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Health Care Services Review
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Medical Fee Review
>
Fee Schedule
>
Fee Schedule 94010-95806
Begin Main Content Area
Page Content
Content Editor
2024 Workers' Compensation Part B Fee Schedule
94010-95806
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
94010
004
XXX
0
X
105.46
X
94010
26
004
XXX
0
X
44.96
X
94010
TC
004
XXX
0
X
40.05
X
94010
003
XXX
0
X
105.77
X
94010
26
003
XXX
0
X
47.05
X
94010
TC
003
XXX
0
X
40.66
X
94010
002
XXX
0
X
103.33
X
94010
26
002
XXX
0
X
48.11
X
94010
TC
002
XXX
0
X
44.31
X
94010
001
XXX
0
X
110.13
X
94010
26
001
XXX
0
X
49.11
X
94010
TC
001
XXX
0
X
45.15
X
94011
004
XXX
0
X
167.71
X
94011
003
XXX
0
X
167.71
X
94011
002
XXX
0
X
167.71
X
94011
001
XXX
0
X
179.51
X
94012
004
XXX
0
X
257.92
X
94012
002
XXX
0
X
257.92
X
94012
003
XXX
0
X
257.92
X
94012
001
XXX
0
X
275.76
X
94013
004
XXX
0
X
54.61
X
94013
001
XXX
0
X
58.58
X
94013
002
XXX
0
X
54.61
X
94013
003
XXX
0
X
54.61
X
94014
001
XXX
0
X
112.09
X
94014
26
001
XXX
0
X
68.54
X
94014
TC
001
XXX
0
X
43.52
X
94014
003
XXX
0
X
99.68
X
94014
26
003
XXX
0
X
63.10
X
94014
TC
003
XXX
0
X
36.57
X
94014
002
XXX
0
X
99.68
X
94014
26
002
XXX
0
X
63.10
X
94014
TC
002
XXX
0
X
36.57
X
94014
004
XXX
0
X
99.68
X
94014
26
004
XXX
0
X
63.10
X
94014
TC
004
XXX
0
X
36.57
X
94015
002
XXX
0
X
43.05
X
94015
004
XXX
0
X
43.05
X
94015
003
XXX
0
X
43.05
X
94015
001
XXX
0
X
46.71
X
94016
004
XXX
0
X
64.24
X
94016
003
XXX
0
X
64.24
X
94016
002
XXX
0
X
64.24
X
94016
001
XXX
0
X
70.67
X
94060
004
XXX
0
X
173.93
X
94060
26
004
XXX
0
X
68.36
X
94060
TC
004
XXX
0
X
89.43
X
94060
003
XXX
0
X
163.54
X
94060
26
003
XXX
0
X
71.93
X
94060
TC
003
XXX
0
X
88.02
X
94060
002
XXX
0
X
185.42
X
94060
26
002
XXX
0
X
73.49
X
94060
TC
002
XXX
0
X
98.55
X
94060
001
XXX
0
X
187.98
X
94060
26
001
XXX
0
X
77.20
X
94060
TC
001
XXX
0
X
99.93
X
94070
002
XXX
0
X
223.00
X
94070
26
002
XXX
0
X
89.96
X
94070
TC
002
XXX
0
X
133.04
X
94070
001
XXX
0
X
260.28
X
94070
26
001
XXX
0
X
99.49
X
94070
TC
001
XXX
0
X
160.78
X
94070
004
XXX
0
X
223.00
X
94070
26
004
XXX
0
X
89.96
X
94070
TC
004
XXX
0
X
133.04
X
94070
003
XXX
0
X
223.00
X
94070
26
003
XXX
0
X
89.96
X
94070
TC
003
XXX
0
X
133.04
X
94150
001
XXX
9
X
43.61
X
94150
26
001
XXX
9
X
21.58
X
94150
TC
001
XXX
9
X
40.93
X
94150
002
XXX
9
X
44.15
X
94150
26
002
XXX
9
X
22.00
X
94150
TC
002
XXX
9
X
38.98
X
94150
003
XXX
9
