Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
76145	MED PHYSIC DOS EVAL RAD EXPS	PRXOVR	DEF					NA	NA	NA	N
76145	MED PHYSIC DOS EVAL RAD EXPS	MAXFEE	DEF					591.80	1/1/2021	12/31/2299	N
76950	ECHO GUIDANCE RADIOTHERAPY	PRXOVR	DEF					NA	NA	NA	N
76950	ECHO GUIDANCE RADIOTHERAPY	MAXFEE	DEF					NA			N
76965	ECHO GUIDANCE RADIOTHERAPY	PRXOVR	DEF					NA	NA	NA	N
76965	ECHO GUIDANCE RADIOTHERAPY	MAXFEE	DEF					74.86	1/1/2018	12/31/2299	N
76965	ECHO GUIDANCE RADIOTHERAPY	MAXFEE	DEF	26				56.15	1/1/2018	12/31/2299	N
76965	ECHO GUIDANCE RADIOTHERAPY	MAXFEE	DEF	TC				18.71	1/1/2018	12/31/2299	N
76998	US GUIDE INTRAOP	PRXOVR	DEF					NA	NA	NA	N
76998	US GUIDE INTRAOP	MAXFEE	DEF					112.05	1/1/2018	12/31/2299	N
76998	US GUIDE INTRAOP	MAXFEE	DEF	26				44.82	1/1/2018	12/31/2299	N
76998	US GUIDE INTRAOP	MAXFEE	DEF	TC				67.23	1/1/2018	12/31/2299	N
76999	ECHO EXAMINATION PROCEDURE	PRXOVR	DEF					NA	NA	NA	N
76999	ECHO EXAMINATION PROCEDURE	MANUAL	DEF					NA	NA	NA	N
77001	FLUOROGUIDE FOR VEIN DEVICE	PRXOVR	DEF					NA	NA	NA	N
77001	FLUOROGUIDE FOR VEIN DEVICE	MAXFEE	DEF					59.44	1/1/2018	12/31/2299	N
77001	FLUOROGUIDE FOR VEIN DEVICE	MAXFEE	DEF	26				11.89	1/1/2018	12/31/2299	N
77001	FLUOROGUIDE FOR VEIN DEVICE	MAXFEE	DEF	TC				47.55	1/1/2018	12/31/2299	N
77002	NEEDLE LOCALIZATION BY XRAY	PRXOVR	DEF					NA	NA	NA	N
77002	NEEDLE LOCALIZATION BY XRAY	MAXFEE	DEF					59.89	1/1/2018	12/31/2299	N
77002	NEEDLE LOCALIZATION BY XRAY	MAXFEE	DEF	26				23.96	1/1/2018	12/31/2299	N
77002	NEEDLE LOCALIZATION BY XRAY	MAXFEE	DEF	TC				35.93	1/1/2018	12/31/2299	N
77003	FLUOROGUIDE FOR SPINE INJECT	PRXOVR	DEF					NA	NA	NA	N
77003	FLUOROGUIDE FOR SPINE INJECT	MAXFEE	DEF					53.06	1/1/2018	12/31/2299	N
77003	FLUOROGUIDE FOR SPINE INJECT	MAXFEE	DEF	26				21.22	1/1/2018	12/31/2299	N
77003	FLUOROGUIDE FOR SPINE INJECT	MAXFEE	DEF	TC				31.84	1/1/2018	12/31/2299	N
77011	CT SCAN FOR LOCALIZATION	PRXOVR	DEF					NA	NA	NA	N
77011	CT SCAN FOR LOCALIZATION	MAXFEE	DEF					182.62	1/1/2018	12/31/2299	N
77011	CT SCAN FOR LOCALIZATION	MAXFEE	DEF	26				54.79	1/1/2018	12/31/2299	N
77011	CT SCAN FOR LOCALIZATION	MAXFEE	DEF	TC				127.83	1/1/2018	12/31/2299	N
77012	CT SCAN FOR NEEDLE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
77012	CT SCAN FOR NEEDLE BIOPSY	MAXFEE	DEF					104.85	1/1/2018	12/31/2299	N
77012	CT SCAN FOR NEEDLE BIOPSY	MAXFEE	DEF	26				41.94	1/1/2018	12/31/2299	N
77012	CT SCAN FOR NEEDLE BIOPSY	MAXFEE	DEF	TC				62.91	1/1/2018	12/31/2299	N
77013	CT GUIDE FOR TISSUE ABLATION	PRXOVR	DEF					NA	NA	NA	N
77013	CT GUIDE FOR TISSUE ABLATION	MAXFEE	DEF					379.53	1/1/2018	12/31/2299	N
77013	CT GUIDE FOR TISSUE ABLATION	MAXFEE	DEF	26				132.84	1/1/2018	12/31/2299	N
77013	CT GUIDE FOR TISSUE ABLATION	MAXFEE	DEF	TC				246.69	1/1/2018	12/31/2299	N
77014	CT SCAN FOR THERAPY GUIDE	PRXOVR	DEF					NA	NA	NA	N
77014	CT SCAN FOR THERAPY GUIDE	MAXFEE	DEF					100.96	1/1/2018	12/31/2299	N
77014	CT SCAN FOR THERAPY GUIDE	MAXFEE	DEF	26				35.34	1/1/2018	12/31/2299	N
77014	CT SCAN FOR THERAPY GUIDE	MAXFEE	DEF	TC				65.62	1/1/2018	12/31/2299	N
77021	MRI GUIDANCE NDL PLMT RS&I	PRXOVR	DEF					NA	NA	NA	N
77021	MRI GUIDANCE NDL PLMT RS&I	MAXFEE	DEF					278	1/1/2018	12/31/2299	N
