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2024 Workers' Compensation Part B Fee Schedule

93620-94005

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CPT/HCPC Code Modifier Medicare Location Global Surgery Indicator Multiple Surgery Indicator Prevailing Charge Amount Fee Schedule Amount Site of Service Amount
93620   003 0 2 X 3,410.89 X
93620 26 003 0 2 X 2,785.12 X
93620 TC 003 0 2 X 874.26 X
93620   002 0 2 X 3,634.92 X
93620 26 002 0 2 X 2,847.22 X
93620 TC 002 0 2 X 950.18 X
93620   001 0 2 X 3,688.44 X
93620 26 001 0 2 X 2,862.15 X
93620 TC 001 0 2 X 968.22 X
93620   004 0 2 X 3,364.74 X
93620 26 004 0 2 X 2,771.57 X
93620 TC 004 0 2 X 860.52 X
93621 26 002 ZZZ 0 X 2,959.30 X
93621 26 003 ZZZ 0 X 2,793.38 X
93621 26 004 ZZZ 0 X 2,757.84 X
93621 26 001 ZZZ 0 X 2,999.10 X
93622 26 004 ZZZ 0 X 2,742.20 X
93622 26 003 ZZZ 0 X 2,777.50 X
93622 26 002 ZZZ 0 X 2,940.62 X
93622 26 001 ZZZ 0 X 2,979.79 X
93623 26 001 ZZZ 0 X 607.03 X
93623 26 002 ZZZ 0 X 599.49 X
93623 26 003 ZZZ 0 X 567.76 X
93623 26 004 ZZZ 0 X 560.65 X
93624   001 0 2 X 1,045.39 X
93624 26 001 0 2 X 893.56 X
93624 TC 001 0 2 X 215.09 X
93624   004 0 2 X 964.86 X
93624 26 004 0 2 X 870.20 X
93624 TC 004 0 2 X 191.00 X
93624   003 0 2 X 977.02 X
93624 26 003 0 2 X 783.06 X
93624 TC 003 0 2 X 194.00 X
93624   002 0 2 X 1,032.16 X
93624 26 002 0 2 X 889.78 X
93624 TC 002 0 2 X 211.03 X
93631   002 0 0 X 2,147.06 X
93631 26 002 0 0 X 1,452.34 X
93631 TC 002 0 0 X 694.72 X
93631   001 0 0 X 2,182.49 X
93631 26 001 0 0 X 2,877.43 X
93631 TC 001 0 0 X 710.37 X
93631   004 0 0 X 1,974.29 X
93631 26 004 0 0 X 2,833.68 X
93631 TC 004 0 0 X 619.89 X
93631   003 0 0 X 1,999.93 X
93631 26 003 0 0 X 1,370.60 X
93631 TC 003 0 0 X 629.42 X
93640   001 0 2 X 1,451.48 X
93640 26 001 0 2 X 913.09 X
93640 TC 001 0 2 X 776.46 X
93640   004 0 2 X 1,750.67 X
93640 26 004 0 2 X 860.53 X
93640 TC 004 0 2 X 690.10 X
93640   003 0 2 X 1,776.09 X
93640 26 003 0 2 X 1,074.99 X
93640 TC 003 0 2 X 701.15 X
93640   002 0 2 X 1,913.05 X
93640 26 002 0 2 X 904.27 X
93640 TC 002 0 2 X 762.03 X
93641   004 0 2 X 1,988.81 X
93641 26 004 0 2 X 939.14 X
93641   001 0 2 X 1,533.97 X
93641 26 001 0 2 X 995.60 X
93641   003 0 2 X 2,016.85 X
93641 26 003 0 2 X 1,315.75 X
