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2021 Workers' Compensation Part B Fee Schedule

93313-93619

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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
93313   4 XXX 0 X 138.61 X
93313   3 XXX 0 X 140.26 X
93313   2 XXX 0 X 147.80 X
93313   1 XXX 0 X 149.60 X
93314 26 4 XXX 0 X 138.61 X
93314 26 3 XXX 0 X 140.26 X
93314 26 2 XXX 0 X 147.80 X
93314 26 1 XXX 0 X 149.60 X
93314 TC 4 XXX 0 X 315.87 X
93314 TC 3 XXX 0 X 320.82 X
93314 TC 2 XXX 0 X 350.95 X
93314 TC 1 XXX 0 X 358.05 X
93314   4 XXX 0 X 454.42 X
93314   3 XXX 0 X 461.07 X
93314   2 XXX 0 X 498.73 X
93314   1 XXX 0 X 507.77 X
93315 TC 3 XXX 0 X 280.22 X
93315 TC 4 XXX 0 X 280.22 X
93315 TC 2 XXX 0 X 287.92 X
93315 26 3 XXX 0 X 303.05 X
93315 26 4 XXX 0 X 303.05 X
93315 26 2 XXX 0 X 311.35 X
93315 26 1 XXX 0 X 333.38 X
93315 TC 1 XXX 0 X 342.65 X
93315   3 XXX 0 X 583.27 X
93315   4 XXX 0 X 583.27 X
93315   2 XXX 0 X 599.33 X
93315   1 XXX 0 X 676.04 X
93316   3 XXX 0 X 119.75 X
93316   4 XXX 0 X 119.75 X
93316   2 XXX 0 X 123.09 X
93316   1 XXX 0 X 133.77 X
93317 26 3 XXX 0 X 182.51 X
93317 26 4 XXX 0 X 182.51 X
93317 26 2 XXX 0 X 187.56 X
93317 26 1 XXX 0 X 198.76 X
93317 TC 3 XXX 0 X 280.22 X
93317 TC 4 XXX 0 X 280.22 X
93317 TC 2 XXX 0 X 287.92 X
93317 TC 1 XXX 0 X 342.65 X
93317   3 XXX 0 X 462.77 X
93317   4 XXX 0 X 462.77 X
93317   2 XXX 0 X 475.47 X
93317   1 XXX 0 X 541.40 X
93318     XXX 0 X * X
93320 26 2 ZZZ 0 X 64.29 X
93320 26 3 ZZZ 0 X 64.29 X
93320 26 4 ZZZ 0 X 64.29 X
93320 26 1 ZZZ 0 X 73.39 X
93320 TC 2 ZZZ 0 X 133.91 X
93320 TC 3 ZZZ 0 X 133.91 X
93320 TC 4 ZZZ 0 X 133.91 X
93320 TC 1 ZZZ 0 X 162.25 X
93320   2 ZZZ 0 X 198.19 X
93320   3 ZZZ 0 X 198.19 X
93320   4 ZZZ 0 X 198.19 X
93320   1 ZZZ 0 X 235.62 X
93321 26 1 ZZZ 0 X 71.09 X
93321 26 2 ZZZ 0 X 71.88 X
93321 26 3 ZZZ 0 X 77.54 X
93321 TC 4 ZZZ 0 X 92.26 X
93321 TC 3 ZZZ 0 X 93.67 X
93321 26 4 ZZZ 0 X 95.01 X
93321 TC 2 ZZZ 0 X 102.33 X
93321 TC 1 ZZZ 0 X 104.34 X
93321   4 ZZZ 0 X 126.18 X
93321   3 ZZZ 0 X 165.02 X
93321   2 ZZZ 0 X 180.46 X
93321   1 ZZZ 0 X 186.07 X
93325 26 2 ZZZ 0 X 9.00 X
