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2021 Workers' Compensation Part B Fee Schedule

73218-74022

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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
73218 26 2 XXX 0 X 100.50 X
73218 26 3 XXX 0 X 100.50 X
73218 26 4 XXX 0 X 100.50 X
73218 26 1 XXX 0 X 109.12 X
73218 TC 2 XXX 0 X 803.31 X
73218 TC 3 XXX 0 X 803.31 X
73218 TC 4 XXX 0 X 803.31 X
73218   2 XXX 0 X 903.76 X
73218   3 XXX 0 X 903.76 X
73218   4 XXX 0 X 903.76 X
73218 TC 1 XXX 0 X 953.25 X
73218   1 XXX 0 X 1,062.34 X
73219 26 2 XXX 0 X 119.68 X
73219 26 3 XXX 0 X 119.68 X
73219 26 4 XXX 0 X 119.68 X
73219 26 1 XXX 0 X 129.66 X
73219 TC 2 XXX 0 X 963.15 X
73219 TC 3 XXX 0 X 963.15 X
73219 TC 4 XXX 0 X 963.15 X
73219   2 XXX 0 X 1,082.84 X
73219   3 XXX 0 X 1,082.84 X
73219   4 XXX 0 X 1,082.84 X
73219 TC 1 XXX 0 X 1,143.15 X
73219   1 XXX 0 X 1,272.84 X
73220 26 4 XXX 0 X 204.39 X
73220 26 3 XXX 0 X 209.78 X
73220 26 2 XXX 0 X 219.21 X
73220 26 1 XXX 0 X 219.86 X
73220 TC 4 XXX 0 X 912.01 X
73220 TC 3 XXX 0 X 926.70 X
73220 TC 2 XXX 0 X 1,004.49 X
73220 TC 1 XXX 0 X 1,022.98 X
73220   4 XXX 0 X 1,098.03 X
73220   3 XXX 0 X 1,114.81 X
73220   2 XXX 0 X 1,202.76 X
73220   1 XXX 0 X 1,223.69 X
73221 26 4 XXX 0 X 176.59 X
73221 26 3 XXX 0 X 179.49 X
73221 26 2 XXX 0 X 186.88 X
73221 26 1 XXX 0 X 187.14 X
73221 TC 4 XXX 0 X 912.01 X
73221 TC 3 XXX 0 X 926.70 X
73221 TC 2 XXX 0 X 1,004.49 X
73221 TC 1 XXX 0 X 1,022.98 X
73221   4 XXX 0 X 1,056.85 X
73221   3 XXX 0 X 1,085.94 X
73221   2 XXX 0 X 1,147.85 X
73221   1 XXX 0 X 1,150.95 X
73222 26 2 XXX 0 X 119.68 X
73222 26 3 XXX 0 X 119.68 X
73222 26 4 XXX 0 X 119.68 X
73222 26 1 XXX 0 X 129.66 X
73222 TC 2 XXX 0 X 963.15 X
73222 TC 3 XXX 0 X 963.15 X
73222 TC 4 XXX 0 X 963.15 X
73222   2 XXX 0 X 1,082.84 X
73222   3 XXX 0 X 1,082.84 X
73222   4 XXX 0 X 1,082.84 X
73222 TC 1 XXX 0 X 1,143.15 X
73222   1 XXX 0 X 1,272.84 X
73223 26 2 XXX 0 X 161.01 X
73223 26 3 XXX 0 X 161.01 X
73223 26 4 XXX 0 X 161.01 X
73223 26 1 XXX 0 X 175.50 X
73223 TC 2 XXX 0 X 1,782.84 X
73223 TC 3 XXX 0 X 1,782.84 X
