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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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Health Care Services Review
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Medical Fee Review
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Fee Schedule
>
Fee Schedule 76529-76941
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
76529-76941
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
76529
26
4
XXX
0
X
79.86
X
76529
26
3
XXX
0
X
81.96
X
76529
26
2
XXX
0
X
85.70
X
76529
26
1
XXX
0
X
85.93
X
76529
TC
4
XXX
0
X
111.25
X
76529
TC
3
XXX
0
X
113.02
X
76529
TC
2
XXX
0
X
122.76
X
76529
TC
1
XXX
0
X
125.05
X
76529
4
XXX
0
X
187.47
X
76529
3
XXX
0
X
192.45
X
76529
2
XXX
0
X
202.87
X
76529
1
XXX
0
X
202.89
X
76536
26
4
XXX
0
X
78.47
X
76536
26
3
XXX
0
X
80.40
X
76536
26
2
XXX
0
X
84.06
X
76536
26
1
XXX
0
X
84.35
X
76536
TC
4
XXX
0
X
115.19
X
76536
TC
3
XXX
0
X
117.04
X
76536
TC
2
XXX
0
X
126.99
X
76536
TC
1
XXX
0
X
129.40
X
76536
4
XXX
0
X
189.84
X
76536
3
XXX
0
X
195.01
X
76536
1
XXX
0
X
206.34
X
76536
2
XXX
0
X
207.17
X
76604
26
4
XXX
0
X
77.82
X
76604
26
3
XXX
0
X
79.65
X
76604
26
2
XXX
0
X
83.20
X
76604
26
1
XXX
0
X
83.50
X
76604
TC
4
XXX
0
X
105.70
X
76604
TC
3
XXX
0
X
107.34
X
76604
TC
2
XXX
0
X
116.44
X
76604
TC
1
XXX
0
X
118.57
X
76604
4
XXX
0
X
180.40
X
76604
3
XXX
0
X
185.27
X
76604
1
XXX
0
X
194.71
X
76604
2
XXX
0
X
195.16
X
76641
26
2
XXX
0
X
48.13
X
76641
26
3
XXX
0
X
48.13
X
76641
26
4
XXX
0
X
48.13
X
76641
26
1
XXX
0
X
51.19
X
76641
TC
2
XXX
0
X
89.41
X
76641
TC
3
XXX
0
X
89.41
X
76641
TC
4
XXX
0
X
89.41
X
76641
TC
1
XXX
0
X
104.67
X
76641
2
XXX
0
X
137.54
X
76641
3
XXX
0
X
137.54
X
76641
4
XXX
0
X
137.54
X
76641
1
XXX
0
X
155.85
X
76642
26
2
XXX
0
X
44.83
X
76642
26
3
XXX
0
X
44.83
X
76642
26
4
XXX
0
X
44.83
X
76642
26
1
XXX
0
X
47.68
X
76642
TC
2
XXX
0
X
68.43
X
76642
TC
3
XXX
0
X
68.43
X
76642
TC
4
XXX
0
X
68.43
X
76642
TC
1
XXX
0
X
80.08
X
76642
2
XXX
0
X
113.25
X
76642
3
XXX
0
X
113.25
X
76642
4
XXX
0
X
113.25
X
76642
1
XXX
0
X
127.78
X
76700
26
4
XXX
0
X
111.61
X
76700
26
3
XXX
0
X
114.30
X
76700
26
