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 35606-36578
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
35606-36578
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
35606
004
90
2
X
3,962.07
X
35606
001
90
2
X
4,809.96
X
35606
002
90
2
X
4,724.51
X
35606
003
90
2
X
4,511.71
X
35612
004
90
2
X
4,066.83
X
35612
001
90
2
X
4,321.94
X
35612
003
90
2
X
3,586.39
X
35612
002
90
2
X
3,886.58
X
35616
004
90
2
X
3,560.04
X
35616
002
90
2
X
3,909.28
X
35616
003
90
2
X
4,011.29
X
35616
001
90
2
X
3,983.49
X
35621
001
90
2
X
5,164.11
X
35621
002
90
2
X
5,068.17
X
35621
003
90
2
X
4,909.34
X
35621
004
90
2
X
4,948.86
X
35623
004
90
2
X
2,629.04
X
35623
002
90
2
X
2,838.58
X
35623
003
90
2
X
2,657.92
X
35623
001
90
2
X
2,882.56
X
35626
001
90
2
X
5,362.15
X
35626
004
90
2
X
4,831.10
X
35626
003
90
2
X
4,888.08
X
35626
002
90
2
X
5,269.69
X
35631
003
90
2
X
4,659.70
X
35631
002
90
2
X
5,002.49
X
35631
004
90
2
X
4,606.42
X
35631
001
90
2
X
5,085.69
X
35632
002
90
2
X
3,446.18
X
35632
003
90
2
X
3,446.18
X
35632
004
90
2
X
3,446.18
X
35632
001
90
2
X
3,799.44
X
35633
001
90
2
X
4,103.23
X
35633
004
90
2
X
3,722.26
X
35633
002
90
2
X
3,722.26
X
35633
003
90
2
X
3,722.26
X
35634
004
90
2
X
3,372.47
X
35634
001
90
2
X
3,718.43
X
35634
003
90
2
X
3,372.47
X
35634
002
90
2
X
3,372.47
X
35636
003
90
2
X
3,882.20
X
35636
002
90
2
X
4,138.58
X
35636
001
90
2
X
4,200.91
X
35636
004
90
2
X
3,838.34
X
35637
001
90
2
X
3,334.06
X
35637
003
90
2
X
2,957.12
X
35637
002
90
2
X
2,957.12
X
35637
004
90
2
X
2,957.12
X
35638
004
90
2
X
3,003.86
X
35638
002
90
2
X
3,003.86
X
35638
003
90
2
X
3,003.86
X
35638
001
90
2
X
3,386.77
X
35642
001
90
2
X
3,323.88
X
35642
004
90
2
X
3,024.82
X
35642
002
90
2
X
3,271.98
X
35642
003
90
2
X
3,058.94
X
35645
001
90
2
X
5,228.80
X
35645
004
90
2
X
3,037.28
X
35645
003
90
2
X
3,072.21
X
35645
002
90
2
X
5,207.42
X
35646
004
90
2
X
5,245.41
X
35646
003
90
2
X
5,473.86
X
35646
002
90
2
X
5,911.16
X
35646
001
90
2
X
6,017.09
X
35647
001
90
2
X
3,762.13
X
35647
004
90
2
X
3,368.36
X
35647
002
90
2
X
3,368.36
X
35647
003
90
2
X
3,368.36
X
35650
004
90
2
X
3,426.40
X
35650
001
90
2
X
5,681.04
X
35650
002
90
2
X
5,612.52
X
35650
003
90
2
X
5,445.42
X
35654
002
90
2
X
5,515.66
X
35654
003
90
2
X
5,216.31
X
35654
004
90
2
X
5,418.42
X
35654
001
90
2
X
5,459.00
X
35656
004
90
2
X
4,354.47
X
35656
001
90
2
X