73223 TC 4 XXX 0 X 1,782.84 X
73223   2 XXX 0 X 1,943.83 X
73223   3 XXX 0 X 1,943.83 X
73223   4 XXX 0 X 1,943.83 X
73223 TC 1 XXX 0 X 2,115.30 X
73223   1 XXX 0 X 2,290.79 X
73225     XXX 9 X * X
73501 26 2 XXX 0 X 12.36 X
73501 26 3 XXX 0 X 12.36 X
73501 26 4 XXX 0 X 12.36 X
73501 26 1 XXX 0 X 13.25 X
73501 TC 2 XXX 0 X 24.35 X
73501 TC 3 XXX 0 X 24.35 X
73501 TC 4 XXX 0 X 24.35 X
73501 TC 1 XXX 0 X 28.55 X
73501   2 XXX 0 X 36.71 X
73501   3 XXX 0 X 36.71 X
73501   4 XXX 0 X 36.71 X
73501   1 XXX 0 X 41.78 X
73502 26 2 XXX 0 X 14.66 X
73502 26 3 XXX 0 X 14.66 X
73502 26 4 XXX 0 X 14.66 X
73502 26 1 XXX 0 X 15.67 X
73502 TC 2 XXX 0 X 36.51 X
73502 TC 3 XXX 0 X 36.51 X
73502 TC 4 XXX 0 X 36.51 X
73502 TC 1 XXX 0 X 42.78 X
73502   2 XXX 0 X 51.16 X
73502   3 XXX 0 X 51.16 X
73502   4 XXX 0 X 51.16 X
73502   1 XXX 0 X 58.44 X
73503 26 2 XXX 0 X 18.78 X
73503 26 3 XXX 0 X 18.78 X
73503 26 4 XXX 0 X 18.78 X
73503 26 1 XXX 0 X 20.18 X
73503 TC 2 XXX 0 X 45.19 X
73503 TC 3 XXX 0 X 45.19 X
73503 TC 4 XXX 0 X 45.19 X
73503 TC 1 XXX 0 X 52.94 X
73503   2 XXX 0 X 63.96 X
73503   3 XXX 0 X 63.96 X
73503   4 XXX 0 X 63.96 X
73503   1 XXX 0 X 73.12 X
73521 26 2 XXX 0 X 15.08 X
73521 26 3 XXX 0 X 15.08 X
73521 26 4 XXX 0 X 15.08 X
73521 26 1 XXX 0 X 16.19 X
73521 TC 2 XXX 0 X 33.93 X
73521 TC 3 XXX 0 X 33.93 X
73521 TC 4 XXX 0 X 33.93 X
73521 TC 1 XXX 0 X 39.72 X
73521   2 XXX 0 X 48.99 X
73521   3 XXX 0 X 48.99 X
73521   4 XXX 0 X 48.99 X
73521   1 XXX 0 X 55.92 X
73522 26 2 XXX 0 X 19.70 X
73522 26 3 XXX 0 X 19.70 X
73522 26 4 XXX 0 X 19.70 X
73522 26 1 XXX 0 X 21.13 X
73522 TC 2 XXX 0 X 40.86 X
73522 TC 3 XXX 0 X 40.86 X
73522 TC 4 XXX 0 X 40.86 X
73522 TC 1 XXX 0 X 47.85 X
73522   2 XXX 0 X 60.55 X
73522   3 XXX 0 X 60.55 X
73522   4 XXX 0 X 60.55 X
73522   1 XXX 0 X 68.97 X
73523 26 2 XXX 0 X 21.08 X
73523 26 3 XXX 0 X 21.08 X
73523 26 4 XXX 0 X 21.08 X
73523 26 1 XXX 0 X 22.59 X
73523 TC 2 XXX 0 X 49.11 X
73523 TC 3 XXX 0 X 49.11 X
73523 TC 4 XXX 0 X 49.11 X
73523 TC 1 XXX 0 X 57.52 X
73523   2 XXX 0 X 70.18 X
73523   3 XXX 0 X 70.18 X
73523   4 XXX 0 X 70.18 X