77021	MRI GUIDANCE NDL PLMT RS&I	MAXFEE	DEF	26				55.60	1/1/2018	12/31/2299	N
77021	MRI GUIDANCE NDL PLMT RS&I	MAXFEE	DEF	TC				222.40	1/1/2018	12/31/2299	N
77022	MRI GDN PARNCHYMA TISS ABLTJ	PRXOVR	DEF					NA	NA	NA	N
77022	MRI GDN PARNCHYMA TISS ABLTJ	MAXFEE	DEF					410.18	1/1/2018	12/31/2299	N
77022	MRI GDN PARNCHYMA TISS ABLTJ	MAXFEE	DEF	26				164.07	1/1/2018	12/31/2299	N
77022	MRI GDN PARNCHYMA TISS ABLTJ	MAXFEE	DEF	TC				246.11	1/1/2018	12/31/2299	N
77031	STEREOTACT GUIDE FOR BRST BX	PRXOVR	DEF					NA	NA	NA	N
77031	STEREOTACT GUIDE FOR BRST BX	MAXFEE	DEF					NA			N
77032	GUIDANCE FOR NEEDLE BREAST	PRXOVR	DEF					NA	NA	NA	N
77032	GUIDANCE FOR NEEDLE BREAST	MAXFEE	DEF					NA			N
77261	RADIATION THERAPY PLANNING	PRXOVR	DEF					NA	NA	NA	N
77261	RADIATION THERAPY PLANNING	MAXFEE	DEF					53.55	1/1/2018	12/31/2299	N
77261	RADIATION THERAPY PLANNING	MAXFEE	DEF	26				0	1/1/2018	12/31/2299	N
77262	RADIATION THERAPY PLANNING	PRXOVR	DEF					NA	NA	NA	N
77262	RADIATION THERAPY PLANNING	MAXFEE	DEF					81.43	1/1/2018	12/31/2299	N
77262	RADIATION THERAPY PLANNING	MAXFEE	DEF	26				0	1/1/2018	12/31/2299	N
77263	RADIATION THERAPY PLANNING	PRXOVR	DEF					NA	NA	NA	N
77263	RADIATION THERAPY PLANNING	MAXFEE	DEF					120.98	1/1/2018	12/31/2299	N
77263	RADIATION THERAPY PLANNING	MAXFEE	DEF	26				0	1/1/2018	12/31/2299	N
77280	SET RADIATION THERAPY FIELD	PRXOVR	DEF					NA	NA	NA	N
77280	SET RADIATION THERAPY FIELD	MAXFEE	DEF					128.88	1/1/2018	12/31/2299	N
77280	SET RADIATION THERAPY FIELD	MAXFEE	DEF	26				32.22	1/1/2018	12/31/2299	N
77280	SET RADIATION THERAPY FIELD	MAXFEE	DEF	TC				96.66	1/1/2018	12/31/2299	N
77285	SET RADIATION THERAPY FIELD	PRXOVR	DEF					NA	NA	NA	N
77285	SET RADIATION THERAPY FIELD	MAXFEE	DEF					210.26	1/1/2018	12/31/2299	N
77285	SET RADIATION THERAPY FIELD	MAXFEE	DEF	26				52.57	1/1/2018	12/31/2299	N
77285	SET RADIATION THERAPY FIELD	MAXFEE	DEF	TC				157.70	1/1/2018	12/31/2299	N
77290	SET RADIATION THERAPY FIELD	PRXOVR	DEF					NA	NA	NA	N
77290	SET RADIATION THERAPY FIELD	MAXFEE	DEF					284.37	1/1/2018	12/31/2299	N
77290	SET RADIATION THERAPY FIELD	MAXFEE	DEF	26				56.87	1/1/2018	12/31/2299	N
77290	SET RADIATION THERAPY FIELD	MAXFEE	DEF	TC				227.50	1/1/2018	12/31/2299	N
77293	RESPIRATOR MOTION MGMT SIMUL	PRXOVR	DEF					NA	NA	NA	N
77293	RESPIRATOR MOTION MGMT SIMUL	MAXFEE	DEF					292.41	1/1/2018	12/31/2299	N
77293	RESPIRATOR MOTION MGMT SIMUL	MAXFEE	DEF	26				73.10	1/1/2018	12/31/2299	N
77293	RESPIRATOR MOTION MGMT SIMUL	MAXFEE	DEF	TC				219.31	1/1/2018	12/31/2299	N
77295	3-D RADIOTHERAPY PLAN	PRXOVR	DEF					NA	NA	NA	N
77295	3-D RADIOTHERAPY PLAN	MAXFEE	DEF					365.22	1/1/2018	12/31/2299	N
77295	3-D RADIOTHERAPY PLAN	MAXFEE	DEF	26				182.61	1/1/2018	12/31/2299	N
77295	3-D RADIOTHERAPY PLAN	MAXFEE	DEF	TC				182.61	1/1/2018	12/31/2299	N
77299	UNLISTED PX THER RAD TX PLNG	PRXOVR	DEF					NA	NA	NA	N
77299	UNLISTED PX THER RAD TX PLNG	MANUAL	DEF					NA	NA	NA	N
77300	RADIATION THERAPY DOSE PLAN	PRXOVR	DEF					NA	NA	NA	N
77300	RADIATION THERAPY DOSE PLAN	MAXFEE	DEF					54.17	1/1/2018	12/31/2299	N
77300	RADIATION THERAPY DOSE PLAN	MAXFEE	DEF	26				21.67	1/1/2018	12/31/2299	N
