Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
70010	CONTRAST X-RAY OF BRAIN	PRXOVR	DEF					NA	NA	NA	N
70010	CONTRAST X-RAY OF BRAIN	MAXFEE	DEF					54.15	1/1/2018	12/31/2299	N
70015	CONTRAST X-RAY OF BRAIN	PRXOVR	DEF					NA	NA	NA	N
70015	CONTRAST X-RAY OF BRAIN	MAXFEE	DEF					81.94	1/1/2018	12/31/2299	N
70015	CONTRAST X-RAY OF BRAIN	MAXFEE	DEF	26				40.97	1/1/2018	12/31/2299	N
70015	CONTRAST X-RAY OF BRAIN	MAXFEE	DEF	TC				40.97	1/1/2018	12/31/2299	N
70030	X-RAY EYE FOR FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
70030	X-RAY EYE FOR FOREIGN BODY	MAXFEE	DEF					17.94	1/1/2018	12/31/2299	N
70030	X-RAY EYE FOR FOREIGN BODY	MAXFEE	DEF	26				7.18	1/1/2018	12/31/2299	N
70030	X-RAY EYE FOR FOREIGN BODY	MAXFEE	DEF	TC				10.76	1/1/2018	12/31/2299	N
70100	X-RAY EXAM OF JAW <4VIEWS	PRXOVR	DEF					NA	NA	NA	N
70100	X-RAY EXAM OF JAW <4VIEWS	MAXFEE	DEF					21.17	1/1/2018	12/31/2299	N
70100	X-RAY EXAM OF JAW <4VIEWS	MAXFEE	DEF	26				7.41	1/1/2018	12/31/2299	N
70100	X-RAY EXAM OF JAW <4VIEWS	MAXFEE	DEF	TC				13.76	1/1/2018	12/31/2299	N
70110	X-RAY EXAM OF JAW 4/> VIEWS	PRXOVR	DEF					NA	NA	NA	N
70110	X-RAY EXAM OF JAW 4/> VIEWS	MAXFEE	DEF					26.60	1/1/2018	12/31/2299	N
70110	X-RAY EXAM OF JAW 4/> VIEWS	MAXFEE	DEF	26				7.98	1/1/2018	12/31/2299	N
70110	X-RAY EXAM OF JAW 4/> VIEWS	MAXFEE	DEF	TC				18.62	1/1/2018	12/31/2299	N
70120	X-RAY EXAM OF MASTOIDS	PRXOVR	DEF					NA	NA	NA	N
70120	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF					23.87	1/1/2018	12/31/2299	N
70120	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF	26				5.97	1/1/2018	12/31/2299	N
70120	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF	TC				17.90	1/1/2018	12/31/2299	N
70130	X-RAY EXAM OF MASTOIDS	PRXOVR	DEF					NA	NA	NA	N
70130	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF					34.44	1/1/2018	12/31/2299	N
70130	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF	26				13.78	1/1/2018	12/31/2299	N
70130	X-RAY EXAM OF MASTOIDS	MAXFEE	DEF	TC				20.66	1/1/2018	12/31/2299	N
70134	X-RAY EXAM OF MIDDLE EAR	PRXOVR	DEF					NA	NA	NA	N
70134	X-RAY EXAM OF MIDDLE EAR	MAXFEE	DEF					33.08	1/1/2018	12/31/2299	N
70134	X-RAY EXAM OF MIDDLE EAR	MAXFEE	DEF	26				13.23	1/1/2018	12/31/2299	N
70134	X-RAY EXAM OF MIDDLE EAR	MAXFEE	DEF	TC				19.85	1/1/2018	12/31/2299	N
70140	X-RAY EXAM OF FACIAL BONES	PRXOVR	DEF					NA	NA	NA	N
70140	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF					24.13	1/1/2018	12/31/2299	N
70140	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF	26				8.45	1/1/2018	12/31/2299	N
70140	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF	TC				15.68	1/1/2018	12/31/2299	N
70150	X-RAY EXAM OF FACIAL BONES	PRXOVR	DEF					NA	NA	NA	N
70150	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF					31.48	1/1/2018	12/31/2299	N
70150	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF	26				11.02	1/1/2018	12/31/2299	N
70150	X-RAY EXAM OF FACIAL BONES	MAXFEE	DEF	TC				20.46	1/1/2018	12/31/2299	N
70160	X-RAY EXAM OF NASAL BONES	PRXOVR	DEF					NA	NA	NA	N
70160	X-RAY EXAM OF NASAL BONES	MAXFEE	DEF					20.66	1/1/2018	12/31/2299	N
70160	X-RAY EXAM OF NASAL BONES	MAXFEE	DEF	26				7.23	1/1/2018	12/31/2299	N
70160	X-RAY EXAM OF NASAL BONES	MAXFEE	DEF	TC				13.43	1/1/2018	12/31/2299	N
70170	X-RAY EXAM OF TEAR DUCT	PRXOVR	DEF					NA	NA	NA	N
70170	X-RAY EXAM OF TEAR DUCT	MAXFEE	DEF					137.51	1/1/2018	12/31/2299	N
70170	X-RAY EXAM OF TEAR DUCT	MAXFEE	DEF	26				13.75	1/1/2018	12/31/2299	N
70170	X-RAY EXAM OF TEAR DUCT	MAXFEE	DEF	TC				123.76	1/1/2018	12/31/2299	N
70190	X-RAY EXAM OF EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
70190	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF					24.84	1/1/2018	12/31/2299	N
70190	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF	26				8.69	1/1/2018	12/31/2299	N
70190	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF	TC				16.15	1/1/2018	12/31/2299	N
70200	X-RAY EXAM OF EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
70200	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF					31.23	1/1/2018	12/31/2299	N
70200	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF	26				10.93	1/1/2018	12/31/2299	N
70200	X-RAY EXAM OF EYE SOCKETS	MAXFEE	DEF	TC				20.30	1/1/2018	12/31/2299	N
70210	X-RAY EXAM OF SINUSES	PRXOVR	DEF					NA	NA	NA	N
70210	X-RAY EXAM OF SINUSES	MAXFEE	DEF					23.36	1/1/2018	12/31/2299	N
70210	X-RAY EXAM OF SINUSES	MAXFEE	DEF	26				7.01	1/1/2018	12/31/2299	N
70210	X-RAY EXAM OF SINUSES	MAXFEE	DEF	TC				16.35	1/1/2018	12/31/2299	N
70220	X-RAY EXAM OF SINUSES	PRXOVR	DEF					NA	NA	NA	N
70220	X-RAY EXAM OF SINUSES	MAXFEE	DEF					30.23	1/1/2018	12/31/2299	N
70220	X-RAY EXAM OF SINUSES	MAXFEE	DEF	26				10.58	1/1/2018	12/31/2299	N
70220	X-RAY EXAM OF SINUSES	MAXFEE	DEF	TC				19.65	1/1/2018	12/31/2299	N
70240	X-RAY EXAM PITUITARY SADDLE	PRXOVR	DEF					NA	NA	NA	N
70240	X-RAY EXAM PITUITARY SADDLE	MAXFEE	DEF					18.71	1/1/2018	12/31/2299	N
70240	X-RAY EXAM PITUITARY SADDLE	MAXFEE	DEF	26				7.48	1/1/2018	12/31/2299	N
70240	X-RAY EXAM PITUITARY SADDLE	MAXFEE	DEF	TC				11.23	1/1/2018	12/31/2299	N
70250	X-RAY EXAM OF SKULL	PRXOVR	DEF					NA	NA	NA	N
70250	X-RAY EXAM OF SKULL	MAXFEE	DEF					26.15	1/1/2018	12/31/2299	N
70250	X-RAY EXAM OF SKULL	MAXFEE	DEF	26				7.85	1/1/2018	12/31/2299	N
70250	X-RAY EXAM OF SKULL	MAXFEE	DEF	TC				18.31	1/1/2018	12/31/2299	N
70260	X-RAY EXAM OF SKULL	PRXOVR	DEF					NA	NA	NA	N
70260	X-RAY EXAM OF SKULL	MAXFEE	DEF					37.45	1/1/2018	12/31/2299	N
70260	X-RAY EXAM OF SKULL	MAXFEE	DEF	26				11.24	1/1/2018	12/31/2299	N
70260	X-RAY EXAM OF SKULL	MAXFEE	DEF	TC				26.22	1/1/2018	12/31/2299	N
70300	X-RAY EXAM OF TEETH	PRXOVR	DEF					NA	NA	NA	N
70300	X-RAY EXAM OF TEETH	MAXFEE	DEF					11.27	1/1/2018	12/31/2299	N
70300	X-RAY EXAM OF TEETH	MAXFEE	DEF	26				4.51	1/1/2018	12/31/2299	N
70300	X-RAY EXAM OF TEETH	MAXFEE	DEF	TC				6.76	1/1/2018	12/31/2299	N
70310	X-RAY EXAM OF TEETH	PRXOVR	DEF					NA	NA	NA	N
70310	X-RAY EXAM OF TEETH	MAXFEE	DEF					17.55	1/1/2018	12/31/2299	N