73523   1 XXX 0 X 80.09 X
73525 26 4 XXX 0 X 77.24 X
73525 26 3 XXX 0 X 78.08 X
73525 26 2 XXX 0 X 81.67 X
73525 26 1 XXX 0 X 81.85 X
73525 TC 4 XXX 0 X 170.84 X
73525 TC 3 XXX 0 X 173.55 X
73525 TC 2 XXX 0 X 188.21 X
73525 TC 1 XXX 0 X 191.73 X
73525   4 XXX 0 X 239.68 X
73525   3 XXX 0 X 247.81 X
73525   2 XXX 0 X 261.72 X
73525   1 XXX 0 X 266.05 X
73551 26 2 XXX 0 X 10.98 X
73551 26 3 XXX 0 X 10.98 X
73551 26 4 XXX 0 X 10.98 X
73551 26 1 XXX 0 X 11.79 X
73551 TC 2 XXX 0 X 23.49 X
73551 TC 3 XXX 0 X 23.49 X
73551 TC 4 XXX 0 X 23.49 X
73551 TC 1 XXX 0 X 27.52 X
73551   2 XXX 0 X 34.47 X
73551   3 XXX 0 X 34.47 X
73551   4 XXX 0 X 34.47 X
73551   1 XXX 0 X 39.32 X
73552 26 2 XXX 0 X 12.36 X
73552 26 3 XXX 0 X 12.36 X
73552 26 4 XXX 0 X 12.36 X
73552 26 1 XXX 0 X 13.25 X
73552 TC 2 XXX 0 X 27.82 X
73552 TC 3 XXX 0 X 27.82 X
73552 TC 4 XXX 0 X 27.82 X
73552 TC 1 XXX 0 X 32.61 X
73552   2 XXX 0 X 40.19 X
73552   3 XXX 0 X 40.19 X
73552   4 XXX 0 X 40.19 X
73552   1 XXX 0 X 45.87 X
73560 26 4 XXX 0 X 22.29 X
73560 26 3 XXX 0 X 22.60 X
73560 26 2 XXX 0 X 23.66 X
73560 26 1 XXX 0 X 23.69 X
73560 TC 4 XXX 0 X 42.87 X
73560 TC 3 XXX 0 X 43.59 X
73560 TC 2 XXX 0 X 47.14 X
73560 TC 1 XXX 0 X 48.04 X
73560   4 XXX 0 X 63.39 X
73560   3 XXX 0 X 65.26 X
73560   2 XXX 0 X 68.97 X
73560   1 XXX 0 X 70.10 X
73562 26 4 XXX 0 X 25.09 X
73562 26 3 XXX 0 X 25.86 X
73562 26 2 XXX 0 X 26.92 X
73562 26 1 XXX 0 X 27.01 X
73562 TC 4 XXX 0 X 46.89 X
73562 TC 3 XXX 0 X 47.61 X
73562 TC 2 XXX 0 X 51.81 X
73562 TC 1 XXX 0 X 52.80 X
73562   4 XXX 0 X 69.79 X
73562   3 XXX 0 X 72.50 X
73562   2 XXX 0 X 76.14 X
73562   1 XXX 0 X 77.49 X
73564 26 4 XXX 0 X 30.59 X
73564 26 3 XXX 0 X 31.40 X
73564 26 2 XXX 0 X 32.80 X
73564 26 1 XXX 0 X 32.92 X
73564 TC 4 XXX 0 X 50.85 X
73564 TC 3 XXX 0 X 51.62 X
73564 TC 2 XXX 0 X 56.09 X
73564 TC 1 XXX 0 X 57.13 X
73564   4 XXX 0 X 80.10 X
73564   3 XXX 0 X 82.24 X
73564   2 XXX 0 X 85.97 X
73564   1 XXX 0 X 87.42 X
73565 26 4 XXX 0 X 20.54 X
73565 26 3 XXX 0 X 20.72 X
73565 26 2 XXX 0 X 21.76 X
73565 26 1 XXX 0 X 22.10 X
73565 TC 4 XXX 0 X 39.33 X
