2021 Workers' Compensation Part B Fee Schedule
95937-97016
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"Effective Jan. 1, 2017, CMS (Medicare) has deleted the PT and OT evaluation and re-evaluation HCPCS codes as follows:
97001 PT Evaluation
97002 PT Re-evaluation
97003 OT Evaluation
97004 OT Re-evaluation
CMS has added the following new HCPCS codes for these services:
97161 PT Eval Low Complex 20 min
97162 PT Eval Mod Complex 30 min
97163 PT Eval High Complex 45 min
97165 OT Eval Low Complex 30 min
97166 OT Eval Mod Complex 45 min
97167 OT Eval High Complex 60 min
97164 PT Re-eval Est Plan Care
97168 OT Re-eval Est Plan Care
The Pennsylvania Workers’ Compensation Part B Fee Schedule reimbursement for all new HCPCS codes have been calculated in compliance with 34 Pa. Code Section 127.153(c), which states on or after Jan. 1, 1995, payment rates under the act for new HCPCS codes will be based on the rates allowed in the Medicare fee schedule on the effective date of the new codes, and 34 Pa. Code Section 127.104, which requires payments to outpatient providers for services rendered under the act be calculated by multiplying the Medicare Part B reimbursement for the services by 113%. Furthermore, CMS has determined that the 2017 Medicare fee schedule reimbursement amounts will remain the same for all three levels of the physical and occupational evaluation services regardless of the time indicator or acuity of services rendered. The re-evaluation codes are not impacted by the newly-introduced tier complexity stratification."
CPT/HCPC Code |
Modifier |
Medicare Location |
Global Surgery Indicator |
Multiple Surgery Indicator |
Prevailing Charge Amount |
Fee Schedule Amount |
Site of Service Amount |
95937 |
TC |
4 |
XXX |
0 |
X |
27.87 |
X |
95937 |
TC |
3 |
XXX |
0 |
X |
28.28 |
X |
95937 |
TC |
2 |
XXX |
0 |
X |
30.96 |
X |
95937 |
TC |
1 |
XXX |
0 |
X |
31.60 |
X |
95937 |
26 |
3 |
XXX |
0 |
X |
114.93 |
X |
95937 |
|
4 |
XXX |
0 |
X |
123.02 |
X |
95937 |
|
3 |
XXX |
0 |
X |
123.49 |
X |
95937 |
|
1 |
XXX |
0 |
X |
128.47 |
X |
95937 |
26 |
4 |
XXX |
0 |
X |
129.08 |
X |
95937 |
|
2 |
XXX |
0 |
X |
140.11 |
X |
95937 |
26 |
2 |
XXX |
0 |
X |
150.48 |
X |
95937 |
26 |
1 |
XXX |
0 |
X |
150.90 |
X |
95938 |
26 |
2 |
XXX |
0 |
X |
61.30 |
X |
95938 |
26 |
3 |
XXX |
0 |
X |
61.30 |
X |
95938 |
26 |
4 |
XXX |
0 |
X |
61.30 |
X |
95938 |
26 |
1 |
XXX |
0 |
X |
65.58 |
X |
95938 |
TC |
2 |
XXX |
0 |
X |
331.55 |
X |
95938 |
TC |
3 |
XXX |
0 |
X |
331.55 |
X |
95938 |
TC |
4 |
XXX |
0 |
X |
331.55 |
X |
95938 |
TC |
1 |
XXX |
0 |
X |
385.06 |
X |
95938 |
|
2 |
XXX |
0 |
X |
392.85 |
X |
95938 |
|
3 |
XXX |
0 |
X |
392.85 |
X |
95938 |
|
4 |
XXX |
0 |
X |
392.85 |
X |
95938 |
|
1 |
XXX |
0 |
X |
450.65 |
X |
95939 |
26 |
2 |
XXX |
0 |
X |
161.37 |
X |
95939 |
26 |
3 |
XXX |
0 |
