707.59
47540   1 0 2 X 7,367.45 757.81
47541   2 0 2 X 1,478.78 376.81
47541   3 0 2 X 1,478.78 376.81
47541   4 0 2 X 1,478.78 376.81
47541   1 0 2 X 1,694.15 404.75
47542   2 ZZZ 0 X 648.42 178.43
47542   3 ZZZ 0 X 648.42 178.43
47542   4 ZZZ 0 X 648.42 178.43
47542   1 ZZZ 0 X 744.27 194.37
47543   2 ZZZ 0 X 1,649.71 224.14
47543   3 ZZZ 0 X 1,649.71 224.14
47543   4 ZZZ 0 X 1,649.71 224.14
47543   1 ZZZ 0 X 1,912.63 244.60
47544   2 ZZZ 0 X 1,023.89 287.22
47544   3 ZZZ 0 X 1,023.89 287.22
47544   4 ZZZ 0 X 1,023.89 287.22
47544   1 ZZZ 0 X 1,170.92 308.96
47550   4 0 0 X 435.81 X
47550   3 0 0 X 440.51 X
47550   2 0 0 X 469.75 X
47550   1 0 0 X 476.84 X
47552   3 0 2 X 684.90 X
47552   4 0 2 X 703.98 X
47552   2 0 2 X 713.94 X
47552   1 0 2 X 721.06 X
47553   4 0 3 X 890.18 X
47553   3 0 3 X 900.33 X
47553   1 0 3 X 949.44 X
47553   2 0 3 X 956.14 X
47554   4 0 3 X 1,209.80 X
47554   3 0 3 X 1,223.09 X
47554   2 0 3 X 1,291.53 X
47554   1 0 3 X 1,308.08 X
47555   4 0 3 X 870.42 X
47555   3 0 3 X 879.88 X
47555   2 0 3 X 920.64 X
47555   1 0 3 X 926.17 X
47556   4 0 3 X 955.14 X
47556   3 0 3 X 974.16 X
47556   2 0 3 X 1,001.06 X
47556   1 0 3 X 1,007.65 X
47562   2 90 2 X 1,380.02 X
47562   3 90 2 X 1,380.02 X
47562   4 90 2 X 1,380.02 X
47562   1 90 2 X 1,539.98 X
47563   2 90 2 X 1,484.55 X
47563   3 90 2 X 1,484.55 X
47563   4 90 2 X 1,484.55 X
47563   1 90 2 X 1,656.52 X
47564   2 90 2 X 1,763.15 X
47564   3 90 2 X 1,763.15 X
47564   4 90 2 X 1,763.15 X
47564   1 90 2 X 1,966.16 X
47570   2 90 2 X 1,584.21 X
47570   3 90 2 X 1,584.21 X
47570   4 90 2 X 1,584.21 X
47570   1 90 2 X 1,770.06 X
47579     YYY 2 X # X
47600   4 90 2 X 1,775.29 X
47600   3 90 2 X 1,800.48 X
47600   2 90 2 X 1,931.89 X
47600   1 90 2 X 1,960.09 X
47605   4 90 2 X 1,884.71 X
47605   3 90 2 X 1,921.21 X
47605   2 90 2 X 2,067.38 X
47605   1 90 2 X 2,096.34 X
47610   4 90 2 X 2,204.76 X
47610   3 90 2 X 2,255.14 X
47610   2 90 2 X 2,404.87 X
47610   1 90 2 X 2,438.72 X
47612   4 90 2 X 3,216.80 X
47612   3 90 2 X 3,262.52 X
47612   1 90 2 X 3,384.98 X
47612   2 90 2 X 3,391.40 X
47620   4 90 2 X 2,649.59 X
47620   3 90 2 X 2,670.95 X
47620   2 90 2 X 2,813.03 X
47620   1 90 2 X 2,859.58 X
47700   3 90 2 X 2,461.54 X
47700   1 90 2 X 2,488.88 X
47700   4 90 2 X 2,509.37 X
