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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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Fee Schedule
>
Fee Schedule 78606-80436
Begin Main Content Area
Page Content
2021 Workers' Compensation Part B Fee Schedule
78606-80436
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
78606
26
1
XXX
0
X
129.84
X
78606
26
4
XXX
0
X
132.94
X
78606
26
2
XXX
0
X
133.01
X
78606
26
3
XXX
0
X
133.92
X
78606
TC
4
XXX
0
X
314.54
X
78606
TC
3
XXX
0
X
319.67
X
78606
TC
2
XXX
0
X
346.36
X
78606
TC
1
XXX
0
X
352.68
X
78606
4
XXX
0
X
394.82
X
78606
3
XXX
0
X
400.84
X
78606
1
XXX
0
X
439.15
X
78606
2
XXX
0
X
439.31
X
78608
XXX
0
X
*
X
78609
XXX
0
X
*
X
78610
26
1
XXX
0
X
50.83
X
78610
26
2
XXX
0
X
52.63
X
78610
26
4
XXX
0
X
53.12
X
78610
26
3
XXX
0
X
54.34
X
78610
TC
4
XXX
0
X
128.71
X
78610
TC
3
XXX
0
X
130.77
X
78610
TC
2
XXX
0
X
141.90
X
78610
TC
1
XXX
0
X
144.58
X
78610
3
XXX
0
X
261.87
X
78610
2
XXX
0
X
264.17
X
78610
4
XXX
0
X
270.81
X
78610
1
XXX
0
X
275.12
X
78630
26
1
XXX
0
X
154.75
X
78630
26
2
XXX
0
X
158.76
X
78630
26
3
XXX
0
X
160.41
X
78630
26
4
XXX
0
X
161.91
X
78630
TC
4
XXX
0
X
409.92
X
78630
TC
3
XXX
0
X
416.57
X
78630
TC
2
XXX
0
X
451.70
X
78630
TC
1
XXX
0
X
459.94
X
78630
3
XXX
0
X
511.69
X
78630
4
XXX
0
X
518.69
X
78630
2
XXX
0
X
543.51
X
78630
1
XXX
0
X
552.98
X
78635
26
4
XXX
0
X
144.04
X
78635
26
3
XXX
0
X
145.05
X
78635
26
2
XXX
0
X
147.61
X
78635
26
1
XXX
0
X
147.96
X
78635
TC
4
XXX
0
X
207.39
X
78635
TC
3
XXX
0
X
210.71
X
78635
TC
2
XXX
0
X
228.53
X
78635
TC
1
XXX
0
X
232.81
X
78635
4
XXX
0
X
365.60
X
78635
3
XXX
0
X
369.47
X
78635
2
XXX
0
X
381.46
X
78635
1
XXX
0
X
383.66
X
78645
26
4
XXX
0
X
140.90
X
78645
26
3
XXX
0
X
141.84
X
78645
26
2
XXX
0
X
144.23
X
78645
26
1
XXX
0
X
144.63
X
78645
TC
4
XXX
0
X
279.65
X
78645
TC
3
XXX
0
X
284.19
X
78645
TC
2
XXX
0
X
308.08
X
78645
TC
1
XXX
0
X
313.68
X
78645
4
XXX
0
X
407.42
X
78645
3
XXX
0
X
412.16
X
78645
2
XXX
0
X
427.31
X
78645
1
XXX
0
X
430.04
X
78650
26
1
XXX
0
X
116.96
X
78650
26
2
XXX
0
X
122.18
X
78650
26
4
XXX
0
X
124.35
X
78650
26
3
XXX
0
X
126.93
X
78650
TC
4
XXX
0
X
377.31
X
78650
TC
3
XXX
0
X
383.38
X
78650
TC
2
XXX
0
X
415.55
X
78650
TC
1
XXX
0
X
423.17
X
78650
3
XXX
0
X
591.69
X
78650
2
XXX
0
X
602.13
X
78650
4
XXX
0
X
606.95
X
78650
1
XXX
