You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Skip Ribbon Commands
Skip to main content
Turn off Animations
Turn on Animations
An Official
Pennsylvania
Government Website
Translate
DLI
Department of Labor & Industry
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
Search
Search
Menu
Department of Labor & Industry
Menu
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
I am a(n)...
Find Services
Bureaus & Offices
Make a Payment
Contact Us
Publications
DLI
>
Businesses
>
Workers' Compensation Services
>
Workers' Compensation
>
Health Care Services Review
>
Medical Fee Review
>
Fee Schedule
>
Fee Schedule 97018-99347
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
97018-99347
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
97018
001
XXX
5
X
53.06
X
97018
003
XXX
5
X
47.59
X
97018
002
XXX
5
X
51.62
X
97018
004
XXX
5
X
48.62
X
97022
001
XXX
5
X
42.55
X
97022
002
XXX
5
X
42.01
X
97022
003
XXX
5
X
38.30
X
97022
004
XXX
5
X
39.06
X
97024
001
XXX
5
X
46.08
X
97024
002
XXX
5
X
41.01
X
97024
003
XXX
5
X
40.46
X
97024
004
XXX
5
X
38.00
X
97026
004
XXX
5
X
40.01
X
97026
002
XXX
5
X
42.95
X
97026
003
XXX
5
X
40.52
X
97026
001
XXX
5
X
54.40
X
97028
002
XXX
5
X
37.59
X
97028
004
XXX
5
X
43.20
X
97028
003
XXX
5
X
35.71
X
97028
001
XXX
5
X
35.09
X
97032
002
XXX
5
X
41.13
X
97032
003
XXX
5
X
39.21
X
97032
004
XXX
5
X
38.72
X
97032
001
XXX
5
X
42.01
X
97033
001
XXX
5
X
44.42
X
97033
002
XXX
5
X
43.34
X
97033
004
XXX
5
X
46.31
X
97033
003
XXX
5
X
41.02
X
97034
004
XXX
5
X
35.05
X
97034
003
XXX
5
X
42.50
X
97034
002
XXX
5
X
41.61
X
97034
001
XXX
5
X
38.57
X
97035
002
XXX
5
X
33.98
X
97035
003
XXX
5
X
32.34
X
97035
004
XXX
5
X
31.95
X
97035
001
XXX
5
X
34.74
X
97036
002
XXX
5
X
44.46
X
97036
004
XXX
5
X
58.96
X
97036
003
XXX
5
X
59.66
X
97036
001
XXX
5
X
45.27
X
97037
XXX
9
X
#
X
97039
002
XXX
0
X
57.50
X
97039
003
XXX
0
X
54.13
X
97039
004
XXX
0
X
53.45
X
97039
001
XXX
0
X
58.28
X
97110
003
XXX
5
X
52.18
X
97110
004
XXX
5
X
49.65
X
97110
002
XXX
5
X
53.46
X
97110
001
XXX
5
X
54.26
X
97112
001
XXX
5
X
50.64
X
97112
004
XXX
5
X
46.71
X
97112
003
XXX
5
X
47.30
X
97112
002
XXX
5
X
50.79
X
97113
001
XXX
5
X
69.35
X
97113
002
XXX
5
X
47.12
X
97113
003
XXX
5
X
48.07
X
97113
004
XXX
5
X
63.94
X
97116
004
XXX
5
X
41.05
X
97116
003
XXX
5
X
46.90
X
97116
002
XXX
5
X
44.01
X
97116
001
XXX
5
X
50.32
X
97124
002
XXX
5
X
42.01
X
97124
001
XXX
5
X
42.55
X
97124
004
XXX
5
X
39.14
X
97124
003
XXX
5
X
39.59
X
97129
003
XXX
0
X
33.26
32.80
97129
002
XXX
0
X
33.26
32.80
97129
001
XXX
