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2021 Workers' Compensation Part B Fee Schedule

95807-95933

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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
95807 26 2 XXX 0 X 278.84 X
95807 26 3 XXX 0 X 278.84 X
95807 26 4 XXX 0 X 278.84 X
95807 26 1 XXX 0 X 317.17 X
95807 TC 2 XXX 0 X 516.25 X
95807 TC 3 XXX 0 X 516.25 X
95807 TC 4 XXX 0 X 516.25 X
95807 TC 1 XXX 0 X 624.60 X
95807   2 XXX 0 X 795.13 X
95807   3 XXX 0 X 795.13 X
95807   4 XXX 0 X 795.13 X
95807   1 XXX 0 X 941.76 X
95808 26 4 XXX 0 X 394.82 X
95808 TC 4 XXX 0 X 427.66 X
95808 TC 3 XXX 0 X 434.45 X
95808 26 3 XXX 0 X 449.16 X
95808 26 2 XXX 0 X 457.28 X
95808 26 1 XXX 0 X 468.40 X
95808 TC 1 XXX 0 X 482.19 X
95808   4 XXX 0 X 813.51 X
95808 TC 2 XXX 0 X 878.26 X
95808   3 XXX 0 X 944.51 X
95808   1 XXX 0 X 977.10 X
95808   2 XXX 0 X 1,043.09 X
95810 26 4 XXX 0 X 394.82 X
95810 TC 4 XXX 0 X 427.66 X
95810 TC 3 XXX 0 X 434.45 X
95810 26 3 XXX 0 X 449.16 X
95810 26 2 XXX 0 X 457.28 X
95810 26 1 XXX 0 X 468.40 X
95810 TC 1 XXX 0 X 482.19 X
95810   4 XXX 0 X 813.51 X
95810 TC 2 XXX 0 X 878.26 X
95810   3 XXX 0 X 944.51 X
95810   1 XXX 0 X 977.10 X
95810   2 XXX 0 X 1,043.09 X
95811 26 2 XXX 0 X 499.18 X
95811 26 3 XXX 0 X 499.18 X
95811 26 4 XXX 0 X 499.18 X
95811 TC 2 XXX 0 X 542.23 X
95811 TC 3 XXX 0 X 542.23 X
95811 TC 4 XXX 0 X 542.23 X
95811 26 1 XXX 0 X 553.80 X
95811 TC 1 XXX 0 X 655.86 X
95811   2 XXX 0 X 1,041.43 X
95811   3 XXX 0 X 1,041.43 X
95811   4 XXX 0 X 1,041.43 X
95811   1 XXX 0 X 1,209.66 X
95812 TC 3 XXX 0 X 102.84 X
95812 TC 4 XXX 0 X 115.29 X
95812 TC 2 XXX 0 X 128.84 X
95812 TC 1 XXX 0 X 133.62 X
95812 26 4 XXX 0 X 135.73 X
95812 26 3 XXX 0 X 147.08 X
95812 26 2 XXX 0 X 149.37 X
95812 26 1 XXX 0 X 154.02 X
95812   3 XXX 0 X 245.22 X
95812   4 XXX 0 X 249.31 X
95812   2 XXX 0 X 265.12 X
95812   1 XXX 0 X 286.02 X
95813 TC 4 XXX 0 X 115.29 X
95813 TC 3 XXX 0 X 117.37 X
95813 TC 2 XXX 0 X 128.84 X
95813 TC 1 XXX 0 X 133.62 X
95813 26 4 XXX 0 X 189.01 X
95813 26 3 XXX 0 X 191.26 X
95813 26 2 XXX 0 X 198.97 X
95813 26 1 XXX 0 X 202.62 X
95813   4 XXX 0 X 304.29 X
95813   3 XXX 0 X 308.64 X
95813   2 XXX 0 X 327.75 X
95813   1 XXX 0 X 336.28 X
95816 TC 3 XXX 0 X 74.31 X
95816 TC 4 XXX 0 X 108.91 X