2
XXX
0
X
119.35
X
76700
26
1
XXX
0
X
119.66
X
76700
TC
4
XXX
0
X
160.48
X
76700
TC
3
XXX
0
X
163.07
X
76700
TC
2
XXX
0
X
176.83
X
76700
TC
1
XXX
0
X
180.04
X
76700
4
XXX
0
X
266.38
X
76700
3
XXX
0
X
273.50
X
76700
2
XXX
0
X
288.10
X
76700
1
XXX
0
X
289.42
X
76705
26
4
XXX
0
X
82.41
X
76705
26
3
XXX
0
X
84.59
X
76705
26
2
XXX
0
X
88.26
X
76705
26
1
XXX
0
X
88.56
X
76705
TC
4
XXX
0
X
115.19
X
76705
TC
3
XXX
0
X
117.04
X
76705
TC
2
XXX
0
X
126.99
X
76705
TC
1
XXX
0
X
129.40
X
76705
4
XXX
0
X
193.66
X
76705
3
XXX
0
X
198.94
X
76705
1
XXX
0
X
209.84
X
76705
2
XXX
0
X
213.90
X
76706
26
2
XXX
0
X
35.77
X
76706
26
3
XXX
0
X
35.77
X
76706
26
4
XXX
0
X
35.77
X
76706
26
1
XXX
0
X
38.20
X
76706
TC
2
XXX
0
X
80.43
X
76706
TC
3
XXX
0
X
80.43
X
76706
TC
4
XXX
0
X
80.43
X
76706
TC
1
XXX
0
X
93.25
X
76706
2
XXX
0
X
116.20
X
76706
3
XXX
0
X
116.20
X
76706
4
XXX
0
X
116.20
X
76706
1
XXX
0
X
131.46
X
76770
26
4
XXX
0
X
102.81
X
76770
26
3
XXX
0
X
105.14
X
76770
26
2
XXX
0
X
109.83
X
76770
26
1
XXX
0
X
110.22
X
76770
TC
4
XXX
0
X
160.48
X
76770
TC
3
XXX
0
X
163.07
X
76770
TC
2
XXX
0
X
176.83
X
76770
TC
1
XXX
0
X
180.04
X
76770
4
XXX
0
X
257.41
X
76770
3
XXX
0
X
264.31
X
76770
2
XXX
0
X
278.57
X
76770
1
XXX
0
X
280.87
X
76775
26
4
XXX
0
X
81.45
X
76775
26
3
XXX
0
X
83.69
X
76775
26
2
XXX
0
X
87.40
X
76775
26
1
XXX
0
X
87.65
X
76775
TC
4
XXX
0
X
115.19
X
76775
TC
3
XXX
0
X
117.04
X
76775
TC
1
XXX
0
X
129.40
X
76775
TC
2
XXX
0
X
135.57
X
76775
4
XXX
0
X
193.02
X
76775
3
XXX
0
X
198.19
X
76775
1
XXX
0
X
208.96
X
76775
2
XXX
0
X
235.10
X
76776
26
2
XXX
0
X
53.47
X
76776
26
3
XXX
0
X
53.47
X
76776
26
4
XXX
0
X
53.47
X
76776
26
1
XXX
0
X
58.20
X
76776
TC
2
XXX
0
X
123.58
X
76776
TC
3
XXX
0
X
123.58
X
76776
TC
4
XXX
0
X
123.58
X
76776
TC
1
XXX
0
X
153.71
X
76776
2
XXX
0
X
177.05
X
76776
3
XXX
0
X
177.05
X
76776
4
XXX
0
X
177.05
X
76776
1
XXX
0
X
211.93
X
76800
26
4
XXX
0
X
141.84
X
76800
26
3
XXX
0
X
143.35
X
76800
TC
4
XXX
0
X
150.84
X
76800
26
2
XXX
0
X
151.20
X
76800
26
1
XXX
0
X
153.16
X
76800
TC
3
XXX
0
X
155.31
X
76800
TC
2
XXX
0
X
163.79
X
76800
TC
1
XXX
0
X
164.50
X
76800
4
XXX
0
X
280.87
X
76800
3
XXX
0
X
288.49