0
X
35.46
34.92
97129
004
XXX
0
X
33.26
32.80
97130
001
ZZZ
0
X
33.90
X
97130
004
ZZZ
0
X
31.81
X
97130
003
ZZZ
0
X
31.81
X
97130
002
ZZZ
0
X
31.81
X
97139
002
XXX
0
X
67.53
X
97139
003
XXX
0
X
63.77
X
97139
004
XXX
0
X
63.01
X
97139
001
XXX
0
X
68.40
X
97140
001
XXX
5
X
58.43
44.92
97140
003
XXX
5
X
53.56
42.07
97140
004
XXX
5
X
53.56
42.07
97140
002
XXX
5
X
53.56
42.07
97150
003
XXX
5
X
47.75
X
97150
004
XXX
5
X
47.09
X
97150
002
XXX
5
X
50.48
X
97150
001
XXX
5
X
51.79
X
97151
XXX
0
X
*
X
97152
XXX
0
X
*
X
97153
XXX
0
X
*
X
97154
XXX
0
X
*
X
97155
XXX
0
X
*
X
97156
XXX
0
X
*
X
97157
XXX
0
X
*
X
97158
XXX
0
X
*
X
97161
001
XXX
5
X
161.44
X
97161
002
XXX
5
X
145.95
X
97161
003
XXX
5
X
145.95
X
97161
004
XXX
5
X
145.95
X
97162
002
XXX
5
X
145.95
X
97162
003
XXX
5
X
145.95
X
97162
004
XXX
5
X
145.95
X
97162
001
XXX
5
X
161.44
X
97163
002
XXX
5
X
145.95
X
97163
004
XXX
5
X
145.95
X
97163
003
XXX
5
X
145.95
X
97163
001
XXX
5
X
161.44
X
97164
004
XXX
5
X
57.66
X
97164
003
XXX
5
X
57.66
X
97164
002
XXX
5
X
57.66
X
97164
001
XXX
5
X
60.73
X
97165
001
XXX
5
X
126.48
X
97165
004
XXX
5
X
116.12
X
97165
003
XXX
5
X
116.12
X
97165
002
XXX
5
X
116.12
X
97166
003
XXX
5
X
116.12
X
97166
004
XXX
5
X
116.12
X
97166
002
XXX
5
X
116.12
X
97166
001
XXX
5
X
126.48
X
97167
003
XXX
5
X
116.12
X
97167
001
XXX
5
X
126.48
X
97167
002
XXX
5
X
116.12
X
97167
004
XXX
5
X
116.12
X
97168
004
XXX
5
X
76.52
X
97168
002
XXX
5
X
76.52
X
97168
003
XXX
5
X
76.52
X
97168
001
XXX
5
X
83.62
X
97169
XXX
9
X
*
X
97170
XXX
9
X
*
X
97171
XXX
9
X
*
X
97172
XXX
9
X
*
X
97530
003
XXX
5
X
69.08
X
97530
004
XXX
5
X
68.72
X
97530
001
XXX
5
X
72.44
X
97530
002
XXX
5
X
70.66
X
97533
001
XXX
5
X
69.35
48.99
97533
002
XXX
5
X
63.38
46.02
97533
003
XXX
5
X
63.38
46.02
97533
004
XXX
5
X
63.38
46.02
97535
001
XXX
5
X
53.08
X
97535
002
XXX
5
X
51.21
X
97535
003
XXX
5
X
48.72
X
97535
004
XXX
5
X
48.04
X
97537
002
XXX
5
X
51.21
X
97537
003
XXX
5
X
48.72
X
97537
004
XXX
5
X
48.04
X
97537
001
XXX
5
X
53.08
X
97542
004
XXX
5
X
40.39
X
97542
003
XXX
5
X
40.98
X
97542
002
XXX
5
X
43.34
X
97542
001
XXX
5
X
44.96
X
97545
001
XXX
0
X
238.10
X
97545
004
XXX
0
X
230.33
X
97545
003
XXX
0
X
240.24
X
97545
002
XXX
0
X
223.51
X
97546
004
ZZZ
0
X
115.17
X
97546
003
ZZZ
0
X
120.16
X
97546
002
ZZZ
0
X
119.18
X
97546
001
ZZZ
0
X
111.73
X
97550
002
XXX
5
X
56.79
X
97550
003
XXX
5
X
56.79
X
97550
004
XXX
5
X
56.79
X
97550
001
XXX
5
X
61.01
X
97551
003
ZZZ
0
X
28.32
26.26
97551
002
ZZZ
0
X
28.32
26.26
97551
001
ZZZ
0
X
30.25
27.91
97551
004
ZZZ
0
X