X
41.13
X
94150
26
003
XXX
9
X
20.12
X
94150
TC
003
XXX
9
X
8.53
X
94150
004
XXX
9
X
39.58
X
94150
26
004
XXX
9
X
22.82
X
94150
TC
004
XXX
9
X
8.40
X
94200
001
XXX
0
X
81.17
X
94200
26
001
XXX
0
X
28.87
X
94200
TC
001
XXX
0
X
89.66
X
94200
002
XXX
0
X
77.44
X
94200
26
002
XXX
0
X
28.51
X
94200
TC
002
XXX
0
X
88.06
X
94200
004
XXX
0
X
87.47
X
94200
26
004
XXX
0
X
21.25
X
94200
TC
004
XXX
0
X
24.23
X
94200
003
XXX
0
X
77.13
X
94200
26
003
XXX
0
X
26.94
X
94200
TC
003
XXX
0
X
24.61
X
94375
004
XXX
0
X
113.20
X
94375
26
004
XXX
0
X
44.31
X
94375
TC
004
XXX
0
X
46.58
X
94375
002
XXX
0
X
120.16
X
94375
26
002
XXX
0
X
48.82
X
94375
TC
002
XXX
0
X
112.93
X
94375
003
XXX
0
X
117.18
X
94375
26
003
XXX
0
X
47.63
X
94375
TC
003
XXX
0
X
111.94
X
94375
001
XXX
0
X
121.14
X
94375
26
001
XXX
0
X
49.15
X
94375
TC
001
XXX
0
X
113.97
X
94450
004
XXX
0
X
100.45
X
94450
26
004
XXX
0
X
63.13
X
94450
TC
004
XXX
0
X
37.25
X
94450
003
XXX
0
X
101.77
X
94450
26
003
XXX
0
X
63.89
X
94450
TC
003
XXX
0
X
37.85
X
94450
002
XXX
0
X
108.37
X
94450
26
002
XXX
0
X
67.10
X
94450
TC
002
XXX
0
X
41.30
X
94450
001
XXX
0
X
225.45
X
94450
26
001
XXX
0
X
67.90
X
94450
TC
001
XXX
0
X
42.09
X
94452
001
XXX
0
X
118.22
X
94452
26
001
XXX
0
X
35.10
X
94452
TC
001
XXX
0
X
83.13
X
94452
002
XXX
0
X
101.18
X
94452
26
002
XXX
0
X
32.39
X
94452
TC
002
XXX
0
X
68.82
X
94452
003
XXX
0
X
101.18
X
94452
26
003
XXX
0
X
32.39
X
94452
TC
003
XXX
0
X
68.82
X
94452
004
XXX
0
X
101.18
X
94452
26
004
XXX
0
X
32.39
X
94452
TC
004
XXX
0
X
68.82
X
94453
004
XXX
0
X
143.87
X
94453
26
004
XXX
0
X
41.67
X
94453
TC
004
XXX
0
X
102.20
X
94453
003
XXX
0
X
143.87
X
94453
26
003
XXX
0
X
41.67
X
94453
TC
003
XXX
0
X
102.20
X
94453
002
XXX
0
X
143.87
X
94453
26
002
XXX
0
X
41.67
X
94453
TC
002
XXX
0
X
102.20
X
94453
001
XXX
0
X
168.15
X
94453
26
001
XXX
0
X
44.96
X
94453
TC
001
XXX
0
X
123.19
X
94610
003
XXX
0
X
107.48
X
94610
004
XXX
0
X
107.48
X
94610
001
XXX
0
X
124.34
X
94610
002
XXX
0
X
107.48
X
94617
002
XXX
0
X
135.52
X
94617
26
002
XXX
0
X
49.29
X
94617
TC
002
XXX
0
X
86.26
X
94617
003
XXX
0
X
135.52
X
94617
26
003
XXX
0
X
49.29
X
94617
TC
003
XXX
0
X
86.26
X
94617
004
XXX
0
X
135.52
X
94617
26
004
XXX
0
X
49.29
X
94617
TC
004
XXX
0
X
86.26
X
94617
001
XXX
0
X
151.38
X
94617
26
001
XXX
0
X
52.23
X
94617
TC
001
XXX
0
X
99.14
X
94618
001
XXX
0
X
53.94
X
94618
26
001
XXX
0
X
35.72
X
94618
TC
001
XXX
0
X
18.23
X
94618
004
XXX
0
X
49.52
X
94618
26
004
XXX
0
X