X |
161.37 |
X |
95939 |
26 |
4 |
XXX |
0 |
X |
161.37 |
X |
95939 |
26 |
1 |
XXX |
0 |
X |
172.81 |
X |
95939 |
TC |
2 |
XXX |
0 |
X |
457.73 |
X |
95939 |
TC |
3 |
XXX |
0 |
X |
457.73 |
X |
95939 |
TC |
4 |
XXX |
0 |
X |
457.73 |
X |
95939 |
TC |
1 |
XXX |
0 |
X |
531.55 |
X |
95939 |
|
2 |
XXX |
0 |
X |
619.11 |
X |
95939 |
|
3 |
XXX |
0 |
X |
619.11 |
X |
95939 |
|
4 |
XXX |
0 |
X |
619.11 |
X |
95939 |
|
1 |
XXX |
0 |
X |
704.40 |
X |
95940 |
|
2 |
XXX |
0 |
X |
43.44 |
X |
95940 |
|
3 |
XXX |
0 |
X |
43.44 |
X |
95940 |
|
4 |
XXX |
0 |
X |
43.44 |
X |
95940 |
|
1 |
XXX |
0 |
X |
46.69 |
X |
95941 |
|
|
XXX |
9 |
X |
* |
X |
95943 |
|
|
XXX |
0 |
X |
* |
X |
95954 |
TC |
4 |
XXX |
0 |
X |
41.47 |
X |
95954 |
TC |
3 |
XXX |
0 |
X |
42.08 |
X |
95954 |
TC |
2 |
XXX |
0 |
X |
46.59 |
X |
95954 |
TC |
1 |
XXX |
0 |
X |
47.68 |
X |
95954 |
26 |
1 |
XXX |
0 |
X |
241.90 |
X |
95954 |
26 |
4 |
XXX |
0 |
X |
374.09 |
X |
95954 |
26 |
3 |
XXX |
0 |
X |
378.59 |
X |
95954 |
26 |
2 |
XXX |
0 |
X |
401.14 |
X |
95954 |
|
4 |
XXX |
0 |
X |
415.50 |
X |
95954 |
|
3 |
XXX |
0 |
X |
420.62 |
X |
95954 |
|
2 |
XXX |
0 |
X |
447.75 |
X |
95954 |
|
1 |
XXX |
0 |
X |
454.35 |
X |
95955 |
TC |
4 |
XXX |
0 |
X |
165.58 |
X |
95955 |
TC |
3 |
XXX |
0 |
X |
168.14 |
X |
95955 |
26 |
4 |
XXX |
0 |
X |
176.27 |
X |
95955 |
26 |
3 |
XXX |
0 |
X |
178.47 |
X |
95955 |
TC |
2 |
XXX |
0 |
X |
184.50 |
X |
95955 |
TC |
1 |
XXX |
0 |
X |
188.40 |
X |
95955 |
26 |
2 |
XXX |
0 |
X |
189.81 |
X |
95955 |
26 |
1 |
XXX |
0 |
X |
192.50 |
X |
95955 |
|
4 |
XXX |
0 |
X |
341.84 |
X |
95955 |
|
1 |
XXX |
0 |
X |
380.90 |
X |
95955 |
|
2 |
XXX |
0 |
X |
423.44 |
X |
95955 |
|
3 |
XXX |
0 |
X |
460.67 |
X |
95957 |
TC |
4 |
XXX |
0 |
X |
140.77 |
X |
95957 |
TC |
3 |
XXX |
0 |
X |
142.97 |
X |
95957 |
TC |
2 |
XXX |
0 |
X |
155.81 |
X |
95957 |
TC |
1 |
XXX |
0 |
X |
158.84 |
X |
95957 |
26 |
2 |
XXX |
0 |
X |
249.03 |
X |
95957 |
26 |
1 |
XXX |
0 |
X |
258.39 |
X |
95957 |
|
2 |
XXX |
0 |
X |
297.37 |
X |
95957 |
26 |
4 |
XXX |
0 |
X |
297.40 |
X |
95957 |
26 |
3 |
XXX |
0 |
X |
300.57 |
X |
95957 |
|
4 |
XXX |
0 |
X |
438.17 |
X |
95957 |
|
3 |
XXX |
0 |
X |
443.50 |
X |
95957 |
|
1 |
XXX |
0 |
X |
473.03 |
X |
95958 |
TC |
4 |
XXX |
0 |
X |
144.77 |
X |
95958 |
TC |
3 |
XXX |
0 |
X |
147.05 |
X |
95958 |
TC |
2 |
XXX |
0 |
X |
160.48 |
X |
95958 |
TC |
1 |
XXX |
0 |
X |
163.70 |
X |
95958 |
26 |
1 |
XXX |
0 |
X |
451.54 |
X |
95958 |
26 |
4 |
XXX |
0 |
X |
647.96 |
X |
95958 |
26 |
3 |
XXX |
0 |
X |
655.71 |
X |
95958 |
26 |
2 |
XXX |
0 |
X |
694.78 |
X |
95958 |
|
1 |
XXX |
0 |
X |
699.52 |
X |
95958 |
|
4 |
XXX |
0 |
X |
792.71 |
X |
95958 |
|
3 |
XXX |
0 |
X |
802.70 |
X |
95958 |
|
2 |
XXX |
0 |
X |
855.23 |
X |
95961 |
|
|
XXX |
0 |
X |
* |
X |
95962 |
|
|
ZZZ |
0 |
X |
* |
X |
95965 |
26 |
2 |
XXX |
0 |
