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         62.41 1/1/2024 12/31/2299 N
77001 FLUOROGUIDE FOR VEIN DEVICE MAXFEE DEF TC       49.93 1/1/2024 12/31/2299 N
77001 FLUOROGUIDE FOR VEIN DEVICE MAXFEE DEF 26       12.48 1/1/2024 12/31/2299 N
77002 NEEDLE LOCALIZATION BY XRAY PRXOVR DEF         NA NA NA N
77002 NEEDLE LOCALIZATION BY XRAY MAXFEE DEF         62.88 1/1/2024 12/31/2299 N
77002 NEEDLE LOCALIZATION BY XRAY MAXFEE DEF TC       37.73 1/1/2024 12/31/2299 N
77002 NEEDLE LOCALIZATION BY XRAY MAXFEE DEF 26       25.15 1/1/2024 12/31/2299 N
77003 FLUOROGUIDE FOR SPINE INJECT PRXOVR DEF         NA NA NA N
77003 FLUOROGUIDE FOR SPINE INJECT MAXFEE DEF         55.71 1/1/2024 12/31/2299 N
77003 FLUOROGUIDE FOR SPINE INJECT MAXFEE DEF TC       33.43 1/1/2024 12/31/2299 N
77003 FLUOROGUIDE FOR SPINE INJECT MAXFEE DEF 26       22.28 1/1/2024 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         291.90 1/1/2024 12/31/2299 N
77021 MRI GUIDANCE NDL PLMT RS&I MAXFEE DEF TC       233.52 1/1/2024 12/31/2299 N
77021 MRI GUIDANCE NDL PLMT RS&I MAXFEE DEF 26       58.38 1/1/2024 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 26       0 1/1/2018 12/31/2299 N
77261 RADIATION THERAPY PLANNING MAXFEE DEF         56.23 1/1/2024 12/31/2299 N
77262 RADIATION THERAPY PLANNING PRXOVR DEF         NA NA NA N
77262 RADIATION THERAPY PLANNING MAXFEE DEF 26       0 1/1/2018 12/31/2299 N
77262 RADIATION THERAPY PLANNING MAXFEE DEF         85.51 1/1/2024 12/31/2299 N
77263 RADIATION THERAPY PLANNING PRXOVR DEF         NA NA NA N
77263 RADIATION THERAPY PLANNING MAXFEE DEF 26       0 1/1/2018 12/31/2299 N
77263 RADIATION THERAPY PLANNING MAXFEE DEF         127.03 1/1/2024 12/31/2299 N
77280 SET RADIATION THERAPY FIELD PRXOVR DEF         NA NA NA N
77280 SET RADIATION THERAPY FIELD MAXFEE DEF         137.74 1/1/2024 12/31/2299 N
77280 SET RADIATION THERAPY FIELD MAXFEE DEF TC       103.31 1/1/2024 12/31/2299 N
77280 SET RADIATION THERAPY FIELD MAXFEE DEF 26       34.44 1/1/2024 12/31/2299 N
77285 SET RADIATION THERAPY FIELD PRXOVR DEF         NA NA NA N
77285 SET RADIATION THERAPY FIELD MAXFEE DEF         227.71 1/1/2024 12/31/2299 N
77285 SET RADIATION THERAPY FIELD MAXFEE DEF TC       170.78 1/1/2024 12/31/2299 N
77285 SET RADIATION THERAPY FIELD MAXFEE DEF 26       56.93 1/1/2024 12/31/2299 N
77290 SET RADIATION THERAPY FIELD PRXOVR DEF         NA NA NA N
77290 SET RADIATION THERAPY FIELD MAXFEE DEF         298.59 1/1/2024 12/31/2299 N
77290 SET RADIATION THERAPY FIELD MAXFEE DEF TC       238.87 1/1/2024 12/31/2299 N
77290 SET RADIATION THERAPY FIELD MAXFEE DEF 26       59.72 1/1/2024 12/31/2299 N
77293 RESPIRATOR MOTION MGMT SIMUL PRXOVR DEF         NA NA NA N
77293 RESPIRATOR MOTION MGMT SIMUL MAXFEE DEF         307.03 1/1/2024 12/31/2299 N
77293 RESPIRATOR MOTION MGMT SIMUL MAXFEE DEF TC       230.27 1/1/2024 12/31/2299 N
77293 RESPIRATOR MOTION MGMT SIMUL MAXFEE DEF 26       76.76 1/1/2024 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         1324.19 1/1/2024 12/31/2299 N
77301 RADIOTHERAPY DOSE PLAN IMRT MAXFEE DEF TC       926.93 1/1/2024 12/31/2299 N
77301 RADIOTHERAPY DOSE PLAN IMRT MAXFEE DEF 26       397.26 1/1/2024 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         109.04 1/1/2024 12/31/2299 N
77306 TELETHX ISODOSE PLAN SIMPLE MAXFEE DEF TC       54.52 1/1/2024 12/31/2299 N