77300	RADIATION THERAPY DOSE PLAN	MAXFEE	DEF	TC				32.50	1/1/2018	12/31/2299	N
77301	RADIOTHERAPY DOSE PLAN IMRT	PRXOVR	DEF					NA	NA	NA	N
77301	RADIOTHERAPY DOSE PLAN IMRT	MAXFEE	DEF					1261.13	1/1/2018	12/31/2299	N
77301	RADIOTHERAPY DOSE PLAN IMRT	MAXFEE	DEF	26				378.34	1/1/2018	12/31/2299	N
77301	RADIOTHERAPY DOSE PLAN IMRT	MAXFEE	DEF	TC				882.79	1/1/2018	12/31/2299	N
77305	TELETX ISODOSE PLAN SIMPLE	PRXOVR	DEF					NA	NA	NA	N
77305	TELETX ISODOSE PLAN SIMPLE	MAXFEE	DEF					NA			N
77306	TELETHX ISODOSE PLAN SIMPLE	PRXOVR	DEF					NA	NA	NA	N
77306	TELETHX ISODOSE PLAN SIMPLE	MAXFEE	DEF					103.84	1/1/2018	12/31/2299	N
77306	TELETHX ISODOSE PLAN SIMPLE	MAXFEE	DEF	26				51.92	1/1/2018	12/31/2299	N
77306	TELETHX ISODOSE PLAN SIMPLE	MAXFEE	DEF	TC				51.92	1/1/2018	12/31/2299	N
77307	TELETHX ISODOSE PLAN CPLX	PRXOVR	DEF					NA	NA	NA	N
77307	TELETHX ISODOSE PLAN CPLX	MAXFEE	DEF					202.92	1/1/2018	12/31/2299	N
77307	TELETHX ISODOSE PLAN CPLX	MAXFEE	DEF	26				101.46	1/1/2018	12/31/2299	N
77307	TELETHX ISODOSE PLAN CPLX	MAXFEE	DEF	TC				101.46	1/1/2018	12/31/2299	N
77310	TELETX ISODOSE PLAN INTERMED	PRXOVR	DEF					NA	NA	NA	N
77310	TELETX ISODOSE PLAN INTERMED	MAXFEE	DEF					NA			N
77315	TELETX ISODOSE PLAN COMPLEX	PRXOVR	DEF					NA	NA	NA	N
77315	TELETX ISODOSE PLAN COMPLEX	MAXFEE	DEF					NA			N
77316	BRACHYTX ISODOSE PLAN SIMPLE	PRXOVR	DEF					NA	NA	NA	N
77316	BRACHYTX ISODOSE PLAN SIMPLE	MAXFEE	DEF					132.34	1/1/2018	12/31/2299	N
77316	BRACHYTX ISODOSE PLAN SIMPLE	MAXFEE	DEF	26				52.94	1/1/2018	12/31/2299	N
77316	BRACHYTX ISODOSE PLAN SIMPLE	MAXFEE	DEF	TC				79.40	1/1/2018	12/31/2299	N
77317	BRACHYTX ISODOSE INTERMED	PRXOVR	DEF					NA	NA	NA	N
77317	BRACHYTX ISODOSE INTERMED	MAXFEE	DEF					173.30	1/1/2018	12/31/2299	N
77317	BRACHYTX ISODOSE INTERMED	MAXFEE	DEF	26				69.32	1/1/2018	12/31/2299	N
77317	BRACHYTX ISODOSE INTERMED	MAXFEE	DEF	TC				103.98	1/1/2018	12/31/2299	N
77318	BRACHYTX ISODOSE COMPLEX	PRXOVR	DEF					NA	NA	NA	N
77318	BRACHYTX ISODOSE COMPLEX	MAXFEE	DEF					250.42	1/1/2018	12/31/2299	N
77318	BRACHYTX ISODOSE COMPLEX	MAXFEE	DEF	26				125.21	1/1/2018	12/31/2299	N
77318	BRACHYTX ISODOSE COMPLEX	MAXFEE	DEF	TC				125.21	1/1/2018	12/31/2299	N
77321	SPECIAL TELETX PORT PLAN	PRXOVR	DEF					NA	NA	NA	N
77321	SPECIAL TELETX PORT PLAN	MAXFEE	DEF					74.47	1/1/2018	12/31/2299	N
77321	SPECIAL TELETX PORT PLAN	MAXFEE	DEF	26				37.24	1/1/2018	12/31/2299	N
77321	SPECIAL TELETX PORT PLAN	MAXFEE	DEF	TC				37.23	1/1/2018	12/31/2299	N
77326	BRACHYTX ISODOSE CALC SIMP	PRXOVR	DEF					NA	NA	NA	N
77326	BRACHYTX ISODOSE CALC SIMP	MAXFEE	DEF					NA			N
77327	BRACHYTX ISODOSE CALC INTERM	PRXOVR	DEF					NA	NA	NA	N
77327	BRACHYTX ISODOSE CALC INTERM	MAXFEE	DEF					NA			N
77328	BRACHYTX ISODOSE PLAN COMPL	PRXOVR	DEF					NA	NA	NA	N
77328	BRACHYTX ISODOSE PLAN COMPL	MAXFEE	DEF					NA			N
77331	SPECIAL RADIATION DOSIMETRY	PRXOVR	DEF					NA	NA	NA	N
77331	SPECIAL RADIATION DOSIMETRY	MAXFEE	DEF					46.90	1/1/2018	12/31/2299	N
77331	SPECIAL RADIATION DOSIMETRY	MAXFEE	DEF	26				32.83	1/1/2018	12/31/2299	N
77331	SPECIAL RADIATION DOSIMETRY	MAXFEE	DEF	TC				14.07	1/1/2018	12/31/2299	N
77332	RADIATION TREATMENT AID(S)	PRXOVR	DEF					NA	NA	NA	N