93325 26 3 ZZZ 0 X 9.00 X
93325 26 4 ZZZ 0 X 9.00 X
93325 26 1 ZZZ 0 X 10.17 X
93325 TC 2 ZZZ 0 X 227.88 X
93325 TC 3 ZZZ 0 X 227.88 X
93325 TC 4 ZZZ 0 X 227.88 X
93325   2 ZZZ 0 X 236.87 X
93325   3 ZZZ 0 X 236.87 X
93325   4 ZZZ 0 X 236.87 X
93325 TC 1 ZZZ 0 X 276.73 X
93325   1 ZZZ 0 X 286.97 X
93350 TC 4 XXX 0 X 284.63 X
93350 TC 3 XXX 0 X 289.10 X
93350 TC 1 XXX 0 X 321.23 X
93350 26 4 XXX 0 X 477.66 X
93350 26 3 XXX 0 X 479.50 X
93350 26 2 XXX 0 X 488.28 X
93350 26 1 XXX 0 X 490.41 X
93350 TC 2 XXX 0 X 621.24 X
93350   4 XXX 0 X 911.09 X
93350   3 XXX 0 X 914.82 X
93350   2 XXX 0 X 934.47 X
93350   1 XXX 0 X 939.19 X
93351   2 XXX 0 X 401.53 X
93351   3 XXX 0 X 401.53 X
93351   4 XXX 0 X 401.53 X
93351   1 XXX 0 X 465.89 X
93352   2 XXX 0 X 55.67 X
93352   3 XXX 0 X 55.67 X
93352   4 XXX 0 X 55.67 X
93352   1 XXX 0 X 64.98 X
93355   2 XXX 6 X 302.46 X
93355   3 XXX 6 X 302.46 X
93355   4 XXX 6 X 302.46 X
93355   1 XXX 6 X 321.41 X
93356   2 ZZZ 0 X 45.75 14.18
93356   3 ZZZ 0 X 45.75 14.18
93356   4 ZZZ 0 X 45.75 14.18
93356   1 ZZZ 0 X 51.61 15.25
93451 26 2 0 2 X 221.83 X
93451 26 3 0 2 X 221.83 X
93451 26 4 0 2 X 221.83 X
93451 26 1 0 2 X 246.11 X
93451 TC 2 0 2 X 877.37 X
93451 TC 3 0 2 X 877.37 X
93451 TC 4 0 2 X 877.37 X
93451 TC 1 0 2 X 993.32 X
93451   2 0 2 X 1,099.20 X
93451   3 0 2 X 1,099.20 X
93451   4 0 2 X 1,099.20 X
93451   1 0 2 X 1,239.43 X
93452 26 2 0 2 X 388.97 X
93452 26 3 0 2 X 388.97 X
93452 26 4 0 2 X 388.97 X
93452 26 1 0 2 X 432.14 X
93452 TC 2 0 2 X 838.11 X
93452 TC 3 0 2 X 838.11 X
93452 TC 4 0 2 X 838.11 X
93452 TC 1 0 2 X 948.91 X
93452   2 0 2 X 1,227.07 X
93452   3 0 2 X 1,227.07 X
93452   4 0 2 X 1,227.07 X
93452   1 0 2 X 1,381.07 X
93453 26 2 0 2 X 509.73 X
93453 26 3 0 2 X 509.73 X
93453 26 4 0 2 X 509.73 X
93453 26 1 0 2 X 565.85 X
93453 TC 2 0 2 X 1,096.01 X
93453 TC 3 0 2 X 1,096.01 X
93453 TC 4 0 2 X 1,096.01 X
93453 TC 1 0 2 X 1,240.89 X
93453   2 0 2 X 1,605.71 X
93453   3 0 2 X 1,605.71 X
93453   4 0 2 X 1,605.71 X
93453   1 0 2 X 1,806.76 X
93454 26 2 0 2 X 391.98 X
93454 26 3 0 2 X 391.98 X
93454 26 4 0 2 X 391.98 X
93454 26 1 0 2 X 435.28 X
