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Individuals
Individuals
Unemployment Benefits
Disability Services
Find A Job
Workers' Compensation Services
Workforce Development
PennSERVE
Individual Services
Uniform Construction Code
Labor Management Relations
Misclassified Workers
Businesses
Businesses
Employer UC Info
Finding Skilled Workers
Disability Services
Workforce Development
Workers' Compensation Services
Labor-Management Relations
Pennsylvania Business One-Stop
State Workers' Insurance Fund
Employer Services
About L&I
About L&I
Equal Opportunity
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Councils and Committees
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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 69644-70450
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
69644-70450
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
69644
4
90
2
X
3,669.71
X
69644
3
90
2
X
3,716.86
X
69644
2
90
2
X
3,843.20
X
69644
1
90
2
X
4,047.59
X
69645
3
90
2
X
3,472.25
X
69645
4
90
2
X
3,493.37
X
69645
2
90
2
X
3,789.47
X
69645
1
90
2
X
3,849.97
X
69646
4
90
2
X
3,653.23
X
69646
3
90
2
X
3,768.24
X
69646
2
90
2
X
3,951.94
X
69646
1
90
2
X
4,012.65
X
69650
4
90
2
X
1,991.91
X
69650
3
90
2
X
2,017.38
X
69650
2
90
2
X
2,114.27
X
69650
1
90
2
X
2,185.18
X
69660
3
90
2
X
2,573.53
X
69660
4
90
2
X
2,886.18
X
69660
1
90
2
X
2,961.95
X
69660
2
90
2
X
3,120.11
X
69661
4
90
2
X
3,127.14
X
69661
3
90
2
X
3,167.08
X
69661
2
90
2
X
3,376.49
X
69661
1
90
2
X
3,426.95
X
69662
4
90
2
X
3,066.84
X
69662
3
90
2
X
3,105.81
X
69662
2
90
2
X
3,312.93
X
69662
1
90
2
X
3,362.81
X
69666
4
90
2
X
2,621.76
X
69666
3
90
2
X
2,634.15
X
69666
2
90
2
X
2,705.77
X
69666
1
90
2
X
2,722.96
X
69667
4
90
2
X
2,202.50
X
69667
3
90
2
X
2,231.10
X
69667
1
90
2
X
2,433.36
X
69667
2
90
2
X
2,690.22
X
69670
4
90
2
X
1,959.50
X
69670
3
90
2
X
2,165.42
X
69670
2
90
2
X
2,173.66
X
69670
1
90
2
X
2,263.44
X
69676
4
90
2
X
1,635.23
X
69676
3
90
2
X
1,655.41
X
69676
2
90
2
X
1,755.72
X
69676
1
90
2
X
1,779.85
X
69700
4
90
2
X
1,464.00
X
69700
3
90
2
X
1,482.23
X
69700
2
90
2
X
1,575.50
X
69700
1
90
2
X
1,597.96
X
69705
2
0
3
X
3,308.89
193.69
69705
3
0
3
X
3,308.89
193.69
69705
4
0
3
X
3,308.89
193.69
69705
1
0
3
X
3,803.75
210.82
69706
2
0
3
X
3,411.22
269.73
69706
3
0
3
X
3,411.22
