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 55530-57511
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
55530-57511
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
55530
004
90
2
X
1,158.52
X
55530
001
90
2
X
1,265.99
X
55530
003
90
2
X
1,172.80
X
55530
002
90
2
X
1,247.85
X
55535
001
90
2
X
1,239.52
X
55535
004
90
2
X
1,145.65
X
55535
002
90
2
X
1,223.85
X
55535
003
90
2
X
1,258.99
X
55540
001
90
2
X
1,441.69
X
55540
004
90
2
X
1,740.84
X
55540
003
90
2
X
1,709.84
X
55540
002
90
2
X
1,796.87
X
55550
002
90
2
X
945.22
X
55550
003
90
2
X
945.22
X
55550
001
90
2
X
1,044.32
X
55550
004
90
2
X
945.22
X
55559
YYY
2
X
#
X
55600
002
90
2
X
1,211.83
X
55600
003
90
2
X
1,142.95
X
55600
001
90
2
X
1,228.52
X
55600
004
90
2
X
1,129.60
X
55605
004
90
2
X
1,422.84
X
55605
001
90
2
X
1,542.32
X
55605
002
90
2
X
1,522.37
X
55605
003
90
2
X
1,439.86
X
55650
001
90
2
X
2,149.18
X
55650
003
90
2
X
2,377.18
X
55650
002
90
2
X
2,122.61
X
55650
004
90
2
X
1,989.08
X
55680
004
90
2
X
990.44
X
55680
002
90
2
X
1,060.40
X
55680
003
90
2
X
1,002.80
X
55680
001
90
2
X
1,074.32
X
55700
003
0
2
X
399.74
X
55700
002
0
2
X
483.52
X
55700
004
0
2
X
398.00
X
55700
001
0
2
X
494.45
X
55705
001
10
2
X
1,183.67
X
55705
003
10
2
X
1,062.61
X
55705
002
10
2
X
1,178.81
X
55705
004
10
2
X
1,075.72
X
55706
004
10
2
X
686.56
X
55706
001
10
2
X
755.14
X
55706
002
10
2
X
686.56
X
55706
003
10
2
X
686.56
X
55720
003
90
2
X
1,196.69
X
55720
002
90
2
X
1,255.31
X
55720
004
90
2
X
1,183.31
X
55720
001
90
2
X
1,269.52
X
55725
003
90
2
X
1,448.21
X
55725
002
90
2
X
1,528.69
X
55725
001
90
2
X
1,548.12
X
55725
004
90
2
X
1,679.37
X
55801
002
90
2
X
3,368.48
X
55801
003
90
2
X
3,178.68
X
55801
004
90
2
X
3,140.87
X
55801
001
90
2
X
3,414.39
X
55810
002
90
2
X
4,580.92
X
55810
003
90
2
X
4,476.15
X
55810
004
90
2
X
4,211.06
X
55810
001
90
2
X
4,572.32
X
55812
003
90
2
X
4,731.55
X
55812
002
90
2
X
4,999.73
X
55812
001
90
2
X
5,064.59
X
55812
004
90
2
X
4,676.18
X
55815
004
90
2
X
5,777.36
X
55815
003
90
2
X
5,848.39
X
55815
002
90
2
X
6,193.03
X
55815
001
90
2
X
6,275.95
X
55821
002
90
2
X
3,089.12
X
55821
003
90
2
X
2,907.46
X
55821
004
90
2
X
2,929.70
X
55821
001
90
2
X
3,132.77
X
55831
003
90
2
X
3,155.30
X
55831
002
90
2
X
3,351.04
X
55831
004
90
2
X
3,116.34
X
55831
001
90
2
X
3,398.18
X
55840
001
90
2
X
4,405.21
X
55840
004
90
2
X
4,065.41
X
55840
002
90
2
X
4,348.75
X
55840
003
90
2
X
4,114.62
X
55842
004
90
2
X
4,863.51
X
55842
002
90
2
X
4,998.45
X
55842
003
90