95816 TC 2 XXX 0 X 120.51 X
95816 TC 1 XXX 0 X 122.96 X
95816 26 4 XXX 0 X 127.63 X
95816 26 2 XXX 0 X 144.43 X
95816 26 3 XXX 0 X 146.85 X
95816 26 1 XXX 0 X 150.32 X
95816   4 XXX 0 X 203.26 X
95816   3 XXX 0 X 219.94 X
95816   2 XXX 0 X 240.79 X
95816   1 XXX 0 X 275.84 X
95819 TC 3 XXX 0 X 74.31 X
95819 TC 4 XXX 0 X 108.91 X
95819 TC 2 XXX 0 X 120.51 X
95819 TC 1 XXX 0 X 122.96 X
95819 26 4 XXX 0 X 135.71 X
95819 26 2 XXX 0 X 153.29 X
95819 26 3 XXX 0 X 155.06 X
95819 26 1 XXX 0 X 159.26 X
95819   3 XXX 0 X 228.14 X
95819   4 XXX 0 X 243.21 X
95819   2 XXX 0 X 249.65 X
95819   1 XXX 0 X 284.84 X
95822 26 2 XXX 0 X 134.10 X
95822 26 4 XXX 0 X 138.99 X
95822 TC 4 XXX 0 X 149.48 X
95822 TC 3 XXX 0 X 151.83 X
95822 TC 2 XXX 0 X 159.10 X
95822 TC 1 XXX 0 X 168.85 X
95822 26 3 XXX 0 X 173.00 X
95822 26 1 XXX 0 X 175.07 X
95822   2 XXX 0 X 282.69 X
95822   4 XXX 0 X 288.56 X
95822   3 XXX 0 X 292.47 X
95822   1 XXX 0 X 317.52 X
95824     XXX 0 X * X
95829 TC 4 XXX 0 X 12.79 X
95829 TC 3 XXX 0 X 12.95 X
95829 TC 2 XXX 0 X 14.39 X
95829 TC 1 XXX 0 X 14.74 X
95829   3 XXX 0 X 399.58 X
95829 26 2 XXX 0 X 401.67 X
95829 26 1 XXX 0 X 403.56 X
95829   2 XXX 0 X 407.74 X
95829   1 XXX 0 X 409.81 X
95829 26 4 XXX 0 X 559.84 X
95829 26 3 XXX 0 X 565.23 X
95829   4 XXX 0 X 572.57 X
95830   4 XXX 0 X 211.26 X
95830   3 XXX 0 X 213.68 X
95830   1 XXX 0 X 234.16 X
95830   2 XXX 0 X 254.06 X
95836   2 XXX 0 X 131.92 X
95836   3 XXX 0 X 131.92 X
95836   4 XXX 0 X 131.92 X
95836   1 XXX 0 X 143.42 X
95851   4 XXX 0 X 43.94 34.43
95851   3 XXX 0 X 44.44 34.80
95851   2 XXX 0 X 47.02 36.74
95851   1 XXX 0 X 47.55 37.22
95852   4 XXX 0 X 29.32 23.41
95852   3 XXX 0 X 29.70 23.68
95852   2 XXX 0 X 31.55 25.11
95852   1 XXX 0 X 32.06 25.52
95857   4 XXX 0 X 89.20 68.77
95857   3 XXX 0 X 89.82 69.20
95857   2 XXX 0 X 92.51 71.52
95857   1 XXX 0 X 93.44 72.07
95860 TC 4 XXX 0 X 31.03 X
95860 TC 3 XXX 0 X 31.52 X
95860 TC 1 XXX 0 X 35.08 X
95860 TC 2 XXX 0 X 37.57 X
95860 26 4 XXX 0 X 149.59 X
95860 26 3 XXX 0 X 154.31 X
95860 26 2 XXX 0 X 156.98 X
95860 26 1 XXX 0 X 157.84 X
95860   3 XXX 0 X 190.97 X
95860   4 XXX 0 X 191.03 X
95860   2 XXX 0 X 194.24 X
95860   1 XXX 0 X 195.92 X
95861 TC 4 XXX 0 X 61.25 X
95861 TC 3 XXX 0 X 61.60 X
95861 TC 2 XXX 0 X 67.91 X
