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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule 92627-93312
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
92627-93312
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
92627
002
ZZZ
0
X
39.59
X
92627
001
ZZZ
0
X
50.21
X
92627
004
ZZZ
0
X
39.59
X
92627
003
ZZZ
0
X
39.59
X
92630
XXX
9
X
*
X
92633
XXX
9
X
*
X
92640
003
XXX
0
X
88.08
X
92640
002
XXX
0
X
88.08
X
92640
004
XXX
0
X
88.08
X
92640
001
XXX
0
X
108.01
X
92650
XXX
0
X
*
X
92651
003
XXX
0
X
116.36
X
92651
004
XXX
0
X
116.36
X
92651
001
XXX
0
X
128.55
X
92651
002
XXX
0
X
116.36
X
92652
001
XXX
0
X
167.90
X
92652
004
XXX
0
X
152.83
X
92652
003
XXX
0
X
152.83
X
92652
002
XXX
0
X
152.83
X
92653
004
XXX
0
X
111.74
X
92653
003
XXX
0
X
111.74
X
92653
001
XXX
0
X
122.91
X
92653
002
XXX
0
X
111.74
X
92700
XXX
0
X
#
X
92920
004
0
2
X
884.85
X
92920
003
0
2
X
884.85
X
92920
002
0
2
X
884.85
X
92920
001
0
2
X
983.61
X
92921
ZZZ
9
X
*
X
92924
001
0
2
X
1,169.63
X
92924
002
0
2
X
1,051.98
X
92924
003
0
2
X
1,051.98
X
92924
004
0
2
X
1,051.98
X
92925
ZZZ
9
X
*
X
92928
001
0
2
X
1,093.06
X
92928
002
0
2
X
982.98
X
92928
003
0
2
X
982.98
X
92928
004
0
2
X
982.98
X
92929
ZZZ
9
X
*
X
92933
001
0
2
X
1,222.29
X
92933
002
0
2
X
1,099.25
X
92933
003
0
2
X
1,099.25
X
92933
004
0
2
X
1,099.25
X
92934
ZZZ
9
X
*
X
92937
002
0
2
X
981.90
X
92937
001
0
2
X
1,091.93
X
92937
004
0
2
X
981.90
X
92937
003
0
2
X
981.90
X
92938
ZZZ
9
X
*
X
92941
002
0
2
X
1,101.47
X
92941
003
0
2
X
1,101.47
X
92941
004
0
2
X
1,101.47
X
92941
001
0
2
X
1,224.93
X
92943
001
0
2
X
1,224.93
X
92943
003
0
2
X
1,101.47
X
92943
002
0
2
X
1,101.47
X
92943
004
0
2
X
1,101.47
X
92944
ZZZ
9
X
*
X
92950
0
0
X
*
X
92953
004
0
0
X
142.27
X
92953
002
0
0
X
153.43
X
92953
003
0
0
X
145.42
X
92953
001
0
0
X
157.77
X
92960
002
0
0
X
480.73
X
92960
003
0
0
X
419.03
X
92960
004
0
0
X
413.88
X
92960
001
0
0
X
501.43
X
92961
004
0
9
X
554.37
X
92961
003
0
9
X
554.37
X
92961
002
0
9
X
554.37
X
92961
001
0
9
X
606.47
X
92970
0
0
X
*
X
92971
0
0
X
*
X
92972
004
ZZZ
0
X
153.49
X
92972
003
ZZZ
0
X
153.49
X
92972
002
ZZZ
0
X
153.49
X
92972
001
ZZZ
0
X
164.72
X
92973
003
ZZZ
0
X
380.73
X
92973
001
ZZZ
0
X
417.12
X
92973
004
ZZZ
0
X
380.73
X
92973
002
ZZZ
0
X
380.73
X
92974
002
ZZZ
0
X
413.72
X
92974
004
ZZZ
0
X
413.72
X
92974
001
ZZZ
0
X
500.71
X
92974
003
ZZZ
0
X
413.72
X
92975
003