0
X
624.04
X
78660
26
4
XXX
0
X
67.98
X
78660
26
3
XXX
0
X
68.75
X
78660
26
2
XXX
0
X
72.60
X
78660
26
1
XXX
0
X
73.51
X
78660
TC
4
XXX
0
X
172.39
X
78660
TC
3
XXX
0
X
175.16
X
78660
TC
2
XXX
0
X
189.92
X
78660
TC
1
XXX
0
X
193.38
X
78660
4
XXX
0
X
223.08
X
78660
3
XXX
0
X
226.76
X
78660
2
XXX
0
X
239.18
X
78660
1
XXX
0
X
241.57
X
78699
XXX
0
X
#
X
78700
26
4
XXX
0
X
86.59
X
78700
26
3
XXX
0
X
87.28
X
78700
26
2
XXX
0
X
89.18
X
78700
26
1
XXX
0
X
89.44
X
78700
TC
4
XXX
0
X
247.01
X
78700
TC
3
XXX
0
X
251.06
X
78700
TC
2
XXX
0
X
271.98
X
78700
TC
1
XXX
0
X
276.92
X
78700
3
XXX
0
X
312.08
X
78700
4
XXX
0
X
316.46
X
78700
2
XXX
0
X
331.36
X
78700
1
XXX
0
X
337.04
X
78701
26
1
XXX
0
X
82.64
X
78701
26
2
XXX
0
X
85.72
X
78701
26
4
XXX
0
X
86.47
X
78701
26
3
XXX
0
X
88.25
X
78701
TC
4
XXX
0
X
289.09
X
78701
TC
3
XXX
0
X
293.77
X
78701
TC
2
XXX
0
X
318.32
X
78701
TC
1
XXX
0
X
324.13
X
78701
3
XXX
0
X
348.29
X
78701
4
XXX
0
X
348.88
X
78701
2
XXX
0
X
370.97
X
78701
1
XXX
0
X
373.86
X
78707
26
2
XXX
0
X
108.86
X
78707
26
3
XXX
0
X
108.86
X
78707
26
4
XXX
0
X
108.86
X
78707
26
1
XXX
0
X
120.06
X
78707
TC
2
XXX
0
X
345.92
X
78707
TC
3
XXX
0
X
345.92
X
78707
TC
4
XXX
0
X
345.92
X
78707
TC
1
XXX
0
X
416.63
X
78707
2
XXX
0
X
454.80
X
78707
3
XXX
0
X
454.80
X
78707
4
XXX
0
X
454.80
X
78707
1
XXX
0
X
536.62
X
78708
26
2
XXX
0
X
127.85
X
78708
26
3
XXX
0
X
127.85
X
78708
26
4
XXX
0
X
127.85
X
78708
26
1
XXX
0
X
139.65
X
78708
TC
2
XXX
0
X
345.92
X
78708
TC
3
XXX
0
X
345.92
X
78708
TC
4
XXX
0
X
345.92
X
78708
TC
1
XXX
0
X
416.60
X
78708
2
XXX
0
X
473.78
X
78708
3
XXX
0
X
473.78
X
78708
4
XXX
0
X
473.78
X
78708
1
XXX
0
X
556.26
X
78709
26
2
XXX
0
X
143.03
X
78709
26
3
XXX
0
X
143.03
X
78709
26
4
XXX
0
X
143.03
X
78709
26
1
XXX
0
X
155.36
X
78709
TC
2
XXX
0
X
345.92
X
78709
TC
3
XXX
0
X
345.92
X
78709
TC
4
XXX
0
X
345.92
X
78709
TC
1
XXX
0
X
416.63
X
78709
2
XXX
0
X
488.96
X
78709
3
XXX
0
X
488.96
X
78709
4
XXX
0
X
488.96
X
78709
1
XXX
0
X
571.96
X
78725
26
4
XXX
0
X
79.92
X
78725
26
3
XXX
0
X
80.55
X
78725
26
2
XXX
0
X
82.22
X
78725
26
1
XXX
0
X
82.41
X
78725
TC
4
XXX
0
X
145.41
X
78725
TC
3
XXX
0
X
147.73
X
78725
TC
2
XXX
0
X
160.17
X
78725
TC
1
XXX
0
X
163.13
X
78725
3
XXX
0
X
270.59
X
78725
2
XXX
0
X
274.32
X
78725
4
XXX
0
X
278.56
X
78725
1
XXX
0
X
284.87
X
78730
26
4
XXX
0
X
100.81