77332	RADIATION TREATMENT AID(S)	MAXFEE	DEF					58.04	1/1/2018	12/31/2299	N
77332	RADIATION TREATMENT AID(S)	MAXFEE	DEF	26				23.22	1/1/2018	12/31/2299	N
77332	RADIATION TREATMENT AID(S)	MAXFEE	DEF	TC				34.82	1/1/2018	12/31/2299	N
77333	RADIATION TREATMENT AID(S)	PRXOVR	DEF					NA	NA	NA	N
77333	RADIATION TREATMENT AID(S)	MAXFEE	DEF					42.69	1/1/2018	12/31/2299	N
77333	RADIATION TREATMENT AID(S)	MAXFEE	DEF	26				34.15	1/1/2018	12/31/2299	N
77333	RADIATION TREATMENT AID(S)	MAXFEE	DEF	TC				8.54	1/1/2018	12/31/2299	N
77334	RADIATION TREATMENT AID(S)	PRXOVR	DEF					NA	NA	NA	N
77334	RADIATION TREATMENT AID(S)	MAXFEE	DEF					130.73	1/1/2018	12/31/2299	N
77334	RADIATION TREATMENT AID(S)	MAXFEE	DEF	26				52.29	1/1/2018	12/31/2299	N
77334	RADIATION TREATMENT AID(S)	MAXFEE	DEF	TC				78.44	1/1/2018	12/31/2299	N
77336	RADIATION PHYSICS CONSULT	PRXOVR	DEF					NA	NA	NA	N
77336	RADIATION PHYSICS CONSULT	MAXFEE	DEF					50.32	1/1/2018	12/31/2299	N
77338	DESIGN MLC DEVICE FOR IMRT	PRXOVR	DEF					NA	NA	NA	N
77338	DESIGN MLC DEVICE FOR IMRT	MAXFEE	DEF					249.44	1/1/2018	12/31/2299	N
77338	DESIGN MLC DEVICE FOR IMRT	MAXFEE	DEF	26				124.72	1/1/2018	12/31/2299	N
77338	DESIGN MLC DEVICE FOR IMRT	MAXFEE	DEF	TC				124.72	1/1/2018	12/31/2299	N
77370	RADIATION PHYSICS CONSULT	PRXOVR	DEF					NA	NA	NA	N
77370	RADIATION PHYSICS CONSULT	MAXFEE	DEF					95.17	1/1/2018	12/31/2299	N
77370	RADIATION PHYSICS CONSULT	MAXFEE	DEF	26				0	1/1/2018	12/31/2299	N
77371	SRS MULTISOURCE	PRXOVR	DEF					NA	NA	NA	N
77371	SRS MULTISOURCE	MAXFEE	DEF					817.36	1/1/2018	12/31/2299	N
77372	SRS LINEAR BASED	PRXOVR	DEF					NA	NA	NA	N
77372	SRS LINEAR BASED	MAXFEE	DEF					620.45	1/1/2018	12/31/2299	N
77373	SBRT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77373	SBRT DELIVERY	MAXFEE	DEF					988.17	1/1/2018	12/31/2299	N
77385	NTSTY MODUL RAD TX DLVR SMPL	PRXOVR	DEF					NA	NA	NA	N
77385	NTSTY MODUL RAD TX DLVR SMPL	MAXFEE	DEF					279.22	1/1/2018	12/31/2299	N
77386	NTSTY MODUL RAD TX DLVR CPLX	PRXOVR	DEF					NA	NA	NA	N
77386	NTSTY MODUL RAD TX DLVR CPLX	MAXFEE	DEF					279.22	1/1/2018	12/31/2299	N
77387	GUIDANCE FOR RADJ TX DLVR	PRXOVR	DEF					NA	NA	NA	N
77387	GUIDANCE FOR RADJ TX DLVR	MAXFEE	DEF					53.31	1/1/2018	12/31/2299	N
77387	GUIDANCE FOR RADJ TX DLVR	MAXFEE	DEF	26				15.99	1/1/2018	12/31/2299	N
77387	GUIDANCE FOR RADJ TX DLVR	MAXFEE	DEF	TC				37.32	1/1/2018	12/31/2299	N
77399	UNLISTED PX MED RADJ PHYSICS	PRXOVR	DEF					NA	NA	NA	N
77399	UNLISTED PX MED RADJ PHYSICS	MANUAL	DEF					NA	NA	NA	N
77401	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77401	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					16.55	1/1/2018	12/31/2299	N
77402	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77402	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					66.79	1/1/2018	12/31/2299	N
77403	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77403	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77404	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77404	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77406	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77406	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77407	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77407	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					145.01	1/1/2018	12/31/2299	N