70310	X-RAY EXAM OF TEETH	MAXFEE	DEF	26				5.27	1/1/2018	12/31/2299	N
70310	X-RAY EXAM OF TEETH	MAXFEE	DEF	TC				12.29	1/1/2018	12/31/2299	N
70320	FULL MOUTH X-RAY OF TEETH	PRXOVR	DEF					NA	NA	NA	N
70320	FULL MOUTH X-RAY OF TEETH	MAXFEE	DEF					30	1/1/2018	12/31/2299	N
70320	FULL MOUTH X-RAY OF TEETH	MAXFEE	DEF	26				9	1/1/2018	12/31/2299	N
70320	FULL MOUTH X-RAY OF TEETH	MAXFEE	DEF	TC				21	1/1/2018	12/31/2299	N
70328	X-RAY EXAM OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
70328	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF					20.37	1/1/2018	12/31/2299	N
70328	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF	26				6.11	1/1/2018	12/31/2299	N
70328	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF	TC				14.26	1/1/2018	12/31/2299	N
70330	X-RAY EXAM OF JAW JOINTS	PRXOVR	DEF					NA	NA	NA	N
70330	X-RAY EXAM OF JAW JOINTS	MAXFEE	DEF					32.14	1/1/2018	12/31/2299	N
70330	X-RAY EXAM OF JAW JOINTS	MAXFEE	DEF	26				9.64	1/1/2018	12/31/2299	N
70330	X-RAY EXAM OF JAW JOINTS	MAXFEE	DEF	TC				22.50	1/1/2018	12/31/2299	N
70332	X-RAY EXAM OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
70332	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF					59.21	1/1/2018	12/31/2299	N
70332	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF	26				20.72	1/1/2018	12/31/2299	N
70332	X-RAY EXAM OF JAW JOINT	MAXFEE	DEF	TC				38.49	1/1/2018	12/31/2299	N
70336	MAGNETIC IMAGE JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
70336	MAGNETIC IMAGE JAW JOINT	MAXFEE	DEF					262.42	1/1/2018	12/31/2299	N
70336	MAGNETIC IMAGE JAW JOINT	MAXFEE	DEF	26				52.48	1/1/2018	12/31/2299	N
70336	MAGNETIC IMAGE JAW JOINT	MAXFEE	DEF	TC				209.94	1/1/2018	12/31/2299	N
70350	X-RAY HEAD FOR ORTHODONTIA	PRXOVR	DEF					NA	NA	NA	N
70350	X-RAY HEAD FOR ORTHODONTIA	MAXFEE	DEF					16.67	1/1/2018	12/31/2299	N
70350	X-RAY HEAD FOR ORTHODONTIA	MAXFEE	DEF	26				6.67	1/1/2018	12/31/2299	N
70350	X-RAY HEAD FOR ORTHODONTIA	MAXFEE	DEF	TC				10	1/1/2018	12/31/2299	N
70355	PANORAMIC X-RAY OF JAWS	PRXOVR	DEF					NA	NA	NA	N
70355	PANORAMIC X-RAY OF JAWS	MAXFEE	DEF					17.49	1/1/2018	12/31/2299	N
70355	PANORAMIC X-RAY OF JAWS	MAXFEE	DEF	26				6.12	1/1/2018	12/31/2299	N
70355	PANORAMIC X-RAY OF JAWS	MAXFEE	DEF	TC				11.37	1/1/2018	12/31/2299	N
70360	X-RAY EXAM OF NECK	PRXOVR	DEF					NA	NA	NA	N
70360	X-RAY EXAM OF NECK	MAXFEE	DEF					17.94	1/1/2018	12/31/2299	N
70360	X-RAY EXAM OF NECK	MAXFEE	DEF	26				5.38	1/1/2018	12/31/2299	N
70360	X-RAY EXAM OF NECK	MAXFEE	DEF	TC				12.56	1/1/2018	12/31/2299	N
70370	THROAT X-RAY & FLUOROSCOPY	PRXOVR	DEF					NA	NA	NA	N
70370	THROAT X-RAY & FLUOROSCOPY	MAXFEE	DEF					47.50	1/1/2018	12/31/2299	N
70370	THROAT X-RAY & FLUOROSCOPY	MAXFEE	DEF	26				14.25	1/1/2018	12/31/2299	N
70370	THROAT X-RAY & FLUOROSCOPY	MAXFEE	DEF	TC				33.25	1/1/2018	12/31/2299	N
70371	SPEECH EVALUATION COMPLEX	PRXOVR	DEF					NA	NA	NA	N
70371	SPEECH EVALUATION COMPLEX	MAXFEE	DEF					80.29	1/1/2018	12/31/2299	N
70371	SPEECH EVALUATION COMPLEX	MAXFEE	DEF	26				32.12	1/1/2018	12/31/2299	N
70371	SPEECH EVALUATION COMPLEX	MAXFEE	DEF	TC				48.17	1/1/2018	12/31/2299	N
70373	CONTRAST X-RAY OF LARYNX	PRXOVR	DEF					NA	NA	NA	N
70373	CONTRAST X-RAY OF LARYNX	MAXFEE	DEF					NA			N
70380	X-RAY EXAM OF SALIVARY GLAND	PRXOVR	DEF					NA	NA	NA	N
70380	X-RAY EXAM OF SALIVARY GLAND	MAXFEE	DEF					24.66	1/1/2018	12/31/2299	N
70380	X-RAY EXAM OF SALIVARY GLAND	MAXFEE	DEF	26				7.40	1/1/2018	12/31/2299	N
70380	X-RAY EXAM OF SALIVARY GLAND	MAXFEE	DEF	TC				17.26	1/1/2018	12/31/2299	N
70390	X-RAY EXAM OF SALIVARY DUCT	PRXOVR	DEF					NA	NA	NA	N
70390	X-RAY EXAM OF SALIVARY DUCT	MAXFEE	DEF					62.68	1/1/2018	12/31/2299	N
70390	X-RAY EXAM OF SALIVARY DUCT	MAXFEE	DEF	26				15.67	1/1/2018	12/31/2299	N
70390	X-RAY EXAM OF SALIVARY DUCT	MAXFEE	DEF	TC				47.01	1/1/2018	12/31/2299	N
70450	CT HEAD/BRAIN W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70450	CT HEAD/BRAIN W/O DYE	MAXFEE	DEF					100.97	1/1/2018	12/31/2299	N
70450	CT HEAD/BRAIN W/O DYE	MAXFEE	DEF	26				35.34	1/1/2018	12/31/2299	N
70450	CT HEAD/BRAIN W/O DYE	MAXFEE	DEF	TC				65.63	1/1/2018	12/31/2299	N
70460	CT HEAD/BRAIN W/DYE	PRXOVR	DEF					NA	NA	NA	N
70460	CT HEAD/BRAIN W/DYE	MAXFEE	DEF					137.87	1/1/2018	12/31/2299	N
70460	CT HEAD/BRAIN W/DYE	MAXFEE	DEF	26				48.25	1/1/2018	12/31/2299	N
70460	CT HEAD/BRAIN W/DYE	MAXFEE	DEF	TC				89.62	1/1/2018	12/31/2299	N
70470	CT HEAD/BRAIN W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
70470	CT HEAD/BRAIN W/O & W/DYE	MAXFEE	DEF					162.60	1/1/2018	12/31/2299	N
70470	CT HEAD/BRAIN W/O & W/DYE	MAXFEE	DEF	26				48.78	1/1/2018	12/31/2299	N
70470	CT HEAD/BRAIN W/O & W/DYE	MAXFEE	DEF	TC				113.82	1/1/2018	12/31/2299	N
70480	CT ORBIT/EAR/FOSSA W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70480	CT ORBIT/EAR/FOSSA W/O DYE	MAXFEE	DEF					157	1/1/2018	12/31/2299	N
70480	CT ORBIT/EAR/FOSSA W/O DYE	MAXFEE	DEF	26				47.10	1/1/2018	12/31/2299	N
70480	CT ORBIT/EAR/FOSSA W/O DYE	MAXFEE	DEF	TC				109.90	1/1/2018	12/31/2299	N
70481	CT ORBIT/EAR/FOSSA W/DYE	PRXOVR	DEF					NA	NA	NA	N
70481	CT ORBIT/EAR/FOSSA W/DYE	MAXFEE	DEF					205.38	1/1/2018	12/31/2299	N
70481	CT ORBIT/EAR/FOSSA W/DYE	MAXFEE	DEF	26				51.35	1/1/2018	12/31/2299	N
70481	CT ORBIT/EAR/FOSSA W/DYE	MAXFEE	DEF	TC				154.03	1/1/2018	12/31/2299	N
70482	CT ORBIT/EAR/FOSSA W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
70482	CT ORBIT/EAR/FOSSA W/O&W/DYE	MAXFEE	DEF					246.35	1/1/2018	12/31/2299	N
70482	CT ORBIT/EAR/FOSSA W/O&W/DYE	MAXFEE	DEF	26				61.59	1/1/2018	12/31/2299	N
70482	CT ORBIT/EAR/FOSSA W/O&W/DYE	MAXFEE	DEF	TC				184.76	1/1/2018	12/31/2299	N
70486	CT MAXILLOFACIAL W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70486	CT MAXILLOFACIAL W/O DYE	MAXFEE	DEF					118.49	1/1/2018	12/31/2299	N
70486	CT MAXILLOFACIAL W/O DYE	MAXFEE	DEF	26				35.55	1/1/2018	12/31/2299	N
70486	CT MAXILLOFACIAL W/O DYE	MAXFEE	DEF	TC				82.94	1/1/2018	12/31/2299	N
70487	CT MAXILLOFACIAL W/DYE	PRXOVR	DEF					NA	NA	NA	N