X
78730
26
3
XXX
0
X
101.35
X
78730
26
2
XXX
0
X
102.66
X
78730
26
1
XXX
0
X
102.87
X
78730
TC
4
XXX
0
X
119.18
X
78730
TC
3
XXX
0
X
121.10
X
78730
TC
2
XXX
0
X
131.27
X
78730
TC
1
XXX
0
X
133.73
X
78730
4
XXX
0
X
246.39
X
78730
3
XXX
0
X
248.57
X
78730
2
XXX
0
X
255.46
X
78730
1
XXX
0
X
256.69
X
78740
26
1
XXX
0
X
88.38
X
78740
26
4
XXX
0
X
91.28
X
78740
26
2
XXX
0
X
91.37
X
78740
26
3
XXX
0
X
93.08
X
78740
TC
4
XXX
0
X
172.39
X
78740
TC
3
XXX
0
X
175.16
X
78740
TC
2
XXX
0
X
189.92
X
78740
TC
1
XXX
0
X
193.38
X
78740
3
XXX
0
X
346.47
X
78740
2
XXX
0
X
351.02
X
78740
4
XXX
0
X
356.49
X
78740
1
XXX
0
X
364.31
X
78761
26
4
XXX
0
X
156.95
X
78761
26
3
XXX
0
X
158.12
X
78761
26
2
XXX
0
X
161.16
X
78761
26
1
XXX
0
X
161.62
X
78761
TC
4
XXX
0
X
259.72
X
78761
TC
3
XXX
0
X
263.97
X
78761
TC
2
XXX
0
X
286.02
X
78761
TC
1
XXX
0
X
291.19
X
78761
4
XXX
0
X
442.31
X
78761
3
XXX
0
X
447.01
X
78761
2
XXX
0
X
461.71
X
78761
1
XXX
0
X
464.48
X
78799
XXX
0
X
#
X
78800
26
1
XXX
0
X
100.00
X
78800
26
3
XXX
0
X
101.01
X
78800
26
4
XXX
0
X
101.12
X
78800
26
2
XXX
0
X
101.64
X
78800
TC
4
XXX
0
X
276.47
X
78800
TC
3
XXX
0
X
280.90
X
78800
TC
2
XXX
0
X
304.28
X
78800
TC
1
XXX
0
X
309.84
X
78800
4
XXX
0
X
411.94
X
78800
3
XXX
0
X
416.74
X
78800
1
XXX
0
X
421.89
X
78800
2
XXX
0
X
427.43
X
78801
26
1
XXX
0
X
112.17
X
78801
26
4
XXX
0
X
114.67
X
78801
26
2
XXX
0
X
115.31
X
78801
26
3
XXX
0
X
116.96
X
78801
TC
4
XXX
0
X
343.98
X
78801
TC
3
XXX
0
X
349.50
X
78801
TC
2
XXX
0
X
379.04
X
78801
TC
1
XXX
0
X
386.03
X
78801
3
XXX
0
X
576.59
X
78801
2
XXX
0
X
586.50
X
78801
4
XXX
0
X
591.41
X
78801
1
XXX
0
X
607.83
X
78802
26
1
XXX
0
X
150.03
X
78802
26
3
XXX
0
X
152.99
X
78802
26
2
XXX
0
X
153.01
X
78802
26
4
XXX
0
X
153.64
X
78802
TC
4
XXX
0
X
450.40
X
78802
TC
3
XXX
0
X
457.68
X
78802
TC
2
XXX
0
X
496.30
X
78802
TC
1
XXX
0
X
505.47
X
78802
3
XXX
0
X
659.40
X
78802
4
XXX
0
X
673.37
X
78802
2
XXX
0
X
674.34
X
78802
1
XXX
0
X
697.15
X
78803
26
4
XXX
0
X
136.06
X
78803
26
3
XXX
0
X
137.58
X
78803
26
2
XXX
0
X
144.82
X
78803
26
1
XXX
0
X
146.65
X
78803
TC
4
XXX
0
X
533.00
X
78803
TC
3
XXX
0
X
541.61
X
78803
TC
2
XXX
0
X
586.83
X
78803
TC
1
XXX
0
X
597.56
X
78803
4
XXX
0
X
669.05
X
78803
3
XXX
0
X
679.18
X
78803
2
XXX
0
X
731.67
X
78803
1
XXX
0
X
744.17
X
78804
26
2
XXX
0
X
99.96
X
78804
26
3
XXX
0
X
99.96
X
