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2020 Workers' Compensation Part B Fee Schedule

94010-95806

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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
94010 TC 4 XXX 0 X 32.67 X
94010 TC 3 XXX 0 X 33.17 X
94010 TC 2 XXX 0 X 36.15 X
94010 26 4 XXX 0 X 36.68 X
94010 TC 1 XXX 0 X 36.84 X
94010 26 3 XXX 0 X 38.38 X
94010 26 2 XXX 0 X 39.25 X
94010 26 1 XXX 0 X 40.06 X
94010   2 XXX 0 X 84.30 X
94010   4 XXX 0 X 86.03 X
94010   3 XXX 0 X 86.29 X
94010   1 XXX 0 X 89.85 X
94011   2 XXX 0 X 136.82 X
94011   3 XXX 0 X 136.82 X
94011   4 XXX 0 X 136.82 X
94011   1 XXX 0 X 146.45 X
94012   2 XXX 0 X 210.42 X
94012   3 XXX 0 X 210.42 X
94012   4 XXX 0 X 210.42 X
94012   1 XXX 0 X 224.97 X
94013   2 XXX 0 X 44.55 X
94013   3 XXX 0 X 44.55 X
94013   4 XXX 0 X 44.55 X
94013   1 XXX 0 X 47.79 X
94014 TC 2 XXX 0 X 29.83 X
94014 TC 3 XXX 0 X 29.83 X
94014 TC 4 XXX 0 X 29.83 X
94014 TC 1 XXX 0 X 35.51 X
94014 26 2 XXX 0 X 51.48 X
94014 26 3 XXX 0 X 51.48 X
94014 26 4 XXX 0 X 51.48 X
94014 26 1 XXX 0 X 55.92 X
94014   2 XXX 0 X 81.33 X
94014   3 XXX 0 X 81.33 X
94014   4 XXX 0 X 81.33 X
94014   1 XXX 0 X 91.45 X
94015   2 XXX 0 X 35.12 X
94015   3 XXX 0 X 35.12 X
94015   4 XXX 0 X 35.12 X
94015   1 XXX 0 X 38.11 X
94016   2 XXX 0 X 52.41 X
94016   3 XXX 0 X 52.41 X
94016   4 XXX 0 X 52.41 X
94016   1 XXX 0 X 57.66 X
94060 26 4 XXX 0 X 55.77 X
94060 26 3 XXX 0 X 58.68 X
94060 26 2 XXX 0 X 59.95 X
94060 26 1 XXX 0 X 62.98 X
94060 TC 3 XXX 0 X 71.81 X
94060 TC 4 XXX 0 X 72.95 X
94060 TC 2 XXX 0 X 80.40 X
94060 TC 1 XXX 0 X 81.53 X
94060   3 XXX 0 X 133.42 X
94060   4 XXX 0 X 141.89 X
94060   2 XXX 0 X 151.28 X
94060   1 XXX 0 X 153.36 X
94070 26 2 XXX 0 X 73.39 X
94070 26 3 XXX 0 X 73.39 X
94070 26 4 XXX 0 X 73.39 X
94070 26 1 XXX 0 X 81.17 X
94070 TC 2 XXX 0 X 108.54 X
94070 TC 3 XXX 0 X 108.54 X
94070 TC 4 XXX 0 X 108.54 X
94070 TC 1 XXX 0 X 131.17 X
94070   2 XXX 0 X 181.93 X
94070   3 XXX 0 X 181.93 X
94070   4 XXX 0 X 181.93 X
94070   1 XXX 0 X 212.34 X
94150 TC 4 XXX 9 X 6.85 X
94150 TC 3 XXX 9 X 6.96 X
94150 26 3 XXX 9 X 16.42 X
94150 26 1 XXX 9 X 17.60 X
94150 26 2 XXX 9 X 17.94 X
94150 26 4 XXX 9 X 18.61 X
94150 TC 2 XXX 9 X 31.80 X
94150   4 XXX 9 X 32.29 X
94150 TC 1 XXX 9 X 33.39 X
94150   3 XXX 9 X 33.56 X
94150   1 XXX 9 X 35.57 X
94150   2 XXX 9 X 36.01 X
94200 26 4 XXX 0 X 17.33 X
94200 TC 4 XXX 0 X 19.77 X