269.73
69706
4
0
3
X
3,411.22
269.73
69706
1
0
3
X
3,916.30
293.05
69711
90
2
X
*
X
69714
2
90
2
X
1,718.76
X
69714
3
90
2
X
1,718.76
X
69714
4
90
2
X
1,718.76
X
69714
1
90
2
X
1,905.34
X
69715
2
90
2
X
2,178.74
X
69715
3
90
2
X
2,178.74
X
69715
4
90
2
X
2,178.74
X
69715
1
90
2
X
2,410.75
X
69717
2
90
2
X
1,772.13
X
69717
3
90
2
X
1,772.13
X
69717
4
90
2
X
1,772.13
X
69717
1
90
2
X
1,960.30
X
69718
2
90
2
X
2,204.93
X
69718
3
90
2
X
2,204.93
X
69718
4
90
2
X
2,204.93
X
69718
1
90
2
X
2,439.61
X
69720
4
90
2
X
3,028.63
X
69720
3
90
2
X
3,645.40
X
69720
2
90
2
X
3,793.89
X
69720
1
90
2
X
3,896.41
X
69725
4
90
2
X
3,093.14
X
69725
3
90
2
X
3,130.42
X
69725
2
90
2
X
3,311.09
X
69725
1
90
2
X
3,354.66
X
69740
4
90
2
X
2,546.05
X
69740
2
90
2
X
2,741.86
X
69740
1
90
2
X
2,781.94
X
69740
3
90
2
X
3,274.05
X
69745
4
90
2
X
2,948.26
X
69745
3
90
2
X
2,985.05
X
69745
2
90
2
X
3,166.89
X
69745
1
90
2
X
3,210.73
X
69799
YYY
2
X
#
X
69801
4
90
2
X
2,140.84
X
69801
2
90
2
X
2,338.56
X
69801
3
90
2
X
2,358.04
X
69801
1
90
2
X
2,379.44
X
69805
4
90
2
X
2,526.77
X
69805
3
90
2
X
2,559.84
X
69805
2
90
2
X
2,751.86
X
69805
1
90
2
X
2,798.05
X
69806
4
90
2
X
3,023.35
X
69806
3
90
2
X
3,063.01
X
69806
2
90
2
X
3,557.92
X
69806
1
90
2
X
3,711.11
X
69905
4
90
2
X
2,556.07
X
69905
3
90
2
X
2,589.16
X
69905
2
90
2
X
2,784.09
X
69905
1
90
2
X
2,831.02
X
69910
4
90
2
X
3,136.87
X
69910
3
90
2
X
3,177.83
X
69910
2
90
2
X
3,410.08
X
69910
1
90
2
X
3,465.95
X
69915
4
90
2
X
3,482.73
X
69915
3
90
2
X
3,525.23
X
69915
2
90
2
X
3,744.87
X
69915
1
90
2
X
3,872.78
X
69930
4
90
2
X
3,927.36
X
69930
3
90
2
X
3,979.73
X
69930
2
90
2
X
4,293.04
X
69930
1
90
2
X
4,778.02
X
69949
YYY
2
X
#
X
69950
4
90
2
X
3,646.92
X
69950
3
90
2
X
3,690.94
X
69950
2
90
2
X
3,927.11
X
69950
1
90
2
X
4,286.87
X
69955
4
90
2
X
3,923.81
X
69955
3
90
2
X
3,972.05
X
69955
2
90
2
X
4,219.30
X
69955
1
90
2
X
4,278.92
X
69960
4
90
2
X
3,474.08
X
69960
3
90
2
X
3,516.67
X
69960
1
90
2
X
3,785.09
X
69960
2
90
2
X
4,835.19
X
69970
4
90
2
X
3,890.87
X
69970
3
90
2
X
3,938.31
X
69970
2
90
2
X
4,183.75
X
69970
1
90
2
X
4,242.96
X
69979
YYY
2
X
#
X
69990
2
ZZZ
0
X
422.08
X
69990
3
ZZZ
0
X
422.08
X
69990
4
ZZZ
0
X
422.08
X
69990
1
ZZZ
0
X
484.50
X
70010
26
4
XXX
0
X
163.48
X
70010
26
3
XXX
0
X
167.74
X
70010
26
2
XXX
0
X
175.28
X
70010
26