33.73
X
94618
TC
004
XXX
0
X
15.81
X
94618
003
XXX
0
X
49.52
X
94618
26
003
XXX
0
X
33.73
X
94618
TC
003
XXX
0
X
15.81
X
94618
002
XXX
0
X
49.52
X
94618
26
002
XXX
0
X
33.73
X
94618
TC
002
XXX
0
X
15.81
X
94619
001
XXX
0
X
105.42
X
94619
26
001
XXX
0
X
32.74
X
94619
TC
001
XXX
0
X
72.66
X
94619
004
XXX
0
X
93.70
X
94619
26
004
XXX
0
X
30.85
X
94619
TC
004
XXX
0
X
62.86
X
94619
003
XXX
0
X
93.70
X
94619
26
003
XXX
0
X
30.85
X
94619
TC
003
XXX
0
X
62.86
X
94619
002
XXX
0
X
93.70
X
94619
26
002
XXX
0
X
30.85
X
94619
TC
002
XXX
0
X
62.86
X
94621
001
XXX
0
X
260.24
X
94621
26
001
XXX
0
X
110.03
X
94621
TC
001
XXX
0
X
150.10
X
94621
004
XXX
0
X
227.12
X
94621
26
004
XXX
0
X
101.48
X
94621
TC
004
XXX
0
X
125.58
X
94621
003
XXX
0
X
227.12
X
94621
26
003
XXX
0
X
101.48
X
94621
TC
003
XXX
0
X
125.58
X
94621
002
XXX
0
X
227.12
X
94621
26
002
XXX
0
X
101.48
X
94621
TC
002
XXX
0
X
125.58
X
94625
003
XXX
0
X
75.66
22.36
94625
004
XXX
0
X
75.66
22.36
94625
001
XXX
0
X
85.65
24.18
94625
002
XXX
0
X
75.66
22.36
94626
001
XXX
0
X
96.86
34.48
94626
002
XXX
0
X
86.38
32.29
94626
003
XXX
0
X
86.38
32.29
94626
004
XXX
0
X
86.38
32.29
94640
004
XXX
0
X
52.34
X
94640
003
XXX
0
X
39.76
X
94640
002
XXX
0
X
43.33
X
94640
001
XXX
0
X
44.11
X
94642
XXX
0
X
85.20
X
94644
001
XXX
0
X
72.26
X
94644
003
XXX
0
X
58.61
X
94644
002
XXX
0
X
58.61
X
94644
004
XXX
0
X
58.61
X
94645
001
XXX
0
X
27.89
X
94645
002
XXX
0
X
22.34
X
94645
003
XXX
0
X
22.34
X
94645
004
XXX
0
X
22.34
X
94660
001
XXX
0
X
160.10
X
94660
003
XXX
0
X
185.17
X
94660
004
XXX
0
X
192.61
X
94660
002
XXX
0
X
158.06
X
94662
002
XXX
0
X
189.61
X
94662
004
XXX
0
X
104.74
X
94662
003
XXX
0
X
187.88
X
94662
001
XXX
0
X
111.39
X
94664
004
XXX
0
X
43.87
X
94664
003
XXX
0
X
48.10
X
94664
002
XXX
0
X
53.25
X
94664
001
XXX
0
X
50.70
X
94667
004
XXX
0
X
56.85
X
94667
003
XXX
0
X
64.44
X
94667
002
XXX
0
X
66.68
X
94667
001
XXX
0
X
67.18
X
94668
002
XXX
0
X
38.33
X
94668
004
XXX
0
X
34.46
X
94668
003
XXX
0
X
35.05
X
94668
001
XXX
0
X
39.09
X
94669
001
XXX
0
X
61.32
X
94669
002
XXX
0
X
52.52
X
94669
003
XXX
0
X
52.52
X
94669
004
XXX
0
X
52.52
X
94680
001
XXX
0
X
125.81
X
94680
26
001
XXX
0
X
78.06
X
94680
TC
001
XXX
0
X
61.48
X
94680
003
XXX
0
X
113.73
X
94680
26
003
XXX
0
X
58.65
X
94680
TC
003
XXX
0
X
54.11
X
94680
002
XXX
0
X
169.30
X
94680
26
002
XXX
0
X
73.26
X
94680
TC
002
XXX
0
X
60.05
X
94680
004
XXX
0
X
112.16
X
94680
26
004
XXX
0
X
58.84
X
94680
TC
004
XXX
0
X
53.26
X