94200 TC 3 XXX 0 X 20.07 X
94200 26 3 XXX 0 X 21.97 X
94200 26 2 XXX 0 X 23.25 X
94200 26 1 XXX 0 X 23.55 X
94200   3 XXX 0 X 62.93 X
94200   2 XXX 0 X 63.17 X
94200   1 XXX 0 X 66.22 X
94200   4 XXX 0 X 71.36 X
94200 TC 2 XXX 0 X 71.84 X
94200 TC 1 XXX 0 X 73.15 X
94250 TC 4 XXX 0 X 10.70 X
94250 TC 3 XXX 0 X 10.84 X
94250 TC 2 XXX 0 X 11.79 X
94250 TC 1 XXX 0 X 12.00 X
94250 26 4 XXX 0 X 20.14 X
94250 26 3 XXX 0 X 20.39 X
94250 26 2 XXX 0 X 21.61 X
94250 26 1 XXX 0 X 21.95 X
94250   4 XXX 0 X 30.81 X
94250   3 XXX 0 X 31.25 X
94250   2 XXX 0 X 33.41 X
94250   1 XXX 0 X 33.95 X
94375 26 4 XXX 0 X 36.15 X
94375 TC 4 XXX 0 X 38.00 X
94375 26 3 XXX 0 X 38.86 X
94375 26 2 XXX 0 X 39.83 X
94375 26 1 XXX 0 X 40.10 X
94375 TC 3 XXX 0 X 91.33 X
94375 TC 2 XXX 0 X 92.13 X
94375   4 XXX 0 X 92.35 X
94375 TC 1 XXX 0 X 92.98 X
94375   3 XXX 0 X 95.59 X
94375   2 XXX 0 X 98.03 X
94375   1 XXX 0 X 98.83 X
94400 TC 4 XXX 0 X 27.54 X
94400 TC 3 XXX 0 X 27.96 X
94400 TC 2 XXX 0 X 31.46 X
94400 TC 1 XXX 0 X 32.37 X
94400 26 4 XXX 0 X 78.52 X
94400 26 2 XXX 0 X 87.17 X
94400 26 3 XXX 0 X 97.51 X
94400 26 1 XXX 0 X 100.58 X
94400   4 XXX 0 X 106.07 X
94400   1 XXX 0 X 121.42 X
94400   3 XXX 0 X 191.43 X
94400   2 XXX 0 X 196.16 X
94450 TC 4 XXX 0 X 30.39 X
94450 TC 3 XXX 0 X 30.88 X
94450 TC 2 XXX 0 X 33.69 X
94450 TC 1 XXX 0 X 34.34 X
94450 26 4 XXX 0 X 51.50 X
94450 26 3 XXX 0 X 52.12 X
94450 26 2 XXX 0 X 54.74 X
94450 26 1 XXX 0 X 55.40 X
94450   4 XXX 0 X 81.95 X
94450   3 XXX 0 X 83.03 X
94450   2 XXX 0 X 88.41 X
94450   1 XXX 0 X 183.93 X
94452 26 2 XXX 0 X 26.42 X
94452 26 3 XXX 0 X 26.42 X
94452 26 4 XXX 0 X 26.42 X
94452 26 1 XXX 0 X 28.63 X
94452 TC 2 XXX 0 X 56.14 X
94452 TC 3 XXX 0 X 56.14 X
94452 TC 4 XXX 0 X 56.14 X
94452 TC 1 XXX 0 X 67.82 X
94452   2 XXX 0 X 82.54 X
94452   3 XXX 0 X 82.54 X
94452   4 XXX 0 X 82.54 X
94452   1 XXX 0 X 96.44 X
94453 26 2 XXX 0 X 34.00 X
94453 26 3 XXX 0 X 34.00 X
94453 26 4 XXX 0 X 34.00 X
94453 26 1 XXX 0 X 36.68 X
94453 TC 2 XXX 0 X 83.37 X
94453 TC 3 XXX 0 X 83.37 X
94453 TC 4 XXX 0 X 83.37 X
94453 TC 1 XXX 0 X 100.50 X
94453   2 XXX 0 X 117.38 X
94453   3 XXX 0 X 117.38 X
94453   4 XXX 0 X 117.38 X
94453   1 XXX 0 X 137.18 X
94610   2 XXX 0 X 87.70 X
94610   3 XXX 0 X 87.70 X
94610   4 XXX 0 X 87.70 X
94610   1 XXX 0 X 101.44 X
94617 26 2 XXX 0 X 40.20 X
94617 26 3 XXX 0 X 40.20 X
94617 26 4 XXX 0 X 40.20 X
94617 26 1 XXX 0 X 42.61 X