93454 TC 2 0 2 X 872.99 X
93454 TC 3 0 2 X 872.99 X
93454 TC 4 0 2 X 872.99 X
93454 TC 1 0 2 X 988.39 X
93454   2 0 2 X 1,264.97 X
93454   3 0 2 X 1,264.97 X
93454   4 0 2 X 1,264.97 X
93454   1 0 2 X 1,423.68 X
93455 26 2 0 2 X 452.31 X
93455 26 3 0 2 X 452.31 X
93455 26 4 0 2 X 452.31 X
93455 26 1 0 2 X 502.00 X
93455 TC 2 0 2 X 1,023.31 X
93455 TC 3 0 2 X 1,023.31 X
93455 TC 4 0 2 X 1,023.31 X
93455 TC 1 0 2 X 1,158.68 X
93455   2 0 2 X 1,475.62 X
93455   3 0 2 X 1,475.62 X
93455   4 0 2 X 1,475.62 X
93455   1 0 2 X 1,660.64 X
93456 26 2 0 2 X 501.50 X
93456 26 3 0 2 X 501.50 X
93456 26 4 0 2 X 501.50 X
93456 26 1 0 2 X 556.29 X
93456 TC 2 0 2 X 1,081.96 X
93456 TC 3 0 2 X 1,081.96 X
93456 TC 4 0 2 X 1,081.96 X
93456 TC 1 0 2 X 1,224.99 X
93456   2 0 2 X 1,583.43 X
93456   3 0 2 X 1,583.43 X
93456   4 0 2 X 1,583.43 X
93456   1 0 2 X 1,781.30 X
93457 26 2 0 2 X 562.44 X
93457 26 3 0 2 X 562.44 X
93457 26 4 0 2 X 562.44 X
93457 26 1 0 2 X 624.11 X
93457 TC 2 0 2 X 1,231.71 X
93457 TC 3 0 2 X 1,231.71 X
93457 TC 4 0 2 X 1,231.71 X
93457 TC 1 0 2 X 1,394.43 X
93457   2 0 2 X 1,794.12 X
93457   3 0 2 X 1,794.12 X
93457   4 0 2 X 1,794.12 X
93457   1 0 2 X 2,018.55 X
93458 26 2 0 2 X 478.27 X
93458 26 3 0 2 X 478.27 X
93458 26 4 0 2 X 478.27 X
93458 26 1 0 2 X 531.05 X
93458 TC 2 0 2 X 1,048.50 X
93458 TC 3 0 2 X 1,048.50 X
93458 TC 4 0 2 X 1,048.50 X
93458 TC 1 0 2 X 1,187.17 X
93458   2 0 2 X 1,526.77 X
93458   3 0 2 X 1,526.77 X
93458   4 0 2 X 1,526.77 X
93458   1 0 2 X 1,718.21 X
93459 26 2 0 2 X 538.07 X
93459 26 3 0 2 X 538.07 X
93459 26 4 0 2 X 538.07 X
93459 26 1 0 2 X 596.91 X
93459 TC 2 0 2 X 1,148.33 X
93459 TC 3 0 2 X 1,148.33 X
93459 TC 4 0 2 X 1,148.33 X
93459 TC 1 0 2 X 1,300.14 X
93459   2 0 2 X 1,686.42 X
93459   3 0 2 X 1,686.42 X
93459   4 0 2 X 1,686.42 X
93459   1 0 2 X 1,897.04 X
93460 26 2 0 2 X 599.44 X
93460 26 3 0 2 X 599.44 X
93460 26 4 0 2 X 599.44 X
93460 26 1 0 2 X 664.96 X
93460 TC 2 0 2 X 1,206.49 X
93460 TC 3 0 2 X 1,206.49 X
93460 TC 4 0 2 X 1,206.49 X
93460 TC 1 0 2 X 1,365.92 X
93460   2 0 2 X 1,805.94 X
93460   3 0 2 X 1,805.94 X
93460   4 0 2 X 1,805.94 X
93460   1 0 2 X 2,030.92 X