4,539.92
X
35656
003
90
2
X
4,369.61
X
35656
002
90
2
X
4,326.49
X
35661
001
90
2
X
3,929.67
X
35661
003
90
2
X
3,627.93
X
35661
002
90
2
X
3,830.39
X
35661
004
90
2
X
3,734.26
X
35663
004
90
2
X
3,445.53
X
35663
001
90
2
X
3,886.28
X
35663
002
90
2
X
4,096.60
X
35663
003
90
2
X
4,249.28
X
35665
001
90
2
X
4,371.58
X
35665
004
90
2
X
4,088.52
X
35665
003
90
2
X
4,068.46
X
35665
002
90
2
X
4,266.66
X
35666
003
90
2
X
4,691.35
X
35666
002
90
2
X
4,522.80
X
35666
001
90
2
X
5,339.31
X
35666
004
90
2
X
4,114.55
X
35671
001
90
2
X
6,082.93
X
35671
004
90
2
X
5,873.38
X
35671
003
90
2
X
5,892.26
X
35671
002
90
2
X
6,073.64
X
35681
004
ZZZ
0
X
2,739.40
X
35681
001
ZZZ
0
X
3,127.13
X
35681
003
ZZZ
0
X
2,773.32
X
35681
002
ZZZ
0
X
3,058.11
X
35682
004
ZZZ
0
X
1,016.57
1,010.74
35682
001
ZZZ
0
X
1,216.81
1,210.05
35682
003
ZZZ
0
X
1,016.57
1,010.74
35682
002
ZZZ
0
X
1,016.57
1,010.74
35683
004
ZZZ
0
X
1,172.33
1,164.07
35683
002
ZZZ
0
X
1,172.33
1,164.07
35683
003
ZZZ
0
X
1,172.33
1,164.07
35683
001
ZZZ
0
X
1,383.76
1,374.13
35685
004
ZZZ
0
X
468.28
X
35685
002
ZZZ
0
X
468.28
X
35685
003
ZZZ
0
X
468.28
X
35685
001
ZZZ
0
X
521.02
X
35686
001
ZZZ
0
X
430.99
X
35686
003
ZZZ
0
X
387.36
X
35686
002
ZZZ
0
X
387.36
X
35686
004
ZZZ
0
X
387.36
X
35691
004
90
2
X
4,127.86
X
35691
001
90
2
X
4,610.57
X
35691
002
90
2
X
5,832.08
X
35691
003
90
2
X
4,177.99
X
35693
002
90
2
X
2,834.61
X
35693
003
90
2
X
2,648.11
X
35693
001
90
2
X
2,879.93
X
35693
004
90
2
X
2,618.28
X
35694
002
90
2
X
3,279.95
X
35694
003
90
2
X
3,071.57
X
35694
004
90
2
X
3,038.12
X
35694
001
90
2
X
3,330.75
X
35695
001
90
2
X
3,330.75
X
35695
004
90
2
X
3,038.12
X
35695
003
90
2
X
3,071.57
X
35695
002
90
2
X
3,279.95
X
35697
002
ZZZ
0
X
346.96
X
35697
003
ZZZ
0
X
346.96
X
35697
004
ZZZ
0
X
346.96
X
35697
001
ZZZ
0
X
386.45
X
35700
001
ZZZ
0
X
575.65
X
35700
003
ZZZ
0
X
530.77
X
35700
002
ZZZ
0
X
566.88
X
35700
004
ZZZ
0
X
524.96
X
35701
004
90
2
X
1,234.31
X
35701
003
90
2
X
1,561.80
X
35701
002
90
2
X
1,608.54
X
35701
001
90
2
X
1,619.78
X
35702
001
90
2
X
637.81
X
35702
002
90
2
X
579.09
X
35702
003
90
2
X
579.09
X
35702
004
90
2
X
579.09
X
35703
001
90
2
X
648.02
X
35703
004
90
2
X
588.76
X
35703
002
90
2
X
588.76
X
35703
003
90
2
X
588.76
X
35800
001
90
2
X
1,400.80
X
35800
004
90
2
X
1,267.82
X
35800
003
90
2
X
1,282.79
X
35800
002
90
2
X
1,377.79
X
35820
003
90
2
X