94617 TC 2 XXX 0 X 70.37 X
94617 TC 3 XXX 0 X 70.37 X
94617 TC 4 XXX 0 X 70.37 X
94617 TC 1 XXX 0 X 80.89 X
94617   2 XXX 0 X 110.56 X
94617   3 XXX 0 X 110.56 X
94617   4 XXX 0 X 110.56 X
94617   1 XXX 0 X 123.50 X
94618 TC 2 XXX 0 X 12.90 X
94618 TC 3 XXX 0 X 12.90 X
94618 TC 4 XXX 0 X 12.90 X
94618 TC 1 XXX 0 X 14.87 X
94618 26 2 XXX 0 X 27.51 X
94618 26 3 XXX 0 X 27.51 X
94618 26 4 XXX 0 X 27.51 X
94618 26 1 XXX 0 X 29.15 X
94618   2 XXX 0 X 40.40 X
94618   3 XXX 0 X 40.40 X
94618   4 XXX 0 X 40.40 X
94618   1 XXX 0 X 44.01 X
94621 26 2 XXX 0 X 82.79 X
94621 26 3 XXX 0 X 82.79 X
94621 26 4 XXX 0 X 82.79 X
94621 26 1 XXX 0 X 89.76 X
94621 TC 2 XXX 0 X 102.46 X
94621 TC 3 XXX 0 X 102.46 X
94621 TC 4 XXX 0 X 102.46 X
94621 TC 1 XXX 0 X 122.47 X
94621   2 XXX 0 X 185.29 X
94621   3 XXX 0 X 185.29 X
94621   4 XXX 0 X 185.29 X
94621   1 XXX 0 X 212.31 X
94640   3 XXX 0 X 32.44 X
94640   2 XXX 0 X 35.34 X
94640   1 XXX 0 X 35.98 X
94640   4 XXX 0 X 42.71 X
94642     XXX 0 X 69.50 X
94644   2 XXX 0 X 47.82 X
94644   3 XXX 0 X 47.82 X
94644   4 XXX 0 X 47.82 X
94644   1 XXX 0 X 58.95 X
94645   2 XXX 0 X 18.22 X
94645   3 XXX 0 X 18.22 X
94645   4 XXX 0 X 18.22 X
94645   1 XXX 0 X 22.75 X
94660   2 XXX 0 X 128.95 X
94660   1 XXX 0 X 130.61 X
94660   3 XXX 0 X 151.07 X
94660   4 XXX 0 X 157.13 X
94662   4 XXX 0 X 85.45 X
94662   1 XXX 0 X 90.88 X
94662   3 XXX 0 X 153.28 X
94662   2 XXX 0 X 154.69 X
94664   4 XXX 0 X 35.79 X
94664   3 XXX 0 X 39.24 X
94664   1 XXX 0 X 41.36 X
94664   2 XXX 0 X 43.44 X
94667   4 XXX 0 X 46.38 X
94667   3 XXX 0 X 52.57 X
94667   2 XXX 0 X 54.40 X
94667   1 XXX 0 X 54.82 X
94668   4 XXX 0 X 28.11 X
94668   3 XXX 0 X 28.59 X
94668   2 XXX 0 X 31.27 X
94668   1 XXX 0 X 31.89 X
94669   2 XXX 0 X 42.85 X
94669   3 XXX 0 X 42.85 X
94669   4 XXX 0 X 42.85 X
94669   1 XXX 0 X 50.03 X
94680 TC 4 XXX 0 X 43.45 X
94680 TC 3 XXX 0 X 44.14 X
94680 26 3 XXX 0 X 47.85 X
94680 26 4 XXX 0 X 48.01 X
94680 TC 2 XXX 0 X 49.00 X
94680 TC 1 XXX 0 X 50.16 X
94680 26 2 XXX 0 X 59.76 X
94680 26 1 XXX 0 X 63.68 X
94680   4 XXX 0 X 91.50 X
94680   3 XXX 0 X 92.78 X
94680   1 XXX 0 X 102.64 X
94680   2 XXX 0 X 138.12 X
94681 26 4 XXX 0 X 105.63 X
94681 TC 4 XXX 0 X 111.09 X
94681 26 2 XXX 0 X 111.16 X
94681 26 3 XXX 0 X 111.27 X
94681 TC 3 XXX 0 X 112.81 X
94681 26 1 XXX 0 X 113.07 X
94681 TC 1 XXX 0 X 126.26 X
94681   3 XXX 0 X 162.07 X
94681 TC 2 XXX 0 X 178.26 X