93461 26 2 0 2 X 661.47 X
93461 26 3 0 2 X 661.47 X
93461 26 4 0 2 X 661.47 X
93461 26 1 0 2 X 734.10 X
93461 TC 2 0 2 X 1,406.73 X
93461 TC 3 0 2 X 1,406.73 X
93461 TC 4 0 2 X 1,406.73 X
93461 TC 1 0 2 X 1,592.67 X
93461   2 0 2 X 2,068.16 X
93461   3 0 2 X 2,068.16 X
93461   4 0 2 X 2,068.16 X
93461   1 0 2 X 2,326.82 X
93462   2 ZZZ 0 X 304.49 X
93462   3 ZZZ 0 X 304.49 X
93462   4 ZZZ 0 X 304.49 X
93462   1 ZZZ 0 X 337.64 X
93463   2 ZZZ 0 X 161.18 X
93463   3 ZZZ 0 X 161.18 X
93463   4 ZZZ 0 X 161.18 X
93463   1 ZZZ 0 X 177.96 X
93464 26 2 ZZZ 0 X 142.03 X
93464 26 3 ZZZ 0 X 142.03 X
93464 26 4 ZZZ 0 X 142.03 X
93464 26 1 ZZZ 0 X 156.73 X
93464 TC 2 ZZZ 0 X 223.97 X
93464 TC 3 ZZZ 0 X 223.97 X
93464 TC 4 ZZZ 0 X 223.97 X
93464 TC 1 ZZZ 0 X 253.60 X
93464   2 ZZZ 0 X 366.01 X
93464   3 ZZZ 0 X 366.01 X
93464   4 ZZZ 0 X 366.01 X
93464   1 ZZZ 0 X 410.37 X
93503   3 0 0 X 531.96 X
93503   4 0 0 X 542.95 X
93503   1 0 0 X 569.97 X
93503   2 0 0 X 592.25 X
93505 TC 4 0 2 X 166.30 X
93505 TC 3 0 2 X 168.87 X
93505 TC 2 0 2 X 184.95 X
93505 TC 1 0 2 X 188.86 X
93505 26 3 0 2 X 699.75 X
93505 26 4 0 2 X 730.24 X
93505 26 2 0 2 X 746.45 X
93505 26 1 0 2 X 751.67 X
93505   4 0 2 X 815.01 X
93505   3 0 2 X 825.27 X
93505   2 0 2 X 876.24 X
93505   1 0 2 X 888.48 X
93530 26 2 0 2 X 620.54 X
93530 26 3 0 2 X 620.54 X
93530 26 4 0 2 X 620.54 X
93530 26 1 0 2 X 697.08 X
93530 TC 2 0 2 X 1,318.56 X
93530 TC 3 0 2 X 1,318.56 X
93530 TC 4 0 2 X 1,318.56 X
93530 TC 1 0 2 X 1,594.27 X
93530   2 0 2 X 1,939.09 X
93530   3 0 2 X 1,939.09 X
93530   4 0 2 X 1,939.09 X
93530   1 0 2 X 2,291.37 X
93531 26 2 0 2 X 1,078.80 X
93531 26 3 0 2 X 1,078.80 X
93531 26 4 0 2 X 1,078.80 X
93531 26 1 0 2 X 1,193.67 X
93531 TC 2 0 2 X 3,768.05 X
93531 TC 3 0 2 X 3,768.05 X
93531 TC 4 0 2 X 3,768.05 X
93531 TC 1 0 2 X 4,556.40 X
93531   2 0 2 X 4,846.84 X
93531   3 0 2 X 4,846.84 X
93531   4 0 2 X 4,846.84 X
93531   1 0 2 X 5,750.10 X
93532 26 2 0 2 X 1,341.39 X
93532 26 3 0 2 X 1,341.39 X
93532 26 4 0 2 X 1,341.39 X
93532 26 1 0 2 X 1,488.91 X
93532 TC 2 0 2 X 3,667.50 X
93532 TC 3 0 2 X 3,667.50 X
93532 TC 4 0 2 X 3,667.50 X