0
2
X
1,383.54
X
92975
002
0
2
X
1,654.30
X
92975
001
0
2
X
1,769.24
X
92975
004
0
2
X
2,341.68
X
92977
004
XXX
0
X
467.52
X
92977
003
XXX
0
X
469.30
X
92977
002
XXX
0
X
509.80
X
92977
001
XXX
0
X
521.93
X
92978
004
ZZZ
0
X
634.65
X
92978
26
004
ZZZ
0
X
245.89
X
92978
TC
004
ZZZ
0
X
388.77
X
92978
001
ZZZ
0
X
742.72
X
92978
26
001
ZZZ
0
X
271.90
X
92978
TC
001
ZZZ
0
X
470.84
X
92978
003
ZZZ
0
X
634.65
X
92978
26
003
ZZZ
0
X
245.89
X
92978
TC
003
ZZZ
0
X
388.77
X
92978
002
ZZZ
0
X
652.12
X
92978
26
002
ZZZ
0
X
252.68
X
92978
TC
002
ZZZ
0
X
399.44
X
92979
002
ZZZ
0
X
402.25
X
92979
26
002
ZZZ
0
X
202.04
X
92979
TC
002
ZZZ
0
X
200.17
X
92979
004
ZZZ
0
X
391.38
X
92979
26
004
ZZZ
0
X
196.58
X
92979
TC
004
ZZZ
0
X
194.79
X
92979
003
ZZZ
0
X
391.38
X
92979
26
003
ZZZ
0
X
196.58
X
92979
TC
003
ZZZ
0
X
194.79
X
92979
001
ZZZ
0
X
453.19
X
92979
26
001
ZZZ
0
X
217.21
X
92979
TC
001
ZZZ
0
X
235.92
X
92986
90
2
X
*
X
92987
004
90
2
X
3,123.65
X
92987
003
90
2
X
3,167.15
X
92987
002
90
2
X
3,333.90
X
92987
001
90
2
X
3,446.93
X
92990
004
90
2
X
2,566.99
X
92990
003
90
2
X
2,597.21
X
92990
002
90
2
X
2,723.45
X
92990
001
90
2
X
3,306.66
X
92997
004
0
2
X
2,349.01
X
92997
003
0
2
X
2,349.01
X
92997
002
0
2
X
2,349.01
X
92997
001
0
2
X
2,664.80
X
92998
004
ZZZ
0
X
908.58
X
92998
001
ZZZ
0
X
1,012.46
X
92998
002
ZZZ
0
X
908.58
X
92998
003
ZZZ
0
X
908.58
X
93000
001
XXX
6
X
83.13
X
93000
003
XXX
6
X
76.33
X
93000
002
XXX
6
X
81.84
X
93000
004
XXX
6
X
75.22
X
93005
004
XXX
6
X
62.32
X
93005
003
XXX
6
X
79.24
X
93005
002
XXX
6
X
71.78
X
93005
001
XXX
6
X
74.61
X
93010
001
XXX
0
X
34.95
X
93010
002
XXX
0
X
34.48
X
93010
003
XXX
0
X
32.77
X
93010
004
XXX
0
X
32.39
X
93015
001
XXX
6
X
374.28
X
93015
003
XXX
6
X
356.27
X
93015
002
XXX
6
X
375.06
X
93015
004
XXX
6
X
357.60
X
93016
001
XXX
0
X
89.68
X
93016
003
XXX
0
X
83.95
X
93016
004
XXX
0
X
82.93
X
93016
002
XXX
0
X
88.56
X
93017
003
XXX
6
X
204.89
X
93017
002
XXX
6
X
179.15
X
93017
004
XXX
6
X
161.98
X
93017
001
XXX
6
X
182.58
X
93018
002
XXX
0
X
166.33
X
93018
003
XXX
0
X
165.98
X
93018
004
XXX
0
X
163.32
X
93018
001
XXX
0
X
169.26
X
93024
001
XXX
6
X
424.40
X
93024
26
001
XXX
6
X
301.12
X
93024
TC
001
XXX
6
X
123.27
X
93024
002
XXX
6
X
307.16
X
93024
26
002
XXX
6
X
237.96
X
93024
TC
002
XXX
6
X
120.92
X
93024
003
XXX
6
X
290.86
X
93024
26
003
XXX
6
X
227.50
X
93024
TC
003
XXX
6
X
110.80
X
93024
004