70487	CT MAXILLOFACIAL W/DYE	MAXFEE	DEF					142.97	1/1/2018	12/31/2299	N
70487	CT MAXILLOFACIAL W/DYE	MAXFEE	DEF	26				42.89	1/1/2018	12/31/2299	N
70487	CT MAXILLOFACIAL W/DYE	MAXFEE	DEF	TC				100.08	1/1/2018	12/31/2299	N
70488	CT MAXILLOFACIAL W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
70488	CT MAXILLOFACIAL W/O & W/DYE	MAXFEE	DEF					173.56	1/1/2018	12/31/2299	N
70488	CT MAXILLOFACIAL W/O & W/DYE	MAXFEE	DEF	26				52.07	1/1/2018	12/31/2299	N
70488	CT MAXILLOFACIAL W/O & W/DYE	MAXFEE	DEF	TC				121.49	1/1/2018	12/31/2299	N
70490	CT SOFT TISSUE NECK W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70490	CT SOFT TISSUE NECK W/O DYE	MAXFEE	DEF					157	1/1/2018	12/31/2299	N
70490	CT SOFT TISSUE NECK W/O DYE	MAXFEE	DEF	26				47.10	1/1/2018	12/31/2299	N
70490	CT SOFT TISSUE NECK W/O DYE	MAXFEE	DEF	TC				109.90	1/1/2018	12/31/2299	N
70491	CT SOFT TISSUE NECK W/DYE	PRXOVR	DEF					NA	NA	NA	N
70491	CT SOFT TISSUE NECK W/DYE	MAXFEE	DEF					205.38	1/1/2018	12/31/2299	N
70491	CT SOFT TISSUE NECK W/DYE	MAXFEE	DEF	26				61.61	1/1/2018	12/31/2299	N
70491	CT SOFT TISSUE NECK W/DYE	MAXFEE	DEF	TC				143.77	1/1/2018	12/31/2299	N
70492	CT SFT TSUE NCK W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
70492	CT SFT TSUE NCK W/O & W/DYE	MAXFEE	DEF					246.29	1/1/2018	12/31/2299	N
70492	CT SFT TSUE NCK W/O & W/DYE	MAXFEE	DEF	26				61.57	1/1/2018	12/31/2299	N
70492	CT SFT TSUE NCK W/O & W/DYE	MAXFEE	DEF	TC				184.72	1/1/2018	12/31/2299	N
70496	CT ANGIOGRAPHY HEAD	PRXOVR	DEF					NA	NA	NA	N
70496	CT ANGIOGRAPHY HEAD	MAXFEE	DEF					250.20	1/1/2018	12/31/2299	N
70496	CT ANGIOGRAPHY HEAD	MAXFEE	DEF	26				62.55	1/1/2018	12/31/2299	N
70496	CT ANGIOGRAPHY HEAD	MAXFEE	DEF	TC				187.65	1/1/2018	12/31/2299	N
70498	CT ANGIOGRAPHY NECK	PRXOVR	DEF					NA	NA	NA	N
70498	CT ANGIOGRAPHY NECK	MAXFEE	DEF					248.71	1/1/2018	12/31/2299	N
70498	CT ANGIOGRAPHY NECK	MAXFEE	DEF	26				62.18	1/1/2018	12/31/2299	N
70498	CT ANGIOGRAPHY NECK	MAXFEE	DEF	TC				186.53	1/1/2018	12/31/2299	N
70540	MRI ORBIT/FACE/NECK W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70540	MRI ORBIT/FACE/NECK W/O DYE	MAXFEE	DEF					291.79	1/1/2018	12/31/2299	N
70540	MRI ORBIT/FACE/NECK W/O DYE	MAXFEE	DEF	26				58.36	1/1/2018	12/31/2299	N
70540	MRI ORBIT/FACE/NECK W/O DYE	MAXFEE	DEF	TC				233.43	1/1/2018	12/31/2299	N
70541	MAGNETIC IMAGE; HEAD (MRA)	PRXOVR	DEF					NA	NA	NA	N
70541	MAGNETIC IMAGE; HEAD (MRA)	MAXFEE	DEF					NA			N
70542	MRI ORBIT/FACE/NECK W/DYE	PRXOVR	DEF					NA	NA	NA	N
70542	MRI ORBIT/FACE/NECK W/DYE	MAXFEE	DEF					333.54	1/1/2018	12/31/2299	N
70542	MRI ORBIT/FACE/NECK W/DYE	MAXFEE	DEF	26				66.71	1/1/2018	12/31/2299	N
70542	MRI ORBIT/FACE/NECK W/DYE	MAXFEE	DEF	TC				266.83	1/1/2018	12/31/2299	N
70543	MRI ORBT/FAC/NCK W/O &W/DYE	PRXOVR	DEF					NA	NA	NA	N
70543	MRI ORBT/FAC/NCK W/O &W/DYE	MAXFEE	DEF					408.63	1/1/2018	12/31/2299	N
70543	MRI ORBT/FAC/NCK W/O &W/DYE	MAXFEE	DEF	26				81.73	1/1/2018	12/31/2299	N
70543	MRI ORBT/FAC/NCK W/O &W/DYE	MAXFEE	DEF	TC				326.90	1/1/2018	12/31/2299	N
70544	MR ANGIOGRAPHY HEAD W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70544	MR ANGIOGRAPHY HEAD W/O DYE	MAXFEE	DEF					291.30	1/1/2018	12/31/2299	N
70544	MR ANGIOGRAPHY HEAD W/O DYE	MAXFEE	DEF	26				58.26	1/1/2018	12/31/2299	N
70544	MR ANGIOGRAPHY HEAD W/O DYE	MAXFEE	DEF	TC				233.04	1/1/2018	12/31/2299	N
70545	MR ANGIOGRAPHY HEAD W/DYE	PRXOVR	DEF					NA	NA	NA	N
70545	MR ANGIOGRAPHY HEAD W/DYE	MAXFEE	DEF					321.62	1/1/2018	12/31/2299	N
70545	MR ANGIOGRAPHY HEAD W/DYE	MAXFEE	DEF	26				64.32	1/1/2018	12/31/2299	N
70545	MR ANGIOGRAPHY HEAD W/DYE	MAXFEE	DEF	TC				257.30	1/1/2018	12/31/2299	N
70546	MR ANGIOGRAPH HEAD W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
70546	MR ANGIOGRAPH HEAD W/O&W/DYE	MAXFEE	DEF					490.36	1/1/2018	12/31/2299	N
70546	MR ANGIOGRAPH HEAD W/O&W/DYE	MAXFEE	DEF	26				98.07	1/1/2018	12/31/2299	N
70546	MR ANGIOGRAPH HEAD W/O&W/DYE	MAXFEE	DEF	TC				392.29	1/1/2018	12/31/2299	N
70547	MR ANGIOGRAPHY NECK W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70547	MR ANGIOGRAPHY NECK W/O DYE	MAXFEE	DEF					290.98	1/1/2018	12/31/2299	N
70547	MR ANGIOGRAPHY NECK W/O DYE	MAXFEE	DEF	26				58.20	1/1/2018	12/31/2299	N
70547	MR ANGIOGRAPHY NECK W/O DYE	MAXFEE	DEF	TC				232.78	1/1/2018	12/31/2299	N
70548	MR ANGIOGRAPHY NECK W/DYE	PRXOVR	DEF					NA	NA	NA	N
70548	MR ANGIOGRAPHY NECK W/DYE	MAXFEE	DEF					346.70	1/1/2018	12/31/2299	N
70548	MR ANGIOGRAPHY NECK W/DYE	MAXFEE	DEF	26				69.34	1/1/2018	12/31/2299	N
70548	MR ANGIOGRAPHY NECK W/DYE	MAXFEE	DEF	TC				277.36	1/1/2018	12/31/2299	N
70549	MR ANGIOGRAPH NECK W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
70549	MR ANGIOGRAPH NECK W/O&W/DYE	MAXFEE	DEF					481.38	1/1/2018	12/31/2299	N
70549	MR ANGIOGRAPH NECK W/O&W/DYE	MAXFEE	DEF	26				96.28	1/1/2018	12/31/2299	N
70549	MR ANGIOGRAPH NECK W/O&W/DYE	MAXFEE	DEF	TC				385.10	1/1/2018	12/31/2299	N
70551	MRI BRAIN STEM W/O DYE	PRXOVR	DEF					NA	NA	NA	N
70551	MRI BRAIN STEM W/O DYE	MAXFEE	DEF					199.37	1/1/2018	12/31/2299	N
70551	MRI BRAIN STEM W/O DYE	MAXFEE	DEF	26				59.81	1/1/2018	12/31/2299	N
70551	MRI BRAIN STEM W/O DYE	MAXFEE	DEF	TC				139.56	1/1/2018	12/31/2299	N
70552	MRI BRAIN STEM W/DYE	PRXOVR	DEF					NA	NA	NA	N
70552	MRI BRAIN STEM W/DYE	MAXFEE	DEF					270.66	1/1/2018	12/31/2299	N
70552	MRI BRAIN STEM W/DYE	MAXFEE	DEF	26				81.20	1/1/2018	12/31/2299	N
70552	MRI BRAIN STEM W/DYE	MAXFEE	DEF	TC				189.46	1/1/2018	12/31/2299	N
70553	MRI BRAIN STEM W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
70553	MRI BRAIN STEM W/O & W/DYE	MAXFEE	DEF					319.74	1/1/2018	12/31/2299	N
70553	MRI BRAIN STEM W/O & W/DYE	MAXFEE	DEF	26				95.92	1/1/2018	12/31/2299	N
70553	MRI BRAIN STEM W/O & W/DYE	MAXFEE	DEF	TC				223.82	1/1/2018	12/31/2299	N
70554	FMRI BRAIN BY TECH	PRXOVR	DEF					NA	NA	NA	N
70554	FMRI BRAIN BY TECH	MAXFEE	DEF					380.72	1/1/2018	12/31/2299	N
70554	FMRI BRAIN BY TECH	MAXFEE	DEF	26				76.14	1/1/2018	12/31/2299	N
70554	FMRI BRAIN BY TECH	MAXFEE	DEF	TC				304.58	1/1/2018	12/31/2299	N