93532 TC 1 0 2 X 4,434.84 X
93532   2 0 2 X 5,008.84 X
93532   3 0 2 X 5,008.84 X
93532   4 0 2 X 5,008.84 X
93532   1 0 2 X 5,923.75 X
93533 26 2 0 2 X 748.34 X
93533 26 3 0 2 X 748.34 X
93533 26 4 0 2 X 748.34 X
93533 26 1 0 2 X 816.54 X
93533 TC 2 0 2 X 3,667.50 X
93533 TC 3 0 2 X 3,667.50 X
93533 TC 4 0 2 X 3,667.50 X
93533   2 0 2 X 4,415.82 X
93533   3 0 2 X 4,415.82 X
93533   4 0 2 X 4,415.82 X
93533 TC 1 0 2 X 4,434.86 X
93533   1 0 2 X 5,251.40 X
93561 TC 4 0 0 X 46.26 X
93561 TC 2 0 0 X 52.10 X
93561 TC 1 0 0 X 53.31 X
93561 TC 3 0 0 X 62.55 X
93561 26 3 0 0 X 157.14 X
93561 26 4 0 0 X 164.08 X
93561 26 2 0 0 X 175.48 X
93561 26 1 0 0 X 177.78 X
93561   3 0 0 X 185.01 X
93561   2 0 0 X 203.20 X
93561   4 0 0 X 210.35 X
93561   1 0 0 X 231.08 X
93562 TC 4 0 0 X 27.12 X
93562 TC 3 0 0 X 27.49 X
93562 TC 2 0 0 X 30.51 X
93562 TC 1 0 0 X 31.20 X
93562   4 0 0 X 100.07 X
93562 26 2 0 0 X 101.22 X
93562   3 0 0 X 104.16 X
93562   1 0 0 X 111.70 X
93562   2 0 0 X 116.94 X
93562 26 3 0 0 X 119.25 X
93562 26 1 0 0 X 120.50 X
93562 26 4 0 0 X 134.51 X
93563   2 ZZZ 0 X 83.05 X
93563   3 ZZZ 0 X 83.05 X
93563   4 ZZZ 0 X 83.05 X
93563   1 ZZZ 0 X 89.32 X
93564   2 ZZZ 0 X 84.60 X
93564   3 ZZZ 0 X 84.60 X
93564   4 ZZZ 0 X 84.60 X
93564   1 ZZZ 0 X 91.15 X
93565   2 ZZZ 0 X 63.94 X
93565   3 ZZZ 0 X 63.94 X
93565   4 ZZZ 0 X 63.94 X
93565   1 ZZZ 0 X 68.80 X
93566   2 ZZZ 0 X 243.73 63.94
93566   3 ZZZ 0 X 243.73 63.94
93566   4 ZZZ 0 X 243.73 63.94
93566   1 ZZZ 0 X 272.24 68.80
93567   2 ZZZ 0 X 201.82 71.93
93567   3 ZZZ 0 X 201.82 71.93
93567   4 ZZZ 0 X 201.82 71.93
93567   1 ZZZ 0 X 224.15 77.19
93568   2 ZZZ 0 X 220.54 65.45
93568   3 ZZZ 0 X 220.54 65.45
93568   4 ZZZ 0 X 220.54 65.45
93568   1 ZZZ 0 X 245.86 70.39
93571 26 2 ZZZ 0 X 185.11 X
93571 26 3 ZZZ 0 X 185.11 X
93571 26 4 ZZZ 0 X 185.11 X
93571 26 1 ZZZ 0 X 200.57 X
93571 TC 2 ZZZ 0 X 343.10 X
93571 TC 3 ZZZ 0 X 343.10 X
93571 TC 4 ZZZ 0 X 343.10 X
93571 TC 1 ZZZ 0 X 409.00 X
93571   2 ZZZ 0 X 528.17 X
93571   3 ZZZ 0 X 528.17 X
93571   4 ZZZ 0 X 528.17 X
93571   1 ZZZ 0 X 609.53 X
93572 26 2 ZZZ 0 X 148.61 X
93572 26 3 ZZZ 0 X 148.61 X