77306 TELETHX ISODOSE PLAN SIMPLE MAXFEE DEF 26       54.52 1/1/2024 12/31/2299 N
77307 TELETHX ISODOSE PLAN CPLX PRXOVR DEF         NA NA NA N
77307 TELETHX ISODOSE PLAN CPLX MAXFEE DEF         213.07 1/1/2024 12/31/2299 N
77307 TELETHX ISODOSE PLAN CPLX MAXFEE DEF TC       106.53 1/1/2024 12/31/2299 N
77307 TELETHX ISODOSE PLAN CPLX MAXFEE DEF 26       106.54 1/1/2024 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 26       52.94 1/1/2018 12/31/2299 N
77316 BRACHYTX ISODOSE PLAN SIMPLE MAXFEE DEF         138.95 1/1/2024 12/31/2299 N
77316 BRACHYTX ISODOSE PLAN SIMPLE MAXFEE DEF TC       83.37 1/1/2024 12/31/2299 N
77316 BRACHYTX ISODOSE PLAN SIMPLE MAXFEE DEF 26       55.58 1/1/2024 12/31/2299 N
77317 BRACHYTX ISODOSE INTERMED PRXOVR DEF         NA NA NA N
77317 BRACHYTX ISODOSE INTERMED MAXFEE DEF         181.96 1/1/2024 12/31/2299 N
77317 BRACHYTX ISODOSE INTERMED MAXFEE DEF TC       109.18 1/1/2024 12/31/2299 N
77317 BRACHYTX ISODOSE INTERMED MAXFEE DEF 26       72.78 1/1/2024 12/31/2299 N
77318 BRACHYTX ISODOSE COMPLEX PRXOVR DEF         NA NA NA N
77318 BRACHYTX ISODOSE COMPLEX MAXFEE DEF         262.94 1/1/2024 12/31/2299 N
77318 BRACHYTX ISODOSE COMPLEX MAXFEE DEF TC       131.47 1/1/2024 12/31/2299 N
77318 BRACHYTX ISODOSE COMPLEX MAXFEE DEF 26       131.47 1/1/2024 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         49.25 1/1/2024 12/31/2299 N
77331 SPECIAL RADIATION DOSIMETRY MAXFEE DEF TC       14.78 1/1/2024 12/31/2299 N
77331 SPECIAL RADIATION DOSIMETRY MAXFEE DEF 26       34.48 1/1/2024 12/31/2299 N
77332 RADIATION TREATMENT AID(S) PRXOVR DEF         NA NA NA N
77332 RADIATION TREATMENT AID(S) MAXFEE DEF         36.73 1/1/2024 12/31/2299 N
77332 RADIATION TREATMENT AID(S) MAXFEE DEF TC       22.04 1/1/2024 12/31/2299 N
77332 RADIATION TREATMENT AID(S) MAXFEE DEF 26       14.69 1/1/2024 12/31/2299 N
77333 RADIATION TREATMENT AID(S) PRXOVR DEF         NA NA NA N
77333 RADIATION TREATMENT AID(S) MAXFEE DEF         64.91 1/1/2024 12/31/2299 N
77333 RADIATION TREATMENT AID(S) MAXFEE DEF TC       12.98 1/1/2024 12/31/2299 N
77333 RADIATION TREATMENT AID(S) MAXFEE DEF 26       51.93 1/1/2024 12/31/2299 N
77334 RADIATION TREATMENT AID(S) PRXOVR DEF         NA NA NA N
77334 RADIATION TREATMENT AID(S) MAXFEE DEF         118.96 1/1/2024 12/31/2299 N
77334 RADIATION TREATMENT AID(S) MAXFEE DEF TC       71.38 1/1/2024 12/31/2299 N
77334 RADIATION TREATMENT AID(S) MAXFEE DEF 26       47.58 1/1/2024 12/31/2299 N
77336 RADIATION PHYSICS CONSULT PRXOVR DEF         NA NA NA N
77336 RADIATION PHYSICS CONSULT MAXFEE DEF         52.83 1/1/2024 12/31/2299 N
77338 DESIGN MLC DEVICE FOR IMRT PRXOVR DEF         NA NA NA N
77338 DESIGN MLC DEVICE FOR IMRT MAXFEE DEF         261.91 1/1/2024 12/31/2299 N
77338 DESIGN MLC DEVICE FOR IMRT MAXFEE DEF TC       130.95 1/1/2024 12/31/2299 N
77338 DESIGN MLC DEVICE FOR IMRT MAXFEE DEF 26       130.96 1/1/2024 12/31/2299 N
77370 RADIATION PHYSICS CONSULT PRXOVR DEF         NA NA NA N
77370 RADIATION PHYSICS CONSULT MAXFEE DEF 26       0 1/1/2018 12/31/2299 N
77370 RADIATION PHYSICS CONSULT MAXFEE DEF         99.93 1/1/2024 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         651.47 1/1/2024 12/31/2299 N
77373 SBRT DELIVERY PRXOVR DEF         NA NA NA N
77373 SBRT DELIVERY MAXFEE DEF         930.49 1/1/2024 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