93641   002 0 2 X 2,161.29 X
93641 26 002 0 2 X 986.20 X
93641 TC 001 0 2 X 776.46 X
93641 TC 002 0 2 X 762.03 X
93641 TC 003 0 2 X 701.15 X
93641 TC 004 0 2 X 690.10 X
93642   002 0 2 X 2,085.91 X
93642 26 002 0 2 X 961.36 X
93642 TC 002 0 2 X 762.03 X
93642   003 0 2 X 1,943.79 X
93642 26 003 0 2 X 1,242.69 X
93642 TC 003 0 2 X 701.15 X
93642   004 0 2 X 1,916.49 X
93642 26 004 0 2 X 915.26 X
93642 TC 004 0 2 X 690.10 X
93642   001 0 2 X 1,508.96 X
93642 26 001 0 2 X 970.59 X
93642 TC 001 0 2 X 776.46 X
93644   001 0 2 X 531.98 X
93644 26 001 0 2 X 350.92 X
93644 TC 001 0 2 X 181.07 X
93644   002 0 2 X 473.12 X
93644 26 002 0 2 X 318.49 X
93644 TC 002 0 2 X 154.60 X
93644   003 0 2 X 473.12 X
93644 26 003 0 2 X 318.49 X
93644 TC 003 0 2 X 154.60 X
93644   004 0 2 X 473.12 X
93644 26 004 0 2 X 318.49 X
93644 TC 004 0 2 X 154.60 X
93650   004 0 2 X 2,668.39 X
93650   003 0 2 X 2,703.74 X
93650   002 0 2 X 2,880.86 X
93650   001 0 2 X 2,923.40 X
93653   003 0 2 X 1,336.26 X
93653   004 0 2 X 1,336.26 X
93653   002 0 2 X 1,336.26 X
93653   001 0 2 X 1,486.77 X
93654   001 0 2 X 1,984.13 X
93654   002 0 2 X 1,783.18 X
93654   003 0 2 X 1,783.18 X
93654   004 0 2 X 1,783.18 X
93655   004 ZZZ 0 X 668.08 X
93655   003 ZZZ 0 X 668.08 X
93655   002 ZZZ 0 X 668.08 X
93655   001 ZZZ 0 X 743.23 X
93656   004 0 2 X 1,783.80 X
93656   002 0 2 X 1,783.80 X
93656   003 0 2 X 1,783.80 X
93656   001 0 2 X 1,984.66 X
93657   001 ZZZ 0 X 744.12 X
93657   003 ZZZ 0 X 668.70 X
93657   002 ZZZ 0 X 668.70 X
93657   004 ZZZ 0 X 668.70 X
93660     0 2 X * X
93662   002 ZZZ 0 X 684.38 X
93662 26 002 ZZZ 0 X 354.33 X
93662 TC 002 ZZZ 0 X 330.05 X
93662   003 ZZZ 0 X 684.38 X
93662 26 003 ZZZ 0 X 354.33 X
93662 TC 003 ZZZ 0 X 330.05 X
93662   004 ZZZ 0 X 684.38 X
93662 26 004 ZZZ 0 X 354.33 X
93662 TC 004 ZZZ 0 X 330.05 X
93662   001 ZZZ 0 X 785.92 X
93662 26 001 ZZZ 0 X 386.14 X
93662 TC 001 ZZZ 0 X 399.78 X
93668     XXX 0 X * X
93701   003 XXX 6 X 74.38 X
93701 26 003 XXX 6 X 19.73 X
93701 TC 003 XXX 6 X 54.68 X
93701   002 XXX 6 X 74.38 X
93701 26 002 XXX 6 X 19.73 X
93701 TC 002 XXX 6 X 54.68 X
93701   001 XXX 6 X 86.36 X
93701 26 001 XXX 6 X 21.64 X
93701 TC 001 XXX 6 X 64.71 X
93701   004 XXX 6 X 74.38 X