1
XXX
0
X
175.88
X
70010
TC
4
XXX
0
X
352.70
X
70010
TC
3
XXX
0
X
358.37
X
70010
TC
2
XXX
0
X
388.38
X
70010
TC
1
XXX
0
X
395.49
X
70010
4
XXX
0
X
501.09
X
70010
3
XXX
0
X
508.38
X
70010
2
XXX
0
X
546.51
X
70010
1
XXX
0
X
555.55
X
70015
TC
4
XXX
0
X
110.43
X
70015
TC
3
XXX
0
X
112.18
X
70015
TC
2
XXX
0
X
121.85
X
70015
TC
1
XXX
0
X
124.19
X
70015
26
4
XXX
0
X
163.48
X
70015
26
3
XXX
0
X
167.74
X
70015
26
2
XXX
0
X
175.28
X
70015
26
1
XXX
0
X
175.88
X
70015
4
XXX
0
X
258.80
X
70015
3
XXX
0
X
262.19
X
70015
2
XXX
0
X
280.02
X
70015
1
XXX
0
X
284.25
X
70030
26
4
XXX
0
X
23.69
X
70030
26
3
XXX
0
X
24.31
X
70030
26
2
XXX
0
X
25.37
X
70030
26
1
XXX
0
X
25.39
X
70030
TC
4
XXX
0
X
34.17
X
70030
TC
3
XXX
0
X
34.70
X
70030
TC
2
XXX
0
X
37.81
X
70030
TC
1
XXX
0
X
38.53
X
70030
4
XXX
0
X
56.68
X
70030
3
XXX
0
X
58.22
X
70030
2
XXX
0
X
61.39
X
70030
1
XXX
0
X
61.43
X
70100
26
4
XXX
0
X
25.09
X
70100
26
3
XXX
0
X
25.83
X
70100
26
2
XXX
0
X
26.92
X
70100
26
1
XXX
0
X
27.01
X
70100
TC
4
XXX
0
X
42.87
X
70100
TC
3
XXX
0
X
44.29
X
70100
TC
1
XXX
0
X
48.04
X
70100
TC
2
XXX
0
X
52.25
X
70100
4
XXX
0
X
66.59
X
70100
3
XXX
0
X
68.41
X
70100
1
XXX
0
X
74.48
X
70100
2
XXX
0
X
81.83
X
70110
26
4
XXX
0
X
34.51
X
70110
26
3
XXX
0
X
35.33
X
70110
26
2
XXX
0
X
36.97
X
70110
26
1
XXX
0
X
37.06
X
70110
TC
4
XXX
0
X
50.85
X
70110
TC
3
XXX
0
X
51.62
X
70110
TC
2
XXX
0
X
56.09
X
70110
TC
1
XXX
0
X
57.13
X
70110
4
XXX
0
X
83.81
X
70110
3
XXX
0
X
86.05
X
70110
1
XXX
0
X
91.76
X
70110
2
XXX
0
X
93.65
X
70120
26
4
XXX
0
X
25.09
X
70120
26
3
XXX
0
X
25.78
X
70120
26
2
XXX
0
X
26.92
X
70120
26
1
XXX
0
X
27.01
X
70120
TC
4
XXX
0
X
50.85
X
70120
TC
3
XXX
0
X
51.62
X
70120
TC
2
XXX
0
X
56.09
X
70120
TC
1
XXX
0
X
57.13
X
70120
4
XXX
0
X
73.78
X
70120
3
XXX
0
X
76.51
X
70120
2
XXX
0
X
80.44
X
70120
1
XXX
0
X
81.78
X
70130
26
4
XXX
0
X
46.16
X
70130
26
3
XXX
0
X
47.24
X
70130
26
2
XXX
0
X
49.34
X
70130
26
1
XXX
0
X
49.50
X
70130
TC
4
XXX
0
X
64.34
X
70130
TC
3
XXX
0
X
65.38
X
70130
TC
2
XXX
0
X
70.94
X
70130
TC
1
XXX
0
X
72.27
X
70130
4
XXX
0
X
108.16
X
70130
3
XXX
0
X
111.09
X
70130
2
XXX
0
X
117.02
X
70130
1
XXX
0
X
118.11
X
70134
26
4
XXX
0
X
46.04
X
70134
26
3
XXX
0
X
47.34
X
70134
26
2
XXX
0
X
49.34
X
70134
26
1
XXX
0
X
49.50
X
70134
TC
4
XXX
0
X
60.40
X
70134
TC
3
XXX
0
X
61.38
X
70134
TC
2
XXX
0
X
66.70