X
76800
2
XXX
0
X
303.15
X
76800
1
XXX
0
X
304.49
X
76801
TC
2
XXX
0
X
72.64
X
76801
TC
3
XXX
0
X
72.64
X
76801
TC
4
XXX
0
X
72.64
X
76801
TC
1
XXX
0
X
88.95
X
76801
26
2
XXX
0
X
93.64
X
76801
26
3
XXX
0
X
93.64
X
76801
26
4
XXX
0
X
93.64
X
76801
26
1
XXX
0
X
101.86
X
76801
2
XXX
0
X
166.35
X
76801
3
XXX
0
X
166.35
X
76801
4
XXX
0
X
166.35
X
76801
1
XXX
0
X
190.79
X
76802
TC
2
XXX
0
X
51.35
X
76802
TC
3
XXX
0
X
51.35
X
76802
TC
4
XXX
0
X
51.35
X
76802
TC
1
XXX
0
X
63.85
X
76802
26
2
XXX
0
X
78.73
X
76802
26
3
XXX
0
X
78.73
X
76802
26
4
XXX
0
X
78.73
X
76802
26
1
XXX
0
X
85.89
X
76802
2
XXX
0
X
130.06
X
76802
3
XXX
0
X
130.06
X
76802
4
XXX
0
X
130.06
X
76802
1
XXX
0
X
149.71
X
76805
26
4
XXX
0
X
136.58
X
76805
26
3
XXX
0
X
140.15
X
76805
26
2
XXX
0
X
146.56
X
76805
26
1
XXX
0
X
146.97
X
76805
TC
4
XXX
0
X
170.84
X
76805
TC
3
XXX
0
X
173.55
X
76805
TC
2
XXX
0
X
188.21
X
76805
TC
1
XXX
0
X
191.73
X
76805
4
XXX
0
X
301.77
X
76805
3
XXX
0
X
309.89
X
76805
1
XXX
0
X
326.25
X
76805
2
XXX
0
X
326.45
X
76810
26
4
XXX
0
X
246.72
X
76810
26
3
XXX
0
X
249.46
X
76810
26
2
XXX
0
X
262.78
X
76810
26
1
XXX
0
X
265.94
X
76810
TC
4
XXX
0
X
340.77
X
76810
TC
3
XXX
0
X
346.30
X
76810
TC
2
XXX
0
X
375.22
X
76810
TC
1
XXX
0
X
382.11
X
76810
4
XXX
0
X
587.43
X
76810
3
XXX
0
X
595.70
X
76810
2
XXX
0
X
638.01
X
76810
1
XXX
0
X
648.10
X
76811
26
2
ZZZ
0
X
182.93
X
76811
26
3
ZZZ
0
X
182.93
X
76811
26
4
ZZZ
0
X
182.93
X
76811
26
1
ZZZ
0
X
201.85
X
76811
TC
2
ZZZ
0
X
246.54
X
76811
TC
3
ZZZ
0
X
246.54
X
76811
TC
4
ZZZ
0
X
246.54
X
76811
TC
1
ZZZ
0
X
302.36
X
76811
2
ZZZ
0
X
429.44
X
76811
3
ZZZ
0
X
429.44
X
76811
4
ZZZ
0
X
429.44
X
76811
1
ZZZ
0
X
504.21
X
76812
TC
2
XXX
0
X
85.59
X
76812
TC
3
XXX
0
X
85.59
X
76812
TC
4
XXX
0
X
85.59
X
76812
TC
1
XXX
0
X
112.58
X
76812
26
2
XXX
0
X
171.16
X
76812
26
3
XXX
0
X
171.16
X
76812
26
4
XXX
0
X
171.16
X
76812
26
1
XXX
0
X
188.08
X
76812
2
XXX
0
X
256.74
X
76812
3
XXX
0
X
256.74
X
76812
4
XXX
0
X
256.74
X
76812
1
XXX
0
X
300.63
X
76813
26
2
XXX
0
X
82.00
X
76813
26
3
XXX
0
X
82.00
X
76813
26
4
XXX
0
X
82.00
X
76813
26
1
XXX
0
X
89.10
X
76813
TC
2
XXX
0
X
98.83
X
76813
TC
3
XXX
0
X