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         21.11 1/1/2024 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         9.40 1/1/2024 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         138.12 1/1/2024 12/31/2299 N
77431 RADIATION THERAPY MANAGEMENT PRXOVR DEF         NA NA NA N
77431 RADIATION THERAPY MANAGEMENT MAXFEE DEF         73.56 1/1/2024 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         503.76 1/1/2024 12/31/2299 N
77469 IO RADIATION TX MANAGEMENT PRXOVR DEF         NA NA NA N
77469 IO RADIATION TX MANAGEMENT MAXFEE DEF         234.66 1/1/2024 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         261.11 1/1/2024 12/31/2299 N
77600 HYPERTHERMIA TREATMENT MAXFEE DEF TC       182.78 1/1/2024 12/31/2299 N
77600 HYPERTHERMIA TREATMENT MAXFEE DEF 26       78.33 1/1/2024 12/31/2299 N
77605 HYPERTHERMIA TREATMENT PRXOVR DEF         NA NA NA N
77605 HYPERTHERMIA TREATMENT MAXFEE DEF         514.42 1/1/2024 12/31/2299 N
77605 HYPERTHERMIA TREATMENT MAXFEE DEF TC       360.09 1/1/2024 12/31/2299 N
77605 HYPERTHERMIA TREATMENT MAXFEE DEF 26       154.33 1/1/2024 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         479.75 1/1/2024 12/31/2299 N
77763 APPLY INTRCAV RADIAT COMPL MAXFEE DEF TC       143.93 1/1/2024 12/31/2299 N
77763 APPLY INTRCAV RADIAT COMPL MAXFEE DEF 26       335.83 1/1/2024 12/31/2299 N
77767 HDR RDNCL SKN SURF BRACHYTX PRXOVR DEF         NA NA NA N
77767 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF         169.04 1/1/2024 12/31/2299 N
77767 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF TC       126.78 1/1/2024 12/31/2299 N
77767 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF 26       42.26 1/1/2024 12/31/2299 N
77768 HDR RDNCL SKN SURF BRACHYTX PRXOVR DEF         NA NA NA N
77768 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF         264.15 1/1/2024 12/31/2299 N
77768 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF TC       211.32 1/1/2024 12/31/2299 N
77768 HDR RDNCL SKN SURF BRACHYTX MAXFEE DEF 26       52.83 1/1/2024 12/31/2299 N
77770 HDR RDNCL NTRSTL/ICAV BRCHTX PRXOVR DEF         NA NA NA N
77770 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF         242.35 1/1/2024 12/31/2299 N
77770 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF TC       201.26 1/1/2024 12/31/2299 N
77770 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF 26       50.31 1/1/2024 12/31/2299 N
77771 HDR RDNCL NTRSTL/ICAV BRCHTX PRXOVR DEF         NA NA NA N
77771 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF         451.92 1/1/2024 12/31/2299 N
77771 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF TC       293.75 1/1/2024 12/31/2299 N
77771 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF 26       158.17 1/1/2024 12/31/2299 N
77772 HDR RDNCL NTRSTL/ICAV BRCHTX PRXOVR DEF         NA NA NA N
77772 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF         688.46 1/1/2024 12/31/2299 N
77772 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF TC       447.50 1/1/2024 12/31/2299 N
77772 HDR RDNCL NTRSTL/ICAV BRCHTX MAXFEE DEF 26       240.96 1/1/2024 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         594.78 1/1/2024 12/31/2299 N
77778 APPLY INTERSTIT RADIAT COMPL MAXFEE DEF TC       178.43 1/1/2024 12/31/2299 N