28.32
26.26
97552
003
XXX
5
X
23.50
X
97552
002
XXX
5
X
23.50
X
97552
001
XXX
5
X
25.90
X
97552
004
XXX
5
X
23.50
X
97597
002
0
0
X
97.07
X
97597
001
0
0
X
109.80
X
97597
004
0
0
X
97.07
X
97597
003
0
0
X
97.07
X
97598
004
ZZZ
0
X
123.96
X
97598
003
ZZZ
0
X
123.96
X
97598
002
ZZZ
0
X
123.96
X
97598
001
ZZZ
0
X
138.88
X
97602
XXX
9
X
*
X
97605
XXX
0
X
*
X
97606
XXX
0
X
*
X
97607
XXX
0
X
*
X
97608
XXX
0
X
*
X
97610
XXX
0
X
*
X
97750
002
XXX
5
X
78.27
X
97750
003
XXX
5
X
70.42
X
97750
004
XXX
5
X
75.99
X
97750
001
XXX
5
X
82.07
X
97755
001
XXX
5
X
79.37
X
97755
002
XXX
5
X
73.35
X
97755
003
XXX
5
X
73.35
X
97755
004
XXX
5
X
73.35
X
97760
004
XXX
5
X
56.77
47.61
97760
003
XXX
5
X
56.77
47.61
97760
002
XXX
5
X
56.77
47.61
97760
001
XXX
5
X
63.53
52.32
97761
004
XXX
5
X
52.27
46.33
97761
001
XXX
5
X
57.73
50.53
97761
002
XXX
5
X
52.27
46.33
97761
003
XXX
5
X
52.27
46.33
97763
002
XXX
5
X
69.17
X
97763
003
XXX
5
X
69.17
X
97763
004
XXX
5
X
69.17
X
97763
001
XXX
5
X
76.39
X
97799
XXX
0
X
#
X
97802
XXX
0
X
*
X
97803
XXX
0
X
*
X
97804
XXX
0
X
*
X
97810
XXX
0
X
*
X
97811
ZZZ
0
X
*
X
97813
XXX
0
X
*
X
97814
ZZZ
0
X
*
X
98925
001
0
0
X
64.28
X
98925
002
0
0
X
67.12
X
98925
004
0
0
X
55.96
X
98925
003
0
0
X
63.77
X
98926
001
0
0
X
88.74
X
98926
004
0
0
X
79.10
X
98926
003
0
0
X
78.68
X
98926
002
0
0
X
87.55
X
98927
002
0
0
X
107.54
X
98927
003
0
0
X
102.42
X
98927
004
0
0
X
101.84
X
98927
001
0
0
X
107.92
X
98928
001
0
0
X
135.36
X
98928
004
0
0
X
116.12
X
98928
003
0
0
X
122.84
X
98928
002
0
0
X
132.84
X
98929
004
0
0
X
155.90
X
98929
002
0
0
X
153.25
X
98929
003
0
0
X
137.01
X
98929
001
0
0
X
131.27
X
98940
001
0
0
X
69.26
54.69
98940
002
0
0
X
64.69
52.02
98940
003
0
0
X
67.17
54.00
98940
004
0
0
X
62.96
50.61
98941
001
0
0
X
86.57
72.00
98941
004
0
0
X
79.65
67.31
98941
003
0
0
X
85.02
71.87
98941
002
0
0
X
81.82
69.17
98942
001
0
0
X
105.62
91.03
98942
002
0
0
X
100.71
88.06
98942
003
0
0
X
104.64
91.47
98942
004
0
0
X
98.00
85.76
98943
XXX
9
X
*
X
98960
XXX
9
X
*
X
98961
XXX
9
X
*
X
98962
XXX
9
X
*
X
98966
XXX
0
X
*
X
98967
XXX
0
X
*
X
98968
XXX
0
X
*
X
98970
XXX
0
X
*
X
98971
XXX
0
X
*
X
98972
XXX
0
X
*
X
98975
004
XXX
0
X
21.90
X
98975
002
XXX
0
X
21.90
X
98975
003
XXX
0
X
21.90
X
98975
001
XXX
0
X
25.41
X
98976
002
XXX
0
X
63.08
X
98976
004
XXX
0
X
63.08
X
98976
003
XXX
0
X
63.08
X
98976
001
XXX
0
X
72.82
X
98977
001
XXX
0
X
72.82
X
98977
004
XXX
0
X
63.08
X
98977
003
XXX
0
X
63.08
X
98977
002
XXX
0
X
63.08
X
98978
X
*
X
98980
004
XXX
0
X
58.31
37.16
98980
002
XXX
0
X
58.31