93701 26 004 XXX 6 X 19.73 X
93701 TC 004 XXX 6 X 54.68 X
93702   001 XXX 6 X 196.80 X
93702   003 XXX 6 X 168.14 X
93702   004 XXX 6 X 168.14 X
93702   002 XXX 6 X 168.14 X
93724   001 0 6 X 1,258.93 X
93724 26 001 0 6 X 828.81 X
93724 TC 001 0 6 X 430.15 X
93724   004 0 6 X 1,154.36 X
93724 26 004 0 6 X 772.47 X
93724 TC 004 0 6 X 381.89 X
93724   003 0 6 X 1,169.52 X
93724 26 003 0 6 X 781.51 X
93724 TC 003 0 6 X 387.92 X
93724   002 0 6 X 1,241.65 X
93724 26 002 0 6 X 819.64 X
93724 TC 002 0 6 X 422.04 X
93740   003 XXX 9 X 62.11 X
93740 26 003 XXX 9 X 46.95 X
93740 TC 003 XXX 9 X 15.16 X
93740   004 XXX 9 X 61.25 X
93740 26 004 XXX 9 X 46.31 X
93740 TC 004 XXX 9 X 14.92 X
93740   001 XXX 9 X 97.53 X
93740 26 001 XXX 9 X 51.18 X
93740 TC 001 XXX 9 X 46.34 X
93740   002 XXX 9 X 66.73 X
93740 26 002 XXX 9 X 50.37 X
93740 TC 002 XXX 9 X 16.36 X
93745     XXX 0 X * X
93750   001 XXX 0 X 97.50 84.88
93750   004 XXX 0 X 89.51 78.85
93750   003 XXX 0 X 89.51 78.85
93750   002 XXX 0 X 89.51 78.85
93770   001 XXX 9 X 39.52 X
93770 26 001 XXX 9 X 36.46 X
93770 TC 001 XXX 9 X 3.01 X
93770   004 XXX 9 X 36.08 X
93770 26 004 XXX 9 X 33.34 X
93770 TC 004 XXX 9 X 2.82 X
93770   002 XXX 9 X 58.06 X
93770 26 002 XXX 9 X 91.77 X
93770 TC 002 XXX 9 X 3.00 X
93770   003 XXX 9 X 53.75 X
93770 26 003 XXX 9 X 90.88 X
93770 TC 003 XXX 9 X 2.83 X
93784     XXX 6 X * X
93786     XXX 6 X * X
93788     XXX 6 X * X
93790     XXX 0 X * X
93792   004 XXX 0 X 75.41 X
93792   003 XXX 0 X 75.41 X
93792   002 XXX 0 X 75.41 X
93792   001 XXX 0 X 86.73 X
93793   001 XXX 0 X 18.88 X
93793   002 XXX 0 X 17.40 X
93793   003 XXX 0 X 17.40 X
93793   004 XXX 0 X 17.40 X
93797   002 0 0 X 59.23 41.90
93797   004 0 0 X 47.32 33.37
93797   003 0 0 X 51.65 36.44
93797   001 0 0 X 59.98 42.31
93798   004 0 0 X 75.72 53.46
93798   002 0 0 X 83.24 58.67
93798   001 0 0 X 84.39 59.59
93798   003 0 0 X 78.90 55.67
93799     XXX 0 X # X
93880   004 XXX 6 X 628.05 X
93880 26 004 XXX 6 X 266.92 X
93880 TC 004 XXX 6 X 350.02 X
93880   003 XXX 6 X 642.73 X
93880 26 003 XXX 6 X 285.29 X
93880 TC 003 XXX 6 X 355.41 X
93880   002 XXX 6 X 657.91 X
93880 26 002 XXX 6 X 282.11 X
93880 TC 002 XXX 6 X 391.44 X
93880   001 XXX 6 X 660.57 X
93880 26 001 XXX 6 X 287.59 X