71010	CHEST X-RAY 1 VIEW FRONTAL	PRXOVR	DEF					NA	NA	NA	N
71010	CHEST X-RAY 1 VIEW FRONTAL	MAXFEE	DEF					19.10	1/1/2018	12/31/2299	N
71010	CHEST X-RAY 1 VIEW FRONTAL	MAXFEE	DEF	26				5.73	1/1/2018	12/31/2299	N
71010	CHEST X-RAY 1 VIEW FRONTAL	MAXFEE	DEF	TC				13.37	1/1/2018	12/31/2299	N
71015	CHEST X-RAY STEREO FRONTAL	PRXOVR	DEF					NA	NA	NA	N
71015	CHEST X-RAY STEREO FRONTAL	MAXFEE	DEF					22.20	1/1/2018	12/31/2299	N
71015	CHEST X-RAY STEREO FRONTAL	MAXFEE	DEF	26				6.66	1/1/2018	12/31/2299	N
71015	CHEST X-RAY STEREO FRONTAL	MAXFEE	DEF	TC				15.54	1/1/2018	12/31/2299	N
71020	CHEST X-RAY 2VW FRONTAL&LATL	PRXOVR	DEF					NA	NA	NA	N
71020	CHEST X-RAY 2VW FRONTAL&LATL	MAXFEE	DEF					24.41	1/1/2018	12/31/2299	N
71020	CHEST X-RAY 2VW FRONTAL&LATL	MAXFEE	DEF	26				8.54	1/1/2018	12/31/2299	N
71020	CHEST X-RAY 2VW FRONTAL&LATL	MAXFEE	DEF	TC				15.87	1/1/2018	12/31/2299	N
71021	CHEST X-RAY FRNT LAT LORDOTC	PRXOVR	DEF					NA	NA	NA	N
71021	CHEST X-RAY FRNT LAT LORDOTC	MAXFEE	DEF					30.38	1/1/2018	12/31/2299	N
71021	CHEST X-RAY FRNT LAT LORDOTC	MAXFEE	DEF	26				10.63	1/1/2018	12/31/2299	N
71021	CHEST X-RAY FRNT LAT LORDOTC	MAXFEE	DEF	TC				19.75	1/1/2018	12/31/2299	N
71022	CHEST X-RAY FRNT LAT OBLIQUE	PRXOVR	DEF					NA	NA	NA	N
71022	CHEST X-RAY FRNT LAT OBLIQUE	MAXFEE	DEF					31.86	1/1/2018	12/31/2299	N
71022	CHEST X-RAY FRNT LAT OBLIQUE	MAXFEE	DEF	26				9.56	1/1/2018	12/31/2299	N
71022	CHEST X-RAY FRNT LAT OBLIQUE	MAXFEE	DEF	TC				22.30	1/1/2018	12/31/2299	N
71023	CHEST X-RAY AND FLUOROSCOPY	PRXOVR	DEF					NA	NA	NA	N
71023	CHEST X-RAY AND FLUOROSCOPY	MAXFEE	DEF					35.86	1/1/2018	12/31/2299	N
71023	CHEST X-RAY AND FLUOROSCOPY	MAXFEE	DEF	26				10.76	1/1/2018	12/31/2299	N
71023	CHEST X-RAY AND FLUOROSCOPY	MAXFEE	DEF	TC				25.10	1/1/2018	12/31/2299	N
71030	CHEST X-RAY 4/> VIEWS	PRXOVR	DEF					NA	NA	NA	N
71030	CHEST X-RAY 4/> VIEWS	MAXFEE	DEF					33.22	1/1/2018	12/31/2299	N
71030	CHEST X-RAY 4/> VIEWS	MAXFEE	DEF	26				9.97	1/1/2018	12/31/2299	N
71030	CHEST X-RAY 4/> VIEWS	MAXFEE	DEF	TC				23.25	1/1/2018	12/31/2299	N
71034	CHEST X-RAY&FLUORO 4/> VIEWS	PRXOVR	DEF					NA	NA	NA	N
71034	CHEST X-RAY&FLUORO 4/> VIEWS	MAXFEE	DEF					56.65	1/1/2018	12/31/2299	N
71034	CHEST X-RAY&FLUORO 4/> VIEWS	MAXFEE	DEF	26				19.83	1/1/2018	12/31/2299	N
71034	CHEST X-RAY&FLUORO 4/> VIEWS	MAXFEE	DEF	TC				36.82	1/1/2018	12/31/2299	N
71035	CHEST X-RAY SPECIAL VIEWS	PRXOVR	DEF					NA	NA	NA	N
71035	CHEST X-RAY SPECIAL VIEWS	MAXFEE	DEF					20.99	1/1/2018	12/31/2299	N
71035	CHEST X-RAY SPECIAL VIEWS	MAXFEE	DEF	26				7.35	1/1/2018	12/31/2299	N
71035	CHEST X-RAY SPECIAL VIEWS	MAXFEE	DEF	TC				13.64	1/1/2018	12/31/2299	N
71040	CONTRAST X-RAY OF BRONCHI	PRXOVR	DEF					NA	NA	NA	N
71040	CONTRAST X-RAY OF BRONCHI	MAXFEE	DEF					NA			N
71045	X-RAY EXAM CHEST 1 VIEW	PRXOVR	DEF					NA	NA	NA	N
71045	X-RAY EXAM CHEST 1 VIEW	MAXFEE	DEF					14.27	1/1/2018	12/31/2299	N
71045	X-RAY EXAM CHEST 1 VIEW	MAXFEE	DEF	26				6.82	1/1/2018	12/31/2299	N
71045	X-RAY EXAM CHEST 1 VIEW	MAXFEE	DEF	TC				7.45	1/1/2018	12/31/2299	N
71046	X-RAY EXAM CHEST 2 VIEWS	PRXOVR	DEF					NA	NA	NA	N
71046	X-RAY EXAM CHEST 2 VIEWS	MAXFEE	DEF					21.77	1/1/2018	12/31/2299	N
71046	X-RAY EXAM CHEST 2 VIEWS	MAXFEE	DEF	26				8.13	1/1/2018	12/31/2299	N
71046	X-RAY EXAM CHEST 2 VIEWS	MAXFEE	DEF	TC				13.64	1/1/2018	12/31/2299	N
71047	X-RAY EXAM CHEST 3 VIEWS	PRXOVR	DEF					NA	NA	NA	N
71047	X-RAY EXAM CHEST 3 VIEWS	MAXFEE	DEF					27.81	1/1/2018	12/31/2299	N
71047	X-RAY EXAM CHEST 3 VIEWS	MAXFEE	DEF	26				10.46	1/1/2018	12/31/2299	N
71047	X-RAY EXAM CHEST 3 VIEWS	MAXFEE	DEF	TC				17.35	1/1/2018	12/31/2299	N
71048	X-RAY EXAM CHEST 4+ VIEWS	PRXOVR	DEF					NA	NA	NA	N
71048	X-RAY EXAM CHEST 4+ VIEWS	MAXFEE	DEF					29.87	1/1/2018	12/31/2299	N
71048	X-RAY EXAM CHEST 4+ VIEWS	MAXFEE	DEF	26				12.02	1/1/2018	12/31/2299	N
71048	X-RAY EXAM CHEST 4+ VIEWS	MAXFEE	DEF	TC				17.85	1/1/2018	12/31/2299	N
71060	CONTRAST X-RAY OF BRONCHI	PRXOVR	DEF					NA	NA	NA	N
71060	CONTRAST X-RAY OF BRONCHI	MAXFEE	DEF					NA			N
71090	X-RAY & PACEMAKER INSERTION	PRXOVR	DEF					NA	NA	NA	N
71090	X-RAY & PACEMAKER INSERTION	MAXFEE	DEF					NA			N
71100	X-RAY EXAM RIBS UNI 2 VIEWS	PRXOVR	DEF					NA	NA	NA	N
71100	X-RAY EXAM RIBS UNI 2 VIEWS	MAXFEE	DEF					23.48	1/1/2018	12/31/2299	N
71100	X-RAY EXAM RIBS UNI 2 VIEWS	MAXFEE	DEF	26				7.04	1/1/2018	12/31/2299	N
71100	X-RAY EXAM RIBS UNI 2 VIEWS	MAXFEE	DEF	TC				16.44	1/1/2018	12/31/2299	N
71101	X-RAY EXAM UNILAT RIBS/CHEST	PRXOVR	DEF					NA	NA	NA	N
71101	X-RAY EXAM UNILAT RIBS/CHEST	MAXFEE	DEF					27.82	1/1/2018	12/31/2299	N
71101	X-RAY EXAM UNILAT RIBS/CHEST	MAXFEE	DEF	26				8.35	1/1/2018	12/31/2299	N
71101	X-RAY EXAM UNILAT RIBS/CHEST	MAXFEE	DEF	TC				19.47	1/1/2018	12/31/2299	N
71110	X-RAY EXAM RIBS BIL 3 VIEWS	PRXOVR	DEF					NA	NA	NA	N
71110	X-RAY EXAM RIBS BIL 3 VIEWS	MAXFEE	DEF					31.93	1/1/2018	12/31/2299	N
71110	X-RAY EXAM RIBS BIL 3 VIEWS	MAXFEE	DEF	26				11.18	1/1/2018	12/31/2299	N
71110	X-RAY EXAM RIBS BIL 3 VIEWS	MAXFEE	DEF	TC				20.75	1/1/2018	12/31/2299	N
71111	X-RAY EXAM RIBS/CHEST4/> VWS	PRXOVR	DEF					NA	NA	NA	N
71111	X-RAY EXAM RIBS/CHEST4/> VWS	MAXFEE	DEF					36.68	1/1/2018	12/31/2299	N
71111	X-RAY EXAM RIBS/CHEST4/> VWS	MAXFEE	DEF	26				12.84	1/1/2018	12/31/2299	N
71111	X-RAY EXAM RIBS/CHEST4/> VWS	MAXFEE	DEF	TC				23.84	1/1/2018	12/31/2299	N
71120	X-RAY EXAM BREASTBONE 2/>VWS	PRXOVR	DEF					NA	NA	NA	N
71120	X-RAY EXAM BREASTBONE 2/>VWS	MAXFEE	DEF					25.19	1/1/2018	12/31/2299	N
71120	X-RAY EXAM BREASTBONE 2/>VWS	MAXFEE	DEF	26				8.82	1/1/2018	12/31/2299	N
71120	X-RAY EXAM BREASTBONE 2/>VWS	MAXFEE	DEF	TC				16.37	1/1/2018	12/31/2299	N
71130	X-RAY STRENOCLAVIC JT 3/>VWS	PRXOVR	DEF					NA	NA	NA	N
71130	X-RAY STRENOCLAVIC JT 3/>VWS	MAXFEE	DEF					27.39	1/1/2018	12/31/2299	N
71130	X-RAY STRENOCLAVIC JT 3/>VWS	MAXFEE	DEF	26				9.59	1/1/2018	12/31/2299	N
71130	X-RAY STRENOCLAVIC JT 3/>VWS	MAXFEE	DEF	TC				17.80	1/1/2018	12/31/2299	N
71250	CT THORAX DX C-	PRXOVR	DEF					NA	NA	NA	N