XXX
6
X
384.28
X
93024
26
004
XXX
6
X
275.20
X
93024
TC
004
XXX
6
X
109.00
X
93025
002
XXX
6
X
556.31
X
93025
003
XXX
6
X
556.31
X
93025
001
XXX
6
X
649.85
X
93025
004
XXX
6
X
556.31
X
93040
003
XXX
6
X
42.15
X
93040
004
XXX
6
X
41.66
X
93040
002
XXX
6
X
44.95
X
93040
001
XXX
6
X
44.39
X
93041
004
XXX
6
X
49.90
X
93041
001
XXX
6
X
52.60
X
93041
002
XXX
6
X
59.74
X
93041
003
XXX
6
X
54.90
X
93042
001
XXX
0
X
32.86
X
93042
003
XXX
0
X
31.73
X
93042
004
XXX
0
X
32.08
X
93042
002
XXX
0
X
33.35
X
93050
001
XXX
6
X
28.77
X
93050
26
001
XXX
6
X
13.77
X
93050
TC
001
XXX
6
X
14.99
X
93050
002
XXX
6
X
25.67
X
93050
26
002
XXX
6
X
12.92
X
93050
TC
002
XXX
6
X
12.76
X
93050
003
XXX
6
X
25.67
X
93050
26
003
XXX
6
X
12.92
X
93050
TC
003
XXX
6
X
12.76
X
93050
004
XXX
6
X
25.67
X
93050
26
004
XXX
6
X
12.92
X
93050
TC
004
XXX
6
X
12.76
X
93150
002
XXX
0
X
104.47
45.13
93150
003
XXX
0
X
104.47
45.13
93150
004
XXX
0
X
104.47
45.13
93150
001
XXX
0
X
115.86
48.45
93151
004
XXX
0
X
91.33
42.62
93151
002
XXX
0
X
91.33
42.62
93151
003
XXX
0
X
91.33
42.62
93151
001
XXX
0
X
101.11
45.78
93152
001
XXX
0
X
182.54
106.95
93152
003
XXX
0
X
166.00
99.45
93152
002
XXX
0
X
166.00
99.45
93152
004
XXX
0
X
166.00
99.45
93153
001
XXX
0
X
60.12
24.66
93153
003
XXX
0
X
54.13
22.92
93153
004
XXX
0
X
54.13
22.92
93153
002
XXX
0
X
54.13
22.92
93224
001
XXX
6
X
560.29
X
93224
004
XXX
6
X
529.81
X
93224
002
XXX
6
X
554.30
X
93224
003
XXX
6
X
539.40
X
93225
003
XXX
6
X
124.77
X
93225
002
XXX
6
X
131.89
X
93225
004
XXX
6
X
122.04
X
93225
001
XXX
6
X
134.44
X
93226
004
XXX
6
X
220.51
X
93226
003
XXX
6
X
213.88
X
93226
002
XXX
6
X
232.90
X
93226
001
XXX
6
X
237.38
X
93227
001
XXX
0
X
142.91
X
93227
003
XXX
0
X
164.47
X
93227
002
XXX
0
X
159.44
X
93227
004
XXX
0
X
157.13
X
93228
001
XXX
0
X
48.24
X
93228
002
XXX
0
X
45.14
X
93228
003
XXX
0
X
45.14
X
93228
004
XXX
0
X
45.14
X
93229
XXX
6
X
*
X
93241
004
XXX
6
X
176.25
X
93241
002
XXX
6
X
176.25
X
93241
003
XXX
6
X
176.25
X
93241
001
XXX
6
X
200.57
X
93242
004
XXX
6
X
19.06
X
93242
002
XXX
6
X
19.06
X
93242
003
XXX
6
X
19.06
X
93242
001
XXX
6
X
22.07
X
93243
003
XXX
6
X
125.01
X
93243
002
XXX
6
X
125.01
X
93243
001
XXX
6
X
144.27
X
93243
004
XXX
6
X
125.01
X
93244
003
XXX
0
X
32.17
X
93244
002
XXX
0
X
32.17
X
93244
001
XXX
0
X
34.23
X
93244
004
XXX
0
X
32.17
X
93245
001
XXX
6
X
219.45
X
93245
002
XXX
6
X
192.88
X
93245
003
XXX
6