2,560.04
X
35820
002
90
2
X
2,622.21
X
35820
001
90
2
X
2,612.15
X
35820
004
90
2
X
2,549.60
X
35840
001
90
2
X
2,553.95
X
35840
004
90
2
X
2,442.41
X
35840
003
90
2
X
2,508.32
X
35840
002
90
2
X
2,516.72
X
35860
001
90
2
X
1,702.64
X
35860
004
90
2
X
1,638.94
X
35860
003
90
2
X
1,648.93
X
35860
002
90
2
X
1,683.20
X
35870
001
90
2
X
9,212.33
X
35870
003
90
2
X
9,212.33
X
35870
002
90
2
X
9,212.33
X
35870
004
90
2
X
9,212.33
X
35875
003
90
2
X
2,452.43
X
35875
002
90
2
X
2,510.03
X
35875
001
90
2
X
2,532.06
X
35875
004
90
2
X
2,444.59
X
35876
002
90
2
X
2,647.66
X
35876
003
90
2
X
2,586.79
X
35876
001
90
2
X
2,670.52
X
35876
004
90
2
X
2,577.74
X
35879
001
90
2
X
2,509.08
X
35879
004
90
2
X
2,238.20
X
35879
003
90
2
X
2,238.20
X
35879
002
90
2
X
2,238.20
X
35881
004
90
2
X
2,455.26
X
35881
002
90
2
X
2,455.26
X
35881
003
90
2
X
2,455.26
X
35881
001
90
2
X
2,749.00
X
35883
004
90
2
X
2,158.32
X
35883
001
90
2
X
2,443.89
X
35883
002
90
2
X
2,158.32
X
35883
003
90
2
X
2,158.32
X
35884
004
90
2
X
2,292.40
X
35884
002
90
2
X
2,292.40
X
35884
003
90
2
X
2,292.40
X
35884
001
90
2
X
2,595.39
X
35901
003
90
2
X
1,674.24
X
35901
002
90
2
X
1,752.07
X
35901
004
90
2
X
1,662.45
X
35901
001
90
2
X
1,771.76
X
35903
001
90
2
X
1,821.78
X
35903
003
90
2
X
1,722.76
X
35903
002
90
2
X
1,801.79
X
35903
004
90
2
X
1,710.55
X
35905
002
90
2
X
2,098.03
X
35905
003
90
2
X
2,011.96
X
35905
004
90
2
X
1,997.13
X
35905
001
90
2
X
2,119.83
X
35907
002
90
2
X
2,126.40
X
35907
003
90
2
X
2,039.75
X
35907
001
90
2
X
2,148.41
X
35907
004
90
2
X
2,024.60
X
36000
001
XXX
9
X
100.15
X
36000
004
XXX
9
X
153.47
X
36000
003
XXX
9
X
135.72
X
36000
002
XXX
9
X
94.06
X
36002
003
0
2
X
388.36
242.23
36002
002
0
2
X
388.36
242.23
36002
001
0
2
X
437.43
265.63
36002
004
0
2
X
388.36
242.23
36005
002
0
2
X
135.72
X
36005
003
0
2
X
176.29
X
36005
004
0
2
X
193.61
X
36005
001
0
2
X
142.05
X
36010
003
XXX
2
X
580.42
X
36010
002
XXX
2
X
607.82
X
36010
004
XXX
2
X
568.71
X
36010
001
XXX
2
X
619.38
X
36011
003
XXX
2
X
514.27
X
36011
002
XXX
2
X
542.56
X
36011
001
XXX
2
X
549.40
X
36011
004
XXX
2
X
508.35
X
36012
003
XXX
2
X
636.02
X
36012
002
XXX
2
X
674.08
X
36012
004
XXX
2
X
628.49
X
36012
001
XXX
2
X
683.33
X
36013
002
XXX
2
X
614.16
X
36013
003
XXX
2
X
586.26
X
36013
004
XXX
2
X
574.52
X
36013
001
XXX
2
X
625.90
X
36014
004
XXX
2
X
537.76
X
36014
002
XXX
2
X
576.63
X