77408	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77408	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77409	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77409	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77411	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77411	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77412	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77412	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					137.66	1/1/2018	12/31/2299	N
77413	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77413	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77414	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77414	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77416	RADIATION TREATMENT DELIVERY	PRXOVR	DEF					NA	NA	NA	N
77416	RADIATION TREATMENT DELIVERY	MAXFEE	DEF					NA			N
77417	RADIOLOGY PORT IMAGES(S)	PRXOVR	DEF					NA	NA	NA	N
77417	RADIOLOGY PORT IMAGES(S)	MAXFEE	DEF					8.95	1/1/2018	12/31/2299	N
77418	RADIATION TX DELIVERY IMRT	PRXOVR	DEF					NA	NA	NA	N
77418	RADIATION TX DELIVERY IMRT	MAXFEE	DEF					NA			N
77421	STEREOSCOPIC X-RAY GUIDANCE	PRXOVR	DEF					NA	NA	NA	N
77421	STEREOSCOPIC X-RAY GUIDANCE	MAXFEE	DEF					NA			N
77422	NEUTRON BEAM TX SIMPLE	PRXOVR	DEF					NA	NA	NA	N
77422	NEUTRON BEAM TX SIMPLE	MAXFEE	DEF					27.87	1/1/2018	12/31/2299	N
77423	NEUTRON BEAM TX COMPLEX	PRXOVR	DEF					NA	NA	NA	N
77423	NEUTRON BEAM TX COMPLEX	MAXFEE	DEF					39.36	1/1/2018	12/31/2299	N
77424	IO RAD TX DELIVERY BY X-RAY	PRXOVR	DEF					NA	NA	NA	N
77424	IO RAD TX DELIVERY BY X-RAY	MANUAL	DEF					NA	NA	NA	N
77425	IO RAD TX DELIVER BY ELCTRNS	PRXOVR	DEF					NA	NA	NA	N
77425	IO RAD TX DELIVER BY ELCTRNS	MANUAL	DEF					NA	NA	NA	N
77427	RADIATION TX MANAGEMENT X5	PRXOVR	DEF					NA	NA	NA	N
77427	RADIATION TX MANAGEMENT X5	MAXFEE	DEF					131.55	1/1/2018	12/31/2299	N
77431	RADIATION THERAPY MANAGEMENT	PRXOVR	DEF					NA	NA	NA	N
77431	RADIATION THERAPY MANAGEMENT	MAXFEE	DEF					70.05	1/1/2018	12/31/2299	N
77432	STEREOTACTIC RADIATION TRMT	PRXOVR	DEF					NA	NA	NA	N
77432	STEREOTACTIC RADIATION TRMT	MAXFEE	DEF					331.51	1/1/2018	12/31/2299	N
77435	SBRT MANAGEMENT	PRXOVR	DEF					NA	NA	NA	N
77435	SBRT MANAGEMENT	MAXFEE	DEF					479.77	1/1/2018	12/31/2299	N
77469	IO RADIATION TX MANAGEMENT	PRXOVR	DEF					NA	NA	NA	N
77469	IO RADIATION TX MANAGEMENT	MAXFEE	DEF					223.48	1/1/2018	12/31/2299	N
77470	SPECIAL RADIATION TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77470	SPECIAL RADIATION TREATMENT	MAXFEE	DEF					125.44	1/1/2018	12/31/2299	N
77470	SPECIAL RADIATION TREATMENT	MAXFEE	DEF	26				87.81	1/1/2018	12/31/2299	N
77470	SPECIAL RADIATION TREATMENT	MAXFEE	DEF	TC				37.63	1/1/2018	12/31/2299	N
77499	UNLISTED PX THER RAD TX MGMT	PRXOVR	DEF					NA	NA	NA	N
77499	UNLISTED PX THER RAD TX MGMT	MANUAL	DEF					NA	NA	NA	N
77520	PROTON TRMT SIMPLE W/O COMP	PRXOVR	DEF					NA	NA	NA	N
77520	PROTON TRMT SIMPLE W/O COMP	MAXFEE	DEF					671.56	1/1/2018	12/31/2299	N
77522	PROTON TRMT SIMPLE W/COMP	PRXOVR	DEF					NA	NA	NA	N
77522	PROTON TRMT SIMPLE W/COMP	MANUAL	DEF					NA	NA	NA	N