78804
26
4
XXX
0
X
99.96
X
78804
26
1
XXX
0
X
107.54
X
78804
TC
2
XXX
0
X
292.07
X
78804
TC
3
XXX
0
X
292.07
X
78804
TC
4
XXX
0
X
292.07
X
78804
TC
1
XXX
0
X
353.06
X
78804
2
XXX
0
X
392.03
X
78804
3
XXX
0
X
392.03
X
78804
4
XXX
0
X
392.03
X
78804
1
XXX
0
X
460.63
X
78808
2
XXX
0
X
63.79
X
78808
3
XXX
0
X
63.79
X
78808
4
XXX
0
X
63.79
X
78808
1
XXX
0
X
74.71
X
78811
XXX
0
X
*
X
78812
XXX
0
X
*
X
78813
XXX
0
X
*
X
78814
XXX
0
X
*
X
78815
XXX
0
X
*
X
78816
XXX
0
X
*
X
78830
26
2
XXX
0
X
85.17
X
78830
26
3
XXX
0
X
85.17
X
78830
26
4
XXX
0
X
85.17
X
78830
26
1
XXX
0
X
90.81
X
78830
TC
2
XXX
0
X
480.89
X
78830
TC
3
XXX
0
X
480.89
X
78830
TC
4
XXX
0
X
480.89
X
78830
TC
1
XXX
0
X
554.16
X
78830
2
XXX
0
X
566.04
X
78830
3
XXX
0
X
566.04
X
78830
4
XXX
0
X
566.04
X
78830
1
XXX
0
X
644.96
X
78831
26
2
XXX
0
X
103.95
X
78831
26
3
XXX
0
X
103.95
X
78831
26
4
XXX
0
X
103.95
X
78831
26
1
XXX
0
X
110.90
X
78831
TC
2
XXX
0
X
713.95
X
78831
TC
3
XXX
0
X
713.95
X
78831
TC
4
XXX
0
X
713.95
X
78831
2
XXX
0
X
817.90
X
78831
3
XXX
0
X
817.90
X
78831
4
XXX
0
X
817.90
X
78831
TC
1
XXX
0
X
822.85
X
78831
1
XXX
0
X
933.75
X
78832
26
2
XXX
0
X
121.07
X
78832
26
3
XXX
0
X
121.07
X
78832
26
4
XXX
0
X
121.07
X
78832
26
1
XXX
0
X
129.13
X
78832
TC
2
XXX
0
X
942.57
X
78832
TC
3
XXX
0
X
942.57
X
78832
TC
4
XXX
0
X
942.57
X
78832
2
XXX
0
X
1,063.64
X
78832
3
XXX
0
X
1,063.64
X
78832
4
XXX
0
X
1,063.64
X
78832
TC
1
XXX
0
X
1,086.12
X
78832
1
XXX
0
X
1,215.25
X
78835
26
2
ZZZ
0
X
26.73
X
78835
26
3
ZZZ
0
X
26.73
X
78835
26
4
ZZZ
0
X
26.73
X
78835
26
1
ZZZ
0
X
28.49
X
78835
TC
2
ZZZ
0
X
92.34
X
78835
TC
3
ZZZ
0
X
92.34
X
78835
TC
4
ZZZ
0
X
92.34
X
78835
TC
1
ZZZ
0
X
106.41
X
78835
2
ZZZ
0
X
119.06
X
78835
3
ZZZ
0
X
119.06
X
78835
4
ZZZ
0
X
119.06
X
78835
1
ZZZ
0
X
134.91
X
78999
XXX
0
X
#
X
79005
26
2
XXX
0
X
163.27
X
79005
26
3
XXX
0
X
163.27
X
79005
26
4
XXX
0
X
163.27
X
79005
TC
2
XXX
0
X
169.96
X
79005
TC
3
XXX
0
X
169.96
X
79005
TC
4
XXX
0
X
169.96
X
79005
26
1
XXX
0
X
176.24
X
79005
TC
1
XXX
0
X
207.70
X
79005
2
XXX
0
X
333.22
X
79005
3
XXX
0
X
333.22
X
79005
4
XXX
0
X
333.22
X
79005
1
XXX
0
X
383.93
X
79101
TC
2
XXX
0
X
169.96
X
79101
TC
3
XXX
0
X
169.96
X
79101
TC
4
XXX
0
X
169.96
X
79101
26
2
XXX
0
X
178.46
X
79101
26
3
XXX
0
X
178.46
X
79101
26
4
XXX
0
X
178.46
X
79101
26
1
XXX
0
X
192.47
X
79101
TC