X
70134
TC
1
XXX
0
X
67.96
X
70134
4
XXX
0
X
104.23
X
70134
3
XXX
0
X
106.98
X
70134
2
XXX
0
X
112.74
X
70134
1
XXX
0
X
113.79
X
70140
26
4
XXX
0
X
25.94
X
70140
26
3
XXX
0
X
26.62
X
70140
26
2
XXX
0
X
27.78
X
70140
26
1
XXX
0
X
27.87
X
70140
TC
4
XXX
0
X
50.85
X
70140
TC
3
XXX
0
X
57.82
X
70140
TC
2
XXX
0
X
59.91
X
70140
4
XXX
0
X
74.61
X
70140
3
XXX
0
X
77.35
X
70140
TC
1
XXX
0
X
77.51
X
70140
2
XXX
0
X
81.32
X
70140
1
XXX
0
X
112.80
X
70150
26
4
XXX
0
X
35.88
X
70150
26
3
XXX
0
X
36.77
X
70150
26
2
XXX
0
X
38.48
X
70150
26
1
XXX
0
X
38.57
X
70150
TC
4
XXX
0
X
64.34
X
70150
TC
3
XXX
0
X
65.38
X
70150
TC
2
XXX
0
X
79.08
X
70150
TC
1
XXX
0
X
80.40
X
70150
4
XXX
0
X
97.98
X
70150
3
XXX
0
X
102.00
X
70150
1
XXX
0
X
108.55
X
70150
2
XXX
0
X
116.96
X
70160
26
4
XXX
0
X
23.41
X
70160
26
3
XXX
0
X
24.06
X
70160
26
2
XXX
0
X
25.06
X
70160
26
1
XXX
0
X
25.09
X
70160
TC
4
XXX
0
X
42.87
X
70160
TC
3
XXX
0
X
45.92
X
70160
TC
2
XXX
0
X
53.14
X
70160
TC
1
XXX
0
X
57.06
X
70160
4
XXX
0
X
64.84
X
70160
3
XXX
0
X
66.59
X
70160
2
XXX
0
X
77.42
X
70160
1
XXX
0
X
78.96
X
70170
26
4
XXX
0
X
40.63
X
70170
26
3
XXX
0
X
41.69
X
70170
26
2
XXX
0
X
43.59
X
70170
26
1
XXX
0
X
43.70
X
70170
TC
4
XXX
0
X
77.07
X
70170
TC
3
XXX
0
X
78.28
X
70170
TC
2
XXX
0
X
84.98
X
70170
TC
1
XXX
0
X
86.54
X
70170
4
XXX
0
X
114.76
X
70170
3
XXX
0
X
118.11
X
70170
2
XXX
0
X
125.09
X
70170
1
XXX
0
X
127.26
X
70190
26
3
XXX
0
X
29.87
X
70190
26
4
XXX
0
X
30.14
X
70190
26
2
XXX
0
X
31.10
X
70190
26
1
XXX
0
X
31.20
X
70190
TC
4
XXX
0
X
50.85
X
70190
TC
3
XXX
0
X
51.62
X
70190
TC
2
XXX
0
X
56.09
X
70190
TC
1
XXX
0
X
57.13
X
70190
4
XXX
0
X
78.47
X
70190
3
XXX
0
X
80.62
X
70190
2
XXX
0
X
84.89
X
70190
1
XXX
0
X
85.24
X
70200
26
4
XXX
0
X
38.33
X
70200
26
3
XXX
0
X
39.39
X
70200
26
2
XXX
0
X
41.19
X
70200
26
1
XXX
0
X
41.30
X
70200
TC
4
XXX
0
X
64.34
X
70200
TC
3
XXX
0
X
65.38
X
70200
TC
2
XXX
0
X
72.85
X
70200
TC
1
XXX
0
X
74.07
X
70200
4
XXX
0
X
100.40
X
70200
3
XXX
0
X
103.08
X
70200
2
XXX
0
X
110.67
X
70200
1
XXX
0
X
115.19
X
70210
26
4
XXX
0
X
22.91
X
70210
26
3
XXX
0
X
23.44
X
70210
26
2
XXX
0
X
25.06
X
70210
26
1
XXX
0
X
25.09
X
70210
TC
4
XXX
0
X
50.85
X
70210
TC
3
XXX
0
X
51.62
X
70210
TC
2
XXX
0
X
56.09
X
70210
TC
1
XXX
0
X
57.13
X
70210
4
XXX
0
X
72.15
X
70210
3
XXX
0
X
74.71
X
70210
2
XXX
0
X
78.71
X
70210