95861 TC 1 XXX 0 X 69.28 X
95861 26 4 XXX 0 X 239.89 X
95861 26 3 XXX 0 X 242.28 X
95861 26 2 XXX 0 X 255.40 X
95861 26 1 XXX 0 X 258.60 X
95861   4 XXX 0 X 300.59 X
95861   3 XXX 0 X 304.49 X
95861   2 XXX 0 X 323.37 X
95861   1 XXX 0 X 327.91 X
95863 TC 4 XXX 0 X 77.11 X
95863 TC 3 XXX 0 X 78.35 X
95863 TC 2 XXX 0 X 85.35 X
95863 TC 1 XXX 0 X 87.03 X
95863 26 4 XXX 0 X 279.44 X
95863 26 3 XXX 0 X 282.83 X
95863 26 2 XXX 0 X 297.78 X
95863 26 1 XXX 0 X 301.38 X
95863   4 XXX 0 X 356.57 X
95863   3 XXX 0 X 361.18 X
95863   2 XXX 0 X 383.12 X
95863   1 XXX 0 X 388.40 X
95864 TC 4 XXX 0 X 147.09 X
95864 TC 3 XXX 0 X 149.40 X
95864 TC 2 XXX 0 X 162.62 X
95864 TC 1 XXX 0 X 165.79 X
95864 26 1 XXX 0 X 306.13 X
95864 26 4 XXX 0 X 318.86 X
95864 26 3 XXX 0 X 322.81 X
95864 26 2 XXX 0 X 340.76 X
95864   4 XXX 0 X 465.91 X
95864   3 XXX 0 X 472.22 X
95864   2 XXX 0 X 503.44 X
95864   1 XXX 0 X 510.89 X
95865 TC 2 XXX 0 X 39.54 X
95865 TC 3 XXX 0 X 39.54 X
95865 TC 4 XXX 0 X 39.54 X
95865 TC 1 XXX 0 X 49.15 X
95865 26 2 XXX 0 X 144.53 X
95865 26 3 XXX 0 X 144.53 X
95865 26 4 XXX 0 X 144.53 X
95865 26 1 XXX 0 X 158.62 X
95865   2 XXX 0 X 184.09 X
95865   3 XXX 0 X 184.09 X
95865   4 XXX 0 X 184.09 X
95865   1 XXX 0 X 207.79 X
95866 TC 2 XXX 0 X 12.67 X
95866 TC 3 XXX 0 X 12.67 X
95866 TC 4 XXX 0 X 12.67 X
95866 TC 1 XXX 0 X 16.27 X
95866 26 2 XXX 0 X 112.40 X
95866 26 3 XXX 0 X 112.40 X
95866 26 4 XXX 0 X 112.40 X
95866 26 1 XXX 0 X 123.18 X
95866   2 XXX 0 X 125.09 X
95866   3 XXX 0 X 125.09 X
95866   4 XXX 0 X 125.09 X
95866   1 XXX 0 X 139.44 X
95867 TC 4 XXX 0 X 47.72 X
95867 TC 3 XXX 0 X 48.43 X
95867 TC 2 XXX 0 X 52.66 X
95867 TC 1 XXX 0 X 53.71 X
95867 26 4 XXX 0 X 103.26 X
95867 26 3 XXX 0 X 111.94 X
95867 26 2 XXX 0 X 114.44 X
95867 26 1 XXX 0 X 115.08 X
95867   1 XXX 0 X 135.06 X
95867   4 XXX 0 X 150.93 X
95867   3 XXX 0 X 153.00 X
95867   2 XXX 0 X 163.24 X
95868 TC 4 XXX 0 X 57.21 X
95868 TC 3 XXX 0 X 58.15 X
95868 TC 2 XXX 0 X 63.29 X
95868 TC 1 XXX 0 X 64.52 X
95868 26 4 XXX 0 X 235.18 X
95868 26 3 XXX 0 X 238.07 X
95868 26 2 XXX 0 X 251.13 X
95868 26 1 XXX 0 X 254.26 X
95868   4 XXX 0 X 290.30 X
95868   3 XXX 0 X 292.50 X
95868   2 XXX 0 X 302.59 X
95868   1 XXX 0 X 305.43 X
95869 TC 4 XXX 0 X 17.52 X
95869 TC 3 XXX 0 X 17.77 X