98.83
X
76813
TC
4
XXX
0
X
98.83
X
76813
TC
1
XXX
0
X
124.17
X
76813
2
XXX
0
X
180.83
X
76813
3
XXX
0
X
180.83
X
76813
4
XXX
0
X
180.83
X
76813
1
XXX
0
X
213.30
X
76814
TC
2
XXX
0
X
51.37
X
76814
TC
3
XXX
0
X
51.37
X
76814
TC
4
XXX
0
X
51.37
X
76814
TC
1
XXX
0
X
66.09
X
76814
26
2
XXX
0
X
68.85
X
76814
26
3
XXX
0
X
68.85
X
76814
26
4
XXX
0
X
68.85
X
76814
26
1
XXX
0
X
75.00
X
76814
2
XXX
0
X
120.21
X
76814
3
XXX
0
X
120.21
X
76814
4
XXX
0
X
120.21
X
76814
1
XXX
0
X
141.12
X
76815
26
2
XXX
0
X
74.88
X
76815
26
3
XXX
0
X
74.88
X
76815
26
4
XXX
0
X
74.88
X
76815
26
1
XXX
0
X
82.64
X
76815
TC
2
XXX
0
X
109.89
X
76815
TC
3
XXX
0
X
109.89
X
76815
TC
4
XXX
0
X
109.89
X
76815
TC
1
XXX
0
X
132.48
X
76815
2
XXX
0
X
184.77
X
76815
3
XXX
0
X
184.77
X
76815
4
XXX
0
X
184.77
X
76815
1
XXX
0
X
215.10
X
76816
26
4
XXX
0
X
79.86
X
76816
26
3
XXX
0
X
81.96
X
76816
26
2
XXX
0
X
85.70
X
76816
26
1
XXX
0
X
85.93
X
76816
TC
4
XXX
0
X
90.57
X
76816
TC
3
XXX
0
X
92.03
X
76816
TC
2
XXX
0
X
99.83
X
76816
TC
1
XXX
0
X
101.71
X
76816
4
XXX
0
X
167.00
X
76816
3
XXX
0
X
171.54
X
76816
2
XXX
0
X
180.61
X
76816
1
XXX
0
X
181.49
X
76817
26
2
XXX
0
X
70.86
X
76817
26
3
XXX
0
X
70.86
X
76817
26
4
XXX
0
X
70.86
X
76817
26
1
XXX
0
X
76.71
X
76817
TC
2
XXX
0
X
100.41
X
76817
TC
3
XXX
0
X
100.41
X
76817
TC
4
XXX
0
X
100.41
X
76817
TC
1
XXX
0
X
119.74
X
76817
2
XXX
0
X
171.24
X
76817
3
XXX
0
X
171.24
X
76817
4
XXX
0
X
171.24
X
76817
1
XXX
0
X
196.46
X
76818
26
4
XXX
0
X
105.95
X
76818
26
3
XXX
0
X
108.68
X
76818
26
2
XXX
0
X
113.53
X
76818
26
1
XXX
0
X
113.96
X
76818
TC
4
XXX
0
X
131.86
X
76818
TC
3
XXX
0
X
134.00
X
76818
TC
2
XXX
0
X
145.35
X
76818
TC
1
XXX
0
X
147.97
X
76818
4
XXX
0
X
233.65
X
76818
3
XXX
0
X
239.90
X
76818
1
XXX
0
X
252.21
X
76818
2
XXX
0
X
252.66
X
76819
26
2
XXX
0
X
65.90
X
76819
26
3
XXX
0
X
65.90
X
76819
26
4
XXX
0
X
65.90
X
76819
26
1
XXX
0
X
71.80
X
76819
TC
2
XXX
0
X
117.30
X
76819
TC
3
XXX
0
X
117.30
X
76819
TC
4
XXX
0
X
117.30
X
76819
TC
1
XXX
0
X
140.36
X
76819
2
XXX
0
X
183.20
X
76819
3
XXX
0
X
183.20
X
76819
4
XXX
0
X
183.20
X
76819
1
XXX
0
X
212.21
X
76820
26
2
XXX
0
X
47.20
X
76820
26
3
XXX
0
X
47.20