X |
771.05 |
X |
95965 |
26 |
3 |
XXX |
0 |
X |
771.05 |
X |
95965 |
26 |
4 |
XXX |
0 |
X |
771.05 |
X |
95965 |
26 |
1 |
XXX |
0 |
X |
835.38 |
X |
95966 |
26 |
2 |
XXX |
0 |
X |
390.18 |
X |
95966 |
26 |
3 |
XXX |
0 |
X |
390.18 |
X |
95966 |
26 |
4 |
XXX |
0 |
X |
390.18 |
X |
95966 |
26 |
1 |
XXX |
0 |
X |
425.99 |
X |
95967 |
26 |
2 |
ZZZ |
0 |
X |
342.08 |
X |
95967 |
26 |
3 |
ZZZ |
0 |
X |
342.08 |
X |
95967 |
26 |
4 |
ZZZ |
0 |
X |
342.08 |
X |
95967 |
26 |
1 |
ZZZ |
0 |
X |
373.96 |
X |
95970 |
|
2 |
XXX |
0 |
X |
46.34 |
44.97 |
95970 |
|
3 |
XXX |
0 |
X |
46.34 |
44.97 |
95970 |
|
4 |
XXX |
0 |
X |
46.34 |
44.97 |
95970 |
|
1 |
XXX |
0 |
X |
52.86 |
51.20 |
95971 |
|
2 |
XXX |
0 |
X |
77.33 |
75.22 |
95971 |
|
3 |
XXX |
0 |
X |
77.33 |
75.22 |
95971 |
|
4 |
XXX |
0 |
X |
77.33 |
75.22 |
95971 |
|
1 |
XXX |
0 |
X |
85.78 |
83.30 |
95972 |
|
2 |
XXX |
0 |
X |
144.44 |
140.94 |
95972 |
|
3 |
XXX |
0 |
X |
144.44 |
140.94 |
95972 |
|
4 |
XXX |
0 |
X |
144.44 |
140.94 |
95972 |
|
1 |
XXX |
0 |
X |
157.08 |
152.99 |
95976 |
|
2 |
XXX |
0 |
X |
48.53 |
47.73 |
95976 |
|
3 |
XXX |
0 |
X |
48.53 |
47.73 |
95976 |
|
4 |
XXX |
0 |
X |
48.53 |
47.73 |
95976 |
|
1 |
XXX |
0 |
X |
52.36 |
51.45 |
95977 |
|
2 |
XXX |
0 |
X |
64.41 |
63.63 |
95977 |
|
3 |
XXX |
0 |
X |
64.41 |
63.63 |
95977 |
|
4 |
XXX |
0 |
X |
64.41 |
63.63 |
95977 |
|
1 |
XXX |
0 |
X |
69.48 |
68.55 |
95980 |
|
2 |
XXX |
0 |
X |
59.91 |
X |
95980 |
|
3 |
XXX |
0 |
X |
59.91 |
X |
95980 |
|
4 |
XXX |
0 |
X |
59.91 |
X |
95980 |
|
1 |
XXX |
0 |
X |
65.78 |
X |
95981 |
|
2 |
XXX |
0 |
X |
41.02 |
23.40 |
95981 |
|
3 |
XXX |
0 |
X |
41.02 |
23.40 |
95981 |
|
4 |
XXX |
0 |
X |
41.02 |
23.40 |
95981 |
|
1 |
XXX |
0 |
X |
46.98 |
25.70 |
95982 |
|
2 |
XXX |
0 |
X |
63.11 |
47.09 |
95982 |
|
3 |
XXX |
0 |
X |
63.11 |
47.09 |
95982 |
|
4 |
XXX |
0 |
X |
63.11 |
47.09 |
95982 |
|
1 |
XXX |
0 |
X |
70.63 |
51.38 |
95983 |
|
2 |
XXX |
0 |
X |
61.11 |
60.30 |
95983 |
|
3 |
XXX |
0 |
X |
61.11 |
60.30 |
95983 |
|
4 |
XXX |
0 |
X |
61.11 |
60.30 |
95983 |
|
1 |
XXX |
0 |
X |
66.08 |
65.17 |
95984 |
|
2 |
ZZZ |
0 |
X |
53.16 |
52.75 |
95984 |
|
3 |
ZZZ |
0 |
X |
53.16 |
52.75 |
95984 |
|
4 |
ZZZ |
0 |
X |
53.16 |
52.75 |
95984 |
|
1 |
ZZZ |
0 |
X |
57.37 |
56.91 |
95990 |
|
2 |
ZZZ |
0 |
X |
99.11 |
X |
95990 |
|
3 |
ZZZ |
0 |
X |
99.11 |
X |
95990 |
|
4 |
ZZZ |
0 |
X |
99.11 |
X |
95990 |
|
1 |
ZZZ |
0 |
X |
118.21 |
X |
95991 |
|
2 |
XXX |
0 |
X |
148.43 |
68.72 |
95991 |
|
3 |
XXX |
0 |
X |
148.43 |
68.72 |
95991 |
|
4 |
XXX |
0 |
X |
148.43 |
68.72 |
95991 |
|
1 |
XXX |
0 |
X |
168.32 |
74.64 |
95992 |
|
|
XXX |
0 |
X |
* |
X |
95999 |
|
|
XXX |
0 |
X |
# |
X |
96000 |
|
2 |
XXX |
0 |
X |
172.29 |
X |
96000 |
|
3 |
XXX |
0 |
X |
172.29 |
X |
96000 |
|
4 |
XXX |
0 |
X |
172.29 |
X |
96000 |
|
1 |
XXX |
0 |
X |
185.65 |
X |