2
X
4,886.62
X
55842
001
90
2
X
5,025.50
X
55845
002
90
2
X
5,996.15
X
55845
003
90
2
X
5,728.20
X
55845
001
90
2
X
6,078.17
X
55845
004
90
2
X
5,694.10
X
55860
002
90
2
X
2,328.47
X
55860
003
90
2
X
2,216.54
X
55860
004
90
2
X
2,191.22
X
55860
001
90
2
X
2,355.56
X
55862
002
90
2
X
3,306.17
X
55862
003
90
2
X
3,132.75
X
55862
001
90
2
X
3,348.17
X
55862
004
90
2
X
3,095.97
X
55865
001
90
2
X
5,428.08
X
55865
004
90
2
X
4,988.10
X
55865
002
90
2
X
5,383.64
X
55865
003
90
2
X
5,051.42
X
55866
001
90
2
X
3,775.15
X
55866
004
90
2
X
3,461.58
X
55866
002
90
2
X
3,461.58
X
55866
003
90
2
X
3,461.58
X
55867
001
90
2
X
1,289.95
X
55867
004
90
2
X
1,197.35
X
55867
003
90
2
X
1,197.35
X
55867
002
90
2
X
1,197.35
X
55870
0
2
X
*
X
55873
001
90
2
X
2,724.01
X
55873
004
90
2
X
2,471.13
X
55873
002
90
2
X
2,471.13
X
55873
003
90
2
X
2,471.13
X
55874
001
0
2
X
5,955.73
269.65
55874
003
0
2
X
5,204.41
248.96
55874
002
0
2
X
5,204.41
248.96
55874
004
0
2
X
5,204.41
248.96
55875
003
90
2
X
1,268.68
X
55875
002
90
2
X
1,268.68
X
55875
004
90
2
X
1,268.68
X
55875
001
90
2
X
1,412.80
X
55876
001
0
2
X
292.04
214.79
55876
004
0
2
X
249.89
186.74
55876
002
0
2
X
249.89
186.74
55876
003
0
2
X
249.89
186.74
55880
004
90
2
X
1,284.58
X
55880
001
90
2
X
1,390.86
X
55880
003
90
2
X
1,284.58
X
55880
002
90
2
X
1,284.58
X
55899
YYY
2
X
#
X
55920
004
0
2
X
758.28
X
55920
002
0
2
X
758.28
X
55920
001
0
2
X
830.95
X
55920
003
0
2
X
758.28
X
56405
001
10
2
X
313.25
X
56405
004
10
2
X
315.58
X
56405
003
10
2
X
317.69
X
56405
002
10
2
X
321.55
X
56420
001
10
2
X
303.16
X
56420
004
10
2
X
278.69
X
56420
003
10
2
X
293.75
X
56420
002
10
2
X
296.35
X
56440
002
10
2
X
668.72
X
56440
003
10
2
X
619.89
X
56440
001
10
2
X
680.52
X
56440
004
10
2
X
612.66
X
56441
004
10
2
X
398.84
X
56441
001
10
2
X
440.18
X
56441
002
10
2
X
433.00
X
56441
003
10
2
X
403.57
X
56442
004
0
2
X
78.11
X
56442
001
0
2
X
89.42
X
56442
002
0
2
X
78.11
X
56442
003
0
2
X
78.11
X
56501
004
10
2
X
280.25
246.15
56501
001
10
2
X
325.86
284.71
56501
003
10
2
X
261.85
229.28
56501
002
10
2
X
329.27
288.66
56515
002
10
2
X
1,014.20
X
56515
003
10
2
X
999.23
X
56515
001
10
2
X
1,027.60
X
56515
004
10
2
X
765.24
X
56605
004
0
2
X
247.20
X
56605
001
0
2
X
306.73
X
56605
003
0
2
X
258.03
X
56605
002
0
2
X
314.55
X
56606
003
ZZZ
0
X
88.92
X
56606
002
ZZZ
0
X
95.89
X
56606
004
ZZZ
0
X
87.82
X
56606
001
ZZZ
0
X
97.59
X
56620
004
90
2
X
1,549.34
X
56620
002
90
2
X
1,628.15
X
56620
003
90
2
X
1,541.36
X
56620
001
90
2
X