1
XXX
0
X
80.06
X
70220
26
4
XXX
0
X
34.47
X
70220
26
3
XXX
0
X
35.33
X
70220
26
2
XXX
0
X
36.97
X
70220
26
1
XXX
0
X
37.06
X
70220
TC
4
XXX
0
X
64.34
X
70220
TC
3
XXX
0
X
65.38
X
70220
TC
2
XXX
0
X
70.94
X
70220
TC
1
XXX
0
X
72.27
X
70220
4
XXX
0
X
96.28
X
70220
3
XXX
0
X
99.21
X
70220
2
XXX
0
X
105.14
X
70220
1
XXX
0
X
106.86
X
70240
26
4
XXX
0
X
26.39
X
70240
26
3
XXX
0
X
27.12
X
70240
26
2
XXX
0
X
28.26
X
70240
26
1
XXX
0
X
28.32
X
70240
TC
4
XXX
0
X
34.17
X
70240
TC
3
XXX
0
X
34.70
X
70240
TC
1
XXX
0
X
38.53
X
70240
TC
2
XXX
0
X
39.18
X
70240
4
XXX
0
X
59.44
X
70240
3
XXX
0
X
60.98
X
70240
1
XXX
0
X
63.99
X
70240
2
XXX
0
X
71.64
X
70250
26
4
XXX
0
X
33.23
X
70250
26
3
XXX
0
X
34.15
X
70250
26
2
XXX
0
X
35.76
X
70250
26
1
XXX
0
X
35.88
X
70250
TC
4
XXX
0
X
50.85
X
70250
TC
3
XXX
0
X
55.63
X
70250
TC
2
XXX
0
X
69.94
X
70250
TC
1
XXX
0
X
70.86
X
70250
4
XXX
0
X
82.82
X
70250
3
XXX
0
X
85.36
X
70250
2
XXX
0
X
108.75
X
70250
1
XXX
0
X
108.91
X
70260
26
4
XXX
0
X
46.19
X
70260
26
3
XXX
0
X
47.17
X
70260
26
2
XXX
0
X
49.34
X
70260
26
1
XXX
0
X
49.50
X
70260
TC
4
XXX
0
X
73.09
X
70260
TC
3
XXX
0
X
74.27
X
70260
TC
1
XXX
0
X
82.24
X
70260
TC
2
XXX
0
X
86.21
X
70260
4
XXX
0
X
116.51
X
70260
3
XXX
0
X
120.66
X
70260
1
XXX
0
X
128.05
X
70260
2
XXX
0
X
130.72
X
70300
XXX
0
X
*
X
70310
XXX
0
X
*
X
70320
XXX
0
X
*
X
70328
26
4
XXX
0
X
25.09
X
70328
26
3
XXX
0
X
25.78
X
70328
26
2
XXX
0
X
26.92
X
70328
26
1
XXX
0
X
27.01
X
70328
TC
4
XXX
0
X
40.54
X
70328
TC
3
XXX
0
X
41.19
X
70328
TC
2
XXX
0
X
44.61
X
70328
TC
1
XXX
0
X
51.94
X
70328
4
XXX
0
X
64.34
X
70328
3
XXX
0
X
66.04
X
70328
2
XXX
0
X
68.97
X
70328
1
XXX
0
X
70.10
X
70330
26
4
XXX
0
X
33.23
X
70330
26
3
XXX
0
X
34.17
X
70330
26
2
XXX
0
X
35.73
X
70330
26
1
XXX
0
X
35.87
X
70330
TC
4
XXX
0
X
68.34
X
70330
TC
3
XXX
0
X
69.38
X
70330
TC
2
XXX
0
X
75.22
X
70330
TC
1
XXX
0
X
76.59
X
70330
4
XXX
0
X
99.43
X
70330
3
XXX
0
X
102.00
X
70330
2
XXX
0
X
107.71
X
70330
1
XXX
0
X
109.54
X
70332
26
4
XXX
0
X
76.10
X
70332
26
3
XXX
0
X
78.08
X
70332
26
2
XXX
0
X
81.67
X
70332
26
1
XXX
0
X
81.85
X
70332
TC
4
XXX
0
X
170.84
X
70332
TC
3
XXX
0
X
173.55
X
70332
TC
2
XXX
0
X
188.21
X
70332
TC
1
XXX
0
X
191.73
X
70332
4
XXX
0
X
239.68
X
70332
3
XXX
0
X
247.81
X
70332
2
XXX
0
X
261.72
X
70332
1
XXX
0
X
266.05
X
70336
26
4
XXX
0
X
174.09
X