71250	CT THORAX DX C-	MAXFEE	DEF	TC				109	1/1/2018	12/31/2299	N
71250	CT THORAX DX C-	MAXFEE	DEF					145.33	1/1/2018	12/31/2299	N
71250	CT THORAX DX C-	MAXFEE	DEF	26				36.33	1/1/2018	12/31/2299	N
71260	CT THORAX DX C+	PRXOVR	DEF					NA	NA	NA	N
71260	CT THORAX DX C+	MAXFEE	DEF					194.22	1/1/2018	12/31/2299	N
71260	CT THORAX DX C+	MAXFEE	DEF	26				58.27	1/1/2018	12/31/2299	N
71260	CT THORAX DX C+	MAXFEE	DEF	TC				135.95	1/1/2018	12/31/2299	N
71270	CT THORAX DX C-/C+	PRXOVR	DEF					NA	NA	NA	N
71270	CT THORAX DX C-/C+	MAXFEE	DEF					231.94	1/1/2018	12/31/2299	N
71270	CT THORAX DX C-/C+	MAXFEE	DEF	26				57.99	1/1/2018	12/31/2299	N
71270	CT THORAX DX C-/C+	MAXFEE	DEF	TC				173.96	1/1/2018	12/31/2299	N
71271	CT THORAX LUNG CANCER SCR C-	PRXOVR	DEF					NA	NA	NA	N
71271	CT THORAX LUNG CANCER SCR C-	MAXFEE	DEF	26				37.94	1/1/2021	12/31/2299	N
71271	CT THORAX LUNG CANCER SCR C-	MAXFEE	DEF	TC				67.98	1/1/2021	12/31/2299	N
71271	CT THORAX LUNG CANCER SCR C-	MAXFEE	DEF					105.92	1/1/2021	12/31/2299	N
71275	CT ANGIOGRAPHY CHEST	PRXOVR	DEF					NA	NA	NA	N
71275	CT ANGIOGRAPHY CHEST	MAXFEE	DEF					254.23	1/1/2018	12/31/2299	N
71275	CT ANGIOGRAPHY CHEST	MAXFEE	DEF	26				76.27	1/1/2018	12/31/2299	N
71275	CT ANGIOGRAPHY CHEST	MAXFEE	DEF	TC				177.96	1/1/2018	12/31/2299	N
71550	MRI CHEST W/O DYE	PRXOVR	DEF					NA	NA	NA	N
71550	MRI CHEST W/O DYE	MAXFEE	DEF					302.68	1/1/2018	12/31/2299	N
71550	MRI CHEST W/O DYE	MAXFEE	DEF	26				60.54	1/1/2018	12/31/2299	N
71550	MRI CHEST W/O DYE	MAXFEE	DEF	TC				242.14	1/1/2018	12/31/2299	N
71551	MRI CHEST W/DYE	PRXOVR	DEF					NA	NA	NA	N
71551	MRI CHEST W/DYE	MAXFEE	DEF					379.88	1/1/2018	12/31/2299	N
71551	MRI CHEST W/DYE	MAXFEE	DEF	26				75.98	1/1/2018	12/31/2299	N
71551	MRI CHEST W/DYE	MAXFEE	DEF	TC				303.90	1/1/2018	12/31/2299	N
71552	MRI CHEST W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
71552	MRI CHEST W/O & W/DYE	MAXFEE	DEF					478.15	1/1/2018	12/31/2299	N
71552	MRI CHEST W/O & W/DYE	MAXFEE	DEF	26				95.63	1/1/2018	12/31/2299	N
71552	MRI CHEST W/O & W/DYE	MAXFEE	DEF	TC				382.52	1/1/2018	12/31/2299	N
71555	MRI ANGIO CHEST W OR W/O DYE	PRXOVR	DEF					NA	NA	NA	N
71555	MRI ANGIO CHEST W OR W/O DYE	MAXFEE	DEF					335.67	1/1/2018	12/31/2299	N
71555	MRI ANGIO CHEST W OR W/O DYE	MAXFEE	DEF	26				67.13	1/1/2018	12/31/2299	N
71555	MRI ANGIO CHEST W OR W/O DYE	MAXFEE	DEF	TC				268.54	1/1/2018	12/31/2299	N
72010	X-RAY EXAM SPINE AP&LAT	PRXOVR	DEF					NA	NA	NA	N
72010	X-RAY EXAM SPINE AP&LAT	MAXFEE	DEF					NA			N
72020	X-RAY EXAM OF SPINE 1 VIEW	PRXOVR	DEF					NA	NA	NA	N
72020	X-RAY EXAM OF SPINE 1 VIEW	MAXFEE	DEF					17.22	1/1/2018	12/31/2299	N
72020	X-RAY EXAM OF SPINE 1 VIEW	MAXFEE	DEF	26				6.03	1/1/2018	12/31/2299	N
72020	X-RAY EXAM OF SPINE 1 VIEW	MAXFEE	DEF	TC				11.19	1/1/2018	12/31/2299	N
72040	X-RAY EXAM NECK SPINE 2-3 VW	PRXOVR	DEF					NA	NA	NA	N
72040	X-RAY EXAM NECK SPINE 2-3 VW	MAXFEE	DEF					23.93	1/1/2018	12/31/2299	N
72040	X-RAY EXAM NECK SPINE 2-3 VW	MAXFEE	DEF	26				8.38	1/1/2018	12/31/2299	N
72040	X-RAY EXAM NECK SPINE 2-3 VW	MAXFEE	DEF	TC				15.55	1/1/2018	12/31/2299	N
72050	X-RAY EXAM NECK SPINE 4/5VWS	PRXOVR	DEF					NA	NA	NA	N
72050	X-RAY EXAM NECK SPINE 4/5VWS	MAXFEE	DEF					35.15	1/1/2018	12/31/2299	N
72050	X-RAY EXAM NECK SPINE 4/5VWS	MAXFEE	DEF	26				12.30	1/1/2018	12/31/2299	N
72050	X-RAY EXAM NECK SPINE 4/5VWS	MAXFEE	DEF	TC				22.85	1/1/2018	12/31/2299	N
72052	X-RAY EXAM NECK SPINE 6/>VWS	PRXOVR	DEF					NA	NA	NA	N
72052	X-RAY EXAM NECK SPINE 6/>VWS	MAXFEE	DEF					43.03	1/1/2018	12/31/2299	N
72052	X-RAY EXAM NECK SPINE 6/>VWS	MAXFEE	DEF	26				15.06	1/1/2018	12/31/2299	N
72052	X-RAY EXAM NECK SPINE 6/>VWS	MAXFEE	DEF	TC				27.97	1/1/2018	12/31/2299	N
72069	X-RAY EXAM TRUNK SPINE STAND	PRXOVR	DEF					NA	NA	NA	N
72069	X-RAY EXAM TRUNK SPINE STAND	MAXFEE	DEF					NA			N
72070	X-RAY EXAM THORAC SPINE 2VWS	PRXOVR	DEF					NA	NA	NA	N
72070	X-RAY EXAM THORAC SPINE 2VWS	MAXFEE	DEF					25.18	1/1/2018	12/31/2299	N
72070	X-RAY EXAM THORAC SPINE 2VWS	MAXFEE	DEF	26				8.81	1/1/2018	12/31/2299	N
72070	X-RAY EXAM THORAC SPINE 2VWS	MAXFEE	DEF	TC				16.37	1/1/2018	12/31/2299	N
72072	X-RAY EXAM THORAC SPINE 3VWS	PRXOVR	DEF					NA	NA	NA	N
72072	X-RAY EXAM THORAC SPINE 3VWS	MAXFEE	DEF					27.51	1/1/2018	12/31/2299	N
72072	X-RAY EXAM THORAC SPINE 3VWS	MAXFEE	DEF	26				8.25	1/1/2018	12/31/2299	N
72072	X-RAY EXAM THORAC SPINE 3VWS	MAXFEE	DEF	TC				19.26	1/1/2018	12/31/2299	N
72074	X-RAY EXAM THORAC SPINE4/>VW	PRXOVR	DEF					NA	NA	NA	N
72074	X-RAY EXAM THORAC SPINE4/>VW	MAXFEE	DEF					32.23	1/1/2018	12/31/2299	N
72074	X-RAY EXAM THORAC SPINE4/>VW	MAXFEE	DEF	26				9.67	1/1/2018	12/31/2299	N
72074	X-RAY EXAM THORAC SPINE4/>VW	MAXFEE	DEF	TC				22.56	1/1/2018	12/31/2299	N
72080	X-RAY EXAM THORACOLMB 2/> VW	PRXOVR	DEF					NA	NA	NA	N
72080	X-RAY EXAM THORACOLMB 2/> VW	MAXFEE	DEF					25.67	1/1/2018	12/31/2299	N
72080	X-RAY EXAM THORACOLMB 2/> VW	MAXFEE	DEF	26				8.98	1/1/2018	12/31/2299	N
72080	X-RAY EXAM THORACOLMB 2/> VW	MAXFEE	DEF	TC				16.69	1/1/2018	12/31/2299	N
72081	X-RAY EXAM ENTIRE SPI 1 VW	PRXOVR	DEF					NA	NA	NA	N
72081	X-RAY EXAM ENTIRE SPI 1 VW	MAXFEE	DEF					27.89	1/1/2018	12/31/2299	N
72081	X-RAY EXAM ENTIRE SPI 1 VW	MAXFEE	DEF	26				8.37	1/1/2018	12/31/2299	N
72081	X-RAY EXAM ENTIRE SPI 1 VW	MAXFEE	DEF	TC				19.52	1/1/2018	12/31/2299	N
72082	X-RAY EXAM ENTIRE SPI 2/3 VW	PRXOVR	DEF					NA	NA	NA	N
72082	X-RAY EXAM ENTIRE SPI 2/3 VW	MAXFEE	DEF					44.50	1/1/2018	12/31/2299	N
72082	X-RAY EXAM ENTIRE SPI 2/3 VW	MAXFEE	DEF	26				13.35	1/1/2018	12/31/2299	N
72082	X-RAY EXAM ENTIRE SPI 2/3 VW	MAXFEE	DEF	TC				31.15	1/1/2018	12/31/2299	N
72083	X-RAY EXAM ENTIRE SPI 4/5 VW	PRXOVR	DEF					NA	NA	NA	N
72083	X-RAY EXAM ENTIRE SPI 4/5 VW	MAXFEE	DEF					48.34	1/1/2018	12/31/2299	N
72083	X-RAY EXAM ENTIRE SPI 4/5 VW	MAXFEE	DEF	26				14.50	1/1/2018	12/31/2299	N
72083	X-RAY EXAM ENTIRE SPI 4/5 VW	MAXFEE	DEF	TC				33.84	1/1/2018	12/31/2299	N
72084	X-RAY EXAM ENTIRE SPI 6/> VW	PRXOVR	DEF					NA	NA	NA	N
72084	X-RAY EXAM ENTIRE SPI 6/> VW	MAXFEE	DEF					57.47	1/1/2018	12/31/2299	N