1,684.40
X
56625
002
90
2
X
2,167.24
X
56625
003
90
2
X
1,986.31
X
56625
004
90
2
X
1,962.69
X
56625
001
90
2
X
2,319.28
X
56630
003
90
2
X
4,420.93
X
56630
002
90
2
X
4,537.97
X
56630
004
90
2
X
2,925.47
X
56630
001
90
2
X
4,553.56
X
56631
003
90
2
X
4,040.17
X
56631
002
90
2
X
4,417.95
X
56631
001
90
2
X
4,509.54
X
56631
004
90
2
X
3,991.95
X
56632
002
90
2
X
4,813.49
X
56632
003
90
2
X
4,420.78
X
56632
004
90
2
X
4,367.79
X
56632
001
90
2
X
4,908.72
X
56633
001
90
2
X
4,704.85
X
56633
004
90
2
X
3,262.33
X
56633
003
90
2
X
4,565.93
X
56633
002
90
2
X
4,688.08
X
56634
004
90
2
X
4,348.57
X
56634
003
90
2
X
4,401.30
X
56634
002
90
2
X
4,793.22
X
56634
001
90
2
X
4,888.12
X
56637
004
90
2
X
4,584.70
X
56637
003
90
2
X
4,639.81
X
56637
002
90
2
X
5,038.20
X
56637
001
90
2
X
5,134.77
X
56640
001
90
2
X
5,108.83
X
56640
004
90
2
X
4,575.17
X
56640
002
90
2
X
5,015.20
X
56640
003
90
2
X
4,629.14
X
56700
003
10
2
X
479.45
X
56700
002
10
2
X
513.69
X
56700
001
10
2
X
521.96
X
56700
004
10
2
X
474.00
X
56740
004
10
2
X
746.05
X
56740
002
10
2
X
810.04
X
56740
003
10
2
X
733.36
X
56740
001
10
2
X
800.18
X
56800
001
10
2
X
822.96
X
56800
003
10
2
X
906.43
X
56800
002
10
2
X
936.64
X
56800
004
10
2
X
745.50
X
56805
001
90
2
X
3,209.13
X
56805
004
90
2
X
2,952.27
X
56805
002
90
2
X
3,166.06
X
56805
003
90
2
X
2,987.74
X
56810
001
10
2
X
911.84
X
56810
002
10
2
X
890.41
X
56810
003
10
2
X
861.68
X
56810
004
10
2
X
872.55
X
56820
003
0
2
X
251.74
176.66
56820
002
0
2
X
251.74
176.66
56820
004
0
2
X
251.74
176.66
56820
001
0
2
X
282.91
194.71
56821
001
0
2
X
366.15
268.12
56821
004
0
2
X
326.81
243.43
56821
003
0
2
X
326.81
243.43
56821
002
0
2
X
326.81
243.43
57000
003
10
2
X
350.45
X
57000
002
10
2
X
645.85
X
57000
004
10
2
X
546.83
X
57000
001
10
2
X
696.59
X
57010
001
90
2
X
954.31
X
57010
004
90
2
X
889.22
X
57010
003
90
2
X
898.99
X
57010
002
90
2
X
956.51
X
57020
001
0
2
X
259.00
X
57020
004
0
2
X
238.20
X
57020
002
0
2
X
255.35
X
57020
003
0
2
X
240.84
X
57022
001
10
2
X
404.57
X
57022
003
10
2
X
366.57
X
57022
002
10
2
X
366.57
X
57022
004
10
2
X
366.57
X
57023
001
10
2
X
404.57
X
57023
003
10
2
X
366.57
X
57023
002
10
2
X
366.57
X
57023
004
10
2
X
366.57
X
57061
002
10
2
X
324.37
X
57061
003
10
2
X
325.75
X
57061
001
10
2
X
334.26
X
57061
004
10
2
X
312.83
X
57065
004
10
2
X
1,051.32
X
57065
001
10
2
X
1,087.55
X
57065
003
10
2
X
1,054.76
X
57065
002
10
2
X
1,081.12
X
57100
003
0
2
X
315.87
260.27
57100
002
0
2
X
317.84
262.43
57100
004
0
2
X