37.16
98980
003
XXX
0
X
58.31
37.16
98980
001
XXX
0
X
64.16
39.75
98981
004
ZZZ
0
X
47.68
37.10
98981
003
ZZZ
0
X
47.68
37.10
98981
002
ZZZ
0
X
47.68
37.10
98981
001
ZZZ
0
X
52.02
39.83
99000
XXX
9
X
*
X
99001
XXX
9
X
*
X
99002
XXX
9
X
*
X
99024
XXX
9
X
*
X
99026
XXX
9
X
*
X
99027
XXX
9
X
*
X
99050
XXX
9
X
*
X
99051
XXX
9
X
*
X
99053
XXX
9
X
*
X
99056
XXX
9
X
*
X
99058
XXX
9
X
*
X
99060
XXX
9
X
*
X
99070
XXX
9
X
#
X
99071
XXX
9
X
#
X
99072
XXX
9
X
*
X
99075
XXX
9
X
#
X
99078
XXX
9
X
#
X
99080
XXX
9
X
#
X
99082
XXX
0
X
#
X
99091
XXX
0
X
*
X
99100
ZZZ
9
X
*
X
99116
ZZZ
9
X
*
X
99135
ZZZ
9
X
*
X
99140
ZZZ
9
X
*
X
99151
002
XXX
9
X
111.85
35.77
99151
001
XXX
9
X
126.32
38.18
99151
004
XXX
9
X
111.85
35.77
99151
003
XXX
9
X
111.85
35.77
99152
004
XXX
9
X
74.06
18.64
99152
003
XXX
9
X
74.06
18.64
99152
002
XXX
9
X
74.06
18.64
99152
001
XXX
9
X
84.13
19.90
99153
003
ZZZ
9
X
15.65
X
99153
002
ZZZ
9
X
15.65
X
99153
004
ZZZ
9
X
15.65
X
99153
001
ZZZ
9
X
18.21
X
99155
004
XXX
9
X
140.09
X
99155
003
XXX
9
X
140.09
X
99155
002
XXX
9
X
140.09
X
99155
001
XXX
9
X
149.68
X
99156
002
XXX
9
X
114.91
X
99156
003
XXX
9
X
114.91
X
99156
004
XXX
9
X
114.91
X
99156
001
XXX
9
X
122.20
X
99157
001
ZZZ
9
X
92.61
X
99157
002
ZZZ
9
X
87.12
X
99157
003
ZZZ
9
X
87.12
X
99157
004
ZZZ
9
X
87.12
X
99170
004
0
2
X
313.48
218.32
99170
003
0
2
X
313.48
218.32
99170
002
0
2
X
313.48
218.32
99170
001
0
2
X
350.41
239.03
99172
XXX
9
X
*
X
99173
XXX
9
X
*
X
99174
XXX
9
X
*
X
99175
004
XXX
0
X
134.10
X
99175
002
XXX
0
X
148.31
X
99175
001
XXX
0
X
151.17
X
99175
003
XXX
0
X
136.24
X
99177
XXX
9
X
*
X
99183
002
XXX
0
X
423.24
X
99183
003
XXX
0
X
403.10
X
99183
004
XXX
0
X
398.35
X
99183
001
XXX
0
X
428.10
X
99184
001
XXX
0
X
391.48
X
99184
003
XXX
0
X
364.89
X
99184
002
XXX
0
X
364.89
X
99184
004
XXX
0
X
364.89
X
99188
XXX
0
X
*
X
99190
XXX
9
X
*
X
99191
XXX
9
X
*
X
99192
XXX
9
X
*
X
99195
003
XXX
0
X
42.55
X
99195
004
XXX
0
X
41.90
X
99195
002
XXX
0
X
42.31
X
99195
001
XXX
0
X
36.63
X
99199
XXX
0
X
#
X
99202
002
XXX
0
X
125.82
103.43
99202
003
XXX
0
X
115.15
94.53
99202
004
XXX
0
X
115.15
94.59
99202
001
XXX
0
X
132.29
108.68
99203
002
XXX
0
X
159.26
135.03
99203
001
XXX
0
X
161.28
136.54
99203
003
XXX
0
X
149.13
126.55
99203
004
XXX
0
X
144.81
123.21
99204
003
XXX
0
X
224.98
191.56
99204
002
XXX
0
X
250.73
212.92
99204
004
XXX
0
X
221.53
188.56
99204
001
XXX
0
X
269.07
227.72
99205
001
XXX
0
X
321.15
278.62
99205
004
XXX
0
X
269.87
234.44
99205
003
XXX
0
X
275.56
239.56
99205
002
XXX
0
X
302.35
261.47
99211
003
XXX