94681
001
XXX
0
X
242.04
X
94681
26
001
XXX
0
X
138.60
X
94681
TC
001
XXX
0
X
154.77
X
94681
002
XXX
0
X
279.05
X
94681
26
002
XXX
0
X
136.24
X
94681
TC
002
XXX
0
X
218.50
X
94681
003
XXX
0
X
198.66
X
94681
26
003
XXX
0
X
136.39
X
94681
TC
003
XXX
0
X
138.28
X
94681
004
XXX
0
X
268.80
X
94681
26
004
XXX
0
X
129.47
X
94681
TC
004
XXX
0
X
136.17
X
94690
004
XXX
0
X
63.68
X
94690
26
004
XXX
0
X
16.82
X
94690
TC
004
XXX
0
X
52.12
X
94690
001
XXX
0
X
71.03
X
94690
26
001
XXX
0
X
17.04
X
94690
TC
001
XXX
0
X
58.83
X
94690
002
XXX
0
X
66.14
X
94690
26
002
XXX
0
X
17.01
X
94690
TC
002
XXX
0
X
57.71
X
94690
003
XXX
0
X
64.63
X
94690
26
003
XXX
0
X
16.85
X
94690
TC
003
XXX
0
X
53.01
X
94726
004
XXX
0
X
84.44
X
94726
26
004
XXX
0
X
20.27
X
94726
TC
004
XXX
0
X
64.17
X
94726
002
XXX
0
X
84.44
X
94726
26
002
XXX
0
X
20.27
X
94726
TC
002
XXX
0
X
64.17
X
94726
003
XXX
0
X
84.44
X
94726
26
003
XXX
0
X
20.27
X
94726
TC
003
XXX
0
X
64.17
X
94726
001
XXX
0
X
96.29
X
94726
26
001
XXX
0
X
21.54
X
94726
TC
001
XXX
0
X
74.78
X
94727
001
XXX
0
X
75.34
X
94727
26
001
XXX
0
X
21.54
X
94727
TC
001
XXX
0
X
53.81
X
94727
002
XXX
0
X
66.51
X
94727
26
002
XXX
0
X
20.27
X
94727
TC
002
XXX
0
X
46.20
X
94727
003
XXX
0
X
66.51
X
94727
26
003
XXX
0
X
20.27
X
94727
TC
003
XXX
0
X
46.20
X
94727
004
XXX
0
X
66.51
X
94727
26
004
XXX
0
X
20.27
X
94727
TC
004
XXX
0
X
46.20
X
94728
004
XXX
0
X
66.51
X
94728
26
004
XXX
0
X
20.27
X
94728
TC
004
XXX
0
X
46.20
X
94728
002
XXX
0
X
66.51
X
94728
26
002
XXX
0
X
20.27
X
94728
TC
002
XXX
0
X
46.20
X
94728
003
XXX
0
X
66.51
X
94728
26
003
XXX
0
X
20.27
X
94728
TC
003
XXX
0
X
46.20
X
94728
001
XXX
0
X
75.34
X
94728
26
001
XXX
0
X
21.54
X
94728
TC
001
XXX
0
X
53.81
X
94729
002
ZZZ
0
X
83.32
X
94729
26
002
ZZZ
0
X
13.52
X
94729
TC
002
ZZZ
0
X
69.77
X
94729
003
ZZZ
0
X
83.32
X
94729
26
003
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0
X
13.52
X
94729
TC
003
ZZZ
0
X
69.77
X
94729
004
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0
X
83.32
X
94729
26
004
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0
X
13.52
X
94729
TC
004
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0
X
69.77
X
94729
001
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0
X
95.61
X
94729
26
001
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0
X
14.46
X
94729
TC
001
ZZZ
0
X
81.13
X
94760
004
XXX
0
X
21.87
X
94760
001
XXX
0
X
23.72
X
94760
002
XXX
0
X
23.42
X
94760
003
XXX
0
X
22.14
X
94761
004