93880 TC 001 XXX 6 X 400.06 X
93882   003 XXX 6 X 619.88 X
93882 26 003 XXX 6 X 262.44 X
93882 TC 003 XXX 6 X 355.41 X
93882   002 XXX 6 X 633.83 X
93882 26 002 XXX 6 X 257.99 X
93882 TC 002 XXX 6 X 391.44 X
93882   001 XXX 6 X 636.18 X
93882 26 001 XXX 6 X 263.23 X
93882 TC 001 XXX 6 X 400.06 X
93882   004 XXX 6 X 605.46 X
93882 26 004 XXX 6 X 244.37 X
93882 TC 004 XXX 6 X 350.02 X
93886   002 XXX 6 X 564.53 X
93886 26 002 XXX 6 X 173.08 X
93886 TC 002 XXX 6 X 391.44 X
93886   003 XXX 6 X 518.68 X
93886 26 003 XXX 6 X 163.34 X
93886 TC 003 XXX 6 X 355.41 X
93886   004 XXX 6 X 511.44 X
93886 26 004 XXX 6 X 161.42 X
93886 TC 004 XXX 6 X 350.02 X
93886   001 XXX 6 X 575.46 X
93886 26 001 XXX 6 X 175.39 X
93886 TC 001 XXX 6 X 400.06 X
93888   004 XXX 6 X 459.38 X
93888 26 004 XXX 6 X 109.40 X
93888 TC 004 XXX 6 X 350.02 X
93888   003 XXX 6 X 466.01 X
93888 26 003 XXX 6 X 110.62 X
93888 TC 003 XXX 6 X 355.41 X
93888   002 XXX 6 X 507.62 X
93888 26 002 XXX 6 X 116.17 X
93888 TC 002 XXX 6 X 391.44 X
93888   001 XXX 6 X 517.63 X
93888 26 001 XXX 6 X 117.57 X
93888 TC 001 XXX 6 X 400.06 X
93890   001 XXX 6 X 556.72 X
93890 26 001 XXX 6 X 122.22 X
93890 TC 001 XXX 6 X 434.48 X
93890   004 XXX 6 X 463.76 X
93890 26 004 XXX 6 X 112.11 X
93890 TC 004 XXX 6 X 351.62 X
93890   002 XXX 6 X 463.76 X
93890 26 002 XXX 6 X 112.11 X
93890 TC 002 XXX 6 X 351.62 X
93890   003 XXX 6 X 463.76 X
93890 26 003 XXX 6 X 112.11 X
93890 TC 003 XXX 6 X 351.62 X
93892   004 XXX 6 X 494.51 X
93892 26 004 XXX 6 X 128.38 X
93892 TC 004 XXX 6 X 366.12 X
93892   003 XXX 6 X 494.51 X
93892 26 003 XXX 6 X 128.38 X
93892 TC 003 XXX 6 X 366.12 X
93892   002 XXX 6 X 494.51 X
93892 26 002 XXX 6 X 128.38 X
93892 TC 002 XXX 6 X 366.12 X
93892   001 XXX 6 X 591.46 X
93892 26 001 XXX 6 X 139.60 X
93892 TC 001 XXX 6 X 451.88 X
93893   001 XXX 6 X 580.11 X
93893 26 001 XXX 6 X 139.60 X
93893 TC 001 XXX 6 X 440.55 X
93893   003 XXX 6 X 485.06 X
93893 26 003 XXX 6 X 128.38 X
93893 TC 003 XXX 6 X 356.71 X
93893   004 XXX 6 X 485.06 X
93893 26 004 XXX 6 X 128.38 X
93893 TC 004 XXX 6 X 356.71 X
93893   002 XXX 6 X 485.06 X
93893 26 002 XXX 6 X 128.38 X
93893 TC 002 XXX 6 X 356.71 X
93895     XXX 6 X * X
93922   001 XXX 6 X 363.86 X
93922 26 001 XXX 6 X 196.07 X