77523	PROTON TRMT INTERMEDIATE	PRXOVR	DEF					NA	NA	NA	N
77523	PROTON TRMT INTERMEDIATE	MANUAL	DEF					NA	NA	NA	N
77525	PROTON TREATMENT COMPLEX	PRXOVR	DEF					NA	NA	NA	N
77525	PROTON TREATMENT COMPLEX	MANUAL	DEF					NA	NA	NA	N
77600	HYPERTHERMIA TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77600	HYPERTHERMIA TREATMENT	MAXFEE	DEF					183.89	1/1/2018	12/31/2299	N
77600	HYPERTHERMIA TREATMENT	MAXFEE	DEF	26				55.17	1/1/2018	12/31/2299	N
77600	HYPERTHERMIA TREATMENT	MAXFEE	DEF	TC				128.72	1/1/2018	12/31/2299	N
77605	HYPERTHERMIA TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77605	HYPERTHERMIA TREATMENT	MAXFEE	DEF					417.05	1/1/2018	12/31/2299	N
77605	HYPERTHERMIA TREATMENT	MAXFEE	DEF	26				125.12	1/1/2018	12/31/2299	N
77605	HYPERTHERMIA TREATMENT	MAXFEE	DEF	TC				291.94	1/1/2018	12/31/2299	N
77610	HYPERTHERMIA TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77610	HYPERTHERMIA TREATMENT	MAXFEE	DEF					571.71	1/1/2018	12/31/2299	N
77610	HYPERTHERMIA TREATMENT	MAXFEE	DEF	26				142.93	1/1/2018	12/31/2299	N
77610	HYPERTHERMIA TREATMENT	MAXFEE	DEF	TC				428.78	1/1/2018	12/31/2299	N
77615	HYPERTHERMIA TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77615	HYPERTHERMIA TREATMENT	MAXFEE	DEF					573.12	1/1/2018	12/31/2299	N
77615	HYPERTHERMIA TREATMENT	MAXFEE	DEF	26				143.28	1/1/2018	12/31/2299	N
77615	HYPERTHERMIA TREATMENT	MAXFEE	DEF	TC				429.84	1/1/2018	12/31/2299	N
77620	HYPERTHERMIA TREATMENT	PRXOVR	DEF					NA	NA	NA	N
77620	HYPERTHERMIA TREATMENT	MAXFEE	DEF					186.13	1/1/2018	12/31/2299	N
77620	HYPERTHERMIA TREATMENT	MAXFEE	DEF	26				55.84	1/1/2018	12/31/2299	N
77620	HYPERTHERMIA TREATMENT	MAXFEE	DEF	TC				130.29	1/1/2018	12/31/2299	N
77750	INFUSE RADIOACTIVE MATERIALS	PRXOVR	DEF					NA	NA	NA	N
77750	INFUSE RADIOACTIVE MATERIALS	MAXFEE	DEF					226.31	1/1/2018	12/31/2299	N
77750	INFUSE RADIOACTIVE MATERIALS	MAXFEE	DEF	26				181.05	1/1/2018	12/31/2299	N
77750	INFUSE RADIOACTIVE MATERIALS	MAXFEE	DEF	TC				45.26	1/1/2018	12/31/2299	N
77761	APPLY INTRCAV RADIAT SIMPLE	PRXOVR	DEF					NA	NA	NA	N
77761	APPLY INTRCAV RADIAT SIMPLE	MAXFEE	DEF					223.08	1/1/2018	12/31/2299	N
77761	APPLY INTRCAV RADIAT SIMPLE	MAXFEE	DEF	26				133.85	1/1/2018	12/31/2299	N
77761	APPLY INTRCAV RADIAT SIMPLE	MAXFEE	DEF	TC				89.23	1/1/2018	12/31/2299	N
77762	APPLY INTRCAV RADIAT INTERM	PRXOVR	DEF					NA	NA	NA	N
77762	APPLY INTRCAV RADIAT INTERM	MAXFEE	DEF					323.29	1/1/2018	12/31/2299	N
77762	APPLY INTRCAV RADIAT INTERM	MAXFEE	DEF	26				193.97	1/1/2018	12/31/2299	N
77762	APPLY INTRCAV RADIAT INTERM	MAXFEE	DEF	TC				129.32	1/1/2018	12/31/2299	N
77763	APPLY INTRCAV RADIAT COMPL	PRXOVR	DEF					NA	NA	NA	N
77763	APPLY INTRCAV RADIAT COMPL	MAXFEE	DEF					456.90	1/1/2018	12/31/2299	N
77763	APPLY INTRCAV RADIAT COMPL	MAXFEE	DEF	26				319.83	1/1/2018	12/31/2299	N
77763	APPLY INTRCAV RADIAT COMPL	MAXFEE	DEF	TC				137.07	1/1/2018	12/31/2299	N
77767	HDR RDNCL SKN SURF BRACHYTX	PRXOVR	DEF					NA	NA	NA	N
77767	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF					160.99	1/1/2018	12/31/2299	N
77767	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF	26				40.25	1/1/2018	12/31/2299	N