XXX
0
X
45.52
X
94761
003
XXX
0
X
46.14
X
94761
002
XXX
0
X
49.77
X
94761
001
XXX
0
X
50.62
X
94762
001
XXX
0
X
109.03
X
94762
004
XXX
0
X
100.52
X
94762
003
XXX
0
X
101.51
X
94762
002
XXX
0
X
107.58
X
94772
002
XXX
0
X
734.95
X
94772
26
002
XXX
0
X
279.21
X
94772
TC
002
XXX
0
X
455.72
X
94772
001
XXX
0
X
734.95
X
94772
26
001
XXX
0
X
279.21
X
94772
TC
001
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0
X
455.72
X
94772
004
XXX
0
X
734.95
X
94772
26
004
XXX
0
X
279.21
X
94772
TC
004
XXX
0
X
455.72
X
94772
003
XXX
0
X
734.95
X
94772
26
003
XXX
0
X
279.21
X
94772
TC
003
XXX
0
X
455.72
X
94774
YYY
0
X
*
X
94775
YYY
0
X
*
X
94776
YYY
0
X
*
X
94777
YYY
0
X
*
X
94780
003
XXX
0
X
80.81
38.91
94780
004
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0
X
80.81
38.91
94780
002
XXX
0
X
80.81
38.91
94780
001
XXX
0
X
90.26
41.65
94781
003
ZZZ
0
X
31.37
13.52
94781
002
ZZZ
0
X
31.37
13.52
94781
001
ZZZ
0
X
35.12
14.46
94781
004
ZZZ
0
X
31.37
13.52
94799
XXX
0
X
#
X
95004
001
XXX
0
X
9.58
X
95004
003
XXX
0
X
8.68
X
95004
002
XXX
0
X
9.89
X
95004
004
XXX
0
X
8.91
X
95012
001
XXX
0
X
37.64
X
95012
003
XXX
0
X
30.56
X
95012
004
XXX
0
X
30.56
X
95012
002
XXX
0
X
30.56
X
95017
003
XXX
0
X
13.63
6.06
95017
002
XXX
0
X
13.63
6.06
95017
001
XXX
0
X
15.42
6.60
95017
004
XXX
0
X
13.63
6.06
95018
004
XXX
0
X
33.25
11.43
95018
001
XXX
0
X
37.61
12.30
95018
002
XXX
0
X
33.25
11.43
95018
003
XXX
0
X
33.25
11.43
95024
001
XXX
0
X
13.51
X
95024
002
XXX
0
X
14.45
X
95024
003
XXX
0
X
13.56
X
95024
004
XXX
0
X
13.68
X
95027
001
XXX
0
X
20.00
X
95027
003
XXX
0
X
19.28
X
95027
004
XXX
0
X
19.16
X
95027
002
XXX
0
X
18.09
X
95028
003
XXX
0
X
20.48
X
95028
004
XXX
0
X
21.41
X
95028
001
XXX
0
X
22.60
X
95028
002
XXX
0
X
23.42
X
95044
001
XXX
0
X
19.79
X
95044
004
XXX
0
X
17.79
X
95044
002
XXX
0
X
19.48
X
95044
003
XXX
0
X
15.16
X
95052
001
XXX
0
X
20.27
X
95052
002
XXX
0
X
20.13
X
95052
003
XXX
0
X
18.62
X
95052
004
XXX
0
X
23.22
X
95056
004
XXX
0
X
16.81
X
95056
003
XXX
0
X
17.01
X
95056
002
XXX
0
X
16.26
X
95056
001
XXX
0
X
15.87
X
95060
001
XXX
0
X
26.99
X
95060
003
XXX
0
X
25.03
X
95060
002
XXX
0
X
26.58
X
95060
004
XXX
0
X
24.72
X
95065
003
XXX
0
X
21.06
X
95065
001
XXX
0
X
20.78
X
95065
002
XXX
0
X
20.40
X
95065
004
XXX
0
X
18.64
X
95070
004
XXX
0
X
205.09
X
95070
003
XXX
0
X
208.67
X
95070
001
XXX
0
X
224.81
X
95070
002
XXX
0
X
221.68
X
95076
002
XXX
0
X
182.19
114.80
95076
004
XXX
0
X
182.19
114.80
95076
003