X
76820
26
4
XXX
0
X
47.20
X
76820
26
1
XXX
0
X
51.44
X
76820
TC
2
XXX
0
X
106.29
X
76820
TC
3
XXX
0
X
106.29
X
76820
TC
4
XXX
0
X
106.29
X
76820
TC
1
XXX
0
X
130.80
X
76820
2
XXX
0
X
153.51
X
76820
3
XXX
0
X
153.51
X
76820
4
XXX
0
X
153.51
X
76820
1
XXX
0
X
182.20
X
76821
26
2
XXX
0
X
65.71
X
76821
26
3
XXX
0
X
65.71
X
76821
26
4
XXX
0
X
65.71
X
76821
26
1
XXX
0
X
71.16
X
76821
TC
2
XXX
0
X
106.29
X
76821
TC
3
XXX
0
X
106.29
X
76821
TC
4
XXX
0
X
106.29
X
76821
TC
1
XXX
0
X
130.80
X
76821
2
XXX
0
X
171.99
X
76821
3
XXX
0
X
171.99
X
76821
4
XXX
0
X
171.99
X
76821
1
XXX
0
X
201.98
X
76825
26
4
XXX
0
X
111.12
X
76825
26
3
XXX
0
X
113.97
X
76825
26
2
XXX
0
X
118.91
X
76825
26
1
XXX
0
X
119.35
X
76825
TC
4
XXX
0
X
160.48
X
76825
TC
3
XXX
0
X
163.07
X
76825
TC
2
XXX
0
X
176.83
X
76825
TC
1
XXX
0
X
180.04
X
76825
4
XXX
0
X
266.08
X
76825
3
XXX
0
X
273.19
X
76825
2
XXX
0
X
287.69
X
76825
1
XXX
0
X
302.38
X
76826
TC
4
XXX
0
X
57.99
X
76826
TC
3
XXX
0
X
58.98
X
76826
TC
1
XXX
0
X
65.34
X
76826
26
1
XXX
0
X
131.17
X
76826
26
2
XXX
0
X
134.00
X
76826
26
3
XXX
0
X
134.26
X
76826
26
4
XXX
0
X
143.58
X
76826
TC
2
XXX
0
X
186.41
X
76826
4
XXX
0
X
186.65
X
76826
3
XXX
0
X
229.62
X
76826
2
XXX
0
X
252.58
X
76826
1
XXX
0
X
258.57
X
76827
TC
4
XXX
0
X
142.34
X
76827
TC
3
XXX
0
X
144.61
X
76827
26
3
XXX
0
X
156.67
X
76827
TC
2
XXX
0
X
157.53
X
76827
26
4
XXX
0
X
157.83
X
76827
26
2
XXX
0
X
158.82
X
76827
TC
1
XXX
0
X
160.61
X
76827
26
1
XXX
0
X
161.32
X
76827
3
XXX
0
X
290.20
X
76827
4
XXX
0
X
292.38
X
76827
2
XXX
0
X
301.59
X
76827
1
XXX
0
X
303.89
X
76828
26
1
XXX
0
X
88.79
X
76828
26
2
XXX
0
X
89.43
X
76828
TC
4
XXX
0
X
92.26
X
76828
TC
3
XXX
0
X
93.67
X
76828
26
3
XXX
0
X
94.63
X
76828
TC
2
XXX
0
X
102.33
X
76828
TC
1
XXX
0
X
104.34
X
76828
26
4
XXX
0
X
111.94
X
76828
4
XXX
0
X
163.42
X
76828
3
XXX
0
X
168.85
X
76828
2
XXX
0
X
183.41
X
76828
1
XXX
0
X
188.91
X
76830
26
4
XXX
0
X
97.07
X
76830
26
3
XXX
0
X
98.75
X
76830
26
2
XXX
0
X
103.25
X
76830
26
1
XXX
0
X
103.55
X
76830
TC
4
XXX
0
X
124.73
X
76830
TC
3
XXX
0
X
126.74
X
76830
TC
2
XXX
0
X
137.64
X
76830
TC
1
XXX
0
X
140.20
X
76830
4
XXX
0
X
216.37
X
76830