95869 TC 2 XXX 0 X 19.53 X
95869 TC 1 XXX 0 X 19.89 X
95869 26 3 XXX 0 X 138.66 X
95869 26 2 XXX 0 X 141.92 X
95869 26 1 XXX 0 X 145.83 X
95869 26 4 XXX 0 X 156.66 X
95869   2 XXX 0 X 160.95 X
95869   4 XXX 0 X 164.21 X
95869   3 XXX 0 X 171.66 X
95869   1 XXX 0 X 177.81 X
95870 TC 2 XXX 0 X 16.69 X
95870 TC 3 XXX 0 X 16.69 X
95870 TC 4 XXX 0 X 16.69 X
95870 TC 1 XXX 0 X 20.33 X
95870 26 2 XXX 0 X 55.38 X
95870 26 3 XXX 0 X 55.38 X
95870 26 4 XXX 0 X 55.38 X
95870 26 1 XXX 0 X 62.34 X
95870   2 XXX 0 X 72.07 X
95870   3 XXX 0 X 72.07 X
95870   4 XXX 0 X 72.07 X
95870   1 XXX 0 X 82.64 X
95872 TC 4 XXX 0 X 50.11 X
95872 TC 3 XXX 0 X 50.89 X
95872 TC 2 XXX 0 X 55.63 X
95872 TC 1 XXX 0 X 56.70 X
95872 26 3 XXX 0 X 188.02 X
95872 26 4 XXX 0 X 188.23 X
95872 26 2 XXX 0 X 196.75 X
95872 26 1 XXX 0 X 198.87 X
95872   4 XXX 0 X 236.03 X
95872   3 XXX 0 X 238.99 X
95872   1 XXX 0 X 255.59 X
95872   2 XXX 0 X 381.31 X
95873 TC 2 ZZZ 0 X 12.19 X
95873 TC 3 ZZZ 0 X 12.19 X
95873 TC 4 ZZZ 0 X 12.19 X
95873 TC 1 ZZZ 0 X 15.43 X
95873 26 2 ZZZ 0 X 32.92 X
95873 26 3 ZZZ 0 X 32.92 X
95873 26 4 ZZZ 0 X 32.92 X
95873 26 1 ZZZ 0 X 35.99 X
95873   2 ZZZ 0 X 45.12 X
95873   3 ZZZ 0 X 45.12 X
95873   4 ZZZ 0 X 45.12 X
95873   1 ZZZ 0 X 51.44 X
95874 TC 2 ZZZ 0 X 12.19 X
95874 TC 3 ZZZ 0 X 12.19 X
95874 TC 4 ZZZ 0 X 12.19 X
95874 TC 1 ZZZ 0 X 15.43 X
95874 26 2 ZZZ 0 X 33.47 X
95874 26 3 ZZZ 0 X 33.47 X
95874 26 4 ZZZ 0 X 33.47 X
95874 26 1 ZZZ 0 X 36.66 X
95874   2 ZZZ 0 X 45.63 X
95874   3 ZZZ 0 X 45.63 X
95874   4 ZZZ 0 X 45.63 X
95874   1 ZZZ 0 X 52.11 X
95875 TC 4 XXX 0 X 35.11 X
95875 TC 3 XXX 0 X 35.64 X
95875 TC 2 XXX 0 X 39.81 X
95875 TC 1 XXX 0 X 40.78 X
95875 26 4 XXX 0 X 132.94 X
95875 26 3 XXX 0 X 134.23 X
95875 26 2 XXX 0 X 139.59 X
95875 26 1 XXX 0 X 140.94 X
95875   4 XXX 0 X 168.06 X
95875   3 XXX 0 X 169.89 X
95875   2 XXX 0 X 179.43 X
95875   1 XXX 0 X 181.73 X
95885 26 2 ZZZ 0 X 24.85 X
95885 26 3 ZZZ 0 X 24.85 X
95885 26 4 ZZZ 0 X 24.85 X
95885 26 1 ZZZ 0 X 26.47 X
95885 TC 2 ZZZ 0 X 50.17 X
95885 TC 3 ZZZ 0 X 50.17 X
95885 TC 4 ZZZ 0 X 50.17 X
95885 TC 1 ZZZ 0 X 58.35 X
95885   2 ZZZ 0 X 75.00 X
95885   3 ZZZ 0 X 75.00 X
95885   4 ZZZ 0 X 75.00 X
95885   1 ZZZ 0 X 84.82 X
95886 TC 2 ZZZ 0 X 52.86 X
95886 TC 3 ZZZ 0 X 52.86 X