93922 TC 001 XXX 6 X 240.34 X
93922   002 XXX 6 X 381.32 X
93922 26 002 XXX 6 X 176.48 X
93922 TC 002 XXX 6 X 233.91 X
93922   004 XXX 6 X 333.99 X
93922 26 004 XXX 6 X 182.95 X
93922 TC 004 XXX 6 X 116.72 X
93922   003 XXX 6 X 390.19 X
93922 26 003 XXX 6 X 194.17 X
93922 TC 003 XXX 6 X 118.50 X
93923   001 XXX 6 X 421.43 X
93923 26 001 XXX 6 X 214.47 X
93923 TC 001 XXX 6 X 279.53 X
93923   003 XXX 6 X 441.69 X
93923 26 003 XXX 6 X 211.00 X
93923 TC 003 XXX 6 X 223.77 X
93923   002 XXX 6 X 437.78 X
93923 26 002 XXX 6 X 194.58 X
93923 TC 002 XXX 6 X 272.23 X
93923   004 XXX 6 X 384.79 X
93923 26 004 XXX 6 X 199.50 X
93923 TC 004 XXX 6 X 220.40 X
93924   001 XXX 6 X 422.09 X
93924 26 001 XXX 6 X 208.97 X
93924 TC 001 XXX 6 X 276.74 X
93924   002 XXX 6 X 446.08 X
93924 26 002 XXX 6 X 203.41 X
93924 TC 002 XXX 6 X 270.55 X
93924   003 XXX 6 X 447.45 X
93924 26 003 XXX 6 X 211.84 X
93924 TC 003 XXX 6 X 244.62 X
93924   004 XXX 6 X 401.36 X
93924 26 004 XXX 6 X 188.96 X
93924 TC 004 XXX 6 X 240.92 X
93925   001 XXX 6 X 516.12 X
93925 26 001 XXX 6 X 116.11 X
93925 TC 001 XXX 6 X 400.06 X
93925   004 XXX 6 X 456.97 X
93925 26 004 XXX 6 X 106.91 X
93925 TC 004 XXX 6 X 350.02 X
93925   003 XXX 6 X 463.68 X
93925 26 003 XXX 6 X 108.25 X
93925 TC 003 XXX 6 X 355.41 X
93925   002 XXX 6 X 505.99 X
93925 26 002 XXX 6 X 114.57 X
93925 TC 002 XXX 6 X 391.44 X
93926   004 XXX 6 X 403.47 X
93926 26 004 XXX 6 X 53.47 X
93926 TC 004 XXX 6 X 350.02 X
93926   002 XXX 6 X 448.88 X
93926 26 002 XXX 6 X 57.50 X
93926 TC 002 XXX 6 X 391.44 X
93926   003 XXX 6 X 409.50 X
93926 26 003 XXX 6 X 54.15 X
93926 TC 003 XXX 6 X 355.41 X
93926   001 XXX 6 X 458.36 X
93926 26 001 XXX 6 X 58.28 X
93926 TC 001 XXX 6 X 400.06 X
93930   001 XXX 6 X 496.39 X
93930 26 001 XXX 6 X 96.36 X
93930 TC 001 XXX 6 X 400.06 X
93930   004 XXX 6 X 438.82 X
93930 26 004 XXX 6 X 88.92 X
93930 TC 004 XXX 6 X 350.02 X
93930   003 XXX 6 X 445.30 X
93930 26 003 XXX 6 X 89.95 X
93930 TC 003 XXX 6 X 355.41 X
93930   002 XXX 6 X 486.47 X
93930 26 002 XXX 6 X 95.04 X
93930 TC 002 XXX 6 X 391.44 X
93931   002 XXX 6 X 438.44 X
93931 26 002 XXX 6 X 47.05 X
93931 TC 002 XXX 6 X 391.44 X
93931   001 XXX 6 X 447.75 X
93931 26 001 XXX 6 X 47.63 X