96001 |
|
2 |
XXX |
0 |
X |
205.58 |
X |
96001 |
|
3 |
XXX |
0 |
X |
205.58 |
X |
96001 |
|
4 |
XXX |
0 |
X |
205.58 |
X |
96001 |
|
1 |
XXX |
0 |
X |
221.38 |
X |
96002 |
|
2 |
XXX |
0 |
X |
39.82 |
X |
96002 |
|
3 |
XXX |
0 |
X |
39.82 |
X |
96002 |
|
4 |
XXX |
0 |
X |
39.82 |
X |
96002 |
|
1 |
XXX |
0 |
X |
43.53 |
X |
96003 |
|
2 |
XXX |
0 |
X |
36.96 |
X |
96003 |
|
3 |
XXX |
0 |
X |
36.96 |
X |
96003 |
|
4 |
XXX |
0 |
X |
36.96 |
X |
96003 |
|
1 |
XXX |
0 |
X |
40.89 |
X |
96004 |
|
2 |
XXX |
0 |
X |
175.52 |
X |
96004 |
|
3 |
XXX |
0 |
X |
175.52 |
X |
96004 |
|
4 |
XXX |
0 |
X |
175.52 |
X |
96004 |
|
1 |
XXX |
0 |
X |
191.60 |
X |
96020 |
26 |
2 |
XXX |
0 |
X |
234.12 |
X |
96020 |
26 |
3 |
XXX |
0 |
X |
234.12 |
X |
96020 |
26 |
4 |
XXX |
0 |
X |
234.12 |
X |
96020 |
26 |
1 |
XXX |
0 |
X |
254.45 |
X |
96040 |
|
|
XXX |
9 |
X |
* |
X |
96105 |
|
4 |
XXX |
0 |
X |
138.89 |
X |
96105 |
|
3 |
XXX |
0 |
X |
141.68 |
X |
96105 |
|
2 |
XXX |
0 |
X |
157.04 |
X |
96105 |
|
1 |
XXX |
0 |
X |
167.03 |
X |
96110 |
|
|
XXX |
0 |
X |
* |
X |
96112 |
|
2 |
XXX |
0 |
X |
160.27 |
151.49 |
96112 |
|
3 |
XXX |
0 |
X |
160.27 |
151.49 |
96112 |
|
4 |
XXX |
0 |
X |
160.27 |
151.49 |
96112 |
|
1 |
XXX |
0 |
X |
171.38 |
161.30 |
96113 |
|
2 |
ZZZ |
0 |
X |
71.63 |
69.25 |
96113 |
|
3 |
ZZZ |
0 |
X |
71.63 |
69.25 |
96113 |
|
4 |
ZZZ |
0 |
X |
71.63 |
69.25 |
96113 |
|
1 |
ZZZ |
0 |
X |
76.57 |
73.83 |
96116 |
|
2 |
XXX |
0 |
X |
170.87 |
160.25 |
96116 |
|
3 |
XXX |
0 |
X |
170.87 |
160.25 |
96116 |
|
4 |
XXX |
0 |
X |
170.87 |
160.25 |
96116 |
|
1 |
XXX |
0 |
X |
189.61 |
176.59 |
96121 |
|
2 |
ZZZ |
0 |
X |
97.49 |
93.10 |
96121 |
|
3 |
ZZZ |
0 |
X |
97.49 |
93.10 |
96121 |
|
4 |
ZZZ |
0 |
X |
97.49 |
93.10 |
96121 |
|
1 |
ZZZ |
0 |
X |
103.39 |
98.37 |
96125 |
|
2 |
XXX |
0 |
X |
141.35 |
119.86 |
96125 |
|
3 |
XXX |
0 |
X |
141.35 |
119.86 |
96125 |
|
4 |
XXX |
0 |
X |
141.35 |
119.86 |
96125 |
|
1 |
XXX |
0 |
X |
156.78 |
130.84 |
96127 |
|
2 |
XXX |
0 |
X |
6.73 |
X |
96127 |
|
3 |
XXX |
0 |
X |
6.73 |
X |
96127 |
|
4 |
XXX |
0 |
X |
6.73 |
X |
96127 |
|
1 |
XXX |
0 |
X |
7.94 |
X |
96130 |
|
2 |
XXX |
0 |
X |
138.96 |
131.00 |
96130 |
|
3 |
XXX |
0 |
X |
138.96 |
131.00 |
96130 |
|
4 |
XXX |
0 |
X |
138.96 |
131.00 |
96130 |
|
1 |
XXX |
0 |
X |
146.60 |
137.45 |
96131 |
|
2 |
ZZZ |
0 |
X |
105.71 |
99.73 |
96131 |
|
3 |
ZZZ |
0 |
X |
105.71 |
99.73 |
96131 |
|
4 |
ZZZ |
0 |
X |
105.71 |
99.73 |
96131 |
|
1 |
ZZZ |
0 |
X |
111.40 |
104.54 |
96132 |
|
2 |
XXX |
0 |
X |
155.28 |
128.56 |
96132 |
|
3 |
XXX |
0 |
X |
155.28 |
128.56 |
96132 |
|
4 |
XXX |
0 |
X |
155.28 |
128.56 |
96132 |
|
1 |
XXX |
0 |
X |
165.23 |
134.58 |
96133 |
|
2 |
ZZZ |
0 |
X |
118.47 |
98.53 |
96133 |
|
3 |
ZZZ |
0 |
X |
118.47 |
98.53 |
96133 |
|
4 |
ZZZ |
0 |
X |
118.47 |
98.53 |
96133 |
|
1 |
ZZZ |
0 |
X |