95886 TC 4 ZZZ 0 X 52.86 X
95886 TC 1 ZZZ 0 X 61.45 X
95886 26 2 ZZZ 0 X 66.36 X
95886 26 3 ZZZ 0 X 66.36 X
95886 26 4 ZZZ 0 X 66.36 X
95886 26 1 ZZZ 0 X 70.89 X
95886   2 ZZZ 0 X 119.23 X
95886   3 ZZZ 0 X 119.23 X
95886   4 ZZZ 0 X 119.23 X
95886   1 ZZZ 0 X 132.34 X
95887 26 2 ZZZ 0 X 52.06 X
95887 26 3 ZZZ 0 X 52.06 X
95887 26 4 ZZZ 0 X 52.06 X
95887 TC 2 ZZZ 0 X 53.75 X
95887 TC 3 ZZZ 0 X 53.75 X
95887 TC 4 ZZZ 0 X 53.75 X
95887 26 1 ZZZ 0 X 55.46 X
95887 TC 1 ZZZ 0 X 62.50 X
95887   2 ZZZ 0 X 105.78 X
95887   3 ZZZ 0 X 105.78 X
95887   4 ZZZ 0 X 105.78 X
95887   1 ZZZ 0 X 117.97 X
95905 26 2 XXX 0 X 4.29 X
95905 26 3 XXX 0 X 4.29 X
95905 26 4 XXX 0 X 4.29 X
95905 26 1 XXX 0 X 4.85 X
95905 TC 2 XXX 0 X 102.50 X
95905 TC 3 XXX 0 X 102.50 X
95905 TC 4 XXX 0 X 102.50 X
95905   2 XXX 0 X 106.80 X
95905   3 XXX 0 X 106.80 X
95905   4 XXX 0 X 106.80 X
95905 TC 1 XXX 0 X 121.72 X
95905   1 XXX 0 X 126.57 X
95907 TC 2 XXX 0 X 54.81 X
95907 TC 3 XXX 0 X 54.81 X
95907 TC 4 XXX 0 X 54.81 X
95907 TC 1 XXX 0 X 64.02 X
95907 26 2 XXX 0 X 70.17 X
95907 26 3 XXX 0 X 70.17 X
95907 26 4 XXX 0 X 70.17 X
95907 26 1 XXX 0 X 74.94 X
95907   2 XXX 0 X 124.98 X
95907   3 XXX 0 X 124.98 X
95907   4 XXX 0 X 124.98 X
95907   1 XXX 0 X 138.95 X
95908 TC 2 XXX 0 X 66.05 X
95908 TC 3 XXX 0 X 66.05 X
95908 TC 4 XXX 0 X 66.05 X
95908 TC 1 XXX 0 X 77.05 X
95908 26 2 XXX 0 X 88.17 X
95908 26 3 XXX 0 X 88.17 X
95908 26 4 XXX 0 X 88.17 X
95908 26 1 XXX 0 X 94.23 X
95908   2 XXX 0 X 154.22 X
95908   3 XXX 0 X 154.22 X
95908   4 XXX 0 X 154.22 X
95908   1 XXX 0 X 171.29 X
95909 TC 2 XXX 0 X 79.64 X
95909 TC 3 XXX 0 X 79.64 X
95909 TC 4 XXX 0 X 79.64 X
95909 TC 1 XXX 0 X 93.17 X
95909 26 2 XXX 0 X 105.21 X
95909 26 3 XXX 0 X 105.21 X
95909 26 4 XXX 0 X 105.21 X
95909 26 1 XXX 0 X 112.27 X
95909   2 XXX 0 X 184.86 X
95909   3 XXX 0 X 184.86 X
95909   4 XXX 0 X 184.86 X
95909   1 XXX 0 X 205.43 X
95910 TC 2 XXX 0 X 102.68 X
95910 TC 3 XXX 0 X 102.68 X
95910 TC 4 XXX 0 X 102.68 X
95910 TC 1 XXX 0 X 120.03 X
95910 26 2 XXX 0 X 140.77 X
95910 26 3 XXX 0 X 140.77 X
95910 26 4 XXX 0 X 140.77 X
95910 26 1 XXX 0 X 150.36 X
95910   2 XXX 0 X 243.47 X
95910   3 XXX 0 X 243.47 X
95910   4 XXX 0 X 243.47 X
95910   1 XXX 0 X 270.39 X
95911 TC 2 XXX 0 X 119.33 X