77767	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF	TC				120.74	1/1/2018	12/31/2299	N
77768	HDR RDNCL SKN SURF BRACHYTX	PRXOVR	DEF					NA	NA	NA	N
77768	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF					251.57	1/1/2018	12/31/2299	N
77768	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF	26				50.31	1/1/2018	12/31/2299	N
77768	HDR RDNCL SKN SURF BRACHYTX	MAXFEE	DEF	TC				201.26	1/1/2018	12/31/2299	N
77770	HDR RDNCL NTRSTL/ICAV BRCHTX	PRXOVR	DEF					NA	NA	NA	N
77770	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF					230.81	1/1/2018	12/31/2299	N
77770	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	26				69.24	1/1/2018	12/31/2299	N
77770	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	TC				161.57	1/1/2018	12/31/2299	N
77771	HDR RDNCL NTRSTL/ICAV BRCHTX	PRXOVR	DEF					NA	NA	NA	N
77771	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF					430.40	1/1/2018	12/31/2299	N
77771	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	26				150.64	1/1/2018	12/31/2299	N
77771	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	TC				279.76	1/1/2018	12/31/2299	N
77772	HDR RDNCL NTRSTL/ICAV BRCHTX	PRXOVR	DEF					NA	NA	NA	N
77772	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF					655.68	1/1/2018	12/31/2299	N
77772	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	26				229.49	1/1/2018	12/31/2299	N
77772	HDR RDNCL NTRSTL/ICAV BRCHTX	MAXFEE	DEF	TC				426.19	1/1/2018	12/31/2299	N
77776	APPLY INTERSTIT RADIAT SIMPL	PRXOVR	DEF					NA	NA	NA	N
77776	APPLY INTERSTIT RADIAT SIMPL	MAXFEE	DEF					NA			N
77777	APPLY INTERSTIT RADIAT INTER	PRXOVR	DEF					NA	NA	NA	N
77777	APPLY INTERSTIT RADIAT INTER	MAXFEE	DEF					NA			N
77778	APPLY INTERSTIT RADIAT COMPL	PRXOVR	DEF					NA	NA	NA	N
77778	APPLY INTERSTIT RADIAT COMPL	MAXFEE	DEF					566.46	1/1/2018	12/31/2299	N
77778	APPLY INTERSTIT RADIAT COMPL	MAXFEE	DEF	26				396.52	1/1/2018	12/31/2299	N
77778	APPLY INTERSTIT RADIAT COMPL	MAXFEE	DEF	TC				169.94	1/1/2018	12/31/2299	N
77785	HDR BRACHYTX 1 CHANNEL	PRXOVR	DEF					NA	NA	NA	N
77785	HDR BRACHYTX 1 CHANNEL	MAXFEE	DEF					NA			N
77786	HDR BRACHYTX 2-12 CHANNEL	PRXOVR	DEF					NA	NA	NA	N
77786	HDR BRACHYTX 2-12 CHANNEL	MAXFEE	DEF					NA			N
77787	HDR BRACHYTX OVER 12 CHAN	PRXOVR	DEF					NA	NA	NA	N
77787	HDR BRACHYTX OVER 12 CHAN	MAXFEE	DEF					NA			N
77789	APPLY SURF LDR RADIONUCLIDE	PRXOVR	DEF					NA	NA	NA	N
77789	APPLY SURF LDR RADIONUCLIDE	MAXFEE	DEF					62.55	1/1/2018	12/31/2299	N
77789	APPLY SURF LDR RADIONUCLIDE	MAXFEE	DEF	26				43.79	1/1/2018	12/31/2299	N
77789	APPLY SURF LDR RADIONUCLIDE	MAXFEE	DEF	TC				18.77	1/1/2018	12/31/2299	N
77790	RADIATION HANDLING	PRXOVR	DEF					NA	NA	NA	N
77790	RADIATION HANDLING	MAXFEE	DEF					55.92	1/1/2018	12/31/2299	N
77790	RADIATION HANDLING	MAXFEE	DEF	26				39.14	1/1/2018	12/31/2299	N
77790	RADIATION HANDLING	MAXFEE	DEF	TC				16.78	1/1/2018	12/31/2299	N
77799	UNLISTED PX CLIN BRACHYTX	PRXOVR	DEF					NA	NA	NA	N
77799	UNLISTED PX CLIN BRACHYTX	MANUAL	DEF					NA	NA	NA	N