3
XXX
0
X
222.19
X
76830
2
XXX
0
X
234.16
X
76830
1
XXX
0
X
234.93
X
76831
2
XXX
0
X
200.54
X
76831
3
XXX
0
X
200.54
X
76831
4
XXX
0
X
200.54
X
76831
1
XXX
0
X
233.65
X
76856
26
4
XXX
0
X
96.23
X
76856
26
3
XXX
0
X
98.77
X
76856
26
2
XXX
0
X
103.25
X
76856
26
1
XXX
0
X
103.55
X
76856
TC
4
XXX
0
X
124.73
X
76856
TC
3
XXX
0
X
126.74
X
76856
TC
2
XXX
0
X
137.64
X
76856
TC
1
XXX
0
X
140.20
X
76856
4
XXX
0
X
216.37
X
76856
3
XXX
0
X
222.19
X
76856
1
XXX
0
X
234.93
X
76856
2
XXX
0
X
237.03
X
76857
26
4
XXX
0
X
51.45
X
76857
26
3
XXX
0
X
52.81
X
76857
26
2
XXX
0
X
55.26
X
76857
26
1
XXX
0
X
55.51
X
76857
TC
4
XXX
0
X
85.82
X
76857
TC
3
XXX
0
X
87.22
X
76857
TC
2
XXX
0
X
94.72
X
76857
TC
1
XXX
0
X
96.56
X
76857
4
XXX
0
X
134.29
X
76857
3
XXX
0
X
137.87
X
76857
2
XXX
0
X
145.51
X
76857
1
XXX
0
X
147.97
X
76870
26
4
XXX
0
X
88.66
X
76870
26
3
XXX
0
X
90.79
X
76870
26
2
XXX
0
X
94.75
X
76870
26
1
XXX
0
X
95.01
X
76870
TC
4
XXX
0
X
124.73
X
76870
TC
3
XXX
0
X
126.74
X
76870
TC
2
XXX
0
X
137.64
X
76870
TC
1
XXX
0
X
140.20
X
76870
4
XXX
0
X
208.69
X
76870
3
XXX
0
X
214.30
X
76870
1
XXX
0
X
226.71
X
76870
2
XXX
0
X
227.07
X
76872
26
4
XXX
0
X
87.65
X
76872
26
3
XXX
0
X
88.66
X
76872
26
2
XXX
0
X
93.60
X
76872
26
1
XXX
0
X
94.75
X
76872
TC
4
XXX
0
X
124.73
X
76872
TC
3
XXX
0
X
126.74
X
76872
TC
2
XXX
0
X
137.64
X
76872
TC
1
XXX
0
X
140.20
X
76872
4
XXX
0
X
212.46
X
76872
3
XXX
0
X
215.39
X
76872
2
XXX
0
X
231.19
X
76872
1
XXX
0
X
234.93
X
76873
26
2
XXX
9
X
138.52
X
76873
26
3
XXX
9
X
138.52
X
76873
26
4
XXX
9
X
138.52
X
76873
26
1
XXX
9
X
150.48
X
76873
TC
2
XXX
9
X
156.68
X
76873
TC
3
XXX
9
X
156.68
X
76873
TC
4
XXX
9
X
156.68
X
76873
TC
1
XXX
9
X
187.87
X
76873
2
XXX
9
X
295.21
X
76873
3
XXX
9
X
295.21
X
76873
4
XXX
9
X
295.21
X
76873
1
XXX
9
X
338.32
X
76881
26
2
XXX
0
X
42.73
X
76881
26
3
XXX
0
X
42.73
X
76881
26
4
XXX
0
X
42.73
X
76881
26
1
XXX
0
X
45.61
X
76881
TC
2
XXX
0
X
123.15
X
76881
TC
3
XXX
0
X
123.15
X
76881
TC
4
XXX
0
X
123.15
X
76881
TC
1
XXX
0
X
139.54
X
76881
2
XXX
0
X
165.92
X
76881
3
XXX
0
X
165.92
X
76881
4
XXX
0
X
165.92
X
76881
1
XXX
0
X
185.17
X
76882
TC
2
XXX
0
X
14.62
X
76882
TC
3