94681   1 XXX 0 X 197.47 X
94681   4 XXX 0 X 219.29 X
94681   2 XXX 0 X 227.66 X
94690 26 4 XXX 0 X 13.72 X
94690 26 3 XXX 0 X 13.75 X
94690 26 2 XXX 0 X 13.88 X
94690 26 1 XXX 0 X 13.90 X
94690 TC 4 XXX 0 X 42.52 X
94690 TC 3 XXX 0 X 43.24 X
94690 TC 2 XXX 0 X 47.08 X
94690 TC 1 XXX 0 X 48.00 X
94690   4 XXX 0 X 51.95 X
94690   3 XXX 0 X 52.72 X
94690   2 XXX 0 X 53.96 X
94690   1 XXX 0 X 57.95 X
94726 26 2 XXX 0 X 16.54 X
94726 26 3 XXX 0 X 16.54 X
94726 26 4 XXX 0 X 16.54 X
94726 26 1 XXX 0 X 17.57 X
94726 TC 2 XXX 0 X 52.35 X
94726 TC 3 XXX 0 X 52.35 X
94726 TC 4 XXX 0 X 52.35 X
94726 TC 1 XXX 0 X 61.00 X
94726   2 XXX 0 X 68.88 X
94726   3 XXX 0 X 68.88 X
94726   4 XXX 0 X 68.88 X
94726   1 XXX 0 X 78.57 X
94727 26 2 XXX 0 X 16.54 X
94727 26 3 XXX 0 X 16.54 X
94727 26 4 XXX 0 X 16.54 X
94727 26 1 XXX 0 X 17.57 X
94727 TC 2 XXX 0 X 37.69 X
94727 TC 3 XXX 0 X 37.69 X
94727 TC 4 XXX 0 X 37.69 X
94727 TC 1 XXX 0 X 43.90 X
94727   2 XXX 0 X 54.25 X
94727   3 XXX 0 X 54.25 X
94727   4 XXX 0 X 54.25 X
94727   1 XXX 0 X 61.46 X
94728 26 2 XXX 0 X 16.54 X
94728 26 3 XXX 0 X 16.54 X
94728 26 4 XXX 0 X 16.54 X
94728 26 1 XXX 0 X 17.57 X
94728 TC 2 XXX 0 X 37.69 X
94728 TC 3 XXX 0 X 37.69 X
94728 TC 4 XXX 0 X 37.69 X
94728 TC 1 XXX 0 X 43.90 X
94728   2 XXX 0 X 54.25 X
94728   3 XXX 0 X 54.25 X
94728   4 XXX 0 X 54.25 X
94728   1 XXX 0 X 61.46 X
94729 26 2 ZZZ 0 X 11.03 X
94729 26 3 ZZZ 0 X 11.03 X
94729 26 4 ZZZ 0 X 11.03 X
94729 26 1 ZZZ 0 X 11.80 X
94729 TC 2 ZZZ 0 X 56.92 X
94729 TC 3 ZZZ 0 X 56.92 X
94729 TC 4 ZZZ 0 X 56.92 X
94729 TC 1 ZZZ 0 X 66.19 X
94729   2 ZZZ 0 X 67.98 X
94729   3 ZZZ 0 X 67.98 X
94729   4 ZZZ 0 X 67.98 X
94729   1 ZZZ 0 X 78.00 X
94750 26 4 XXX 0 X 41.05 X
94750 26 3 XXX 0 X 41.62 X
94750 26 1 XXX 0 X 44.65 X
94750 26 2 XXX 0 X 44.83 X
94750 TC 4 XXX 0 X 45.62 X
94750 TC 3 XXX 0 X 46.30 X
94750 TC 2 XXX 0 X 50.34 X
94750 TC 1 XXX 0 X 51.35 X
94750   4 XXX 0 X 86.65 X
94750   3 XXX 0 X 93.47 X
94750   1 XXX 0 X 95.98 X
94750   2 XXX 0 X 97.47 X
94760   4 XXX 0 X 17.85 X
94760   3 XXX 0 X 18.06 X
94760   2 XXX 0 X 19.11 X
94760   1 XXX 0 X 19.35 X
94761   4 XXX 0 X 37.14 X
94761   3 XXX 0 X 37.65 X
94761   2 XXX 0 X 40.61 X
94761   1 XXX 0 X 41.30 X
94762   4 XXX 0 X 82.01 X
94762   3 XXX 0 X 82.82 X
94762   2 XXX 0 X 87.76 X
94762   1 XXX 0 X 88.96 X
94770 26 3 XXX 0 X 21.40 X
94770 26 4 XXX 0 X 21.46 X
94770 26 2 XXX 0 X 22.77 X