36014
003
XXX
2
X
544.12
X
36014
001
XXX
2
X
584.50
X
36015
002
XXX
2
X
674.08
X
36015
003
XXX
2
X
636.02
X
36015
004
XXX
2
X
628.49
X
36015
001
XXX
2
X
683.33
X
36100
002
XXX
2
X
614.80
X
36100
003
XXX
2
X
578.39
X
36100
001
XXX
2
X
623.69
X
36100
004
XXX
2
X
593.23
X
36140
002
XXX
2
X
489.16
X
36140
003
XXX
2
X
456.55
X
36140
001
XXX
2
X
507.34
X
36140
004
XXX
2
X
466.63
X
36160
004
XXX
2
X
534.97
X
36160
001
XXX
2
X
588.03
X
36160
003
XXX
2
X
541.41
X
36160
002
XXX
2
X
578.93
X
36200
002
0
2
X
622.99
X
36200
003
0
2
X
587.61
X
36200
004
0
2
X
580.51
X
36200
001
0
2
X
631.58
X
36215
001
0
2
X
777.70
X
36215
003
0
2
X
731.78
X
36215
002
0
2
X
768.80
X
36215
004
0
2
X
723.24
X
36216
004
0
2
X
855.26
X
36216
001
0
2
X
919.57
X
36216
003
0
2
X
865.40
X
36216
002
0
2
X
909.07
X
36217
001
0
2
X
1,095.36
X
36217
003
0
2
X
1,030.97
X
36217
002
0
2
X
1,082.83
X
36217
004
0
2
X
1,018.91
X
36218
004
ZZZ
0
X
162.65
X
36218
001
ZZZ
0
X
174.80
X
36218
003
ZZZ
0
X
164.55
X
36218
002
ZZZ
0
X
172.78
X
36221
001
0
2
X
2,030.55
391.32
36221
004
0
2
X
1,766.95
353.74
36221
003
0
2
X
1,766.95
353.74
36221
002
0
2
X
1,766.95
353.74
36222
001
0
2
X
2,512.20
524.94
36222
004
0
2
X
2,189.42
476.13
36222
003
0
2
X
2,189.42
476.13
36222
002
0
2
X
2,189.42
476.13
36223
004
0
2
X
2,394.88
514.77
36223
001
0
2
X
2,748.14
567.39
36223
003
0
2
X
2,394.88
514.77
36223
002
0
2
X
2,394.88
514.77
36224
003
0
2
X
2,600.52
559.75
36224
002
0
2
X
2,600.52
559.75
36224
001
0
2
X
2,983.33
616.22
36224
004
0
2
X
2,600.52
559.75
36225
004
0
2
X
2,377.51
512.65
36225
002
0
2
X
2,377.51
512.65
36225
003
0
2
X
2,377.51
512.65
36225
001
0
2
X
2,727.84
564.74
36226
001
0
2
X
3,040.95
617.38
36226
004
0
2
X
2,650.19
560.75
36226
002
0
2
X
2,650.19
560.75
36226
003
0
2
X
2,650.19
560.75
36227
002
ZZZ
0
X
389.02
177.16
36227
003
ZZZ
0
X
389.02
177.16
36227
001
ZZZ
0
X
440.22
194.45
36227
004
ZZZ
0
X
389.02
177.16
36228
004
ZZZ
0
X
1,817.20
360.86
36228
001
ZZZ
0
X
2,085.29
396.08
36228
003
ZZZ
0
X
1,817.20
360.86
36228
002
ZZZ
0
X
1,817.20
360.86
36245
001
XXX
2
X
882.56
X
36245
003
XXX
2
X
830.59
X
36245
002
XXX
2
X
872.49
X
36245
004
XXX
2
X
820.83
X
36246
002
0
2
X
909.07
X
36246
003
0
2
X
865.40
X
36246
001
0
2
X
919.57
X
36246
004
0
2
X
855.26
X
36247
002
0
2
X
1,082.83
X
36247
003
0
2
X
1,030.97
X
36247
001
0
2
X
1,095.36
X
36247
004
0
2
X
1,018.91
X
36248
001