95911 TC 3 XXX 0 X 119.33 X
95911 TC 4 XXX 0 X 119.33 X
95911 TC 1 XXX 0 X 139.60 X
95911 26 2 XXX 0 X 175.81 X
95911 26 3 XXX 0 X 175.81 X
95911 26 4 XXX 0 X 175.81 X
95911 26 1 XXX 0 X 187.72 X
95911   2 XXX 0 X 295.12 X
95911   3 XXX 0 X 295.12 X
95911   4 XXX 0 X 295.12 X
95911   1 XXX 0 X 327.32 X
95912 TC 2 XXX 0 X 134.99 X
95912 TC 3 XXX 0 X 134.99 X
95912 TC 4 XXX 0 X 134.99 X
95912 TC 1 XXX 0 X 157.93 X
95912 26 2 XXX 0 X 210.94 X
95912 26 3 XXX 0 X 210.94 X
95912 26 4 XXX 0 X 210.94 X
95912 26 1 XXX 0 X 225.32 X
95912   2 XXX 0 X 345.92 X
95912   3 XXX 0 X 345.92 X
95912   4 XXX 0 X 345.92 X
95912   1 XXX 0 X 383.28 X
95913 TC 2 XXX 0 X 151.18 X
95913 TC 3 XXX 0 X 151.18 X
95913 TC 4 XXX 0 X 151.18 X
95913 TC 1 XXX 0 X 177.05 X
95913 26 2 XXX 0 X 250.11 X
95913 26 3 XXX 0 X 250.11 X
95913 26 4 XXX 0 X 250.11 X
95913 26 1 XXX 0 X 267.04 X
95913   2 XXX 0 X 401.33 X
95913   3 XXX 0 X 401.33 X
95913   4 XXX 0 X 401.33 X
95913   1 XXX 0 X 444.09 X
95921 TC 3 XXX 0 X 27.87 X
95921 TC 4 XXX 0 X 27.87 X
95921 TC 2 XXX 0 X 28.61 X
95921 TC 1 XXX 0 X 33.97 X
95921 26 3 XXX 0 X 56.44 X
95921 26 4 XXX 0 X 56.44 X
95921 26 2 XXX 0 X 57.99 X
95921 26 1 XXX 0 X 62.71 X
95921   3 XXX 0 X 84.32 X
95921   4 XXX 0 X 84.32 X
95921   2 XXX 0 X 86.59 X
95921   1 XXX 0 X 96.68 X
95922 TC 3 XXX 0 X 27.87 X
95922 TC 4 XXX 0 X 27.87 X
95922 TC 2 XXX 0 X 28.61 X
95922 TC 1 XXX 0 X 33.97 X
95922 26 3 XXX 0 X 60.62 X
95922 26 4 XXX 0 X 60.62 X
95922 26 2 XXX 0 X 62.26 X
95922 26 1 XXX 0 X 67.71 X
95922   3 XXX 0 X 88.45 X
95922   4 XXX 0 X 88.45 X
95922   2 XXX 0 X 90.88 X
95922   1 XXX 0 X 101.62 X
95923 TC 3 XXX 0 X 27.87 X
95923 TC 4 XXX 0 X 27.87 X
95923 TC 2 XXX 0 X 28.61 X
95923 TC 1 XXX 0 X 33.97 X
95923 26 3 XXX 0 X 56.44 X
95923 26 4 XXX 0 X 56.44 X
95923 26 2 XXX 0 X 57.99 X
95923 26 1 XXX 0 X 62.71 X
95923   3 XXX 0 X 84.32 X
95923   4 XXX 0 X 84.32 X
95923   2 XXX 0 X 86.59 X
95923   1 XXX 0 X 96.68 X
95924 TC 2 XXX 0 X 77.54 X
95924 TC 3 XXX 0 X 77.54 X
95924 TC 4 XXX 0 X 77.54 X
95924 TC 1 XXX 0 X 90.10 X
95924 26 2 XXX 0 X 118.23 X
95924 26 3 XXX 0 X 118.23 X
95924 26 4 XXX 0 X 118.23 X
95924 26 1 XXX 0 X 126.40 X
95924   2 XXX 0 X 195.77 X
95924   3 XXX 0 X 195.77 X
95924   4 XXX 0 X 195.77 X
95924   1 XXX 0 X 216.47 X
95925 TC 4 XXX 0 X 114.51 X