73565 TC 3 XXX 0 X 40.24 X
73565 TC 2 XXX 0 X 42.87 X
73565 TC 1 XXX 0 X 43.28 X
73565   4 XXX 0 X 60.98 X
73565   3 XXX 0 X 61.87 X
73565   2 XXX 0 X 66.39 X
73565   1 XXX 0 X 67.43 X
73580 26 4 XXX 0 X 76.68 X
73580 26 3 XXX 0 X 78.24 X
73580 26 2 XXX 0 X 81.67 X
73580 26 1 XXX 0 X 81.85 X
73580 TC 4 XXX 0 X 214.55 X
73580 TC 3 XXX 0 X 218.00 X
73580 TC 2 XXX 0 X 236.62 X
73580 TC 1 XXX 0 X 266.31 X
73580   4 XXX 0 X 283.41 X
73580   3 XXX 0 X 287.62 X
73580   2 XXX 0 X 310.09 X
73580   1 XXX 0 X 315.48 X
73590 26 4 XXX 0 X 22.12 X
73590 26 3 XXX 0 X 22.65 X
73590 26 2 XXX 0 X 23.66 X
73590 26 1 XXX 0 X 23.69 X
73590 TC 4 XXX 0 X 42.87 X
73590 TC 3 XXX 0 X 43.59 X
73590 TC 2 XXX 0 X 48.26 X
73590 TC 1 XXX 0 X 50.21 X
73590   4 XXX 0 X 63.39 X
73590   3 XXX 0 X 65.25 X
73590   2 XXX 0 X 68.97 X
73590   1 XXX 0 X 71.86 X
73592 26 4 XXX 0 X 20.97 X
73592 26 3 XXX 0 X 21.48 X
73592 26 2 XXX 0 X 22.42 X
73592 26 1 XXX 0 X 22.46 X
73592 TC 4 XXX 0 X 40.54 X
73592 TC 3 XXX 0 X 41.19 X
73592 TC 2 XXX 0 X 44.61 X
73592 TC 1 XXX 0 X 45.44 X
73592   4 XXX 0 X 60.15 X
73592   3 XXX 0 X 61.76 X
73592   2 XXX 0 X 65.56 X
73592   1 XXX 0 X 66.61 X
73600 26 4 XXX 0 X 21.30 X
73600 26 3 XXX 0 X 21.52 X
73600 26 2 XXX 0 X 22.42 X
73600 26 1 XXX 0 X 22.46 X
73600 TC 4 XXX 0 X 40.54 X
73600 TC 3 XXX 0 X 41.19 X
73600 TC 2 XXX 0 X 44.61 X
73600 TC 1 XXX 0 X 46.47 X
73600   4 XXX 0 X 60.15 X
73600   3 XXX 0 X 61.77 X
73600   2 XXX 0 X 65.56 X
73600   1 XXX 0 X 67.62 X
73610 26 4 XXX 0 X 23.69 X
73610 26 3 XXX 0 X 24.35 X
73610 26 2 XXX 0 X 25.37 X
73610 26 1 XXX 0 X 25.39 X
73610 TC 4 XXX 0 X 43.65 X
73610 TC 3 XXX 0 X 44.39 X
73610 TC 2 XXX 0 X 48.04 X
73610 TC 1 XXX 0 X 48.87 X
73610   4 XXX 0 X 66.48 X
73610   3 XXX 0 X 68.39 X
73610   1 XXX 0 X 71.75 X
73610   2 XXX 0 X 72.12 X
73615 26 4 XXX 0 X 76.10 X
73615 26 3 XXX 0 X 78.08 X
73615 26 2 XXX 0 X 81.67 X
73615 26 1 XXX 0 X 81.85 X
73615 TC 4 XXX 0 X 170.84 X
73615 TC 3 XXX 0 X 173.55 X
73615 TC 2 XXX 0 X 188.21 X
73615 TC 1 XXX 0 X 191.73 X
73615   4 XXX 0 X 239.68 X
73615   3 XXX 0 X 247.81 X
73615   2 XXX 0 X 261.72 X