XXX
0
X
182.19
114.80
95076
001
XXX
0
X
200.10
121.90
95079
003
ZZZ
0
X
129.93
105.60
95079
004
ZZZ
0
X
129.93
105.60
95079
001
ZZZ
0
X
140.41
112.20
95079
002
ZZZ
0
X
129.93
105.60
95115
001
XXX
0
X
37.77
X
95115
002
XXX
0
X
35.55
X
95115
003
XXX
0
X
34.74
X
95115
004
XXX
0
X
32.72
X
95117
004
XXX
0
X
49.02
X
95117
001
XXX
0
X
50.00
X
95117
002
XXX
0
X
49.15
X
95117
003
XXX
0
X
46.52
X
95120
XXX
9
X
263.19
X
95125
XXX
9
X
324.73
X
95130
XXX
9
X
131.55
X
95131
XXX
9
X
204.67
X
95132
XXX
9
X
277.48
X
95133
XXX
9
X
350.66
X
95134
XXX
9
X
423.78
X
95144
XXX
0
X
22.79
X
95145
XXX
0
X
109.39
X
95146
XXX
0
X
187.48
X
95147
XXX
0
X
248.53
X
95148
XXX
0
X
321.56
X
95149
XXX
0
X
394.44
X
95165
XXX
0
X
113.43
X
95170
XXX
0
X
*
X
95180
001
XXX
0
X
150.07
X
95180
002
XXX
0
X
154.99
X
95180
003
XXX
0
X
151.41
X
95180
004
XXX
0
X
211.57
X
95199
XXX
0
X
#
X
95249
001
XXX
0
X
88.58
X
95249
004
XXX
0
X
76.95
X
95249
003
XXX
0
X
76.95
X
95249
002
XXX
0
X
76.95
X
95250
003
XXX
0
X
110.23
X
95250
004
XXX
0
X
110.23
X
95250
001
XXX
0
X
129.96
X
95250
002
XXX
0
X
110.23
X
95251
004
XXX
0
X
51.47
X
95251
002
XXX
0
X
51.47
X
95251
003
XXX
0
X
51.47
X
95251
001
XXX
0
X
55.68
X
95700
XXX
0
X
*
X
95705
XXX
0
X
*
X
95706
XXX
0
X
*
X
95707
XXX
0
X
*
X
95708
XXX
0
X
*
X
95709
XXX
0
X
*
X
95710
XXX
0
X
*
X
95711
XXX
0
X
*
X
95712
XXX
0
X
*
X
95713
XXX
0
X
*
X
95714
XXX
0
X
*
X
95715
XXX
0
X
*
X
95716
XXX
0
X
*
X
95717
002
XXX
0
X
143.44
141.56
95717
003
XXX
0
X
143.44
141.56
95717
004
XXX
0
X
143.44
141.56
95717
001
XXX
0
X
154.13
151.96
95718
003
XXX
0
X
188.46
185.67
95718
002
XXX
0
X
188.46
185.67
95718
001
XXX
0
X
203.50
200.27
95718
004
XXX
0
X
188.46
185.67
95719
002
XXX
0
X
221.75
219.41
95719
001
XXX
0
X
239.06
236.36
95719
004
XXX
0
X
221.75
219.41
95719
003
XXX
0
X
221.75
219.41
95720
001
XXX
0
X
315.02
310.16
95720
003
XXX
0
X
291.69
287.48
95720
002
XXX
0
X
291.69
287.48
95720
004
XXX
0
X
291.69
287.48
95721
002
XXX
0
X
294.03
288.39
95721
003
XXX
0
X
294.03
288.39
95721
004
XXX
0
X
294.03
288.39
95721
001
XXX
0
X
317.70
311.24
95722
001
XXX
0
X
385.63
378.63
95722
003
XXX
0
X
356.89
350.78
95722
004
XXX
0
X
356.89
350.78
95722
002
XXX
0
X
356.89
350.78
95723
003
XXX
0
X
364.53
357.04
95723
004
XXX
0
X
364.53
357.04
95723
001
XXX
0
X
394.34
385.69
95723
002
XXX
0
X
364.53
357.04
95724
002
XXX
0
X
455.71
447.27
95724
003
XXX
0
X
455.71
447.27
95724
004
XXX
0
X
455.71
447.27
95724
001
XXX
0
X
492.37
482.65
95725