93931 TC 001 XXX 6 X 400.06 X
93931   004 XXX 6 X 393.87 X
93931 26 004 XXX 6 X 43.92 X
93931 TC 004 XXX 6 X 350.02 X
93931   003 XXX 6 X 399.80 X
93931 26 003 XXX 6 X 44.46 X
93931 TC 003 XXX 6 X 355.41 X
93970   004 XXX 6 X 476.06 X
93970 26 004 XXX 6 X 126.06 X
93970 TC 004 XXX 6 X 350.02 X
93970   003 XXX 6 X 482.93 X
93970 26 003 XXX 6 X 127.60 X
93970 TC 003 XXX 6 X 355.41 X
93970   002 XXX 6 X 526.91 X
93970 26 002 XXX 6 X 135.44 X
93970 TC 002 XXX 6 X 391.44 X
93970   001 XXX 6 X 537.46 X
93970 26 001 XXX 6 X 137.42 X
93970 TC 001 XXX 6 X 400.06 X
93971   002 XXX 6 X 458.92 X
93971 26 002 XXX 6 X 67.55 X
93971 TC 002 XXX 6 X 391.44 X
93971   003 XXX 6 X 419.16 X
93971 26 003 XXX 6 X 63.85 X
93971 TC 003 XXX 6 X 355.41 X
93971   004 XXX 6 X 413.06 X
93971 26 004 XXX 6 X 63.04 X
93971 TC 004 XXX 6 X 350.02 X
93971   001 XXX 6 X 468.44 X
93971 26 001 XXX 6 X 68.40 X
93971 TC 001 XXX 6 X 400.06 X
93975   002 XXX 6 X 671.50 X
93975 26 002 XXX 6 X 280.09 X
93975 TC 002 XXX 6 X 391.44 X
93975   001 XXX 6 X 683.29 X
93975 26 001 XXX 6 X 283.30 X
93975 TC 001 XXX 6 X 400.06 X
93975   004 XXX 6 X 614.17 X
93975 26 004 XXX 6 X 264.19 X
93975 TC 004 XXX 6 X 350.02 X
93975   003 XXX 6 X 622.52 X
93975 26 003 XXX 6 X 267.16 X
93975 TC 003 XXX 6 X 355.41 X
93976   002 XXX 6 X 531.74 X
93976 26 002 XXX 6 X 140.30 X
93976 TC 002 XXX 6 X 391.44 X
93976   001 XXX 6 X 541.94 X
93976 26 001 XXX 6 X 141.87 X
93976 TC 001 XXX 6 X 400.06 X
93976   004 XXX 6 X 482.63 X
93976 26 004 XXX 6 X 132.61 X
93976 TC 004 XXX 6 X 350.02 X
93976   003 XXX 6 X 489.47 X
93976 26 003 XXX 6 X 134.09 X
93976 TC 003 XXX 6 X 355.41 X
93978   002 XXX 6 X 519.51 X
93978 26 002 XXX 6 X 128.02 X
93978 TC 002 XXX 6 X 391.44 X
93978   001 XXX 6 X 529.83 X
93978 26 001 XXX 6 X 129.80 X
93978 TC 001 XXX 6 X 400.06 X
93978   004 XXX 6 X 469.35 X
93978 26 004 XXX 6 X 119.41 X
93978 TC 004 XXX 6 X 350.02 X
93978   003 XXX 6 X 476.21 X
93978 26 003 XXX 6 X 120.81 X
93978 TC 003 XXX 6 X 355.41 X
93979   001 XXX 6 X 466.47 X
93979 26 001 XXX 6 X 66.40 X
93979 TC 001 XXX 6 X 400.06 X
93979   002 XXX 6 X 456.97 X
93979 26 002 XXX 6 X 65.51 X
93979 TC 002 XXX 6 X 391.44 X
93979   003 XXX 6 X 417.22 X
93979 26 003 XXX 6 X 61.87 X
93979 TC 003 XXX 6 X 355.41 X