1
XXX
0
X
207.70
X
79101
2
XXX
0
X
348.36
X
79101
3
XXX
0
X
348.36
X
79101
4
XXX
0
X
348.36
X
79101
1
XXX
0
X
400.18
X
79200
TC
4
XXX
0
X
214.55
X
79200
TC
3
XXX
0
X
218.00
X
79200
TC
2
XXX
0
X
236.62
X
79200
TC
1
XXX
0
X
241.08
X
79200
26
4
XXX
0
X
241.56
X
79200
26
3
XXX
0
X
245.14
X
79200
26
2
XXX
0
X
255.28
X
79200
26
1
XXX
0
X
256.99
X
79200
3
XXX
0
X
705.08
X
79200
2
XXX
0
X
711.06
X
79200
4
XXX
0
X
727.62
X
79200
1
XXX
0
X
738.84
X
79300
26
4
XXX
0
X
200.77
X
79300
26
3
XXX
0
X
203.06
X
79300
26
2
XXX
0
X
214.03
X
79300
TC
4
XXX
0
X
214.55
X
79300
26
1
XXX
0
X
216.73
X
79300
TC
3
XXX
0
X
218.00
X
79300
TC
2
XXX
0
X
236.62
X
79300
TC
1
XXX
0
X
241.08
X
79300
4
XXX
0
X
415.35
X
79300
3
XXX
0
X
421.04
X
79300
2
XXX
0
X
450.66
X
79300
1
XXX
0
X
457.76
X
79403
26
2
XXX
0
X
218.92
X
79403
26
3
XXX
0
X
218.92
X
79403
26
4
XXX
0
X
218.92
X
79403
26
1
XXX
0
X
236.88
X
79403
TC
2
XXX
0
X
283.31
X
79403
TC
3
XXX
0
X
283.31
X
79403
TC
4
XXX
0
X
283.31
X
79403
TC
1
XXX
0
X
337.59
X
79403
2
XXX
0
X
502.24
X
79403
3
XXX
0
X
502.24
X
79403
4
XXX
0
X
502.24
X
79403
1
XXX
0
X
574.45
X
79440
TC
4
XXX
0
X
214.55
X
79440
TC
3
XXX
0
X
218.00
X
79440
TC
2
XXX
0
X
236.62
X
79440
TC
1
XXX
0
X
241.08
X
79440
26
4
XXX
0
X
249.92
X
79440
26
3
XXX
0
X
252.74
X
79440
26
2
XXX
0
X
266.57
X
79440
26
1
XXX
0
X
269.92
X
79440
4
XXX
0
X
464.50
X
79440
3
XXX
0
X
470.71
X
79440
2
XXX
0
X
503.16
X
79440
1
XXX
0
X
510.93
X
79445
TC
2
XXX
0
X
171.05
X
79445
TC
3
XXX
0
X
171.05
X
79445
TC
4
XXX
0
X
171.05
X
79445
TC
1
XXX
0
X
209.58
X
79445
26
2
XXX
0
X
219.67
X
79445
26
3
XXX
0
X
219.67
X
79445
26
4
XXX
0
X
219.67
X
79445
26
1
XXX
0
X
237.75
X
79445
2
XXX
0
X
390.70
X
79445
3
XXX
0
X
390.70
X
79445
4
XXX
0
X
390.70
X
79445
1
XXX
0
X
447.30
X
79999
XXX
0
X
#
X
80047
XXX
9
X
48.30
X
80048
XXX
9
X
24.47
25.30
80050
XXX
9
X
*
X
80051
XXX
9
X
27.01
27.92
80053
XXX
9
X
30.57
31.56
80055
XXX
9
X
232.18
239.90
80061
XXX
9
X
51.61
53.31
80069
XXX
9
X
25.06
25.91
80074
XXX
9
X
137.61
142.19
80076
XXX
9
X
23.65
24.43
80081
XXX
9
X
133.18
X
80143
XXX
9
X
21.06
X
80145
X
45.58
X
80150
XXX
9
X
57.98
59.96
80151
XXX
9
X
21.06
X
80155
XXX
9
X
26.46
X
80156
XXX
9
X
55.90
57.79
80157
XXX
9
X
27.28
28.18
80158
XXX
9
X
69.38
71.72
80159
XXX
9
X
34.57
X
80161
XXX
9
X
21.06
X
80162
XXX
9
X
51.11
52.82
80163
X
24.29
X
80164