73615   1 XXX 0 X 266.05 X
73620 26 4 XXX 0 X 20.97 X
73620 26 3 XXX 0 X 21.52 X
73620 26 2 XXX 0 X 22.42 X
73620 26 1 XXX 0 X 22.46 X
73620 TC 4 XXX 0 X 40.54 X
73620 TC 3 XXX 0 X 41.19 X
73620 TC 2 XXX 0 X 44.61 X
73620 TC 1 XXX 0 X 45.44 X
73620   4 XXX 0 X 60.15 X
73620   3 XXX 0 X 61.77 X
73620   2 XXX 0 X 65.56 X
73620   1 XXX 0 X 66.61 X
73630 26 4 XXX 0 X 23.77 X
73630 26 3 XXX 0 X 24.35 X
73630 26 2 XXX 0 X 25.37 X
73630 26 1 XXX 0 X 25.39 X
73630 TC 4 XXX 0 X 43.65 X
73630 TC 3 XXX 0 X 44.39 X
73630 TC 2 XXX 0 X 48.04 X
73630 TC 1 XXX 0 X 48.87 X
73630   4 XXX 0 X 66.48 X
73630   3 XXX 0 X 68.39 X
73630   1 XXX 0 X 71.75 X
73630   2 XXX 0 X 72.07 X
73650 26 4 XXX 0 X 20.99 X
73650 26 3 XXX 0 X 21.50 X
73650 26 2 XXX 0 X 22.45 X
73650 26 1 XXX 0 X 22.46 X
73650 TC 4 XXX 0 X 38.92 X
73650 TC 3 XXX 0 X 39.52 X
73650 TC 2 XXX 0 X 42.88 X
73650 TC 1 XXX 0 X 43.68 X
73650   4 XXX 0 X 58.60 X
73650   3 XXX 0 X 60.02 X
73650   2 XXX 0 X 63.89 X
73650   1 XXX 0 X 66.09 X
73660 26 4 XXX 0 X 17.48 X
73660 26 3 XXX 0 X 17.91 X
73660 26 2 XXX 0 X 18.67 X
73660 26 1 XXX 0 X 18.81 X
73660 TC 4 XXX 0 X 34.17 X
73660 TC 3 XXX 0 X 34.70 X
73660 TC 2 XXX 0 X 37.81 X
73660 TC 1 XXX 0 X 39.82 X
73660   4 XXX 0 X 50.54 X
73660   3 XXX 0 X 52.03 X
73660   2 XXX 0 X 55.30 X
73660   1 XXX 0 X 57.44 X
73700 26 4 XXX 0 X 149.22 X
73700 26 3 XXX 0 X 153.29 X
73700 26 2 XXX 0 X 160.05 X
73700 26 1 XXX 0 X 160.58 X
73700 TC 4 XXX 0 X 403.54 X
73700 TC 3 XXX 0 X 410.08 X
73700 TC 2 XXX 0 X 444.51 X
73700 TC 1 XXX 0 X 452.65 X
73700   4 XXX 0 X 539.63 X
73700   3 XXX 0 X 554.29 X
73700   2 XXX 0 X 589.32 X
73700   1 XXX 0 X 599.26 X
73701 26 4 XXX 0 X 159.95 X
73701 26 3 XXX 0 X 164.76 X
73701 26 2 XXX 0 X 171.66 X
73701 26 1 XXX 0 X 172.10 X
73701 TC 4 XXX 0 X 480.58 X
73701 TC 3 XXX 0 X 488.35 X
73701 TC 2 XXX 0 X 529.43 X
73701 TC 1 XXX 0 X 539.21 X
73701   4 XXX 0 X 625.65 X
73701   3 XXX 0 X 635.01 X
73701   2 XXX 0 X 684.06 X
73701   1 XXX 0 X 695.78 X
73702 26 4 XXX 0 X 167.66 X
73702 26 3 XXX 0 X 172.09 X
73702 26 2 XXX 0 X 179.84 X
73702 26 1 XXX 0 X 180.29 X
73702 TC 4 XXX 0 X 604.51 X