47700   2 90 2 X 2,525.26 X
47701   4 90 2 X 3,259.27 X
47701   3 90 2 X 3,293.29 X
47701   2 90 2 X 3,473.70 X
47701   1 90 2 X 3,517.79 X
47711   4 90 2 X 2,908.89 X
47711   3 90 2 X 2,941.89 X
47711   2 90 2 X 3,147.71 X
47711   1 90 2 X 3,197.70 X
47712   4 90 2 X 2,908.89 X
47712   3 90 2 X 2,941.89 X
47712   2 90 2 X 3,147.71 X
47712   1 90 2 X 3,197.70 X
47715   4 90 2 X 2,159.24 X
47715   3 90 2 X 2,183.40 X
47715   2 90 2 X 2,329.32 X
47715   1 90 2 X 2,364.74 X
47720   4 90 2 X 2,025.90 X
47720   3 90 2 X 2,131.11 X
47720   2 90 2 X 2,432.72 X
47720   1 90 2 X 2,448.48 X
47721   4 90 2 X 2,494.38 X
47721   3 90 2 X 2,523.16 X
47721   2 90 2 X 2,717.24 X
47721   1 90 2 X 2,764.33 X
47740   4 90 2 X 2,720.08 X
47740   3 90 2 X 2,731.23 X
47740   2 90 2 X 2,803.75 X
47740   1 90 2 X 2,821.32 X
47741   4 90 2 X 3,636.86 X
47741   3 90 2 X 3,663.23 X
47741   2 90 2 X 3,843.27 X
47741   1 90 2 X 3,913.89 X
47760   4 90 2 X 3,011.13 X
47760   3 90 2 X 3,044.74 X
47760   2 90 2 X 3,254.43 X
47760   1 90 2 X 3,305.35 X
47765   4 90 2 X 3,226.99 X
47765   3 90 2 X 3,521.14 X
47765   1 90 2 X 3,675.36 X
47765   2 90 2 X 3,721.05 X
47780   4 90 2 X 3,196.83 X
47780   3 90 2 X 3,233.05 X
47780   2 90 2 X 3,459.52 X
47780   1 90 2 X 3,514.60 X
47785   4 90 2 X 3,196.83 X
47785   3 90 2 X 3,233.05 X
47785   2 90 2 X 3,459.52 X
47785   1 90 2 X 3,514.60 X
47800   4 90 2 X 2,941.18 X
47800   3 90 2 X 3,025.14 X
47800   2 90 2 X 3,184.31 X
47800   1 90 2 X 3,234.99 X
47801   4 90 2 X 1,554.89 X
47801   3 90 2 X 1,572.31 X
47801   2 90 2 X 1,659.36 X
47801   1 90 2 X 1,680.48 X
47802   4 90 2 X 2,473.76 X
47802   3 90 2 X 2,502.11 X
47802   2 90 2 X 2,695.57 X
47802   1 90 2 X 2,702.74 X
47900   4 90 2 X 2,941.18 X
47900   3 90 2 X 3,025.14 X
47900   2 90 2 X 3,184.31 X
47900   1 90 2 X 3,234.99 X
47999     YYY 2 X # X
48000   4 90 2 X 1,906.48 X
48000   3 90 2 X 1,927.70 X
48000   2 90 2 X 2,051.72 X
48000   1 90 2 X 2,081.86 X
48001   4 90 2 X 2,261.03 X
48001   3 90 2 X 2,285.86 X
48001   2 90 2 X 2,441.06 X
48001   1 90 2 X 2,478.79 X
48020   4 90 2 X 1,887.38 X
48020   3 90 2 X 1,908.12 X
48020   2 90 2 X 2,037.48 X
48020   1 90 2 X 2,068.99 X
48100   3 90 2 X 1,327.22 X
48100   4 90 2 X 1,360.44 X
48100   2 90 2 X 1,406.64 X
48100   1 90 2 X 1,439.07 X