XXX
0
X
14.62
X
76882
TC
4
XXX
0
X
14.62
X
76882
TC
1
XXX
0
X
16.73
X
76882
26
2
XXX
0
X
29.68
X
76882
26
3
XXX
0
X
29.68
X
76882
26
4
XXX
0
X
29.68
X
76882
26
1
XXX
0
X
31.71
X
76882
2
XXX
0
X
44.30
X
76882
3
XXX
0
X
44.30
X
76882
4
XXX
0
X
44.30
X
76882
1
XXX
0
X
48.45
X
76885
2
XXX
0
X
202.03
X
76885
3
XXX
0
X
202.03
X
76885
4
XXX
0
X
202.03
X
76885
1
XXX
0
X
235.22
X
76886
2
XXX
0
X
180.19
X
76886
3
XXX
0
X
180.19
X
76886
4
XXX
0
X
180.19
X
76886
1
XXX
0
X
210.07
X
76932
26
4
XXX
0
X
93.02
X
76932
26
3
XXX
0
X
95.48
X
76932
26
2
XXX
0
X
99.86
X
76932
26
1
XXX
0
X
100.21
X
76932
TC
4
XXX
0
X
124.73
X
76932
TC
3
XXX
0
X
126.74
X
76932
TC
2
XXX
0
X
137.64
X
76932
TC
1
XXX
0
X
140.20
X
76932
4
XXX
0
X
213.28
X
76932
3
XXX
0
X
218.89
X
76932
2
XXX
0
X
230.80
X
76932
1
XXX
0
X
232.36
X
76936
26
4
XXX
0
X
180.26
X
76936
26
3
XXX
0
X
182.66
X
76936
26
2
XXX
0
X
192.29
X
76936
26
1
XXX
0
X
196.70
X
76936
TC
4
XXX
0
X
504.41
X
76936
TC
3
XXX
0
X
513.55
X
76936
TC
2
XXX
0
X
561.39
X
76936
TC
1
XXX
0
X
580.79
X
76936
4
XXX
0
X
684.71
X
76936
3
XXX
0
X
696.31
X
76936
2
XXX
0
X
753.67
X
76936
1
XXX
0
X
777.48
X
76937
TC
2
ZZZ
0
X
29.25
X
76937
TC
3
ZZZ
0
X
29.25
X
76937
TC
4
ZZZ
0
X
29.25
X
76937
26
2
ZZZ
0
X
29.91
X
76937
26
3
ZZZ
0
X
29.91
X
76937
26
4
ZZZ
0
X
29.91
X
76937
26
1
ZZZ
0
X
33.61
X
76937
TC
1
ZZZ
0
X
37.61
X
76937
2
ZZZ
0
X
59.14
X
76937
3
ZZZ
0
X
59.14
X
76937
4
ZZZ
0
X
59.14
X
76937
1
ZZZ
0
X
71.27
X
76940
TC
2
XXX
0
X
113.52
X
76940
TC
3
XXX
0
X
113.52
X
76940
TC
4
XXX
0
X
113.52
X
76940
TC
1
XXX
0
X
142.86
X
76940
26
2
XXX
0
X
187.19
X
76940
26
3
XXX
0
X
187.19
X
76940
26
4
XXX
0
X
187.19
X
76940
26
1
XXX
0
X
203.21
X
76940
2
XXX
0
X
300.70
X
76940
3
XXX
0
X
300.70
X
76940
4
XXX
0
X
300.70
X
76940
1
XXX
0
X
346.09
X
76941
TC
4
XXX
0
X
122.56
X
76941
TC
3
XXX
0
X
124.74
X
76941
TC
2
XXX
0
X
136.34
X
76941
TC
1
XXX
0
X
141.03
X
76941
26
4
XXX
0
X
169.25
X
76941
26
3
XXX
0
X
171.29
X
76941
26
2
XXX
0
X
180.61
X
76941
26
1
XXX
0
X
185.12
X
76941
4
XXX
0
X
291.74
X
76941
3
XXX
0
X
296.11
X
76941
2
XXX
0
X
316.99
X
76941
1
XXX
0
X
326.11
X
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