126.03 |
103.17 |
96136 |
|
2 |
XXX |
0 |
X |
54.65 |
29.54 |
96136 |
|
3 |
XXX |
0 |
X |
54.65 |
29.54 |
96136 |
|
4 |
XXX |
0 |
X |
54.65 |
29.54 |
96136 |
|
1 |
XXX |
0 |
X |
60.02 |
31.19 |
96137 |
|
2 |
ZZZ |
0 |
X |
50.38 |
23.26 |
96137 |
|
3 |
ZZZ |
0 |
X |
50.38 |
23.26 |
96137 |
|
4 |
ZZZ |
0 |
X |
50.38 |
23.26 |
96137 |
|
1 |
ZZZ |
0 |
X |
55.52 |
24.40 |
96138 |
|
2 |
XXX |
0 |
X |
43.11 |
X |
96138 |
|
3 |
XXX |
0 |
X |
43.11 |
X |
96138 |
|
4 |
XXX |
0 |
X |
43.11 |
X |
96138 |
|
1 |
XXX |
0 |
X |
49.54 |
X |
96139 |
|
2 |
ZZZ |
0 |
X |
43.11 |
X |
96139 |
|
3 |
ZZZ |
0 |
X |
43.11 |
X |
96139 |
|
4 |
ZZZ |
0 |
X |
43.11 |
X |
96139 |
|
1 |
ZZZ |
0 |
X |
49.54 |
X |
96146 |
|
2 |
XXX |
0 |
X |
2.44 |
X |
96146 |
|
3 |
XXX |
0 |
X |
2.44 |
X |
96146 |
|
4 |
XXX |
0 |
X |
2.44 |
X |
96146 |
|
1 |
XXX |
0 |
X |
2.88 |
X |
96156 |
|
2 |
XXX |
0 |
X |
115.82 |
105.44 |
96156 |
|
3 |
XXX |
0 |
X |
115.82 |
105.44 |
96156 |
|
4 |
XXX |
0 |
X |
115.82 |
105.44 |
96156 |
|
1 |
XXX |
0 |
X |
123.20 |
111.22 |
96158 |
|
2 |
XXX |
0 |
X |
79.05 |
71.86 |
96158 |
|
3 |
XXX |
0 |
X |
79.05 |
71.86 |
96158 |
|
4 |
XXX |
0 |
X |
79.05 |
71.86 |
96158 |
|
1 |
XXX |
0 |
X |
83.91 |
75.63 |
96159 |
|
2 |
ZZZ |
0 |
X |
27.60 |
24.80 |
96159 |
|
3 |
ZZZ |
0 |
X |
27.60 |
24.80 |
96159 |
|
4 |
ZZZ |
0 |
X |
27.60 |
24.80 |
96159 |
|
1 |
ZZZ |
0 |
X |
29.34 |
26.12 |
96160 |
|
2 |
ZZZ |
9 |
X |
5.60 |
X |
96160 |
|
3 |
ZZZ |
9 |
X |
5.60 |
X |
96160 |
|
4 |
ZZZ |
9 |
X |
5.60 |
X |
96160 |
|
1 |
ZZZ |
9 |
X |
6.49 |
X |
96161 |
|
2 |
ZZZ |
9 |
X |
5.60 |
X |
96161 |
|
3 |
ZZZ |
9 |
X |
5.60 |
X |
96161 |
|
4 |
ZZZ |
9 |
X |
5.60 |
X |
96161 |
|
1 |
ZZZ |
9 |
X |
6.49 |
X |
96164 |
|
2 |
XXX |
0 |
X |
11.70 |
10.51 |
96164 |
|
3 |
XXX |
0 |
X |
11.70 |
10.51 |
96164 |
|
4 |
XXX |
0 |
X |
11.70 |
10.51 |
96164 |
|
1 |
XXX |
0 |
X |
12.47 |
11.09 |
96165 |
|
2 |
ZZZ |
0 |
X |
5.44 |
4.63 |
96165 |
|
3 |
ZZZ |
0 |
X |
5.44 |
4.63 |
96165 |
|
4 |
ZZZ |
0 |
X |
5.44 |
4.63 |
96165 |
|
1 |
ZZZ |
0 |
X |
5.74 |
4.82 |
96167 |
|
2 |
XXX |
0 |
X |
84.90 |
76.91 |
96167 |
|
3 |
XXX |
0 |
X |
84.90 |
76.91 |
96167 |
|
4 |
XXX |
0 |
X |
84.90 |
76.91 |
96167 |
|
1 |
XXX |
0 |
X |
90.21 |
81.00 |
96168 |
|
2 |
ZZZ |
0 |
X |
30.11 |
27.31 |
96168 |
|
3 |
ZZZ |
0 |
X |
30.11 |
27.31 |
96168 |
|
4 |
ZZZ |
0 |
X |
30.11 |
27.31 |
96168 |
|
1 |
ZZZ |
0 |
X |
31.99 |
28.75 |
96170 |
|
|
|
|
X |
* |
X |
96171 |
|
|
|
|
X |
* |
X |
96360 |
|
2 |
XXX |
0 |
X |
81.34 |
X |
96360 |
|
3 |
XXX |
0 |
X |
81.34 |
X |
96360 |
|
4 |
XXX |
0 |
X |
81.34 |
X |
96360 |
|
1 |
XXX |
0 |
X |
96.13 |
X |
96361 |
|
2 |
ZZZ |
0 |
X |
24.16 |
X |
96361 |
|
3 |
ZZZ |
0 |
X |
24.16 |
X |
96361 |
|
4 |
ZZZ |
0 |
X |
24.16 |
X |
96361 |
|
1 |
ZZZ |
0 |
X |
28.56 |
X |
96365 |
|
2 |
XXX |
0 |
X |
98.82 |
X |
96365 |
|
3 |
XXX |
0 |
X |