48102   4 10 2 X 586.28 X
48102   3 10 2 X 615.97 X
48102   2 10 2 X 623.53 X
48102   1 10 2 X 630.93 X
48105   2 90 2 X 3,718.10 X
48105   3 90 2 X 3,718.10 X
48105   4 90 2 X 3,718.10 X
48105   1 90 2 X 4,163.54 X
48120   3 90 2 X 2,191.53 X
48120   4 90 2 X 2,572.93 X
48120   2 90 2 X 2,634.24 X
48120   1 90 2 X 2,715.80 X
48140   3 90 2 X 3,193.08 X
48140   4 90 2 X 3,243.89 X
48140   2 90 2 X 3,339.60 X
48140   1 90 2 X 3,432.95 X
48145   4 90 2 X 3,343.27 X
48145   3 90 2 X 3,414.91 X
48145   2 90 2 X 3,637.61 X
48145   1 90 2 X 3,699.53 X
48146   4 90 2 X 3,533.95 X
48146   1 90 2 X 3,565.70 X
48146   3 90 2 X 3,576.24 X
48146   2 90 2 X 3,789.37 X
48148   4 90 2 X 2,149.44 X
48148   3 90 2 X 2,173.46 X
48148   2 90 2 X 2,317.99 X
48148   1 90 2 X 2,353.11 X
48150   3 90 2 X 5,571.77 X
48150   4 90 2 X 5,650.70 X
48150   2 90 2 X 5,824.50 X
48150   1 90 2 X 5,994.55 X
48152   3 90 2 X 5,476.60 X
48152   4 90 2 X 5,556.43 X
48152   2 90 2 X 5,727.03 X
48152   1 90 2 X 5,896.44 X
48153   3 90 2 X 5,571.77 X
48153   4 90 2 X 5,650.70 X
48153   2 90 2 X 5,824.50 X
48153   1 90 2 X 5,994.55 X
48154   3 90 2 X 5,476.60 X
48154   4 90 2 X 5,556.43 X
48154   2 90 2 X 5,727.03 X
48154   1 90 2 X 5,896.44 X
48155   4 90 2 X 3,875.69 X
48155   3 90 2 X 4,769.89 X
48155   1 90 2 X 4,905.78 X
48155   2 90 2 X 4,972.13 X
48400   4 ZZZ 0 X 284.33 X
48400   3 ZZZ 0 X 287.44 X
48400   2 ZZZ 0 X 307.03 X
48400   1 ZZZ 0 X 311.74 X
48500   4 90 2 X 1,959.98 X
48500   3 90 2 X 1,982.53 X
48500   1 90 2 X 2,156.50 X
48500   2 90 2 X 2,247.35 X
48510   2 90 2 X 1,651.01 X
48510   3 90 2 X 1,651.01 X
48510   4 90 2 X 1,651.01 X
48510   1 90 2 X 1,857.01 X
48520   4 90 2 X 2,351.09 X
48520   3 90 2 X 2,516.48 X
48520   2 90 2 X 2,625.77 X
48520   1 90 2 X 2,707.06 X
48540   4 90 2 X 2,738.76 X
48540   3 90 2 X 2,850.64 X
48540   2 90 2 X 2,981.32 X
48540   1 90 2 X 3,078.67 X
48545   4 90 2 X 2,132.40 X
48545   3 90 2 X 2,155.82 X
48545   2 90 2 X 2,302.50 X
48545   1 90 2 X 2,338.20 X
48547   4 90 2 X 3,082.68 X
48547   3 90 2 X 3,116.56 X
48547   2 90 2 X 3,328.28 X
48547   1 90 2 X 3,379.87 X
48548   2 90 2 X 2,163.86 X
48548   3 90 2 X 2,163.86 X
48548   4 90 2 X 2,163.86 X
48548   1 90 2 X 2,430.28 X
48551     XXX 2 X * X
48552   2 XXX 2 X 398.19 X