X
192.88
X
93245
004
XXX
6
X
192.88
X
93246
002
XXX
6
X
19.06
X
93246
004
XXX
6
X
19.06
X
93246
003
XXX
6
X
19.06
X
93246
001
XXX
6
X
22.07
X
93247
001
XXX
6
X
159.80
X
93247
003
XXX
6
X
138.47
X
93247
002
XXX
6
X
138.47
X
93247
004
XXX
6
X
138.47
X
93248
004
XXX
0
X
35.34
X
93248
003
XXX
0
X
35.34
X
93248
002
XXX
0
X
35.34
X
93248
001
XXX
0
X
37.60
X
93260
003
XXX
6
X
100.42
X
93260
26
003
XXX
6
X
69.51
X
93260
TC
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6
X
30.92
X
93260
002
XXX
6
X
100.42
X
93260
26
002
XXX
6
X
69.51
X
93260
TC
002
XXX
6
X
30.92
X
93260
001
XXX
6
X
110.59
X
93260
26
001
XXX
6
X
74.36
X
93260
TC
001
XXX
6
X
36.23
X
93260
004
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6
X
100.42
X
93260
26
004
XXX
6
X
69.51
X
93260
TC
004
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6
X
30.92
X
93261
002
XXX
6
X
91.60
X
93261
26
002
XXX
6
X
60.68
X
93261
TC
002
XXX
6
X
30.92
X
93261
004
XXX
6
X
91.60
X
93261
26
004
XXX
6
X
60.68
X
93261
TC
004
XXX
6
X
30.92
X
93261
003
XXX
6
X
91.60
X
93261
26
003
XXX
6
X
60.68
X
93261
TC
003
XXX
6
X
30.92
X
93261
001
XXX
6
X
101.21
X
93261
26
001
XXX
6
X
64.96
X
93261
TC
001
XXX
6
X
36.23
X
93264
001
XXX
0
X
76.15
53.62
93264
002
XXX
0
X
69.76
50.14
93264
003
XXX
0
X
69.76
50.14
93264
004
XXX
0
X
69.76
50.14
93268
001
XXX
6
X
501.19
X
93268
004
XXX
6
X
445.97
X
93268
002
XXX
6
X
491.86
X
93268
003
XXX
6
X
452.64
X
93270
004
XXX
6
X
117.58
X
93270
001
XXX
6
X
135.98
X
93270
002
XXX
6
X
131.27
X
93270
003
XXX
6
X
119.70
X
93271
001
XXX
6
X
266.13
X
93271
002
XXX
6
X
256.00
X
93271
004
XXX
6
X
228.39
X
93271
003
XXX
6
X
232.45
X
93272
001
XXX
0
X
102.81
X
93272
003
XXX
0
X
94.35
X
93272
002
XXX
0
X
100.16
X
93272
004
XXX
0
X
93.10
X
93278
XXX
6
X
*
X
93279
001
XXX
6
X
108.42
X
93279
26
001
XXX
6
X
68.10
X
93279
TC
001
XXX
6
X
40.32
X
93279
003
XXX
6
X
96.36
X
93279
26
003
XXX
6
X
63.08
X
93279
TC
003
XXX
6
X
33.25
X
93279
004
XXX
6
X
96.36
X
93279
26
004
XXX
6
X
63.08
X
93279
TC
004
XXX
6
X
33.25
X
93279
002
XXX
6
X
96.36
X
93279
26
002
XXX
6
X
63.08
X
93279
TC
002
XXX
6
X
33.25
X
93280
001
XXX
6
X
127.29
X
93280
26
001
XXX
6
X
81.63
X
93280
TC
001
XXX
6
X
45.64
X
93280
004
XXX
6
X
113.56
X
93280
26
004
XXX
6
X
75.58
X
93280
TC
004
XXX
6
X
37.92
X
93280
003
XXX
6
X
113.56
X
93280
26
003
XXX
6
X
75.58
X
93280
TC
003
XXX
6
X
37.92
X
93280
002
XXX
6
X
113.56
X
93280
26
002