93572 26 4 ZZZ 0 X 148.61 X
93572 26 1 ZZZ 0 X 161.14 X
93572 TC 2 ZZZ 0 X 337.81 X
93572 TC 3 ZZZ 0 X 337.81 X
93572 TC 4 ZZZ 0 X 337.81 X
93572 TC 1 ZZZ 0 X 398.97 X
93572   2 ZZZ 0 X 486.37 X
93572   3 ZZZ 0 X 486.37 X
93572   4 ZZZ 0 X 486.37 X
93572   1 ZZZ 0 X 560.06 X
93580   2 ZZZ 0 X 1,776.17 X
93580   3 ZZZ 0 X 1,776.17 X
93580   4 ZZZ 0 X 1,776.17 X
93580   1 ZZZ 0 X 1,952.85 X
93581   2 0 2 X 2,380.81 X
93581   3 0 2 X 2,380.81 X
93581   4 0 2 X 2,380.81 X
93581   1 0 2 X 2,601.09 X
93582   2 0 2 X 946.40 X
93582   3 0 2 X 946.40 X
93582   4 0 2 X 946.40 X
93582   1 0 2 X 1,039.56 X
93583   2 0 2 X 1,053.45 X
93583   3 0 2 X 1,053.45 X
93583   4 0 2 X 1,053.45 X
93583   1 0 2 X 1,157.04 X
93590   2 0 2 X 1,576.85 X
93590   3 0 2 X 1,576.85 X
93590   4 0 2 X 1,576.85 X
93590   1 0 2 X 1,725.69 X
93591   2 0 2 X 1,308.62 X
93591   3 0 2 X 1,308.62 X
93591   4 0 2 X 1,308.62 X
93591   1 0 2 X 1,432.37 X
93592   2 ZZZ 0 X 576.94 X
93592   3 ZZZ 0 X 576.94 X
93592   4 ZZZ 0 X 576.94 X
93592   1 ZZZ 0 X 631.17 X
93600 TC 4 0 0 X 160.58 X
93600 TC 3 0 0 X 163.12 X
93600 TC 2 0 0 X 177.53 X
93600 TC 1 0 0 X 180.92 X
93600 26 4 0 0 X 567.44 X
93600 26 3 0 0 X 568.01 X
93600 26 2 0 0 X 581.03 X
93600   4 0 0 X 595.92 X
93600 26 1 0 0 X 598.00 X
93600   3 0 0 X 604.21 X
93600   2 0 0 X 646.56 X
93600   1 0 0 X 656.69 X
93602 TC 4 0 0 X 91.42 X
93602 TC 3 0 0 X 92.87 X
93602 TC 2 0 0 X 101.03 X
93602 TC 1 0 0 X 103.03 X
93602 26 1 0 0 X 358.01 X
93602 26 4 0 0 X 359.63 X
93602 26 3 0 0 X 361.39 X
93602 26 2 0 0 X 361.70 X
93602   4 0 0 X 422.68 X
93602   3 0 0 X 428.15 X
93602   2 0 0 X 454.71 X
93602   1 0 0 X 461.06 X
93603 TC 4 0 0 X 138.23 X
93603 TC 3 0 0 X 140.54 X
93603 TC 2 0 0 X 152.88 X
93603 TC 1 0 0 X 155.81 X
93603   4 0 0 X 504.42 X
93603   3 0 0 X 511.27 X
93603   1 0 0 X 552.75 X
93603 26 2 0 0 X 575.46 X
93603 26 1 0 0 X 580.53 X
93603 26 4 0 0 X 592.03 X
93603 26 3 0 0 X 613.68 X
93603   2 0 0 X 639.60 X
93609 TC 4 0 0 X 223.35 X
93609 TC 3 0 0 X 226.93 X
93609 TC 2 0 0 X 246.77 X
93609 TC 1 0 0 X 251.47 X
93609 26 2 0 0 X 1,239.53 X
93609   4 0 0 X 1,399.62 X