98.82 |
X |
96365 |
|
4 |
XXX |
0 |
X |
98.82 |
X |
96365 |
|
1 |
XXX |
0 |
X |
116.53 |
X |
96366 |
|
2 |
ZZZ |
0 |
X |
32.15 |
X |
96366 |
|
3 |
ZZZ |
0 |
X |
32.15 |
X |
96366 |
|
4 |
ZZZ |
0 |
X |
32.15 |
X |
96366 |
|
1 |
ZZZ |
0 |
X |
37.22 |
X |
96367 |
|
2 |
ZZZ |
0 |
X |
50.07 |
X |
96367 |
|
3 |
ZZZ |
0 |
X |
50.07 |
X |
96367 |
|
4 |
ZZZ |
0 |
X |
50.07 |
X |
96367 |
|
1 |
ZZZ |
0 |
X |
58.32 |
X |
96368 |
|
2 |
ZZZ |
0 |
X |
30.08 |
X |
96368 |
|
3 |
ZZZ |
0 |
X |
30.08 |
X |
96368 |
|
4 |
ZZZ |
0 |
X |
30.08 |
X |
96368 |
|
1 |
ZZZ |
0 |
X |
34.84 |
X |
96369 |
|
2 |
XXX |
0 |
X |
212.91 |
X |
96369 |
|
3 |
XXX |
0 |
X |
212.91 |
X |
96369 |
|
4 |
XXX |
0 |
X |
212.91 |
X |
96369 |
|
1 |
XXX |
0 |
X |
251.64 |
X |
96370 |
|
2 |
ZZZ |
0 |
X |
23.51 |
X |
96370 |
|
3 |
ZZZ |
0 |
X |
23.51 |
X |
96370 |
|
4 |
ZZZ |
0 |
X |
23.51 |
X |
96370 |
|
1 |
ZZZ |
0 |
X |
26.93 |
X |
96371 |
|
2 |
ZZZ |
0 |
X |
102.53 |
X |
96371 |
|
3 |
ZZZ |
0 |
X |
102.53 |
X |
96371 |
|
4 |
ZZZ |
0 |
X |
102.53 |
X |
96371 |
|
1 |
ZZZ |
0 |
X |
121.80 |
X |
96372 |
|
2 |
XXX |
0 |
X |
30.35 |
X |
96372 |
|
3 |
XXX |
0 |
X |
30.35 |
X |
96372 |
|
4 |
XXX |
0 |
X |
30.35 |
X |
96372 |
|
1 |
XXX |
0 |
X |
34.58 |
X |
96373 |
|
2 |
XXX |
0 |
X |
26.35 |
X |
96373 |
|
3 |
XXX |
0 |
X |
26.35 |
X |
96373 |
|
4 |
XXX |
0 |
X |
26.35 |
X |
96373 |
|
1 |
XXX |
0 |
X |
30.04 |
X |
96374 |
|
2 |
XXX |
0 |
X |
78.05 |
X |
96374 |
|
3 |
XXX |
0 |
X |
78.05 |
X |
96374 |
|
4 |
XXX |
0 |
X |
78.05 |
X |
96374 |
|
1 |
XXX |
0 |
X |
91.63 |
X |
96375 |
|
2 |
ZZZ |
0 |
X |
34.41 |
X |
96375 |
|
3 |
ZZZ |
0 |
X |
34.41 |
X |
96375 |
|
4 |
ZZZ |
0 |
X |
34.41 |
X |
96375 |
|
1 |
ZZZ |
0 |
X |
40.61 |
X |
96376 |
|
|
ZZZ |
9 |
X |
* |
X |
96377 |
|
|
|
|
X |
* |
X |
96379 |
|
|
XXX |
0 |
X |
# |
X |
96401 |
|
2 |
XXX |
0 |
X |
99.19 |
X |
96401 |
|
3 |
XXX |
0 |
X |
99.19 |
X |
96401 |
|
4 |
XXX |
0 |
X |
99.19 |
X |
96401 |
|
1 |
XXX |
0 |
X |
118.91 |
X |
96402 |
|
2 |
XXX |
0 |
X |
53.71 |
X |
96402 |
|
3 |
XXX |
0 |
X |
53.71 |
X |
96402 |
|
4 |
XXX |
0 |
X |
53.71 |
X |
96402 |
|
1 |
XXX |
0 |
X |
63.57 |
X |
96405 |
|
4 |
0 |
2 |
X |
81.85 |
65.82 |
96405 |
|
3 |
0 |
2 |
X |
82.86 |
66.54 |
96405 |
|
2 |
0 |
2 |
X |
87.22 |
69.87 |
96405 |
|
1 |
0 |
2 |
X |
88.25 |
70.71 |
96406 |
|
4 |
0 |
2 |
X |
123.71 |
99.60 |
96406 |
|
3 |
0 |
2 |
X |
125.21 |
100.66 |
96406 |
|
2 |
0 |
2 |
X |
131.52 |
105.52 |
96406 |
|
1 |
0 |
2 |
X |
133.03 |
106.74 |
96409 |
|
2 |
XXX |
0 |
X |
181.88 |
X |
96409 |
|
3 |
XXX |
0 |
X |
181.88 |
X |
96409 |
|
4 |
XXX |
0 |
X |
181.88 |
X |
96409 |
|
1 |
XXX |
0 |
X |
221.00 |
X |
96411 |
|
2 |
ZZZ |
0 |
X |
105.52 |
X |
96411 |
|
3 |
ZZZ |
0 |
X |
105.52 |
X |
96411 |
|
4 |
ZZZ |
0 |
X |
105.52 |
X |
96411 |
|
1 |
ZZZ |
0 |
X |
128.05 |
X |
96413 |
|
2 |
XXX |
0 |
X |
256.46 |