XXX
6
X
75.58
X
93280
TC
002
XXX
6
X
37.92
X
93281
004
XXX
6
X
132.79
X
93281
26
004
XXX
6
X
88.17
X
93281
TC
004
XXX
6
X
44.60
X
93281
003
XXX
6
X
132.79
X
93281
26
003
XXX
6
X
88.17
X
93281
TC
003
XXX
6
X
44.60
X
93281
002
XXX
6
X
132.79
X
93281
26
002
XXX
6
X
88.17
X
93281
TC
002
XXX
6
X
44.60
X
93281
001
XXX
6
X
148.91
X
93281
26
001
XXX
6
X
95.12
X
93281
TC
001
XXX
6
X
53.77
X
93282
001
XXX
6
X
138.14
X
93282
26
001
XXX
6
X
89.36
X
93282
TC
001
XXX
6
X
48.82
X
93282
004
XXX
6
X
123.06
X
93282
26
004
XXX
6
X
82.65
X
93282
TC
004
XXX
6
X
40.45
X
93282
003
XXX
6
X
123.06
X
93282
26
003
XXX
6
X
82.65
X
93282
TC
003
XXX
6
X
40.45
X
93282
002
XXX
6
X
123.06
X
93282
26
002
XXX
6
X
82.65
X
93282
TC
002
XXX
6
X
40.45
X
93283
004
XXX
6
X
149.84
X
93283
26
004
XXX
6
X
104.01
X
93283
TC
004
XXX
6
X
45.78
X
93283
003
XXX
6
X
149.84
X
93283
26
003
XXX
6
X
104.01
X
93283
TC
003
XXX
6
X
45.78
X
93283
002
XXX
6
X
149.84
X
93283
26
002
XXX
6
X
104.01
X
93283
TC
002
XXX
6
X
45.78
X
93283
001
XXX
6
X
167.91
X
93283
26
001
XXX
6
X
112.77
X
93283
TC
001
XXX
6
X
55.17
X
93284
004
XXX
6
X
175.30
X
93284
26
004
XXX
6
X
123.54
X
93284
TC
004
XXX
6
X
51.79
X
93284
003
XXX
6
X
175.30
X
93284
26
003
XXX
6
X
123.54
X
93284
TC
003
XXX
6
X
51.79
X
93284
002
XXX
6
X
175.30
X
93284
26
002
XXX
6
X
123.54
X
93284
TC
002
XXX
6
X
51.79
X
93284
001
XXX
6
X
195.87
X
93284
26
001
XXX
6
X
133.66
X
93284
TC
001
XXX
6
X
62.29
X
93285
004
XXX
6
X
83.16
X
93285
26
004
XXX
6
X
51.69
X
93285
TC
004
XXX
6
X
31.44
X
93285
002
XXX
6
X
83.16
X
93285
26
002
XXX
6
X
51.69
X
93285
TC
002
XXX
6
X
31.44
X
93285
003
XXX
6
X
83.16
X
93285
26
003
XXX
6
X
51.69
X
93285
TC
003
XXX
6
X
31.44
X
93285
001
XXX
6
X
94.20
X
93285
26
001
XXX
6
X
56.05
X
93285
TC
001
XXX
6
X
38.17
X
93286
002
XXX
6
X
47.23
X
93286
26
002
XXX
6
X
26.79
X
93286
TC
002
XXX
6
X
20.53
X
93286
003
XXX
6
X
47.23
X
93286
26
003
XXX
6
X
26.79
X
93286
TC
003
XXX
6
X
20.53
X
93286
004
XXX
6
X
47.23
X
93286
26
004
XXX
6
X
26.79
X
93286
TC
004
XXX
6
X
20.53
X
93286
001
XXX
6
X
53.58
X
93286
26
001
XXX
6
X
28.87
X
93286
TC
001
XXX
6
X
24.77
X
93287
001
XXX
6
X
70.16
X
93287
26
001
XXX
6
X
41.20
X
93287
TC
001
XXX
6
X
28.96
X
93287
002
XXX
6
X
62.40
X
93287
26
002
XXX
6
X
38.72
X
93287
TC
002
XXX
6
X
23.68
X
93287
003
XXX
6
X
62.40
X
93287
26
003
XXX
6
X
38.72
X
93287
TC
003
XXX
6
X
23.68
X
93287
004
XXX
6
X
62.40
X
93287
26