94770 26 1 XXX 0 X 23.03 X
94770 TC 2 XXX 0 X 26.21 X
94770 TC 4 XXX 0 X 28.38 X
94770 TC 3 XXX 0 X 28.72 X
94770 TC 1 XXX 0 X 34.07 X
94770   2 XXX 0 X 47.78 X
94770   1 XXX 0 X 49.52 X
94770   4 XXX 0 X 55.01 X
94770   3 XXX 0 X 55.65 X
94772 26 1 XXX 0 X 227.78 X
94772 26 2 XXX 0 X 227.78 X
94772 26 3 XXX 0 X 227.78 X
94772 26 4 XXX 0 X 227.78 X
94772 TC 1 XXX 0 X 371.79 X
94772 TC 2 XXX 0 X 371.79 X
94772 TC 3 XXX 0 X 371.79 X
94772 TC 4 XXX 0 X 371.79 X
94772   1 XXX 0 X 599.60 X
94772   2 XXX 0 X 599.60 X
94772   3 XXX 0 X 599.60 X
94772   4 XXX 0 X 599.60 X
94774     YYY 0 X * X
94775     YYY 0 X * X
94776     YYY 0 X * X
94777     YYY 0 X * X
94780   2 XXX 0 X 65.93 31.74
94780   3 XXX 0 X 65.93 31.74
94780   4 XXX 0 X 65.93 31.74
94780   1 XXX 0 X 73.64 33.98
94781   2 ZZZ 0 X 25.58 11.03
94781   3 ZZZ 0 X 25.58 11.03
94781   4 ZZZ 0 X 25.58 11.03
94781   1 ZZZ 0 X 28.65 11.80
94799     XXX 0 X * X
95004   3 XXX 0 X 7.08 X
95004   4 XXX 0 X 7.28 X
95004   1 XXX 0 X 7.81 X
95004   2 XXX 0 X 8.07 X
95012   2 XXX 0 X 24.93 X
95012   3 XXX 0 X 24.93 X
95012   4 XXX 0 X 24.93 X
95012   1 XXX 0 X 30.71 X
95017   2 XXX 0 X 11.12 4.95
95017   3 XXX 0 X 11.12 4.95
95017   4 XXX 0 X 11.12 4.95
95017   1 XXX 0 X 12.58 5.39
95018   2 XXX 0 X 27.13 9.33
95018   3 XXX 0 X 27.13 9.33
95018   4 XXX 0 X 27.13 9.33
95018   1 XXX 0 X 30.68 10.04
95024   1 XXX 0 X 11.02 X
95024   3 XXX 0 X 11.07 X
95024   4 XXX 0 X 11.16 X
95024   2 XXX 0 X 11.79 X
95027   2 XXX 0 X 14.75 X
95027   4 XXX 0 X 15.63 X
95027   3 XXX 0 X 15.73 X
95027   1 XXX 0 X 16.31 X
95028   3 XXX 0 X 16.71 X
95028   4 XXX 0 X 17.47 X
95028   1 XXX 0 X 18.44 X
95028   2 XXX 0 X 19.11 X
95044   3 XXX 0 X 12.37 X
95044   4 XXX 0 X 14.52 X
95044   2 XXX 0 X 15.89 X
95044   1 XXX 0 X 16.15 X
95052   3 XXX 0 X 15.18 X
95052   2 XXX 0 X 16.43 X
95052   1 XXX 0 X 16.54 X
95052   4 XXX 0 X 18.95 X
95056   1 XXX 0 X 12.95 X
95056   2 XXX 0 X 13.26 X
95056   4 XXX 0 X 13.71 X
95056   3 XXX 0 X 13.88 X
95060   4 XXX 0 X 20.17 X
95060   3 XXX 0 X 20.42 X
95060   2 XXX 0 X 21.68 X
95060   1 XXX 0 X 22.02 X
95065   4 XXX 0 X 15.20 X
95065   2 XXX 0 X 16.64 X
95065   1 XXX 0 X 16.95 X
95065   3 XXX 0 X 17.18 X
95070   4 XXX 0 X 167.32 X
95070   3 XXX 0 X 170.24 X
95070   2 XXX 0 X 180.85 X
95070   1 XXX 0 X 183.40 X
95071   2 XXX 0 X 181.48 X
95071   4 XXX 0 X 214.21 X
95071   3 XXX 0 X 217.88 X
95071   1 XXX 0 X 234.63 X