48552   3 XXX 2 X 398.19 X
48552   4 XXX 2 X 398.19 X
48552   1 XXX 2 X 434.13 X
48556     90 2 X * X
48999     YYY 2 X # X
49000   4 90 2 X 1,515.27 X
49000   3 90 2 X 1,532.72 X
49000   2 90 2 X 1,646.31 X
49000   1 90 2 X 1,673.90 X
49002   4 90 2 X 1,470.28 X
49002   3 90 2 X 1,487.00 X
49002   2 90 2 X 1,589.39 X
49002   1 90 2 X 1,614.27 X
49010   4 90 2 X 1,716.90 X
49010   3 90 2 X 1,736.39 X
49010   2 90 2 X 1,851.51 X
49010   1 90 2 X 1,879.46 X
49013   2 0 2 X 529.36 X
49013   3 0 2 X 529.36 X
49013   4 0 2 X 529.36 X
49013   1 0 2 X 577.52 X
49014   2 0 2 X 437.30 X
49014   3 0 2 X 437.30 X
49014   4 0 2 X 437.30 X
49014   1 0 2 X 477.77 X
49020   3 90 2 X 1,716.03 X
49020   4 90 2 X 1,716.03 X
49020   2 90 2 X 1,763.61 X
49020   1 90 2 X 1,887.18 X
49040   2 90 2 X 1,334.50 X
49040   3 90 2 X 1,334.50 X
49040   4 90 2 X 1,334.50 X
49040   1 90 2 X 1,510.69 X
49060   2 90 2 X 1,372.55 X
49060   3 90 2 X 1,372.55 X
49060   4 90 2 X 1,372.55 X
49060   1 90 2 X 1,527.26 X
49062   2 90 2 X 1,533.38 X
49062   3 90 2 X 1,533.38 X
49062   4 90 2 X 1,533.38 X
49062   1 90 2 X 1,711.04 X
49082   2 0 2 X 221.89 98.04
49082   3 0 2 X 221.89 98.04
49082   4 0 2 X 221.89 98.04
49082   1 0 2 X 250.25 106.59
49083   2 0 2 X 416.72 151.63
49083   3 0 2 X 416.72 151.63
49083   4 0 2 X 416.72 151.63
49083   1 0 2 X 471.91 164.42
49084   2 0 2 X 139.55 X
49084   3 0 2 X 139.55 X
49084   4 0 2 X 139.55 X
49084   1 0 2 X 150.41 X
49180   1 0 2 X 484.52 X
49180   2 0 2 X 587.78 X
49180   3 0 2 X 621.61 X
49180   4 0 2 X 635.11 X
49185   2 0 0 X 1,236.39 163.53
49185   3 0 0 X 1,236.39 163.53
49185   4 0 0 X 1,236.39 163.53
49185   1 0 0 X 1,431.52 176.17
49203   2 90 2 X 1,612.04 X
49203   3 90 2 X 1,612.04 X
49203   4 90 2 X 1,612.04 X
49203   1 90 2 X 1,791.64 X
49204   2 90 2 X 2,057.57 X
49204   3 90 2 X 2,057.57 X
49204   4 90 2 X 2,057.57 X
49204   1 90 2 X 2,282.86 X
49205   2 90 2 X 2,355.25 X
49205   3 90 2 X 2,355.25 X
49205   4 90 2 X 2,355.25 X
49205   1 90 2 X 2,611.61 X
49215   3 90 2 X 2,337.55 X
49215   2 90 2 X 2,428.32 X
49215   4 90 2 X 2,759.75 X
49215   1 90 2 X 2,984.74 X
49250   4 90 2 X 1,385.59 X
49250   3 90 2 X 1,390.98 X
49250   2 90 2 X 1,424.44 X
49250   1 90 2 X 1,432.60 X
49255   3 90 2 X 1,135.67 X
49255   4 90 2 X 1,221.35 X