73702 TC 3 XXX 0 X 614.31 X
73702 TC 2 XXX 0 X 665.84 X
73702 TC 1 XXX 0 X 678.10 X
73702   4 XXX 0 X 756.16 X
73702   3 XXX 0 X 767.57 X
73702   2 XXX 0 X 827.35 X
73702   1 XXX 0 X 841.58 X
73706 26 2 XXX 0 X 126.71 X
73706 26 3 XXX 0 X 126.71 X
73706 26 4 XXX 0 X 126.71 X
73706 26 1 XXX 0 X 137.95 X
73706 TC 2 XXX 0 X 537.71 X
73706 TC 3 XXX 0 X 537.71 X
73706 TC 4 XXX 0 X 537.71 X
73706 TC 1 XXX 0 X 641.95 X
73706   2 XXX 0 X 664.43 X
73706   3 XXX 0 X 664.43 X
73706   4 XXX 0 X 664.43 X
73706   1 XXX 0 X 779.93 X
73718 26 2 XXX 0 X 100.50 X
73718 26 3 XXX 0 X 100.50 X
73718 26 4 XXX 0 X 100.50 X
73718 26 1 XXX 0 X 109.12 X
73718 TC 2 XXX 0 X 803.31 X
73718 TC 3 XXX 0 X 803.31 X
73718 TC 4 XXX 0 X 803.31 X
73718   2 XXX 0 X 903.76 X
73718   3 XXX 0 X 903.76 X
73718   4 XXX 0 X 903.76 X
73718 TC 1 XXX 0 X 953.25 X
73718   1 XXX 0 X 1,062.34 X
73719 26 2 XXX 0 X 119.68 X
73719 26 3 XXX 0 X 119.68 X
73719 26 4 XXX 0 X 119.68 X
73719 26 1 XXX 0 X 129.66 X
73719 TC 2 XXX 0 X 963.15 X
73719 TC 3 XXX 0 X 963.15 X
73719 TC 4 XXX 0 X 963.15 X
73719   2 XXX 0 X 1,082.84 X
73719   3 XXX 0 X 1,082.84 X
73719   4 XXX 0 X 1,082.84 X
73719 TC 1 XXX 0 X 1,143.15 X
73719   1 XXX 0 X 1,272.84 X
73720 26 4 XXX 0 X 205.93 X
73720 26 3 XXX 0 X 209.93 X
73720 26 2 XXX 0 X 219.21 X
73720 26 1 XXX 0 X 219.86 X
73720 TC 4 XXX 0 X 912.01 X
73720 TC 3 XXX 0 X 926.70 X
73720 TC 2 XXX 0 X 1,004.49 X
73720 TC 1 XXX 0 X 1,022.98 X
73720   4 XXX 0 X 1,098.03 X
73720   3 XXX 0 X 1,114.81 X
73720   2 XXX 0 X 1,202.76 X
73720   1 XXX 0 X 1,223.69 X
73721 26 4 XXX 0 X 174.09 X
73721 26 3 XXX 0 X 179.51 X
73721 26 2 XXX 0 X 186.88 X
73721 26 1 XXX 0 X 187.14 X
73721 TC 4 XXX 0 X 912.01 X
73721 TC 3 XXX 0 X 926.70 X
73721 TC 2 XXX 0 X 1,004.49 X
73721 TC 1 XXX 0 X 1,022.98 X
73721   4 XXX 0 X 1,056.85 X
73721   3 XXX 0 X 1,085.94 X
73721   2 XXX 0 X 1,147.85 X
73721   1 XXX 0 X 1,150.95 X
73722 26 2 XXX 0 X 119.68 X
73722 26 3 XXX 0 X 119.68 X
73722 26 4 XXX 0 X 119.68 X
73722 26 1 XXX 0 X 129.66 X
73722 TC 2 XXX 0 X 963.15 X
73722 TC 3 XXX 0 X 963.15 X
73722 TC 4 XXX 0 X 963.15 X