93979   004 XXX 6 X 411.14 X
93979 26 004 XXX 6 X 61.10 X
93979 TC 004 XXX 6 X 350.02 X
93980   001 XXX 6 X 681.25 X
93980 26 001 XXX 6 X 281.12 X
93980 TC 001 XXX 6 X 400.06 X
93980   004 XXX 6 X 613.03 X
93980 26 004 XXX 6 X 263.01 X
93980 TC 004 XXX 6 X 350.02 X
93980   003 XXX 6 X 621.31 X
93980 26 003 XXX 6 X 265.98 X
93980 TC 003 XXX 6 X 355.41 X
93980   002 XXX 6 X 669.65 X
93980 26 002 XXX 6 X 278.17 X
93980 TC 002 XXX 6 X 391.44 X
93981   001 XXX 6 X 480.56 X
93981 26 001 XXX 6 X 110.92 X
93981 TC 001 XXX 6 X 369.68 X
93981   004 XXX 6 X 426.28 X
93981 26 004 XXX 6 X 103.33 X
93981 TC 004 XXX 6 X 322.96 X
93981   003 XXX 6 X 432.44 X
93981 26 003 XXX 6 X 104.55 X
93981 TC 003 XXX 6 X 327.91 X
93981   002 XXX 6 X 471.29 X
93981 26 002 XXX 6 X 109.73 X
93981 TC 002 XXX 6 X 361.62 X
93985   003 XXX 6 X 355.08 X
93985 26 003 XXX 6 X 53.86 X
93985 TC 003 XXX 6 X 301.19 X
93985   004 XXX 6 X 355.08 X
93985 26 004 XXX 6 X 53.86 X
93985 TC 004 XXX 6 X 301.19 X
93985   001 XXX 6 X 405.12 X
93985 26 001 XXX 6 X 58.00 X
93985 TC 001 XXX 6 X 347.13 X
93985   002 XXX 6 X 355.08 X
93985 26 002 XXX 6 X 53.86 X
93985 TC 002 XXX 6 X 301.19 X
93986   002 XXX 6 X 180.44 X
93986 26 002 XXX 6 X 34.75 X
93986 TC 002 XXX 6 X 145.68 X
93986   004 XXX 6 X 180.44 X
93986 26 004 XXX 6 X 34.75 X
93986 TC 004 XXX 6 X 145.68 X
93986   003 XXX 6 X 180.44 X
93986 26 003 XXX 6 X 34.75 X
93986 TC 003 XXX 6 X 145.68 X
93986   001 XXX 6 X 205.65 X
93986 26 001 XXX 6 X 37.72 X
93986 TC 001 XXX 6 X 167.95 X
93990   002 XXX 6 X 438.44 X
93990 26 002 XXX 6 X 47.05 X
93990 TC 002 XXX 6 X 391.44 X
93990   003 XXX 6 X 399.80 X
93990 26 003 XXX 6 X 44.46 X
93990 TC 003 XXX 6 X 355.41 X
93990   004 XXX 6 X 393.87 X
93990 26 004 XXX 6 X 43.92 X
93990 TC 004 XXX 6 X 350.02 X
93990   001 XXX 6 X 447.75 X
93990 26 001 XXX 6 X 47.63 X
93990 TC 001 XXX 6 X 400.06 X
93998     XXX 0 X # X
94002   001 XXX 0 X 160.20 X
94002   002 XXX 0 X 148.99 X
94002   003 XXX 0 X 148.99 X
94002   004 XXX 0 X 148.99 X
94003   002 XXX 0 X 108.27 X
94003   003 XXX 0 X 108.27 X
94003   004 XXX 0 X 108.27 X
94003   001 XXX 0 X 117.29 X
94004   001 XXX 0 X 85.35 X
94004   002 XXX 0 X 78.94 X
94004   003 XXX 0 X 78.94 X
94004   004 XXX 0 X 78.94 X
94005     XXX 9 X * X