93609   3 0 0 X 1,416.33 X
93609   2 0 0 X 1,486.29 X
93609   1 0 0 X 1,503.21 X
93609 26 4 0 0 X 1,592.90 X
93609 26 3 0 0 X 1,598.37 X
93609 26 1 0 0 X 1,624.50 X
93610 TC 4 0 0 X 111.26 X
93610 TC 3 0 0 X 113.08 X
93610 TC 2 0 0 X 123.12 X
93610 TC 1 0 0 X 125.53 X
93610   3 0 0 X 571.46 X
93610 26 3 0 0 X 657.94 X
93610 26 4 0 0 X 661.11 X
93610 26 2 0 0 X 673.43 X
93610 26 1 0 0 X 675.83 X
93610   4 0 0 X 707.84 X
93610   2 0 0 X 725.20 X
93610   1 0 0 X 728.55 X
93612 TC 4 0 0 X 133.60 X
93612 TC 3 0 0 X 135.68 X
93612 TC 2 0 0 X 147.79 X
93612 TC 1 0 0 X 150.66 X
93612   4 0 0 X 588.75 X
93612 26 3 0 0 X 649.30 X
93612 26 4 0 0 X 662.15 X
93612 26 2 0 0 X 669.89 X
93612 26 1 0 0 X 676.95 X
93612   3 0 0 X 706.19 X
93612   2 0 0 X 731.92 X
93612   1 0 0 X 740.17 X
93613 26 2 XXX 0 X 693.28 X
93613 26 3 XXX 0 X 693.28 X
93613 26 4 XXX 0 X 693.28 X
93613 26 1 XXX 0 X 764.91 X
93615 TC 4 0 0 X 25.45 X
93615 TC 3 0 0 X 25.85 X
93615 TC 2 0 0 X 28.04 X
93615 TC 1 0 0 X 28.52 X
93615 26 4 0 0 X 112.47 X
93615 26 3 0 0 X 113.72 X
93615   2 0 0 X 117.24 X
93615 26 2 0 0 X 118.16 X
93615 26 1 0 0 X 119.34 X
93615   1 0 0 X 120.49 X
93615   4 0 0 X 137.86 X
93615   3 0 0 X 139.54 X
93616 TC 4 0 0 X 25.45 X
93616 TC 3 0 0 X 25.85 X
93616 TC 2 0 0 X 28.04 X
93616 TC 1 0 0 X 28.52 X
93616 26 4 0 0 X 241.39 X
93616 26 3 0 0 X 244.43 X
93616 26 2 0 0 X 257.17 X
93616 26 1 0 0 X 260.28 X
93616   4 0 0 X 266.80 X
93616   3 0 0 X 270.27 X
93616   2 0 0 X 285.23 X
93616   1 0 0 X 288.77 X
93618 TC 4 0 0 X 325.89 X
93618 TC 3 0 0 X 331.04 X
93618 TC 2 0 0 X 360.16 X
93618 TC 1 0 0 X 367.08 X
93618   3 0 0 X 1,187.53 X
93618 26 4 0 0 X 1,834.56 X
93618 26 3 0 0 X 1,839.34 X
93618 26 2 0 0 X 1,861.98 X
93618 26 1 0 0 X 1,867.44 X
93618   4 0 0 X 1,971.24 X
93618   2 0 0 X 2,013.05 X
93618   1 0 0 X 2,021.41 X
93619 TC 4 0 0 X 633.54 X
93619 TC 3 0 0 X 643.61 X
93619 TC 2 0 0 X 700.30 X
93619 TC 1 0 0 X 713.77 X
93619 26 4 0 0 X 2,170.01 X
93619 26 3 0 0 X 2,179.18 X
93619   4 0 0 X 2,179.26 X
93619   3 0 0 X 2,209.85 X
93619 26 2 0 0 X 2,223.71 X
93619 26 1 0 0 X 2,234.37 X
93619   2 0 0 X 2,367.07 X
93619   1 0 0 X 2,404.56 X