ZZZ
0
X
174.80
X
36248
004
ZZZ
0
X
162.65
X
36248
002
ZZZ
0
X
172.78
X
36248
003
ZZZ
0
X
164.55
X
36251
001
0
2
X
2,643.54
522.91
36251
004
0
2
X
2,301.78
473.54
36251
003
0
2
X
2,301.78
473.54
36251
002
0
2
X
2,301.78
473.54
36252
004
0
2
X
2,534.66
616.83
36252
001
0
2
X
2,905.43
680.91
36252
003
0
2
X
2,534.66
616.83
36252
002
0
2
X
2,534.66
616.83
36253
001
0
2
X
4,041.96
728.00
36253
004
0
2
X
3,516.81
659.72
36253
002
0
2
X
3,516.81
659.72
36253
003
0
2
X
3,516.81
659.72
36254
004
0
2
X
3,661.01
711.69
36254
001
0
2
X
4,206.22
785.30
36254
002
0
2
X
3,661.01
711.69
36254
003
0
2
X
3,661.01
711.69
36260
001
90
2
X
1,988.02
X
36260
004
90
2
X
1,800.86
X
36260
002
90
2
X
1,955.52
X
36260
003
90
2
X
1,821.50
X
36261
001
90
2
X
864.57
X
36261
003
90
2
X
806.37
X
36261
002
90
2
X
1,124.23
X
36261
004
90
2
X
797.61
X
36262
002
90
2
X
671.84
X
36262
003
90
2
X
663.51
X
36262
004
90
2
X
624.34
X
36262
001
90
2
X
681.73
X
36299
YYY
2
X
#
X
36400
002
XXX
2
X
28.59
24.09
36400
003
XXX
2
X
27.10
22.93
36400
001
XXX
2
X
28.87
24.29
36400
004
XXX
2
X
26.92
22.65
36405
001
XXX
2
X
68.40
X
36405
004
XXX
2
X
62.21
X
36405
003
XXX
2
X
63.08
X
36405
002
XXX
2
X
67.43
X
36406
004
XXX
2
X
35.61
X
36406
003
XXX
2
X
36.06
X
36406
002
XXX
2
X
37.96
X
36406
001
XXX
2
X
38.42
X
36410
004
XXX
2
X
39.90
X
36410
002
XXX
2
X
42.93
X
36410
003
XXX
2
X
40.42
X
36410
001
XXX
2
X
43.62
X
36415
XXX
9
X
9.98
X
36416
XXX
9
X
*
X
36420
001
XXX
2
X
163.62
X
36420
002
XXX
2
X
161.84
X
36420
003
XXX
2
X
130.01
X
36420
004
XXX
2
X
191.36
X
36425
004
XXX
2
X
138.89
132.65
36425
001
XXX
2
X
166.25
158.86
36425
003
XXX
2
X
163.57
156.61
36425
002
XXX
2
X
138.67
132.60
36430
004
XXX
0
X
96.90
X
36430
002
XXX
0
X
90.67
X
36430
001
XXX
0
X
102.93
X
36430
003
XXX
0
X
87.42
X
36440
002
XXX
2
X
224.04
X
36440
003
XXX
2
X
212.33
X
36440
004
XXX
2
X
209.67
X
36440
001
XXX
2
X
226.87
X
36450
001
XXX
2
X
768.19
X
36450
004
XXX
2
X
412.99
X
36450
003
XXX
2
X
418.03
X
36450
002
XXX
2
X
875.25
X
36455
002
XXX
2
X
509.07
X
36455
003
XXX
2
X
480.32
X
36455
004
XXX
2
X
474.43
X
36455
001
XXX
2
X
516.06
X
36456
003
XXX
2
X
163.99
X
36456
002
XXX
2
X
163.99
X
36456
004
XXX
2
X
163.99
X
36456
001
XXX
2
X
177.40
X
36460
003
XXX
2
X
1,910.70
X
36460
002
XXX
2
X
1,910.70
X
36460
001
XXX
2
X
1,910.70
X
36460
004
XXX
2
X
1,910.70
X
36465
004
0
2
X
2,231.39
180.68
36465
002
0
2
X
2,231.39