95925 TC 3 XXX 0 X 116.33 X
95925 TC 2 XXX 0 X 126.93 X
95925 TC 1 XXX 0 X 129.43 X
95925 26 4 XXX 0 X 149.13 X
95925 26 3 XXX 0 X 150.90 X
95925 26 2 XXX 0 X 161.58 X
95925 26 1 XXX 0 X 167.03 X
95925   4 XXX 0 X 246.81 X
95925   3 XXX 0 X 253.00 X
95925   2 XXX 0 X 257.36 X
95925   1 XXX 0 X 262.81 X
95926 TC 4 XXX 0 X 69.87 X
95926 TC 3 XXX 0 X 71.31 X
95926 TC 2 XXX 0 X 78.67 X
95926 TC 1 XXX 0 X 83.08 X
95926 26 4 XXX 0 X 95.41 X
95926 26 3 XXX 0 X 96.97 X
95926 26 2 XXX 0 X 103.36 X
95926 26 1 XXX 0 X 107.52 X
95926   4 XXX 0 X 165.29 X
95926   3 XXX 0 X 168.21 X
95926   2 XXX 0 X 182.06 X
95926   1 XXX 0 X 190.60 X
95927 TC 4 XXX 0 X 69.87 X
95927 TC 3 XXX 0 X 71.31 X
95927 TC 2 XXX 0 X 78.67 X
95927 TC 1 XXX 0 X 83.08 X
95927 26 4 XXX 0 X 95.41 X
95927 26 3 XXX 0 X 96.97 X
95927 26 2 XXX 0 X 103.36 X
95927 26 1 XXX 0 X 107.52 X
95927   4 XXX 0 X 165.29 X
95927   3 XXX 0 X 168.21 X
95927   2 XXX 0 X 182.06 X
95927   1 XXX 0 X 190.60 X
95928 26 2 XXX 0 X 145.00 X
95928 26 3 XXX 0 X 145.00 X
95928 26 4 XXX 0 X 145.00 X
95928 TC 2 XXX 0 X 148.48 X
95928 TC 3 XXX 0 X 148.48 X
95928 TC 4 XXX 0 X 148.48 X
95928 26 1 XXX 0 X 157.35 X
95928 TC 1 XXX 0 X 178.82 X
95928   2 XXX 0 X 293.49 X
95928   3 XXX 0 X 293.49 X
95928   4 XXX 0 X 293.49 X
95928   1 XXX 0 X 336.22 X
95929 26 2 XXX 0 X 145.00 X
95929 26 3 XXX 0 X 145.00 X
95929 26 4 XXX 0 X 145.00 X
95929 26 1 XXX 0 X 157.35 X
95929 TC 2 XXX 0 X 160.25 X
95929 TC 3 XXX 0 X 160.25 X
95929 TC 4 XXX 0 X 160.25 X
95929 TC 1 XXX 0 X 192.92 X
95929   2 XXX 0 X 305.20 X
95929   3 XXX 0 X 305.20 X
95929   4 XXX 0 X 305.20 X
95929   1 XXX 0 X 350.31 X
95930 TC 4 XXX 0 X 19.47 X
95930 TC 3 XXX 0 X 19.82 X
95930 TC 2 XXX 0 X 21.82 X
95930 TC 1 XXX 0 X 22.84 X
95930 26 4 XXX 0 X 74.78 X
95930 26 3 XXX 0 X 75.99 X
95930 26 2 XXX 0 X 81.45 X
95930 26 1 XXX 0 X 84.86 X
95930   4 XXX 0 X 94.23 X
95930   3 XXX 0 X 95.89 X
95930   2 XXX 0 X 103.30 X
95930   1 XXX 0 X 107.73 X
95933 TC 4 XXX 0 X 65.21 X
95933 TC 3 XXX 0 X 66.25 X
95933 TC 2 XXX 0 X 72.21 X
95933 TC 1 XXX 0 X 73.61 X
95933 26 4 XXX 0 X 109.17 X
95933 26 3 XXX 0 X 111.12 X
95933 26 1 XXX 0 X 114.14 X
95933 26 2 XXX 0 X 116.64 X
95933   4 XXX 0 X 158.76 X
95933   3 XXX 0 X 160.98 X
95933   2 XXX 0 X 173.52 X
95933   1 XXX 0 X 173.92 X