73722   2 XXX 0 X 1,082.84 X
73722   3 XXX 0 X 1,082.84 X
73722   4 XXX 0 X 1,082.84 X
73722 TC 1 XXX 0 X 1,143.15 X
73722   1 XXX 0 X 1,272.84 X
73723 26 2 XXX 0 X 161.01 X
73723 26 3 XXX 0 X 161.01 X
73723 26 4 XXX 0 X 161.01 X
73723 26 1 XXX 0 X 175.50 X
73723 TC 2 XXX 0 X 1,782.84 X
73723 TC 3 XXX 0 X 1,782.84 X
73723 TC 4 XXX 0 X 1,782.84 X
73723   2 XXX 0 X 1,943.83 X
73723   3 XXX 0 X 1,943.83 X
73723   4 XXX 0 X 1,943.83 X
73723 TC 1 XXX 0 X 2,115.30 X
73723   1 XXX 0 X 2,290.79 X
73725 26 4     X 214.30 X
73725 26 3     X 216.63 X
73725 26 2     X 227.46 X
73725 26 1 XXX 0 X 230.07 X
73725 TC 4     X 912.01 X
73725 TC 3     X 926.74 X
73725 TC 2     X 1,004.58 X
73725 TC 1 XXX   X 1,023.04 X
73725   4     X 1,126.31 X
73725   3     X 1,143.36 X
73725   2     X 1,232.04 X
73725   1 XXX 0 X 1,253.10 X
74018 26 2 XXX 0 X 11.49 X
74018 26 3 XXX 0 X 11.49 X
74018 26 4 XXX 0 X 11.49 X
74018 26 1 XXX 0 X 12.26 X
74018 TC 2 XXX 0 X 21.47 X
74018 TC 3 XXX 0 X 21.47 X
74018 TC 4 XXX 0 X 21.47 X
74018 TC 1 XXX 0 X 24.73 X
74018   2 XXX 0 X 32.96 X
74018   3 XXX 0 X 32.96 X
74018   4 XXX 0 X 32.96 X
74018   1 XXX 0 X 36.96 X
74019 26 2 XXX 0 X 14.56 X
74019 26 3 XXX 0 X 14.56 X
74019 26 4 XXX 0 X 14.56 X
74019 26 1 XXX 0 X 15.51 X
74019 TC 2 XXX 0 X 25.68 X
74019 TC 3 XXX 0 X 25.68 X
74019 TC 4 XXX 0 X 25.68 X
74019 TC 1 XXX 0 X 29.54 X
74019   2 XXX 0 X 40.24 X
74019   3 XXX 0 X 40.24 X
74019   4 XXX 0 X 40.24 X
74019   1 XXX 0 X 45.04 X
74021 26 2 XXX 0 X 17.25 X
74021 26 3 XXX 0 X 17.25 X
74021 26 4 XXX 0 X 17.25 X
74021 26 1 XXX 0 X 18.43 X
74021 TC 2 XXX 0 X 29.86 X
74021 TC 3 XXX 0 X 29.86 X
74021 TC 4 XXX 0 X 29.86 X
74021 TC 1 XXX 0 X 34.36 X
74021   2 XXX 0 X 47.10 X
74021   3 XXX 0 X 47.10 X
74021   4 XXX 0 X 47.10 X
74021   1 XXX 0 X 52.80 X
74022 26 4 XXX 0 X 43.43 X
74022 26 3 XXX 0 X 44.43 X
74022 26 2 XXX 0 X 46.46 X
74022 26 1 XXX 0 X 46.65 X
74022 TC 4 XXX 0 X 60.40 X
74022 TC 3 XXX 0 X 61.38 X
74022 TC 2 XXX 0 X 66.70 X
74022 TC 1 XXX 0 X 67.96 X
74022   4 XXX 0 X 101.55 X
74022   3 XXX 0 X 104.24 X
74022   2 XXX 0 X 109.42 X
74022   1 XXX 0 X 111.19 X