72084	X-RAY EXAM ENTIRE SPI 6/> VW	MAXFEE	DEF	26				17.24	1/1/2018	12/31/2299	N
72084	X-RAY EXAM ENTIRE SPI 6/> VW	MAXFEE	DEF	TC				40.23	1/1/2018	12/31/2299	N
72090	X-RAY EXAM SCLOIOSIS ERECT	PRXOVR	DEF					NA	NA	NA	N
72090	X-RAY EXAM SCLOIOSIS ERECT	MAXFEE	DEF					NA			N
72100	X-RAY EXAM L-S SPINE 2/3 VWS	PRXOVR	DEF					NA	NA	NA	N
72100	X-RAY EXAM L-S SPINE 2/3 VWS	MAXFEE	DEF					25.67	1/1/2018	12/31/2299	N
72100	X-RAY EXAM L-S SPINE 2/3 VWS	MAXFEE	DEF	26				8.98	1/1/2018	12/31/2299	N
72100	X-RAY EXAM L-S SPINE 2/3 VWS	MAXFEE	DEF	TC				16.69	1/1/2018	12/31/2299	N
72110	X-RAY EXAM L-2 SPINE 4/>VWS	PRXOVR	DEF					NA	NA	NA	N
72110	X-RAY EXAM L-2 SPINE 4/>VWS	MAXFEE	DEF					35.63	1/1/2018	12/31/2299	N
72110	X-RAY EXAM L-2 SPINE 4/>VWS	MAXFEE	DEF	26				12.47	1/1/2018	12/31/2299	N
72110	X-RAY EXAM L-2 SPINE 4/>VWS	MAXFEE	DEF	TC				23.16	1/1/2018	12/31/2299	N
72114	X-RAY EXAM L-S SPINE BENDING	PRXOVR	DEF					NA	NA	NA	N
72114	X-RAY EXAM L-S SPINE BENDING	MAXFEE	DEF					44.41	1/1/2018	12/31/2299	N
72114	X-RAY EXAM L-S SPINE BENDING	MAXFEE	DEF	26				11.10	1/1/2018	12/31/2299	N
72114	X-RAY EXAM L-S SPINE BENDING	MAXFEE	DEF	TC				33.31	1/1/2018	12/31/2299	N
72120	X-RAY BEND ONLY L-S SPINE	PRXOVR	DEF					NA	NA	NA	N
72120	X-RAY BEND ONLY L-S SPINE	MAXFEE	DEF					32.73	1/1/2018	12/31/2299	N
72120	X-RAY BEND ONLY L-S SPINE	MAXFEE	DEF	26				9.82	1/1/2018	12/31/2299	N
72120	X-RAY BEND ONLY L-S SPINE	MAXFEE	DEF	TC				22.91	1/1/2018	12/31/2299	N
72125	CT NECK SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72125	CT NECK SPINE W/O DYE	MAXFEE	DEF					147.53	1/1/2018	12/31/2299	N
72125	CT NECK SPINE W/O DYE	MAXFEE	DEF	26				36.88	1/1/2018	12/31/2299	N
72125	CT NECK SPINE W/O DYE	MAXFEE	DEF	TC				110.65	1/1/2018	12/31/2299	N
72126	CT NECK SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72126	CT NECK SPINE W/DYE	MAXFEE	DEF					194.18	1/1/2018	12/31/2299	N
72126	CT NECK SPINE W/DYE	MAXFEE	DEF	26				58.25	1/1/2018	12/31/2299	N
72126	CT NECK SPINE W/DYE	MAXFEE	DEF	TC				135.93	1/1/2018	12/31/2299	N
72127	CT NECK SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72127	CT NECK SPINE W/O & W/DYE	MAXFEE	DEF					227.77	1/1/2018	12/31/2299	N
72127	CT NECK SPINE W/O & W/DYE	MAXFEE	DEF	26				45.55	1/1/2018	12/31/2299	N
72127	CT NECK SPINE W/O & W/DYE	MAXFEE	DEF	TC				182.22	1/1/2018	12/31/2299	N
72128	CT CHEST SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72128	CT CHEST SPINE W/O DYE	MAXFEE	DEF					144.39	1/1/2018	12/31/2299	N
72128	CT CHEST SPINE W/O DYE	MAXFEE	DEF	26				36.10	1/1/2018	12/31/2299	N
72128	CT CHEST SPINE W/O DYE	MAXFEE	DEF	TC				108.29	1/1/2018	12/31/2299	N
72129	CT CHEST SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72129	CT CHEST SPINE W/DYE	MAXFEE	DEF					194.18	1/1/2018	12/31/2299	N
72129	CT CHEST SPINE W/DYE	MAXFEE	DEF	26				58.25	1/1/2018	12/31/2299	N
72129	CT CHEST SPINE W/DYE	MAXFEE	DEF	TC				135.93	1/1/2018	12/31/2299	N
72130	CT CHEST SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72130	CT CHEST SPINE W/O & W/DYE	MAXFEE	DEF					228.07	1/1/2018	12/31/2299	N
72130	CT CHEST SPINE W/O & W/DYE	MAXFEE	DEF	26				45.61	1/1/2018	12/31/2299	N
72130	CT CHEST SPINE W/O & W/DYE	MAXFEE	DEF	TC				182.46	1/1/2018	12/31/2299	N
72131	CT LUMBAR SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72131	CT LUMBAR SPINE W/O DYE	MAXFEE	DEF					144.39	1/1/2018	12/31/2299	N
72131	CT LUMBAR SPINE W/O DYE	MAXFEE	DEF	26				36.10	1/1/2018	12/31/2299	N
72131	CT LUMBAR SPINE W/O DYE	MAXFEE	DEF	TC				108.29	1/1/2018	12/31/2299	N
72132	CT LUMBAR SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72132	CT LUMBAR SPINE W/DYE	MAXFEE	DEF					193.61	1/1/2018	12/31/2299	N
72132	CT LUMBAR SPINE W/DYE	MAXFEE	DEF	26				58.08	1/1/2018	12/31/2299	N
72132	CT LUMBAR SPINE W/DYE	MAXFEE	DEF	TC				135.53	1/1/2018	12/31/2299	N
72133	CT LUMBAR SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72133	CT LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF					228.09	1/1/2018	12/31/2299	N
72133	CT LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF	26				45.62	1/1/2018	12/31/2299	N
72133	CT LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF	TC				182.47	1/1/2018	12/31/2299	N
72141	MRI NECK SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72141	MRI NECK SPINE W/O DYE	MAXFEE	DEF					198.02	1/1/2018	12/31/2299	N
72141	MRI NECK SPINE W/O DYE	MAXFEE	DEF	26				59.41	1/1/2018	12/31/2299	N
72141	MRI NECK SPINE W/O DYE	MAXFEE	DEF	TC				138.61	1/1/2018	12/31/2299	N
72142	MRI NECK SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72142	MRI NECK SPINE W/DYE	MAXFEE	DEF					271.43	1/1/2018	12/31/2299	N
72142	MRI NECK SPINE W/DYE	MAXFEE	DEF	26				81.43	1/1/2018	12/31/2299	N
72142	MRI NECK SPINE W/DYE	MAXFEE	DEF	TC				190	1/1/2018	12/31/2299	N
72146	MRI CHEST SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72146	MRI CHEST SPINE W/O DYE	MAXFEE	DEF					198.02	1/1/2018	12/31/2299	N
72146	MRI CHEST SPINE W/O DYE	MAXFEE	DEF	26				59.41	1/1/2018	12/31/2299	N
72146	MRI CHEST SPINE W/O DYE	MAXFEE	DEF	TC				138.61	1/1/2018	12/31/2299	N
72147	MRI CHEST SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72147	MRI CHEST SPINE W/DYE	MAXFEE	DEF					268.90	1/1/2018	12/31/2299	N
72147	MRI CHEST SPINE W/DYE	MAXFEE	DEF	26				80.67	1/1/2018	12/31/2299	N
72147	MRI CHEST SPINE W/DYE	MAXFEE	DEF	TC				188.23	1/1/2018	12/31/2299	N
72148	MRI LUMBAR SPINE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72148	MRI LUMBAR SPINE W/O DYE	MAXFEE	DEF					188.36	1/1/2018	12/31/2299	N
72148	MRI LUMBAR SPINE W/O DYE	MAXFEE	DEF	26				56.51	1/1/2018	12/31/2299	N
72148	MRI LUMBAR SPINE W/O DYE	MAXFEE	DEF	TC				131.85	1/1/2018	12/31/2299	N
72149	MRI LUMBAR SPINE W/DYE	PRXOVR	DEF					NA	NA	NA	N
72149	MRI LUMBAR SPINE W/DYE	MAXFEE	DEF					268.10	1/1/2018	12/31/2299	N
72149	MRI LUMBAR SPINE W/DYE	MAXFEE	DEF	26				80.43	1/1/2018	12/31/2299	N
72149	MRI LUMBAR SPINE W/DYE	MAXFEE	DEF	TC				187.67	1/1/2018	12/31/2299	N