70336
26
3
XXX
0
X
179.84
X
70336
26
2
XXX
0
X
186.88
X
70336
26
1
XXX
0
X
187.14
X
70336
TC
4
XXX
0
X
912.01
X
70336
TC
3
XXX
0
X
926.70
X
70336
TC
2
XXX
0
X
1,004.49
X
70336
TC
1
XXX
0
X
1,022.98
X
70336
4
XXX
0
X
1,056.85
X
70336
3
XXX
0
X
1,085.94
X
70336
2
XXX
0
X
1,147.85
X
70336
1
XXX
0
X
1,150.95
X
70350
XXX
0
X
*
X
70355
XXX
0
X
*
X
70360
26
4
XXX
0
X
23.22
X
70360
26
3
XXX
0
X
23.85
X
70360
26
2
XXX
0
X
24.91
X
70360
26
1
XXX
0
X
24.96
X
70360
TC
4
XXX
0
X
34.17
X
70360
TC
3
XXX
0
X
34.70
X
70360
TC
2
XXX
0
X
37.81
X
70360
TC
1
XXX
0
X
38.53
X
70360
4
XXX
0
X
56.33
X
70360
3
XXX
0
X
57.79
X
70360
1
XXX
0
X
61.43
X
70360
2
XXX
0
X
62.35
X
70370
26
4
XXX
0
X
43.73
X
70370
26
3
XXX
0
X
44.93
X
70370
26
2
XXX
0
X
46.99
X
70370
26
1
XXX
0
X
47.08
X
70370
TC
4
XXX
0
X
105.70
X
70370
TC
3
XXX
0
X
107.34
X
70370
TC
2
XXX
0
X
116.44
X
70370
TC
1
XXX
0
X
118.57
X
70370
4
XXX
0
X
145.82
X
70370
3
XXX
0
X
150.45
X
70370
2
XXX
0
X
159.17
X
70370
1
XXX
0
X
161.80
X
70371
26
4
XXX
0
X
116.03
X
70371
26
3
XXX
0
X
119.06
X
70371
26
2
XXX
0
X
124.51
X
70371
26
1
XXX
0
X
124.89
X
70371
TC
4
XXX
0
X
170.84
X
70371
TC
3
XXX
0
X
173.55
X
70371
TC
2
XXX
0
X
188.21
X
70371
TC
1
XXX
0
X
191.73
X
70371
4
XXX
0
X
281.27
X
70371
3
XXX
0
X
288.77
X
70371
2
XXX
0
X
304.43
X
70371
1
XXX
0
X
305.89
X
70380
26
4
XXX
0
X
23.64
X
70380
26
3
XXX
0
X
24.04
X
70380
26
2
XXX
0
X
25.06
X
70380
26
1
XXX
0
X
25.09
X
70380
TC
4
XXX
0
X
54.83
X
70380
TC
3
XXX
0
X
55.70
X
70380
TC
2
XXX
0
X
60.32
X
70380
TC
1
XXX
0
X
61.43
X
70380
4
XXX
0
X
76.10
X
70380
3
XXX
0
X
78.92
X
70380
2
XXX
0
X
83.01
X
70380
1
XXX
0
X
84.40
X
70390
26
3
XXX
0
X
52.81
X
70390
26
4
XXX
0
X
53.80
X
70390
26
2
XXX
0
X
55.26
X
70390
26
1
XXX
0
X
55.51
X
70390
TC
4
XXX
0
X
145.41
X
70390
TC
3
XXX
0
X
147.73
X
70390
TC
2
XXX
0
X
160.17
X
70390
TC
1
XXX
0
X
163.13
X
70390
4
XXX
0
X
192.92
X
70390
3
XXX
0
X
195.79
X
70390
2
XXX
0
X
211.00
X
70390
1
XXX
0
X
214.62
X
70450
26
4
XXX
0
X
117.92
X
70450
26
3
XXX
0
X
120.71
X
70450
26
2
XXX
0
X
126.14
X
70450
26
1
XXX
0
X
126.49
X
70450
TC
4
XXX
0
X
393.91
X
70450
TC
3
XXX
0
X
404.85
X
70450
TC
2
XXX
0
X
428.66
X
70450
TC
1
XXX
0
X
431.41
X
70450
4
XXX
0
X
511.47
X
70450
3
XXX
0
X
525.54
X
70450
2
XXX
0
X
554.68
X
70450
1
XXX
0
X
557.85
X
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