306.75
252.35
57100
001
0
2
X
318.39
262.49
57105
004
10
2
X
395.75
X
57105
002
10
2
X
409.39
X
57105
003
10
2
X
391.77
X
57105
001
10
2
X
416.14
X
57106
002
90
2
X
806.85
X
57106
003
90
2
X
806.85
X
57106
004
90
2
X
806.85
X
57106
001
90
2
X
904.16
X
57107
001
90
2
X
3,015.04
2,997.73
57107
003
90
2
X
2,778.68
2,763.83
57107
002
90
2
X
2,778.68
2,763.83
57107
004
90
2
X
2,778.68
2,763.83
57109
001
90
2
X
3,714.26
3,671.87
57109
004
90
2
X
3,340.81
3,304.57
57109
003
90
2
X
3,340.81
3,304.57
57109
002
90
2
X
3,340.81
3,304.57
57110
002
90
2
X
2,327.33
X
57110
003
90
2
X
2,256.43
X
57110
004
90
2
X
2,245.16
X
57110
001
90
2
X
2,344.53
X
57111
001
90
2
X
3,678.62
3,745.10
57111
004
90
2
X
3,310.30
3,367.16
57111
003
90
2
X
3,310.30
3,367.16
57111
002
90
2
X
3,310.30
3,367.16
57120
003
90
2
X
1,840.42
X
57120
001
90
2
X
1,753.59
X
57120
002
90
2
X
1,721.19
X
57120
004
90
2
X
1,568.80
X
57130
001
10
2
X
642.23
X
57130
004
10
2
X
574.27
X
57130
002
10
2
X
652.08
X
57130
003
10
2
X
581.14
X
57135
004
10
2
X
510.89
X
57135
001
10
2
X
573.79
X
57135
003
10
2
X
516.86
X
57135
002
10
2
X
553.68
X
57150
004
0
2
X
121.90
112.42
57150
002
0
2
X
128.51
118.48
57150
003
0
2
X
123.03
113.45
57150
001
0
2
X
129.96
119.70
57155
004
0
2
X
827.17
X
57155
001
0
2
X
926.65
X
57155
002
0
2
X
827.17
X
57155
003
0
2
X
827.17
X
57156
001
0
2
X
280.81
191.47
57156
004
0
2
X
256.44
177.52
57156
002
0
2
X
256.44
177.52
57156
003
0
2
X
256.44
177.52
57160
002
0
2
X
121.93
109.40
57160
003
0
2
X
113.51
102.04
57160
004
0
2
X
115.29
103.92
57160
001
0
2
X
122.93
110.67
57170
0
2
X
*
X
57180
001
10
2
X
235.55
X
57180
004
10
2
X
225.10
X
57180
002
10
2
X
233.86
X
57180
003
10
2
X
226.56
X
57200
001
90
2
X
799.78
X
57200
002
90
2
X
786.27
X
57200
003
90
2
X
741.51
X
57200
004
90
2
X
746.08
X
57210
001
90
2
X
1,056.56
X
57210
004
90
2
X
980.05
X
57210
003
90
2
X
969.82
X
57210
002
90
2
X
1,016.13
X
57220
002
90
2
X
1,024.33
X
57220
003
90
2
X
1,067.58
X
57220
001
90
2
X
1,064.25
X
57220
004
90
2
X
936.83
X
57230
002
90
2
X
1,065.77
X
57230
003
90
2
X
1,068.93
X
57230
001
90
2
X
1,082.26
X
57230
004
90
2
X
986.45
X
57240
003
90
2
X
1,464.29
X
57240
002
90
2
X
1,599.44
X
57240
004
90
2
X
1,446.83
X
57240
001
90
2
X
1,632.22
X
57250
004
90
2
X
1,414.62
X
57250
001
90
2
X
1,712.33
X
57250
003
90
2
X
1,431.61
X
57250
002
90
2
X
1,570.28
X
57260
004
90
2
X
1,971.92
X
57260
002
90
2
X
2,089.70
X
57260
001
90
2
X
2,090.75
X
57260
003
90
2
X
1,887.10
X
57265
004
90
2
X
1,941.32
X
57265