72156	MRI NECK SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72156	MRI NECK SPINE W/O & W/DYE	MAXFEE	DEF	26				96.01	1/1/2018	12/31/2299	N
72156	MRI NECK SPINE W/O & W/DYE	MAXFEE	DEF	TC				224.02	1/1/2018	12/31/2299	N
72156	MRI NECK SPINE W/O & W/DYE	MAXFEE	DEF					320.03	1/1/2018	12/31/2299	N
72157	MRI CHEST SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72157	MRI CHEST SPINE W/O & W/DYE	MAXFEE	DEF					320.23	1/1/2018	12/31/2299	N
72157	MRI CHEST SPINE W/O & W/DYE	MAXFEE	DEF	26				96.07	1/1/2018	12/31/2299	N
72157	MRI CHEST SPINE W/O & W/DYE	MAXFEE	DEF	TC				224.16	1/1/2018	12/31/2299	N
72158	MRI LUMBAR SPINE W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72158	MRI LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF	26				95.79	1/1/2018	12/31/2299	N
72158	MRI LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF	TC				223.51	1/1/2018	12/31/2299	N
72158	MRI LUMBAR SPINE W/O & W/DYE	MAXFEE	DEF					319.30	1/1/2018	12/31/2299	N
72159	MR ANGIO SPINE W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
72159	MR ANGIO SPINE W/O&W/DYE	MAXFEE	DEF					349.62	1/1/2018	12/31/2299	N
72159	MR ANGIO SPINE W/O&W/DYE	MAXFEE	DEF	26				69.92	1/1/2018	12/31/2299	N
72159	MR ANGIO SPINE W/O&W/DYE	MAXFEE	DEF	TC				279.70	1/1/2018	12/31/2299	N
72170	X-RAY EXAM OF PELVIS	PRXOVR	DEF					NA	NA	NA	N
72170	X-RAY EXAM OF PELVIS	MAXFEE	DEF					19.86	1/1/2018	12/31/2299	N
72170	X-RAY EXAM OF PELVIS	MAXFEE	DEF	26				6.95	1/1/2018	12/31/2299	N
72170	X-RAY EXAM OF PELVIS	MAXFEE	DEF	TC				12.91	1/1/2018	12/31/2299	N
72190	X-RAY EXAM OF PELVIS	PRXOVR	DEF					NA	NA	NA	N
72190	X-RAY EXAM OF PELVIS	MAXFEE	DEF					26.20	1/1/2018	12/31/2299	N
72190	X-RAY EXAM OF PELVIS	MAXFEE	DEF	26				9.17	1/1/2018	12/31/2299	N
72190	X-RAY EXAM OF PELVIS	MAXFEE	DEF	TC				17.03	1/1/2018	12/31/2299	N
72191	CT ANGIOGRAPH PELV W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
72191	CT ANGIOGRAPH PELV W/O&W/DYE	MAXFEE	DEF					257.76	1/1/2018	12/31/2299	N
72191	CT ANGIOGRAPH PELV W/O&W/DYE	MAXFEE	DEF	26				51.55	1/1/2018	12/31/2299	N
72191	CT ANGIOGRAPH PELV W/O&W/DYE	MAXFEE	DEF	TC				206.21	1/1/2018	12/31/2299	N
72192	CT PELVIS W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72192	CT PELVIS W/O DYE	MAXFEE	DEF	TC				74.02	1/1/2018	12/31/2299	N
72192	CT PELVIS W/O DYE	MAXFEE	DEF					123.36	1/1/2018	12/31/2299	N
72192	CT PELVIS W/O DYE	MAXFEE	DEF	26				49.34	1/1/2018	12/31/2299	N
72193	CT PELVIS W/DYE	PRXOVR	DEF					NA	NA	NA	N
72193	CT PELVIS W/DYE	MAXFEE	DEF					190.92	1/1/2018	12/31/2299	N
72193	CT PELVIS W/DYE	MAXFEE	DEF	26				47.73	1/1/2018	12/31/2299	N
72193	CT PELVIS W/DYE	MAXFEE	DEF	TC				143.19	1/1/2018	12/31/2299	N
72194	CT PELVIS W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72194	CT PELVIS W/O & W/DYE	MAXFEE	DEF					223.01	1/1/2018	12/31/2299	N
72194	CT PELVIS W/O & W/DYE	MAXFEE	DEF	26				44.60	1/1/2018	12/31/2299	N
72194	CT PELVIS W/O & W/DYE	MAXFEE	DEF	TC				178.41	1/1/2018	12/31/2299	N
72195	MRI PELVIS W/O DYE	PRXOVR	DEF					NA	NA	NA	N
72195	MRI PELVIS W/O DYE	MAXFEE	DEF					305.45	1/1/2018	12/31/2299	N
72195	MRI PELVIS W/O DYE	MAXFEE	DEF	26				61.09	1/1/2018	12/31/2299	N
72195	MRI PELVIS W/O DYE	MAXFEE	DEF	TC				244.36	1/1/2018	12/31/2299	N
72196	MRI PELVIS W/DYE	PRXOVR	DEF					NA	NA	NA	N
72196	MRI PELVIS W/DYE	MAXFEE	DEF					363.72	1/1/2018	12/31/2299	N
72196	MRI PELVIS W/DYE	MAXFEE	DEF	26				72.74	1/1/2018	12/31/2299	N
72196	MRI PELVIS W/DYE	MAXFEE	DEF	TC				290.98	1/1/2018	12/31/2299	N
72197	MRI PELVIS W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72197	MRI PELVIS W/O & W/DYE	MAXFEE	DEF					418.79	1/1/2018	12/31/2299	N
72197	MRI PELVIS W/O & W/DYE	MAXFEE	DEF	26				83.76	1/1/2018	12/31/2299	N
72197	MRI PELVIS W/O & W/DYE	MAXFEE	DEF	TC				335.03	1/1/2018	12/31/2299	N
72198	MR ANGIO PELVIS W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
72198	MR ANGIO PELVIS W/O & W/DYE	MAXFEE	DEF					338.90	1/1/2018	12/31/2299	N
72198	MR ANGIO PELVIS W/O & W/DYE	MAXFEE	DEF	26				67.78	1/1/2018	12/31/2299	N
72198	MR ANGIO PELVIS W/O & W/DYE	MAXFEE	DEF	TC				271.12	1/1/2018	12/31/2299	N
72200	X-RAY EXAM SI JOINTS	PRXOVR	DEF					NA	NA	NA	N
72200	X-RAY EXAM SI JOINTS	MAXFEE	DEF					20.66	1/1/2018	12/31/2299	N
72200	X-RAY EXAM SI JOINTS	MAXFEE	DEF	26				7.23	1/1/2018	12/31/2299	N
72200	X-RAY EXAM SI JOINTS	MAXFEE	DEF	TC				13.43	1/1/2018	12/31/2299	N
72202	X-RAY EXAM SI JOINTS 3/> VWS	PRXOVR	DEF					NA	NA	NA	N
72202	X-RAY EXAM SI JOINTS 3/> VWS	MAXFEE	DEF					24.13	1/1/2018	12/31/2299	N
72202	X-RAY EXAM SI JOINTS 3/> VWS	MAXFEE	DEF	26				8.45	1/1/2018	12/31/2299	N
72202	X-RAY EXAM SI JOINTS 3/> VWS	MAXFEE	DEF	TC				15.68	1/1/2018	12/31/2299	N
72220	X-RAY EXAM SACRUM TAILBONE	PRXOVR	DEF					NA	NA	NA	N
72220	X-RAY EXAM SACRUM TAILBONE	MAXFEE	DEF					21.46	1/1/2018	12/31/2299	N
72220	X-RAY EXAM SACRUM TAILBONE	MAXFEE	DEF	26				7.51	1/1/2018	12/31/2299	N
72220	X-RAY EXAM SACRUM TAILBONE	MAXFEE	DEF	TC				13.95	1/1/2018	12/31/2299	N
72240	MYELOGRAPHY NECK SPINE	PRXOVR	DEF					NA	NA	NA	N
72240	MYELOGRAPHY NECK SPINE	MAXFEE	DEF					84.34	1/1/2018	12/31/2299	N
72240	MYELOGRAPHY NECK SPINE	MAXFEE	DEF	26				29.52	1/1/2018	12/31/2299	N
72240	MYELOGRAPHY NECK SPINE	MAXFEE	DEF	TC				54.82	1/1/2018	12/31/2299	N
72255	MYELOGRAPHY THORACIC SPINE	PRXOVR	DEF					NA	NA	NA	N
72255	MYELOGRAPHY THORACIC SPINE	MAXFEE	DEF					83.72	1/1/2018	12/31/2299	N
72255	MYELOGRAPHY THORACIC SPINE	MAXFEE	DEF	26				33.49	1/1/2018	12/31/2299	N
72255	MYELOGRAPHY THORACIC SPINE	MAXFEE	DEF	TC				50.23	1/1/2018	12/31/2299	N
72265	MYELOGRAPHY L-S SPINE	PRXOVR	DEF					NA	NA	NA	N
72265	MYELOGRAPHY L-S SPINE	MAXFEE	DEF					78.77	1/1/2018	12/31/2299	N
72265	MYELOGRAPHY L-S SPINE	MAXFEE	DEF	26				23.63	1/1/2018	12/31/2299	N
72265	MYELOGRAPHY L-S SPINE	MAXFEE	DEF	TC				55.14	1/1/2018	12/31/2299	N
72270	MYELOGPHY 2/> SPINE REGIONS	PRXOVR	DEF					NA	NA	NA	N
72270	MYELOGPHY 2/> SPINE REGIONS	MAXFEE	DEF					109.46	1/1/2018	12/31/2299	N
72270	MYELOGPHY 2/> SPINE REGIONS	MAXFEE	DEF	26				32.84	1/1/2018	12/31/2299	N