0
X
41.63
31.94
99211
002
XXX
0
X
47.16
36.17
99211
001
XXX
0
X
50.02
38.41
99211
004
XXX
0
X
37.03
27.96
99212
001
XXX
0
X
71.62
57.15
99212
002
XXX
0
X
70.79
56.48
99212
003
XXX
0
X
67.33
53.77
99212
004
XXX
0
X
66.54
53.24
99213
002
XXX
0
X
101.07
81.65
99213
001
XXX
0
X
102.27
82.53
99213
004
XXX
0
X
93.82
76.29
99213
003
XXX
0
X
96.63
78.24
99214
002
XXX
0
X
154.99
127.99
99214
003
XXX
0
X
139.52
115.69
99214
004
XXX
0
X
139.79
116.23
99214
001
XXX
0
X
157.82
131.37
99215
004
XXX
0
X
214.58
180.18
99215
002
XXX
0
X
241.61
201.62
99215
003
XXX
0
X
216.18
181.11
99215
001
XXX
0
X
249.71
209.80
99221
004
XXX
0
X
173.14
X
99221
003
XXX
0
X
175.24
X
99221
002
XXX
0
X
184.25
X
99221
001
XXX
0
X
186.47
X
99222
003
XXX
0
X
290.65
X
99222
002
XXX
0
X
305.08
X
99222
004
XXX
0
X
287.29
X
99222
001
XXX
0
X
308.55
X
99223
001
XXX
0
X
391.01
X
99223
002
XXX
0
X
377.10
X
99223
003
XXX
0
X
343.70
X
99223
004
XXX
0
X
343.87
X
99231
001
XXX
0
X
101.76
X
99231
002
XXX
0
X
94.59
X
99231
003
XXX
0
X
89.95
X
99231
004
XXX
0
X
88.84
X
99232
004
XXX
0
X
130.84
X
99232
003
XXX
0
X
131.28
X
99232
002
XXX
0
X
141.00
X
99232
001
XXX
0
X
141.87
X
99233
003
XXX
0
X
186.24
X
99233
004
XXX
0
X
187.90
X
99233
002
XXX
0
X
194.96
X
99233
001
XXX
0
X
197.07
X
99234
002
XXX
0
X
293.49
X
99234
003
XXX
0
X
293.49
X
99234
004
XXX
0
X
293.49
X
99234
001
XXX
0
X
315.67
X
99235
004
XXX
0
X
405.64
X
99235
003
XXX
0
X
405.64
X
99235
002
XXX
0
X
405.64
X
99235
001
XXX
0
X
438.10
X
99236
004
XXX
0
X
489.38
X
99236
003
XXX
0
X
489.38
X
99236
002
XXX
0
X
489.38
X
99236
001
XXX
0
X
525.94
X
99238
001
XXX
0
X
167.16
X
99238
002
XXX
0
X
165.40
X
99238
004
XXX
0
X
156.30
X
99238
003
XXX
0
X
161.86
X
99239
004
XXX
0
X
215.39
X
99239
002
XXX
0
X
227.12
X
99239
003
XXX
0
X
218.09
X
99239
001
XXX
0
X
233.79
X
99242
001
XXX
9
X
206.29
166.84
99242
002
XXX
9
X
197.45
159.63
99242
003
XXX
9
X
189.50
153.24
99242
004
XXX
9
X
189.06
153.12
99243
002
XXX
9
X
242.20
196.97
99243
003
XXX
9
X
229.37
186.71
99243
004
XXX
9
X
227.73
185.65
99243
001
XXX
9
X
256.38
208.46
99244
001
XXX
9
X
370.31
307.61
99244
004
XXX
9
X
336.96
280.79
99244
002
XXX
9
X
366.15
304.21
99244
003
XXX
9
X
345.68
287.75
99245
004
XXX
9
X
398.70
330.74
99245
002
XXX
9
X
439.22
363.40
99245
003
XXX
9
X
415.54
344.40
99245
001
XXX
9
X
441.03
364.76
99252
003
XXX
9
X
191.30
X
99252
002
XXX
9
X
199.36
X
99252
004
XXX
9
X
190.94
X
99252
001
XXX
9
X
207.07
X
99253
002
XXX
9
X
247.38
X
99253
003
XXX
9
X
234.32
X
99253
004
XXX
9
X
232.67
X
99253
001
XXX
9
X
261.57