004
XXX
0
X
416.05
406.23
95725
002
XXX
0
X
416.05
406.23
95725
003
XXX
0
X
416.05
406.23
95725
001
XXX
0
X
450.16
438.86
95726
001
XXX
0
X
622.35
609.94
95726
002
XXX
0
X
575.95
565.19
95726
003
XXX
0
X
575.95
565.19
95726
004
XXX
0
X
575.95
565.19
95782
001
XXX
0
X
1,808.81
X
95782
26
001
XXX
0
X
217.15
X
95782
TC
001
XXX
0
X
1,591.68
X
95782
002
XXX
0
X
1,573.14
X
95782
26
002
XXX
0
X
203.83
X
95782
TC
002
XXX
0
X
1,369.33
X
95782
003
XXX
0
X
1,573.14
X
95782
26
003
XXX
0
X
203.83
X
95782
TC
003
XXX
0
X
1,369.33
X
95782
004
XXX
0
X
1,573.14
X
95782
26
004
XXX
0
X
203.83
X
95782
TC
004
XXX
0
X
1,369.33
X
95783
002
XXX
0
X
1,679.61
X
95783
26
002
XXX
0
X
222.92
X
95783
TC
002
XXX
0
X
1,456.76
X
95783
003
XXX
0
X
1,679.61
X
95783
26
003
XXX
0
X
222.92
X
95783
TC
003
XXX
0
X
1,456.76
X
95783
004
XXX
0
X
1,679.61
X
95783
26
004
XXX
0
X
222.92
X
95783
TC
004
XXX
0
X
1,456.76
X
95783
001
XXX
0
X
1,931.20
X
95783
26
001
XXX
0
X
237.75
X
95783
TC
001
XXX
0
X
1,693.44
X
95800
001
XXX
0
X
386.06
X
95800
26
001
XXX
0
X
106.84
X
95800
TC
001
XXX
0
X
279.21
X
95800
002
XXX
0
X
346.62
X
95800
26
002
XXX
0
X
100.06
X
95800
TC
002
XXX
0
X
246.53
X
95800
003
XXX
0
X
346.62
X
95800
26
003
XXX
0
X
100.06
X
95800
TC
003
XXX
0
X
246.53
X
95800
004
XXX
0
X
346.62
X
95800
26
004
XXX
0
X
100.06
X
95800
TC
004
XXX
0
X
246.53
X
95801
002
XXX
0
X
164.78
X
95801
26
002
XXX
0
X
88.58
X
95801
TC
002
XXX
0
X
76.20
X
95801
004
XXX
0
X
164.78
X
95801
26
004
XXX
0
X
88.58
X
95801
TC
004
XXX
0
X
76.20
X
95801
003
XXX
0
X
164.78
X
95801
26
003
XXX
0
X
88.58
X
95801
TC
003
XXX
0
X
76.20
X
95801
001
XXX
0
X
180.63
X
95801
26
001
XXX
0
X
94.22
X
95801
TC
001
XXX
0
X
86.42
X
95803
XXX
0
X
*
X
95805
001
XXX
0
X
816.96
X
95805
26
001
XXX
0
X
241.59
X
95805
TC
001
XXX
0
X
575.46
X
95805
003
XXX
0
X
698.31
X
95805
26
003
XXX
0
X
222.83
X
95805
TC
003
XXX
0
X
475.55
X
95805
002
XXX
0
X
698.31
X
95805
26
002
XXX
0
X
222.83
X
95805
TC
002
XXX
0
X
475.55
X
95805
004
XXX
0
X
698.31
X
95805
26
004
XXX
0
X
222.83
X
95805
TC
004
XXX
0
X
475.55
X
95806
002
XXX
0
X
837.24
X
95806
26
002
XXX
0
X
383.09
X
95806
TC
002
XXX
0
X
454.16
X
95806
001
XXX
0
X
987.31
X
95806
26
001
XXX
0
X
437.87
X
95806
TC
001
XXX
0
X
549.46
X
95806
003
XXX
0
X
837.24
X
95806
26
003
XXX
0
X
383.09
X
95806
TC
003
XXX
0
X
454.16
X
95806
004
XXX
0
X
837.24
X
95806
26
004
XXX
0
X
383.09
X
95806
TC
004
XXX
0
X
454.16
X
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