95076   2 XXX 0 X 148.63 93.65
95076   3 XXX 0 X 148.63 93.65
95076   4 XXX 0 X 148.63 93.65
95076   1 XXX 0 X 163.24 99.45
95079   2 ZZZ 0 X 105.99 86.15
95079   3 ZZZ 0 X 105.99 86.15
95079   4 ZZZ 0 X 105.99 86.15
95079   1 ZZZ 0 X 114.55 91.53
95115   4 0 0 X 26.69 X
95115   3 0 0 X 28.34 X
95115   2 0 0 X 29.01 X
95115   1 0 0 X 30.81 X
95117   3 0 0 X 37.95 X
95117   4 0 0 X 39.99 X
95117   2 0 0 X 40.10 X
95117   1 0 0 X 40.79 X
95120     XXX 9 X 214.72 X
95125     XXX 9 X 264.92 X
95130     XXX 9 X 107.32 X
95131     XXX 9 X 166.98 X
95132     XXX 9 X 226.38 X
95133     XXX 9 X 286.08 X
95134     XXX 9 X 345.74 X
95144     0 0 X 18.59 X
95145     0 0 X 89.24 X
95146     0 0 X 152.95 X
95147     0 0 X 202.75 X
95148     0 0 X 262.34 X
95149     0 0 X 321.80 X
95165     0 0 X 92.54 X
95170     0 0 X * X
95180   1 0 0 X 122.44 X
95180   3 0 0 X 123.53 X
95180   2 0 0 X 126.44 X
95180   4 0 0 X 172.60 X
95199     0 0 X * X
95249   2 XXX 0 X 62.78 X
95249   3 XXX 0 X 62.78 X
95249   4 XXX 0 X 62.78 X
95249   1 XXX 0 X 72.27 X
95250   2 XXX 0 X 89.92 X
95250   3 XXX 0 X 89.92 X
95250   4 XXX 0 X 89.92 X
95250   1 XXX 0 X 106.02 X
95251   2 XXX 0 X 41.99 X
95251   3 XXX 0 X 41.99 X
95251   4 XXX 0 X 41.99 X
95251   1 XXX 0 X 45.42 X
95700         X # X
95705         X # X
95706         X # X
95707         X # X
95708         X # X
95709         X # X
95710         X # X
95711         X # X
95712         X # X
95713         X # X
95714         X # X
95715         X # X
95716         X # X
95717   2 XXX 0 X 117.02 115.50
95717   3 XXX 0 X 117.02 115.50
95717   4 XXX 0 X 117.02 115.50
95717   1 XXX 0 X 125.75 123.98
95718   2 XXX 0 X 153.76 151.47
95718   3 XXX 0 X 153.76 151.47
95718   4 XXX 0 X 153.76 151.47
95718   1 XXX 0 X 166.02 163.39
95719   2 XXX 0 X 180.91 179.00
95719   3 XXX 0 X 180.91 179.00
95719   4 XXX 0 X 180.91 179.00
95719   1 XXX 0 X 195.04 192.83
95720   2 XXX 0 X 237.97 234.53
95720   3 XXX 0 X 237.97 234.53
95720   4 XXX 0 X 237.97 234.53
95720   1 XXX 0 X 257.01 253.04
95721   2 XXX 0 X 239.88 235.29
95721   3 XXX 0 X 239.88 235.29
95721   4 XXX 0 X 239.88 235.29
95721   1 XXX 0 X 259.20 253.92
95722   2 XXX 0 X 291.16 286.18
95722   3 XXX 0 X 291.16 286.18
95722   4 XXX 0 X 291.16 286.18
95722   1 XXX 0 X 314.61 308.90
95723   2 XXX 0 X 297.40 291.29
95723   3 XXX 0 X 297.40 291.29
95723   4 XXX 0 X 297.40 291.29
95723   1 XXX 0 X 321.71 314.67