X
99254
003
XXX
9
X
347.70
X
99254
002
XXX
9
X
368.22
X
99254
004
XXX
9
X
339.00
X
99254
001
XXX
9
X
372.40
X
99255
001
XXX
9
X
444.39
X
99255
004
XXX
9
X
402.63
X
99255
003
XXX
9
X
419.44
X
99255
002
XXX
9
X
442.81
X
99281
001
XXX
0
X
59.64
X
99281
003
XXX
0
X
58.61
X
99281
002
XXX
0
X
59.00
X
99281
004
XXX
0
X
55.61
X
99282
004
XXX
0
X
85.10
X
99282
002
XXX
0
X
91.25
X
99282
003
XXX
0
X
83.69
X
99282
001
XXX
0
X
96.17
X
99283
004
XXX
0
X
130.75
X
99283
003
XXX
0
X
129.48
X
99283
002
XXX
0
X
137.32
X
99283
001
XXX
0
X
142.65
X
99284
002
XXX
0
X
198.89
X
99284
003
XXX
0
X
186.08
X
99284
004
XXX
0
X
192.08
X
99284
001
XXX
0
X
206.82
X
99285
001
XXX
0
X
331.83
X
99285
004
XXX
0
X
295.19
X
99285
003
XXX
0
X
303.86
X
99285
002
XXX
0
X
331.59
X
99288
XXX
9
X
#
X
99291
002
XXX
0
X
443.60
X
99291
003
XXX
0
X
406.85
X
99291
004
XXX
0
X
392.86
X
99291
001
XXX
0
X
460.09
X
99292
004
ZZZ
0
X
193.01
X
99292
003
ZZZ
0
X
196.80
X
99292
002
ZZZ
0
X
219.59
X
99292
001
ZZZ
0
X
225.77
X
99304
004
XXX
0
X
122.34
X
99304
002
XXX
0
X
122.34
X
99304
003
XXX
0
X
122.34
X
99304
001
XXX
0
X
133.02
X
99305
001
XXX
0
X
176.59
X
99305
002
XXX
0
X
162.49
X
99305
003
XXX
0
X
162.49
X
99305
004
XXX
0
X
162.49
X
99306
004
XXX
0
X
200.63
X
99306
002
XXX
0
X
200.63
X
99306
003
XXX
0
X
200.63
X
99306
001
XXX
0
X
217.76
X
99307
001
XXX
0
X
69.00
X
99307
004
XXX
0
X
63.09
X
99307
003
XXX
0
X
63.09
X
99307
002
XXX
0
X
63.09
X
99308
001
XXX
0
X
113.99
X
99308
002
XXX
0
X
104.55
X
99308
003
XXX
0
X
104.55
X
99308
004
XXX
0
X
104.55
X
99309
001
XXX
0
X
160.70
X
99309
004
XXX
0
X
147.40
X
99309
003
XXX
0
X
147.40
X
99309
002
XXX
0
X
147.40
X
99310
004
XXX
0
X
184.57
X
99310
003
XXX
0
X
184.57
X
99310
002
XXX
0
X
184.57
X
99310
001
XXX
0
X
201.45
X
99315
002
XXX
0
X
149.54
X
99315
003
XXX
0
X
149.54
X
99315
004
XXX
0
X
149.54
X
99315
001
XXX
0
X
163.39
X
99316
004
XXX
0
X
182.47
X
99316
002
XXX
0
X
182.47
X
99316
003
XXX
0
X
182.47
X
99316
001
XXX
0
X
197.49
X
99341
004
XXX
0
X
141.33
X
99341
003
XXX
0
X
141.33
X
99341
002
XXX
0
X
141.33
X
99341
001
XXX
0
X
155.78
X
99342
001
XXX
0
X
210.20
X
99342
002
XXX
0
X
193.07
X
99342
003
XXX
0
X
193.07
X
99342
004
XXX
0
X
193.07
X
99344
004
XXX
0
X
352.76
X
99344
003
XXX
0
X
352.76
X
99344
002
XXX
0
X
352.76
X
99344
001
XXX
0
X
380.83
X
99345
001
XXX
0
X
450.79
X
99345
004
XXX
0
X
420.37
X
99345
003
XXX
0
X
420.37
X
99345
002
XXX
0
X
420.37
X
99347
004
XXX
0
X
111.16
X
99347
003
XXX
0
X
111.16
X
99347
002
XXX
0
X
111.16
X
99347
001
XXX
0
X
122.94
X
Return to CPT/HCPC List