004
XXX
6
X
38.72
X
93287
TC
004
XXX
6
X
23.68
X
93288
004
XXX
6
X
74.25
X
93288
26
004
XXX
6
X
42.18
X
93288
TC
004
XXX
6
X
32.07
X
93288
003
XXX
6
X
74.25
X
93288
26
003
XXX
6
X
42.18
X
93288
TC
003
XXX
6
X
32.07
X
93288
002
XXX
6
X
74.25
X
93288
26
002
XXX
6
X
42.18
X
93288
TC
002
XXX
6
X
32.07
X
93288
001
XXX
6
X
84.45
X
93288
26
001
XXX
6
X
45.56
X
93288
TC
001
XXX
6
X
38.89
X
93289
003
XXX
6
X
114.19
X
93289
26
003
XXX
6
X
76.26
X
93289
TC
003
XXX
6
X
37.92
X
93289
002
XXX
6
X
114.19
X
93289
26
002
XXX
6
X
76.26
X
93289
TC
002
XXX
6
X
37.92
X
93289
001
XXX
6
X
127.94
X
93289
26
001
XXX
6
X
82.31
X
93289
TC
001
XXX
6
X
45.64
X
93289
004
XXX
6
X
114.19
X
93289
26
004
XXX
6
X
76.26
X
93289
TC
004
XXX
6
X
37.92
X
93290
004
XXX
6
X
55.86
X
93290
26
004
XXX
6
X
37.53
X
93290
TC
004
XXX
6
X
18.34
X
93290
003
XXX
6
X
55.86
X
93290
26
003
XXX
6
X
37.53
X
93290
TC
003
XXX
6
X
18.34
X
93290
002
XXX
6
X
55.86
X
93290
26
002
XXX
6
X
37.53
X
93290
TC
002
XXX
6
X
18.34
X
93290
001
XXX
6
X
62.83
X
93290
26
001
XXX
6
X
40.24
X
93290
TC
001
XXX
6
X
22.59
X
93291
001
XXX
6
X
80.88
X
93291
26
001
XXX
6
X
46.59
X
93291
TC
001
XXX
6
X
34.30
X
93291
004
XXX
6
X
71.27
X
93291
26
004
XXX
6
X
42.89
X
93291
TC
004
XXX
6
X
28.37
X
93291
003
XXX
6
X
71.27
X
93291
26
003
XXX
6
X
42.89
X
93291
TC
003
XXX
6
X
28.37
X
93291
002
XXX
6
X
71.27
X
93291
26
002
XXX
6
X
42.89
X
93291
TC
002
XXX
6
X
28.37
X
93292
001
XXX
6
X
73.11
X
93292
26
001
XXX
6
X
45.56
X
93292
TC
001
XXX
6
X
27.55
X
93292
002
XXX
6
X
64.73
X
93292
26
002
XXX
6
X
42.18
X
93292
TC
002
XXX
6
X
22.53
X
93292
003
XXX
6
X
64.73
X
93292
26
003
XXX
6
X
42.18
X
93292
TC
003
XXX
6
X
22.53
X
93292
004
XXX
6
X
64.73
X
93292
26
004
XXX
6
X
42.18
X
93292
TC
004
XXX
6
X
22.53
X
93293
004
XXX
0
X
102.03
X
93293
26
004
XXX
0
X
29.84
X
93293
TC
004
XXX
0
X
72.20
X
93293
003
XXX
0
X
102.03
X
93293
26
003
XXX
0
X
29.84
X
93293
TC
003
XXX
0
X
72.20
X
93293
002
XXX
0
X
102.03
X
93293
26
002
XXX
0
X
29.84
X
93293
TC
002
XXX
0
X
72.20
X
93293
001
XXX
0
X
120.27
X
93293
26
001
XXX
0
X
32.28
X
93293
TC
001
XXX
0
X
87.98
X
93294
002
XXX
0
X
64.40
X
93294
003
XXX
0
X
64.40
X
93294
004
XXX
0
X
64.40
X
93294
001
XXX
0
X
69.83
X
93295
002
XXX
0
X
115.98
X
93295
004
XXX
0
X
115.98
X
93295
003
XXX
0
X
115.98
X
93295
001
XXX
0
X
125.56
X
93296
002
XXX
0
X
60.43
X
93296
003
XXX
0
X
60.43
X
93296
004
XXX
0
X
60.43
X
93296
001