X |
96413 |
|
3 |
XXX |
0 |
X |
256.46 |
X |
96413 |
|
4 |
XXX |
0 |
X |
256.46 |
X |
96413 |
|
1 |
XXX |
0 |
X |
312.26 |
X |
96415 |
|
2 |
ZZZ |
0 |
X |
58.40 |
X |
96415 |
|
3 |
ZZZ |
0 |
X |
58.40 |
X |
96415 |
|
4 |
ZZZ |
0 |
X |
58.40 |
X |
96415 |
|
1 |
ZZZ |
0 |
X |
70.76 |
X |
96416 |
|
2 |
XXX |
0 |
X |
275.08 |
X |
96416 |
|
3 |
XXX |
0 |
X |
275.08 |
X |
96416 |
|
4 |
XXX |
0 |
X |
275.08 |
X |
96416 |
|
1 |
XXX |
0 |
X |
335.91 |
X |
96417 |
|
2 |
ZZZ |
0 |
X |
125.69 |
X |
96417 |
|
3 |
ZZZ |
0 |
X |
125.69 |
X |
96417 |
|
4 |
ZZZ |
0 |
X |
125.69 |
X |
96417 |
|
1 |
ZZZ |
0 |
X |
152.82 |
X |
96420 |
|
4 |
XXX |
0 |
X |
102.55 |
X |
96420 |
|
3 |
XXX |
0 |
X |
104.16 |
X |
96420 |
|
2 |
XXX |
0 |
X |
113.39 |
X |
96420 |
|
1 |
XXX |
0 |
X |
115.56 |
X |
96422 |
|
3 |
XXX |
0 |
X |
102.56 |
X |
96422 |
|
1 |
XXX |
0 |
X |
113.85 |
X |
96422 |
|
4 |
XXX |
0 |
X |
122.14 |
X |
96422 |
|
2 |
XXX |
0 |
X |
124.39 |
X |
96423 |
|
4 |
ZZZ |
0 |
X |
39.75 |
X |
96423 |
|
3 |
ZZZ |
0 |
X |
40.38 |
X |
96423 |
|
2 |
ZZZ |
0 |
X |
90.71 |
X |
96423 |
|
1 |
ZZZ |
0 |
X |
91.02 |
X |
96425 |
|
3 |
XXX |
0 |
X |
100.86 |
X |
96425 |
|
2 |
XXX |
0 |
X |
106.60 |
X |
96425 |
|
4 |
XXX |
0 |
X |
116.79 |
X |
96425 |
|
1 |
XXX |
0 |
X |
131.11 |
X |
96440 |
|
2 |
0 |
0 |
X |
268.43 |
229.41 |
96440 |
|
4 |
0 |
0 |
X |
269.31 |
236.87 |
96440 |
|
3 |
0 |
0 |
X |
295.74 |
252.85 |
96440 |
|
1 |
0 |
0 |
X |
315.23 |
268.54 |
96446 |
|
2 |
XXX |
0 |
X |
253.76 |
31.82 |
96446 |
|
3 |
XXX |
0 |
X |
253.76 |
31.82 |
96446 |
|
4 |
XXX |
0 |
X |
253.76 |
31.82 |
96446 |
|
1 |
XXX |
0 |
X |
286.30 |
35.16 |
96450 |
|
4 |
0 |
0 |
X |
158.40 |
X |
96450 |
|
1 |
0 |
0 |
X |
167.21 |
X |
96450 |
|
2 |
0 |
0 |
X |
176.24 |
X |
96450 |
|
3 |
0 |
0 |
X |
198.36 |
X |
96521 |
|
2 |
XXX |
0 |
X |
227.06 |
X |
96521 |
|
3 |
XXX |
0 |
X |
227.06 |
X |
96521 |
|
4 |
XXX |
0 |
X |
227.06 |
X |
96521 |
|
1 |
XXX |
0 |
X |
276.65 |
X |
96522 |
|
2 |
XXX |
0 |
X |
164.36 |
X |
96522 |
|
3 |
XXX |
0 |
X |
164.36 |
X |
96522 |
|
4 |
XXX |
0 |
X |
164.36 |
X |
96522 |
|
1 |
XXX |
0 |
X |
199.95 |
X |
96523 |
|
2 |
XXX |
0 |
X |
41.60 |
X |
96523 |
|
3 |
XXX |
0 |
X |
41.60 |
X |
96523 |
|
4 |
XXX |
0 |
X |
41.60 |
X |
96523 |
|
1 |
XXX |
0 |
X |
50.69 |
X |
96542 |
|
4 |
XXX |
0 |
X |
217.62 |
X |
96542 |
|
3 |
XXX |
0 |
X |
220.20 |
X |
96542 |
|
2 |
XXX |
0 |
X |
233.44 |
X |
96542 |
|
1 |
XXX |
0 |
X |
236.62 |
X |
96549 |
|
|
XXX |
0 |
X |
# |
X |
96567 |
|
2 |
XXX |
0 |
X |
107.51 |
X |
96567 |
|
3 |
XXX |
0 |
X |
107.51 |
X |
96567 |
|
4 |
XXX |
0 |
X |
107.51 |
X |
96567 |
|
1 |
XXX |
0 |
X |
127.38 |
X |
96570 |
|
2 |
ZZZ |
0 |
X |
147.51 |
127.55 |
96570 |
|
3 |
ZZZ |
0 |
X |
147.51 |
127.55 |
96570 |
|
4 |
ZZZ |
0 |
X |
147.51 |
127.55 |
96570 |
|
1 |
ZZZ |
0 |
X |
171.24 |
147.91 |
96571 |
|
2 |
ZZZ |