49255   2 90 2 X 1,319.66 X
49255   1 90 2 X 1,433.93 X
49320   2 10 2 X 684.73 X
49320   3 10 2 X 684.73 X
49320   4 10 2 X 684.73 X
49320   1 10 2 X 765.68 X
49321   2 10 3 X 729.80 X
49321   3 10 3 X 729.80 X
49321   4 10 3 X 729.80 X
49321   1 10 3 X 816.08 X
49322   2 10 3 X 758.91 X
49322   3 10 3 X 758.91 X
49322   4 10 3 X 758.91 X
49322   1 10 3 X 847.06 X
49323   2 90 3 X 1,174.78 X
49323   3 90 3 X 1,174.78 X
49323   4 90 3 X 1,174.78 X
49323   1 90 3 X 1,309.57 X
49324   2 10 3 X 513.67 X
49324   3 10 3 X 513.67 X
49324   4 10 3 X 513.67 X
49324   1 10 3 X 579.64 X
49325   2 10 3 X 553.03 X
49325   3 10 3 X 553.03 X
49325   4 10 3 X 553.03 X
49325   1 10 3 X 625.56 X
49326   2 ZZZ 0 X 254.07 X
49326   3 ZZZ 0 X 254.07 X
49326   4 ZZZ 0 X 254.07 X
49326   1 ZZZ 0 X 284.30 X
49327   2 ZZZ 0 X 197.06 X
49327   3 ZZZ 0 X 197.06 X
49327   4 ZZZ 0 X 197.06 X
49327   1 ZZZ 0 X 218.00 X
49329     YYY 2 X # X
49400   4 0 2 X 279.45 X
49400   3 0 2 X 282.69 X
49400   2 0 2 X 299.58 X
49400   1 0 2 X 303.71 X
49402   2 90 2 X 1,107.26 X
49402   3 90 2 X 1,107.26 X
49402   4 90 2 X 1,107.26 X
49402   1 90 2 X 1,245.37 X
49405   2 0 2 X 1,137.69 297.02
49405   3 0 2 X 1,137.69 297.02
49405   4 0 2 X 1,137.69 297.02
49405   1 0 2 X 1,298.66 319.28
49406   2 0 2 X 1,137.22 297.48
49406   3 0 2 X 1,137.22 297.48
49406   4 0 2 X 1,137.22 297.48
49406   1 0 2 X 1,298.13 319.78
49407   2 0 2 X 965.21 316.72
49407   3 0 2 X 965.21 316.72
49407   4 0 2 X 965.21 316.72
49407   1 0 2 X 1,096.22 340.73
49411   2 0 2 X 721.45 293.20
49411   3 0 2 X 721.45 293.20
49411   4 0 2 X 721.45 293.20
49411   1 0 2 X 826.52 318.62
49412   2 ZZZ 0 X 123.11 X
49412   3 ZZZ 0 X 123.11 X
49412   4 ZZZ 0 X 123.11 X
49412   1 ZZZ 0 X 136.13 X
49418   2 0 2 X 2,180.22 348.35
49418   3 0 2 X 2,180.22 348.35
49418   4 0 2 X 2,180.22 348.35
49418   1 0 2 X 2,454.04 381.28
49419   2 0 2 X 734.18 X
49419   3 0 2 X 734.18 X
49419   4 0 2 X 734.18 X
49419   1 0 2 X 817.71 X
49421   4 90 2 X 866.45 X
49421   3 90 2 X 876.56 X
49421   2 90 2 X 951.41 X
49421   1 90 2 X 958.64 X
49422   4 10 2 X 866.45 X
49422   3 10 2 X 876.56 X
49422   2 10 2 X 951.41 X
49422   1 10 2 X 958.64 X
49423   2 0 2 X 203.55 X
49423   3 0 2 X 203.55 X
49423   4 0 2 X 203.55 X
49423   1 0 2 X 228.63 X