XXX
9
X
49.20
50.86
80165
X
24.77
X
80167
XXX
9
X
21.06
X
80168
XXX
9
X
62.92
64.99
80169
XXX
9
X
25.68
X
80170
XXX
9
X
63.12
65.21
80171
XXX
9
X
24.78
X
80173
XXX
9
X
39.97
41.30
80175
XXX
9
X
24.78
X
80176
XXX
9
X
51.04
52.76
80177
XXX
9
X
24.78
X
80178
XXX
9
X
24.95
25.76
80179
XXX
9
X
21.06
X
80180
XXX
9
X
33.75
X
80181
XXX
9
X
21.06
X
80183
XXX
9
X
24.78
X
80184
XXX
9
X
43.21
44.67
80185
XXX
9
X
50.16
51.83
80186
XXX
9
X
52.53
54.31
80187
X
32.04
X
80188
XXX
9
X
64.98
67.16
80189
XXX
9
X
30.63
X
80190
XXX
9
X
64.29
66.42
80192
XXX
9
X
64.29
66.42
80193
XXX
9
X
43.58
X
80194
XXX
9
X
55.65
57.54
80195
XXX
9
X
32.90
X
80197
XXX
9
X
44.75
X
80198
XXX
9
X
53.80
55.61
80199
XXX
9
X
33.75
X
80200
XXX
9
X
61.21
63.24
80201
XXX
9
X
*
X
80202
XXX
9
X
49.20
50.86
80203
XXX
9
X
24.78
X
80204
XXX
9
X
43.58
X
80210
XXX
9
X
30.63
X
80230
X
45.58
X
80235
X
32.04
X
80280
X
45.58
X
80285
X
32.04
X
80299
XXX
9
X
*
X
80305
X
19.20
X
80306
X
25.62
X
80307
X
102.50
X
80320
X
*
X
80321
X
*
X
80322
X
*
X
80323
X
*
X
80324
X
*
X
80325
X
*
X
80326
X
*
X
80327
X
*
X
80328
X
#
X
80329
X
*
X
80330
X
*
X
80331
X
*
X
80332
X
*
X
80333
X
*
X
80334
X
*
X
80335
X
*
X
80336
X
*
X
80337
X
*
X
80338
X
*
X
80339
X
*
X
80340
X
*
X
80341
X
*
X
80342
X
*
X
80343
X
*
X
80344
X
*
X
80345
X
*
X
80346
X
*
X
80347
X
*
X
80348
X
*
X
80349
X
*
X
80350
X
*
X
80351
X
*
X
80352
X
*
X
80353
X
*
X
80354
X
*
X
80355
X
*
X
80356
X
*
X
80357
X
*
X
80358
X
*
X
80359
X
*
X
80360
X
*
X
80361
X
*
X
80362
X
*
X
80363
X
*
X
80364
X
*
X
80365
X
*
X
80366
X
*
X
80367
X
*
X
80368
X
*
X
80369
X
*
X
80370
X
*
X
80371
X
*
X
80372
X
*
X
80373
X
*
X
80374
X
*
X
80375
X
*
X
80376
X
*
X
80377
X
*
X
80400
XXX
9
X
122.69
126.76
80402
XXX
9
X
312.94
323.38
80406
XXX
9
X
537.06
554.91
80408
XXX
9
X
491.74
508.12
80410
XXX
9
X
412.11
425.83
80412
XXX
9
X
1,260.12
1,302.12
80414
XXX
9
X
198.59
205.18
80415
XXX
9
X
213.54
220.64
80416
XXX
9
X
442.17
456.87
80417
XXX
9
X
147.36
152.26
80418
XXX
9
X
2,148.44
2,220.04
80420
XXX
9
X
269.95
278.94
80422
XXX
9
X
174.03
179.88
80424
XXX
9
X
191.77
198.13
80426
XXX
9
X
558.28
576.88
80428
XXX
9
X
260.65
269.36
80430
XXX
9
X
303.55
313.65
80432
XXX
9
X
512.02
529.06
80434
XXX
9
X
380.89
393.54
80435
XXX
9
X
396.45
409.59
80436
XXX
9
X
248.86
257.18
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