001
90
2
X
2,187.18
X
57265
002
90
2
X
2,143.78
X
57265
003
90
2
X
1,964.66
X
57267
001
ZZZ
0
X
636.23
X
57267
003
ZZZ
0
X
570.68
X
57267
002
ZZZ
0
X
570.68
X
57267
004
ZZZ
0
X
570.68
X
57268
004
90
2
X
1,534.60
X
57268
002
90
2
X
1,659.38
X
57268
003
90
2
X
1,527.41
X
57268
001
90
2
X
1,691.39
X
57270
004
90
2
X
1,690.97
X
57270
003
90
2
X
1,669.87
X
57270
002
90
2
X
1,762.18
X
57270
001
90
2
X
1,794.03
X
57280
001
90
2
X
2,154.97
X
57280
003
90
2
X
1,951.59
X
57280
002
90
2
X
2,115.29
X
57280
004
90
2
X
1,928.75
X
57282
004
90
2
X
1,922.63
X
57282
001
90
2
X
2,151.90
X
57282
003
90
2
X
1,945.56
X
57282
002
90
2
X
2,111.58
X
57283
004
90
2
X
1,353.39
X
57283
001
90
2
X
1,502.65
X
57283
003
90
2
X
1,353.39
X
57283
002
90
2
X
1,353.39
X
57284
004
90
2
X
2,329.49
X
57284
002
90
2
X
2,499.42
X
57284
003
90
2
X
2,363.09
X
57284
001
90
2
X
2,593.73
X
57285
004
90
2
X
1,091.23
X
57285
003
90
2
X
1,091.23
X
57285
002
90
2
X
1,091.23
X
57285
001
90
2
X
1,195.92
X
57287
003
90
2
X
1,563.93
X
57287
002
90
2
X
1,563.93
X
57287
001
90
2
X
1,730.77
X
57287
004
90
2
X
1,563.93
X
57288
003
90
2
X
2,488.39
X
57288
001
90
2
X
2,637.65
X
57288
002
90
2
X
2,581.83
X
57288
004
90
2
X
2,494.76
X
57289
003
90
2
X
1,652.94
X
57289
002
90
2
X
1,775.30
X
57289
001
90
2
X
1,804.80
X
57289
004
90
2
X
1,632.26
X
57291
004
90
2
X
1,446.64
X
57291
001
90
2
X
1,599.50
X
57291
002
90
2
X
1,572.79
X
57291
003
90
2
X
1,463.08
X
57292
003
90
2
X
2,124.68
X
57292
002
90
2
X
2,263.94
X
57292
004
90
2
X
2,101.40
X
57292
001
90
2
X
2,297.83
X
57295
001
90
2
X
998.50
X
57295
004
90
2
X
886.28
X
57295
002
90
2
X
886.28
X
57295
003
90
2
X
886.28
X
57296
001
90
2
X
1,714.39
X
57296
004
90
2
X
1,529.25
X
57296
003
90
2
X
1,529.25
X
57296
002
90
2
X
1,529.25
X
57300
003
90
2
X
1,811.05
X
57300
002
90
2
X
1,898.38
X
57300
004
90
2
X
1,848.08
X
57300
001
90
2
X
1,972.18
X
57305
004
90
2
X
2,548.25
X
57305
001
90
2
X
2,037.74
X
57305
002
90
2
X
2,667.78
X
57305
003
90
2
X
1,858.05
X
57307
003
90
2
X
1,825.15
X
57307
002
90
2
X
1,950.62
X
57307
001
90
2
X
1,981.10
X
57307
004
90
2
X
2,906.27
X
57308
003
90
2
X
1,636.01
X
57308
002
90
2
X
1,636.01
X
57308
004
90
2
X
1,636.01
X
57308
001
90
2
X
1,861.20
X
57310
004
90
2
X
1,126.36
X
57310
001
90
2
X
2,126.82
X
57310
002
90
2
X
1,205.36
X
57310
003
90
2
X
1,139.72
X
57311
001
90
2
X
1,468.73
X
57311
004
90
2
X
1,362.38
X
57311
002
90
2
X
1,451.27
X
57311
003
90
2
X
1,379.03
X
57320
003
90
2
X
1,877.60
X
57320
002
90
2
X
2,400.52
X
57320
004