180.68
36465
003
0
2
X
2,231.39
180.68
36465
001
0
2
X
2,549.76
196.71
36466
002
0
2
X
2,333.60
229.76
36466
003
0
2
X
2,333.60
229.76
36466
004
0
2
X
2,333.60
229.76
36466
001
0
2
X
2,663.98
249.94
36468
0
2
X
*
X
36470
001
0
2
X
125.04
112.78
36470
004
0
2
X
112.16
101.51
36470
002
0
2
X
122.71
110.92
36470
003
0
2
X
122.14
110.29
36471
004
0
2
X
200.97
181.58
36471
001
0
2
X
213.82
192.71
36471
002
0
2
X
211.71
190.94
36471
003
0
2
X
203.08
183.40
36473
002
0
2
X
2,152.26
267.42
36473
003
0
2
X
2,152.26
267.42
36473
001
0
2
X
2,472.43
288.58
36473
004
0
2
X
2,152.26
267.42
36474
004
ZZZ
0
X
398.98
133.97
36474
001
ZZZ
0
X
451.66
144.59
36474
003
ZZZ
0
X
398.98
133.97
36474
002
ZZZ
0
X
398.98
133.97
36475
004
0
2
X
4,287.14
739.92
36475
001
0
2
X
5,056.08
804.09
36475
003
0
2
X
4,287.14
739.92
36475
002
0
2
X
4,287.14
739.92
36476
001
ZZZ
0
X
978.78
392.22
36476
004
ZZZ
0
X
851.48
362.17
36476
003
ZZZ
0
X
851.48
362.17
36476
002
ZZZ
0
X
851.48
362.17
36478
001
0
2
X
4,654.03
804.09
36478
003
0
2
X
3,951.73
739.92
36478
002
0
2
X
3,951.73
739.92
36478
004
0
2
X
3,951.73
739.92
36479
003
ZZZ
0
X
859.46
362.17
36479
002
ZZZ
0
X
859.46
362.17
36479
004
ZZZ
0
X
859.46
362.17
36479
001
ZZZ
0
X
988.35
392.22
36481
002
0
2
X
1,427.89
X
36481
003
0
2
X
1,347.70
X
36481
001
0
2
X
1,447.20
X
36481
004
0
2
X
1,331.72
X
36482
004
0
2
X
2,971.80
267.88
36482
001
0
2
X
3,394.00
291.41
36482
003
0
2
X
2,971.80
267.88
36482
002
0
2
X
2,971.80
267.88
36483
004
ZZZ
0
X
208.46
133.65
36483
001
ZZZ
0
X
231.11
145.26
36483
003
ZZZ
0
X
208.46
133.65
36483
002
ZZZ
0
X
208.46
133.65
36500
002
0
2
X
220.56
218.26
36500
003
0
2
X
220.10
218.24
36500
004
0
2
X
213.21
210.81
36500
001
0
2
X
219.73
217.74
36510
002
0
2
X
147.52
X
36510
003
0
2
X
142.08
X
36510
001
0
2
X
148.83
X
36510
004
0
2
X
140.63
X
36511
004
0
2
X
197.32
X
36511
002
0
2
X
197.32
X
36511
003
0
2
X
197.32
X
36511
001
0
2
X
214.56
X
36512
004
0
2
X
197.32
X
36512
001
0
2
X
214.56
X
36512
002
0
2
X
197.32
X
36512
003
0
2
X
197.32
X
36513
001
0
2
X
214.56
X
36513
004
0
2
X
197.32
X
36513
002
0
2
X
197.32
X
36513
003
0
2
X
197.32
X
36514
004
0
2
X
197.32
X
36514
001
0
2
X
214.56
X
36514
002
0
2
X
197.32
X
36514
003
0
2
X
197.32
X
36516
001
0
2
X
214.56
X
36516
004
0
2
X
197.32
X
36516
003
0
2
X
197.32
X
36516
002
0
2
X
197.32
X
36522
001
0
2
X
1,536.02
X
36522
004
0
2
X
629.96