XXX
0
X
71.90
X
93297
002
XXX
0
X
45.14
X
93297
001
XXX
0
X
48.24
X
93297
004
XXX
0
X
45.14
X
93297
003
XXX
0
X
45.14
X
93298
001
XXX
0
X
56.05
X
93298
003
XXX
0
X
51.69
X
93298
004
XXX
0
X
51.69
X
93298
002
XXX
0
X
51.69
X
93303
002
XXX
6
X
545.47
X
93303
26
002
XXX
6
X
205.19
X
93303
TC
002
XXX
6
X
340.25
X
93303
003
XXX
6
X
530.82
X
93303
26
003
XXX
6
X
199.73
X
93303
TC
003
XXX
6
X
331.14
X
93303
004
XXX
6
X
530.82
X
93303
26
004
XXX
6
X
199.73
X
93303
TC
004
XXX
6
X
331.14
X
93303
001
XXX
6
X
626.15
X
93303
26
001
XXX
6
X
223.83
X
93303
TC
001
XXX
6
X
402.30
X
93304
004
XXX
6
X
290.62
X
93304
26
004
XXX
6
X
123.86
X
93304
TC
004
XXX
6
X
166.78
X
93304
003
XXX
6
X
290.62
X
93304
26
003
XXX
6
X
123.86
X
93304
TC
003
XXX
6
X
166.78
X
93304
002
XXX
6
X
298.60
X
93304
26
002
XXX
6
X
127.29
X
93304
TC
002
XXX
6
X
171.33
X
93304
001
XXX
6
X
342.01
X
93304
26
001
XXX
6
X
139.25
X
93304
TC
001
XXX
6
X
202.78
X
93306
001
XXX
6
X
531.20
X
93306
26
001
XXX
6
X
135.51
X
93306
TC
001
XXX
6
X
395.73
X
93306
002
XXX
6
X
453.22
X
93306
26
002
XXX
6
X
125.56
X
93306
TC
002
XXX
6
X
327.65
X
93306
003
XXX
6
X
453.22
X
93306
26
003
XXX
6
X
125.56
X
93306
TC
003
XXX
6
X
327.65
X
93306
004
XXX
6
X
453.22
X
93306
26
004
XXX
6
X
125.56
X
93306
TC
004
XXX
6
X
327.65
X
93307
001
XXX
6
X
754.21
X
93307
26
001
XXX
6
X
396.94
X
93307
TC
001
XXX
6
X
416.72
X
93307
002
XXX
6
X
749.61
X
93307
26
002
XXX
6
X
395.69
X
93307
TC
002
XXX
6
X
410.54
X
93307
003
XXX
6
X
725.64
X
93307
26
003
XXX
6
X
390.51
X
93307
TC
003
XXX
6
X
377.55
X
93307
004
XXX
6
X
710.69
X
93307
26
004
XXX
6
X
389.38
X
93307
TC
004
XXX
6
X
371.61
X
93308
003
XXX
6
X
315.65
X
93308
26
003
XXX
6
X
143.87
X
93308
TC
003
XXX
6
X
190.22
X
93308
002
XXX
6
X
347.55
X
93308
26
002
XXX
6
X
143.28
X
93308
TC
002
XXX
6
X
283.89
X
93308
004
XXX
6
X
308.73
X
93308
26
004
XXX
6
X
155.01
X
93308
TC
004
XXX
6
X
187.22
X
93308
001
XXX
6
X
355.80
X
93308
26
001
XXX
6
X
139.88
X
93308
TC
001
XXX
6
X
211.00
X
93312
001
XXX
6
X
1,161.56
X
93312
26
001
XXX
6
X
350.63
X
93312
TC
001
XXX
6
X
419.58
X
93312
002
XXX
6
X
1,156.26
X
93312
26
002
XXX
6
X
350.08
X
93312
TC
002
XXX
6
X
411.25
X
93312
003
XXX
6
X
1,134.16
X
93312
26
003
XXX
6
X
364.49
X
93312
TC
003
XXX
6
X
375.94
X
93312
004
XXX
6
X
663.76
X
93312
26
004
XXX
6
X
391.91
X
93312
TC
004
XXX
6
X
370.15
X
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