99202	OFFICE O/P NEW SF 15-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	FAC					20.84	1/1/2016	12/31/2299	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	NFF					38.93	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	PRXOVR	DEF					NA	NA	NA	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	FAC					32.94	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	NFF					57.76	1/1/2016	12/31/2299	N
99204	OFFICE O/P NEW MOD 45-59 MIN	PRXOVR	DEF					NA	NA	NA	N
99204	OFFICE O/P NEW MOD 45-59 MIN	MAXFEE	FAC					56.15	1/1/2016	12/31/2299	N
99204	OFFICE O/P NEW MOD 45-59 MIN	MAXFEE	NFF					88.07	1/1/2016	12/31/2299	N
99205	OFFICE O/P NEW HI 60-74 MIN	PRXOVR	DEF					NA	NA	NA	N
99205	OFFICE O/P NEW HI 60-74 MIN	MAXFEE	FAC					72.01	1/1/2016	12/31/2299	N
99205	OFFICE O/P NEW HI 60-74 MIN	MAXFEE	NFF					110.67	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	PRXOVR	DEF					NA	NA	NA	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	FAC					5.55	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	NFF					14.50	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	PRXOVR	DEF					NA	NA	NA	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	FAC					12.81	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	NFF					26.73	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	FAC					24.85	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	NFF					43.61	1/1/2016	12/31/2299	N
99214	OFFICE O/P EST MOD 30-39 MIN	PRXOVR	DEF					NA	NA	NA	N
99214	OFFICE O/P EST MOD 30-39 MIN	MAXFEE	FAC					39.90	1/1/2016	12/31/2299	N
99214	OFFICE O/P EST MOD 30-39 MIN	MAXFEE	NFF					66.14	1/1/2016	12/31/2299	N
99215	OFFICE O/P EST HI 40-54 MIN	PRXOVR	DEF					NA	NA	NA	N
99215	OFFICE O/P EST HI 40-54 MIN	MAXFEE	FAC					57.36	1/1/2016	12/31/2299	N
99215	OFFICE O/P EST HI 40-54 MIN	MAXFEE	NFF					89.63	1/1/2016	12/31/2299	N
99241	OFFICE CONSULTATION	PRXOVR	DEF					NA	NA	NA	N
99241	OFFICE CONSULTATION	MAXFEE	DEF					NA			N
99242	OFF/OP CONSLTJ NEW/EST SF 20	PRXOVR	DEF					NA	NA	NA	N
99242	OFF/OP CONSLTJ NEW/EST SF 20	MAXFEE	FAC					23.66	1/1/2014	12/31/2299	N
99242	OFF/OP CONSLTJ NEW/EST SF 20	MAXFEE	NFF					39	1/1/2014	12/31/2299	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	PRXOVR	DEF					NA	NA	NA	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	MAXFEE	FAC					32.90	1/1/2014	12/31/2299	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	MAXFEE	NFF					53.41	1/1/2014	12/31/2299	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	PRXOVR	DEF					NA	NA	NA	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	MAXFEE	FAC					51.82	1/1/2014	12/31/2299	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	MAXFEE	NFF					78.63	1/1/2014	12/31/2299	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	PRXOVR	DEF					NA	NA	NA	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	MAXFEE	FAC					66.28	1/1/2014	12/31/2299	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	MAXFEE	NFF					97.57	1/1/2014	12/31/2299	N
99417	PROLNG OP E/M EACH 15 MIN	PRXOVR	DEF					NA	NA	NA	N
99417	PROLNG OP E/M EACH 15 MIN	MAXFEE	FAC					21.58	1/1/2021	12/31/2299	N
99417	PROLNG OP E/M EACH 15 MIN	MAXFEE	NFF					22.48	1/1/2021	12/31/2299	N
G2212	PROLONG OUTPT/OFFICE VIS	PRXOVR	DEF					NA	NA	NA	N
G2212	PROLONG OUTPT/OFFICE VIS	MAXFEE	FAC					21.58	1/1/2021	12/31/2299	N
G2212	PROLONG OUTPT/OFFICE VIS	MAXFEE	NFF					22.48	1/1/2021	12/31/2299	N