77778 APPLY INTERSTIT RADIAT COMPL MAXFEE DEF 26       416.35 1/1/2024 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         67.48 1/1/2024 12/31/2299 N
77789 APPLY SURF LDR RADIONUCLIDE MAXFEE DEF TC       20.24 1/1/2024 12/31/2299 N
77789 APPLY SURF LDR RADIONUCLIDE MAXFEE DEF 26       47.24 1/1/2024 12/31/2299 N
77790 RADIATION HANDLING PRXOVR DEF         NA NA NA 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
77790 RADIATION HANDLING MAXFEE DEF         16.17 1/1/2024 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 MIN PRXOVR DEF         NA NA NA N
99202 OFFICE O/P NEW SF 15 MIN MAXFEE FAC         24.75 1/1/2024 12/31/2299 N
99202 OFFICE O/P NEW SF 15 MIN MAXFEE NFF         41.27 1/1/2024 12/31/2299 N
99203 OFFICE O/P NEW LOW 30 MIN PRXOVR DEF         NA NA NA N
99203 OFFICE O/P NEW LOW 30 MIN MAXFEE FAC         42.22 1/1/2024 12/31/2299 N
99203 OFFICE O/P NEW LOW 30 MIN MAXFEE NFF         61.22 1/1/2024 12/31/2299 N
99204 OFFICE O/P NEW MOD 45 MIN PRXOVR DEF         NA NA NA N
99204 OFFICE O/P NEW MOD 45 MIN MAXFEE FAC         68.35 1/1/2024 12/31/2299 N
99204 OFFICE O/P NEW MOD 45 MIN MAXFEE NFF         93.36 1/1/2024 12/31/2299 N
99205 OFFICE O/P NEW HI 60 MIN PRXOVR DEF         NA NA NA N
99205 OFFICE O/P NEW HI 60 MIN MAXFEE FAC         92.75 1/1/2024 12/31/2299 N
99205 OFFICE O/P NEW HI 60 MIN MAXFEE NFF         117.31 1/1/2024 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         5.88 1/1/2024 12/31/2299 N
99211 OFF/OP EST MAY X REQ PHY/QHP MAXFEE NFF         15.37 1/1/2024 12/31/2299 N
99212 OFFICE O/P EST SF 10 MIN PRXOVR DEF         NA NA NA N
99212 OFFICE O/P EST SF 10 MIN MAXFEE FAC         18.34 1/1/2024 12/31/2299 N
99212 OFFICE O/P EST SF 10 MIN MAXFEE NFF         28.73 1/1/2024 12/31/2299 N
99213 OFFICE O/P EST LOW 20 MIN PRXOVR DEF         NA NA NA N
99213 OFFICE O/P EST LOW 20 MIN MAXFEE FAC         33.74 1/1/2024 12/31/2299 N
99213 OFFICE O/P EST LOW 20 MIN MAXFEE NFF         46.23 1/1/2024 12/31/2299 N
99214 OFFICE O/P EST MOD 30 MIN PRXOVR DEF         NA NA NA N
99214 OFFICE O/P EST MOD 30 MIN MAXFEE FAC         49.49 1/1/2024 12/31/2299 N
99214 OFFICE O/P EST MOD 30 MIN MAXFEE NFF         70.11 1/1/2024 12/31/2299 N
99215 OFFICE O/P EST HI 40 MIN PRXOVR DEF         NA NA NA N
99215 OFFICE O/P EST HI 40 MIN MAXFEE FAC         73.54 1/1/2024 12/31/2299 N
99215 OFFICE O/P EST HI 40 MIN MAXFEE NFF         95.01 1/1/2024 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         33.92 1/1/2024 12/31/2299 N
99242 OFF/OP CONSLTJ NEW/EST SF 20 MAXFEE NFF         44.13 1/1/2024 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         47.76 1/1/2024 12/31/2299 N
99243 OFF/OP CNSLTJ NEW/EST LOW 30 MAXFEE NFF         60.74 1/1/2024 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         76.31 1/1/2024 12/31/2299 N
99244 OFF/OP CNSLTJ NEW/EST MOD 40 MAXFEE NFF         90.50 1/1/2024 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         94.48 1/1/2024 12/31/2299 N
99245 OFF/OP CONSLTJ NEW/EST HI 55 MAXFEE NFF         110.40 1/1/2024 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         22.87 1/1/2024 12/31/2299 N
99417 PROLNG OP E/M EACH 15 MIN MAXFEE NFF         23.83 1/1/2024 12/31/2299 N
G2212 PROLONG OUTPT/OFFICE VIS PRXOVR DEF         NA NA NA N
G2212 PROLONG OUTPT/OFFICE VIS MAXFEE FAC         22.66 1/1/2024 12/31/2299 N
G2212 PROLONG OUTPT/OFFICE VIS MAXFEE NFF         23.60 1/1/2024 12/31/2299 N