90
2
X
2,290.19
X
57320
001
90
2
X
2,479.83
X
57330
004
90
2
X
2,144.00
X
57330
001
90
2
X
2,318.63
X
57330
003
90
2
X
2,169.70
X
57330
002
90
2
X
2,289.70
X
57335
002
90
2
X
1,862.73
X
57335
003
90
2
X
1,757.69
X
57335
001
90
2
X
1,888.13
X
57335
004
90
2
X
1,736.92
X
57400
004
0
2
X
156.25
X
57400
001
0
2
X
144.42
X
57400
002
0
2
X
159.84
X
57400
003
0
2
X
156.84
X
57410
002
0
2
X
100.61
X
57410
003
0
2
X
128.42
X
57410
001
0
2
X
112.10
X
57410
004
0
2
X
98.21
X
57415
002
10
2
X
117.68
X
57415
003
10
2
X
145.11
X
57415
004
10
2
X
114.67
X
57415
001
10
2
X
146.73
X
57420
003
0
2
X
262.83
187.79
57420
002
0
2
X
262.83
187.79
57420
004
0
2
X
262.83
187.79
57420
001
0
2
X
294.82
206.61
57421
001
0
2
X
384.03
286.00
57421
003
0
2
X
343.49
260.08
57421
002
0
2
X
343.49
260.08
57421
004
0
2
X
343.49
260.08
57423
001
90
2
X
1,692.78
X
57423
003
90
2
X
1,525.64
X
57423
002
90
2
X
1,525.64
X
57423
004
90
2
X
1,525.64
X
57425
003
90
2
X
1,890.13
X
57425
002
90
2
X
1,890.13
X
57425
001
90
2
X
2,093.87
X
57425
004
90
2
X
1,890.13
X
57426
002
90
2
X
1,475.32
X
57426
003
90
2
X
1,475.32
X
57426
001
90
2
X
1,638.54
X
57426
004
90
2
X
1,475.32
X
57452
003
0
2
X
144.32
118.26
57452
002
0
2
X
199.50
164.25
57452
001
0
2
X
202.80
167.02
57452
004
0
2
X
184.13
151.44
57454
001
0
3
X
313.48
247.51
57454
004
0
3
X
281.41
220.93
57454
002
0
3
X
307.86
242.67
57454
003
0
3
X
284.64
223.15
57455
004
0
3
X
315.92
236.31
57455
001
0
3
X
354.03
260.44
57455
002
0
3
X
315.92
236.31
57455
003
0
3
X
315.92
236.31
57456
003
0
3
X
298.54
221.21
57456
002
0
3
X
298.54
221.21
57456
004
0
3
X
298.54
221.21
57456
001
0
3
X
335.22
244.36
57460
004
0
3
X
549.06
X
57460
002
0
3
X
597.60
X
57460
003
0
3
X
555.30
X
57460
001
0
3
X
607.82
X
57461
002
0
3
X
698.69
409.06
57461
003
0
3
X
698.69
409.06
57461
001
0
3
X
793.62
453.17
57461
004
0
3
X
698.69
409.06
57465
001
ZZZ
0
X
81.47
61.95
57465
004
ZZZ
0
X
74.00
57.06
57465
003
ZZZ
0
X
74.00
57.06
57465
002
ZZZ
0
X
74.00
57.06
57500
003
0
2
X
197.97
164.88
57500
002
0
2
X
231.09
192.09
57500
004
0
2
X
230.43
191.93
57500
001
0
2
X
274.48
228.17
57505
002
10
2
X
172.07
143.78
57505
003
10
2
X
164.69
137.12
57505
004
10
2
X
191.51
159.84
57505
001
10
2
X
173.84
145.14
57510
001
10
2
X
226.62
202.84
57510
003
10
2
X
212.62
190.59
57510
002
10
2
X
225.66
201.91
57510
004
10
2
X
223.14
200.64
57511
003
10
2
X
300.88
257.50
57511
002
10
2
X
319.01
273.09
57511
004
10
2
X
316.08
270.36
57511
001
10
2
X
323.44
276.94
Return to CPT/HCPC List