95724   2 XXX 0 X 371.78 364.90
95724   3 XXX 0 X 371.78 364.90
95724   4 XXX 0 X 371.78 364.90
95724   1 XXX 0 X 401.69 393.77
95725   2 XXX 0 X 339.44 331.42
95725   3 XXX 0 X 339.44 331.42
95725   4 XXX 0 X 339.44 331.42
95725   1 XXX 0 X 367.27 358.03
95726   2 XXX 0 X 469.89 461.10
95726   3 XXX 0 X 469.89 461.10
95726   4 XXX 0 X 469.89 461.10
95726   1 XXX 0 X 507.73 497.61
95782 26 2 XXX 0 X 166.29 X
95782 26 3 XXX 0 X 166.29 X
95782 26 4 XXX 0 X 166.29 X
95782 26 1 XXX 0 X 177.16 X
95782 TC 2 XXX 0 X 1,117.15 X
95782 TC 3 XXX 0 X 1,117.15 X
95782 TC 4 XXX 0 X 1,117.15 X
95782   2 XXX 0 X 1,283.42 X
95782   3 XXX 0 X 1,283.42 X
95782   4 XXX 0 X 1,283.42 X
95782 TC 1 XXX 0 X 1,298.55 X
95782   1 XXX 0 X 1,475.69 X
95783 26 2 XXX 0 X 181.86 X
95783 26 3 XXX 0 X 181.86 X
95783 26 4 XXX 0 X 181.86 X
95783 26 1 XXX 0 X 193.97 X
95783 TC 2 XXX 0 X 1,188.47 X
95783 TC 3 XXX 0 X 1,188.47 X
95783 TC 4 XXX 0 X 1,188.47 X
95783   2 XXX 0 X 1,370.29 X
95783   3 XXX 0 X 1,370.29 X
95783   4 XXX 0 X 1,370.29 X
95783 TC 1 XXX 0 X 1,381.57 X
95783   1 XXX 0 X 1,575.54 X
95800 26 2 XXX 0 X 81.63 X
95800 26 3 XXX 0 X 81.63 X
95800 26 4 XXX 0 X 81.63 X
95800 26 1 XXX 0 X 87.16 X
95800 TC 2 XXX 0 X 201.13 X
95800 TC 3 XXX 0 X 201.13 X
95800 TC 4 XXX 0 X 201.13 X
95800 TC 1 XXX 0 X 227.78 X
95800   2 XXX 0 X 282.79 X
95800   3 XXX 0 X 282.79 X
95800   4 XXX 0 X 282.79 X
95800   1 XXX 0 X 314.96 X
95801 TC 2 XXX 0 X 62.17 X
95801 TC 3 XXX 0 X 62.17 X
95801 TC 4 XXX 0 X 62.17 X
95801 TC 1 XXX 0 X 70.51 X
95801 26 2 XXX 0 X 72.27 X
95801 26 3 XXX 0 X 72.27 X
95801 26 4 XXX 0 X 72.27 X
95801 26 1 XXX 0 X 76.86 X
95801   2 XXX 0 X 134.44 X
95801   3 XXX 0 X 134.44 X
95801   4 XXX 0 X 134.44 X
95801   1 XXX 0 X 147.36 X
95803     XXX 0 X * X
95805 26 2 XXX 0 X 181.80 X
95805 26 3 XXX 0 X 181.80 X
95805 26 4 XXX 0 X 181.80 X
95805 26 1 XXX 0 X 197.09 X
95805 TC 2 XXX 0 X 387.97 X
95805 TC 3 XXX 0 X 387.97 X
95805 TC 4 XXX 0 X 387.97 X
95805 TC 1 XXX 0 X 469.48 X
95805   2 XXX 0 X 569.70 X
95805   3 XXX 0 X 569.70 X
95805   4 XXX 0 X 569.70 X
95805   1 XXX 0 X 666.51 X
95806 26 2 XXX 0 X 312.54 X
95806 26 3 XXX 0 X 312.54 X
95806 26 4 XXX 0 X 312.54 X
95806 26 1 XXX 0 X 357.24 X
95806 TC 2 XXX 0 X 370.52 X
95806 TC 3 XXX 0 X 370.52 X
95806 TC 4 XXX 0 X 370.52 X
95806 TC 1 XXX 0 X 448.27 X
95806   2 XXX 0 X 683.05 X
95806   3 XXX 0 X 683.05 X
95806   4 XXX 0 X 683.05 X
95806   1 XXX 0 X 805.49 X