0 |
X |
77.37 |
70.23 |
96571 |
|
3 |
ZZZ |
0 |
X |
77.37 |
70.23 |
96571 |
|
4 |
ZZZ |
0 |
X |
77.37 |
70.23 |
96571 |
|
1 |
ZZZ |
0 |
X |
94.82 |
86.48 |
96573 |
|
2 |
0 |
0 |
X |
227.09 |
X |
96573 |
|
3 |
0 |
0 |
X |
227.09 |
X |
96573 |
|
4 |
0 |
0 |
X |
227.09 |
X |
96573 |
|
1 |
0 |
0 |
X |
258.12 |
X |
96574 |
|
2 |
0 |
0 |
X |
293.82 |
X |
96574 |
|
3 |
0 |
0 |
X |
293.82 |
X |
96574 |
|
4 |
0 |
0 |
X |
293.82 |
X |
96574 |
|
1 |
0 |
0 |
X |
331.87 |
X |
96900 |
|
3 |
XXX |
0 |
X |
33.12 |
X |
96900 |
|
2 |
XXX |
0 |
X |
36.10 |
X |
96900 |
|
4 |
XXX |
0 |
X |
39.54 |
X |
96900 |
|
1 |
XXX |
0 |
X |
40.43 |
X |
96902 |
|
|
XXX |
9 |
X |
* |
X |
96904 |
|
2 |
XXX |
0 |
X |
98.64 |
X |
96904 |
|
3 |
XXX |
0 |
X |
98.64 |
X |
96904 |
|
4 |
XXX |
0 |
X |
98.64 |
X |
96904 |
|
1 |
XXX |
0 |
X |
120.88 |
X |
96910 |
|
4 |
XXX |
0 |
X |
47.72 |
X |
96910 |
|
3 |
XXX |
0 |
X |
48.43 |
X |
96910 |
|
2 |
XXX |
0 |
X |
52.75 |
X |
96910 |
|
1 |
XXX |
0 |
X |
53.71 |
X |
96912 |
|
4 |
XXX |
0 |
X |
54.86 |
X |
96912 |
|
3 |
XXX |
0 |
X |
55.72 |
X |
96912 |
|
2 |
XXX |
0 |
X |
58.41 |
X |
96912 |
|
1 |
XXX |
0 |
X |
60.41 |
X |
96913 |
|
4 |
XXX |
0 |
X |
81.07 |
X |
96913 |
|
3 |
XXX |
0 |
X |
82.08 |
X |
96913 |
|
2 |
XXX |
0 |
X |
86.25 |
X |
96913 |
|
1 |
XXX |
0 |
X |
87.28 |
X |
96920 |
|
2 |
XXX |
0 |
X |
270.39 |
113.18 |
96920 |
|
3 |
XXX |
0 |
X |
270.39 |
113.18 |
96920 |
|
4 |
XXX |
0 |
X |
270.39 |
113.18 |
96920 |
|
1 |
XXX |
0 |
X |
309.81 |
125.01 |
96921 |
|
2 |
0 |
2 |
X |
276.95 |
115.20 |
96921 |
|
3 |
0 |
2 |
X |
276.95 |
115.20 |
96921 |
|
4 |
0 |
2 |
X |
276.95 |
115.20 |
96921 |
|
1 |
0 |
2 |
X |
317.36 |
127.20 |
96922 |
|
2 |
0 |
2 |
X |
383.62 |
206.32 |
96922 |
|
3 |
0 |
2 |
X |
383.62 |
206.32 |
96922 |
|
4 |
0 |
2 |
X |
383.62 |
206.32 |
96922 |
|
1 |
0 |
2 |
X |
436.14 |
227.71 |
96931 |
|
|
YYY |
0 |
X |
* |
X |
96932 |
|
|
YYY |
0 |
X |
* |
X |
96933 |
|
|
YYY |
0 |
X |
* |
X |
96934 |
|
|
YYY |
0 |
X |
* |
X |
96935 |
|
|
YYY |
0 |
X |
* |
X |
96936 |
|
|
YYY |
0 |
X |
* |
X |
96999 |
|
1 |
XXX |
0 |
X |
# |
X |
96999 |
|
2 |
XXX |
0 |
X |
# |
X |
96999 |
|
3 |
XXX |
0 |
X |
# |
X |
96999 |
|
4 |
XXX |
0 |
X |
# |
X |
97010 |
|
3 |
XXX |
9 |
X |
37.02 |
X |
97010 |
|
4 |
XXX |
9 |
X |
37.09 |
X |
97010 |
|
2 |
XXX |
9 |
X |
39.28 |
X |
97010 |
|
1 |
XXX |
9 |
X |
39.82 |
X |
97012 |
|
3 |
XXX |
0 |
X |
38.50 |
X |
97012 |
|
1 |
XXX |
0 |
X |
40.99 |
X |
97012 |
|
2 |
XXX |
0 |
X |
41.16 |
X |
97012 |
|
4 |
XXX |
0 |
X |
42.58 |
X |
97014 |
|
2 |
XXX |
0 |
X |
36.65 |
X |
97014 |
|
3 |
XXX |
0 |
X |
37.20 |
X |
97014 |
|
1 |
XXX |
0 |
X |
38.27 |
X |
97014 |
|
4 |
XXX |
0 |
X |
39.75 |
X |
97016 |
|
4 |
XXX |
0 |
X |
39.52 |
X |
97016 |
|
2 |
XXX |
0 |
X |
42.71 |
X |
97016 |
|
1 |
XXX |
0 |
X |
43.21 |
X |
97016 |
|
3 |
XXX |
0 |
X |
45.83 |
X |