X
36522
003
0
2
X
638.72
X
36522
002
0
2
X
686.00
X
36555
004
0
0
X
682.47
292.40
36555
002
0
0
X
682.47
292.40
36555
003
0
0
X
682.47
292.40
36555
001
0
0
X
777.14
318.64
36556
003
0
0
X
649.54
264.74
36556
002
0
0
X
649.54
264.74
36556
001
0
0
X
736.43
284.15
36556
004
0
0
X
649.54
264.74
36557
004
10
2
X
1,471.36
644.61
36557
003
10
2
X
1,471.36
644.61
36557
002
10
2
X
1,471.36
644.61
36557
001
10
2
X
1,689.19
717.36
36558
003
10
2
X
1,438.81
612.01
36558
002
10
2
X
1,438.81
612.01
36558
004
10
2
X
1,438.81
612.01
36558
001
10
2
X
1,654.59
682.75
36560
003
10
2
X
2,741.53
766.43
36560
002
10
2
X
2,741.53
766.43
36560
004
10
2
X
2,741.53
766.43
36560
001
10
2
X
3,167.94
846.34
36561
002
10
2
X
2,715.24
739.39
36561
003
10
2
X
2,715.24
739.39
36561
004
10
2
X
2,715.24
739.39
36561
001
10
2
X
3,140.17
817.63
36563
001
10
2
X
3,961.79
854.17
36563
002
10
2
X
3,413.37
769.64
36563
003
10
2
X
3,413.37
769.64
36563
004
10
2
X
3,413.37
769.64
36565
002
10
2
X
2,191.17
739.39
36565
003
10
2
X
2,191.17
739.39
36565
001
10
2
X
2,524.17
817.63
36565
004
10
2
X
2,191.17
739.39
36566
001
10
2
X
2,636.38
874.16
36566
004
10
2
X
2,291.93
792.72
36566
002
10
2
X
2,291.93
792.72
36566
003
10
2
X
2,291.93
792.72
36568
002
0
0
X
785.72
213.48
36568
003
0
0
X
785.72
213.48
36568
004
0
0
X
785.72
213.48
36568
001
0
0
X
907.90
235.25
36569
001
0
0
X
823.12
219.54
36569
004
0
0
X
714.22
200.66
36569
002
0
0
X
714.22
200.66
36569
003
0
0
X
714.22
200.66
36570
002
10
2
X
3,500.42
666.94
36570
003
10
2
X
3,500.42
666.94
36570
001
10
2
X
4,071.57
740.92
36570
004
10
2
X
3,500.42
666.94
36571
002
10
2
X
3,150.19
664.57
36571
003
10
2
X
3,150.19
664.57
36571
001
10
2
X
3,660.06
738.40
36571
004
10
2
X
3,150.19
664.57
36572
003
0
0
X
562.59
130.40
36572
002
0
0
X
562.59
130.40
36572
001
0
0
X
635.68
139.79
36572
004
0
0
X
562.59
130.40
36573
002
0
0
X
529.61
120.78
36573
003
0
0
X
529.61
120.78
36573
004
0
0
X
529.61
120.78
36573
001
0
0
X
598.77
129.67
36575
003
0
2
X
344.39
111.68
36575
002
0
2
X
344.39
111.68
36575
001
0
2
X
419.03
145.52
36575
004
0
2
X
344.39
111.68
36576
003
10
2
X
876.91
428.83
36576
002
10
2
X
876.91
428.83
36576
004
10
2
X
876.91
428.83
36576
001
10
2
X
1,013.86
487.27
36578
003
10
2
X
1,114.32
486.31
36578
002
10
2
X
1,114.32
486.31
36578
004
10
2
X
1,114.32
486.31
36578
001
10
2
X
1,289.24
551.06
Return to CPT/HCPC List