72270	MYELOGPHY 2/> SPINE REGIONS	MAXFEE	DEF	TC				76.62	1/1/2018	12/31/2299	N
72275	EPIDUROGRAPHY	PRXOVR	DEF					NA	NA	NA	N
72275	EPIDUROGRAPHY	MAXFEE	DEF					NA			N
72285	DISCOGRAPHY CERV/THOR SPINE	PRXOVR	DEF					NA	NA	NA	N
72285	DISCOGRAPHY CERV/THOR SPINE	MAXFEE	DEF					97.39	1/1/2018	12/31/2299	N
72285	DISCOGRAPHY CERV/THOR SPINE	MAXFEE	DEF	26				48.70	1/1/2018	12/31/2299	N
72285	DISCOGRAPHY CERV/THOR SPINE	MAXFEE	DEF	TC				48.69	1/1/2018	12/31/2299	N
72295	X-RAY OF LOWER SPINE DISK	PRXOVR	DEF					NA	NA	NA	N
72295	X-RAY OF LOWER SPINE DISK	MAXFEE	DEF					85.01	1/1/2018	12/31/2299	N
72295	X-RAY OF LOWER SPINE DISK	MAXFEE	DEF	26				34	1/1/2018	12/31/2299	N
72295	X-RAY OF LOWER SPINE DISK	MAXFEE	DEF	TC				51.01	1/1/2018	12/31/2299	N
73000	X-RAY EXAM OF COLLAR BONE	PRXOVR	DEF					NA	NA	NA	N
73000	X-RAY EXAM OF COLLAR BONE	MAXFEE	DEF					20.22	1/1/2018	12/31/2299	N
73000	X-RAY EXAM OF COLLAR BONE	MAXFEE	DEF	26				7.08	1/1/2018	12/31/2299	N
73000	X-RAY EXAM OF COLLAR BONE	MAXFEE	DEF	TC				13.14	1/1/2018	12/31/2299	N
73010	X-RAY EXAM OF SHOULDER BLADE	PRXOVR	DEF					NA	NA	NA	N
73010	X-RAY EXAM OF SHOULDER BLADE	MAXFEE	DEF					20.66	1/1/2018	12/31/2299	N
73010	X-RAY EXAM OF SHOULDER BLADE	MAXFEE	DEF	26				7.23	1/1/2018	12/31/2299	N
73010	X-RAY EXAM OF SHOULDER BLADE	MAXFEE	DEF	TC				13.43	1/1/2018	12/31/2299	N
73020	X-RAY EXAM OF SHOULDER	PRXOVR	DEF					NA	NA	NA	N
73020	X-RAY EXAM OF SHOULDER	MAXFEE	DEF					18.65	1/1/2018	12/31/2299	N
73020	X-RAY EXAM OF SHOULDER	MAXFEE	DEF	26				6.53	1/1/2018	12/31/2299	N
73020	X-RAY EXAM OF SHOULDER	MAXFEE	DEF	TC				12.12	1/1/2018	12/31/2299	N
73040	CONTRAST X-RAY OF SHOULDER	PRXOVR	DEF					NA	NA	NA	N
73040	CONTRAST X-RAY OF SHOULDER	MAXFEE	DEF					77.53	1/1/2018	12/31/2299	N
73040	CONTRAST X-RAY OF SHOULDER	MAXFEE	DEF	26				23.26	1/1/2018	12/31/2299	N
73040	CONTRAST X-RAY OF SHOULDER	MAXFEE	DEF	TC				54.27	1/1/2018	12/31/2299	N
73050	X-RAY EXAM OF SHOULDERS	PRXOVR	DEF					NA	NA	NA	N
73050	X-RAY EXAM OF SHOULDERS	MAXFEE	DEF					25.70	1/1/2018	12/31/2299	N
73050	X-RAY EXAM OF SHOULDERS	MAXFEE	DEF	26				9	1/1/2018	12/31/2299	N
73050	X-RAY EXAM OF SHOULDERS	MAXFEE	DEF	TC				16.70	1/1/2018	12/31/2299	N
73060	X-RAY EXAM OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
73060	X-RAY EXAM OF HUMERUS	MAXFEE	DEF					21.46	1/1/2018	12/31/2299	N
73060	X-RAY EXAM OF HUMERUS	MAXFEE	DEF	26				7.51	1/1/2018	12/31/2299	N
73060	X-RAY EXAM OF HUMERUS	MAXFEE	DEF	TC				13.95	1/1/2018	12/31/2299	N
73070	X-RAY EXAM OF ELBOW	PRXOVR	DEF					NA	NA	NA	N
73070	X-RAY EXAM OF ELBOW	MAXFEE	DEF					19.35	1/1/2018	12/31/2299	N
73070	X-RAY EXAM OF ELBOW	MAXFEE	DEF	26				5.81	1/1/2018	12/31/2299	N
73070	X-RAY EXAM OF ELBOW	MAXFEE	DEF	TC				13.54	1/1/2018	12/31/2299	N
73080	X-RAY EXAM OF ELBOW	PRXOVR	DEF					NA	NA	NA	N
73080	X-RAY EXAM OF ELBOW	MAXFEE	DEF					21.46	1/1/2018	12/31/2299	N
73080	X-RAY EXAM OF ELBOW	MAXFEE	DEF	26				5.37	1/1/2018	12/31/2299	N
73080	X-RAY EXAM OF ELBOW	MAXFEE	DEF	TC				16.09	1/1/2018	12/31/2299	N
73085	CONTRAST X-RAY OF ELBOW	PRXOVR	DEF					NA	NA	NA	N
73085	CONTRAST X-RAY OF ELBOW	MAXFEE	DEF					77.60	1/1/2018	12/31/2299	N
73085	CONTRAST X-RAY OF ELBOW	MAXFEE	DEF	26				23.28	1/1/2018	12/31/2299	N
73085	CONTRAST X-RAY OF ELBOW	MAXFEE	DEF	TC				54.32	1/1/2018	12/31/2299	N
73090	X-RAY EXAM OF FOREARM	PRXOVR	DEF					NA	NA	NA	N
73090	X-RAY EXAM OF FOREARM	MAXFEE	DEF					19.61	1/1/2018	12/31/2299	N
73090	X-RAY EXAM OF FOREARM	MAXFEE	DEF	26				6.86	1/1/2018	12/31/2299	N
73090	X-RAY EXAM OF FOREARM	MAXFEE	DEF	TC				12.75	1/1/2018	12/31/2299	N
73092	X-RAY EXAM OF ARM INFANT	PRXOVR	DEF					NA	NA	NA	N
73092	X-RAY EXAM OF ARM INFANT	MAXFEE	DEF					19.41	1/1/2018	12/31/2299	N
73092	X-RAY EXAM OF ARM INFANT	MAXFEE	DEF	26				6.79	1/1/2018	12/31/2299	N
73092	X-RAY EXAM OF ARM INFANT	MAXFEE	DEF	TC				12.62	1/1/2018	12/31/2299	N
73100	X-RAY EXAM OF WRIST	PRXOVR	DEF					NA	NA	NA	N
73100	X-RAY EXAM OF WRIST	MAXFEE	DEF					19.41	1/1/2018	12/31/2299	N
73100	X-RAY EXAM OF WRIST	MAXFEE	DEF	26				6.79	1/1/2018	12/31/2299	N
73100	X-RAY EXAM OF WRIST	MAXFEE	DEF	TC				12.62	1/1/2018	12/31/2299	N
73110	X-RAY EXAM OF WRIST	PRXOVR	DEF					NA	NA	NA	N
73110	X-RAY EXAM OF WRIST	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73110	X-RAY EXAM OF WRIST	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73110	X-RAY EXAM OF WRIST	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73115	CONTRAST X-RAY OF WRIST	PRXOVR	DEF					NA	NA	NA	N
73115	CONTRAST X-RAY OF WRIST	MAXFEE	DEF					63.58	1/1/2018	12/31/2299	N
73115	CONTRAST X-RAY OF WRIST	MAXFEE	DEF	26				22.25	1/1/2018	12/31/2299	N
73115	CONTRAST X-RAY OF WRIST	MAXFEE	DEF	TC				41.33	1/1/2018	12/31/2299	N
73120	X-RAY EXAM OF HAND	PRXOVR	DEF					NA	NA	NA	N
73120	X-RAY EXAM OF HAND	MAXFEE	DEF					18.83	1/1/2018	12/31/2299	N
73120	X-RAY EXAM OF HAND	MAXFEE	DEF	26				6.59	1/1/2018	12/31/2299	N
73120	X-RAY EXAM OF HAND	MAXFEE	DEF	TC				12.24	1/1/2018	12/31/2299	N
73130	X-RAY EXAM OF HAND	PRXOVR	DEF					NA	NA	NA	N
73130	X-RAY EXAM OF HAND	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73130	X-RAY EXAM OF HAND	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73130	X-RAY EXAM OF HAND	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73140	X-RAY EXAM OF FINGER(S)	PRXOVR	DEF					NA	NA	NA	N
73140	X-RAY EXAM OF FINGER(S)	MAXFEE	DEF					16.45	1/1/2018	12/31/2299	N
73140	X-RAY EXAM OF FINGER(S)	MAXFEE	DEF	26				5.76	1/1/2018	12/31/2299	N
73140	X-RAY EXAM OF FINGER(S)	MAXFEE	DEF	TC				10.69	1/1/2018	12/31/2299	N
73200	CT UPPER EXTREMITY W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73200	CT UPPER EXTREMITY W/O DYE	MAXFEE	DEF					144.39	1/1/2018	12/31/2299	N
73200	CT UPPER EXTREMITY W/O DYE	MAXFEE	DEF	26				36.10	1/1/2018	12/31/2299	N
73200	CT UPPER EXTREMITY W/O DYE	MAXFEE	DEF	TC				108.29	1/1/2018	12/31/2299	N
73201	CT UPPER EXTREMITY W/DYE	PRXOVR	DEF					NA	NA	NA	N
73201	CT UPPER EXTREMITY W/DYE	MAXFEE	DEF					187.78	1/1/2018	12/31/2299	N
73201	CT UPPER EXTREMITY W/DYE	MAXFEE	DEF	26				46.95	1/1/2018	12/31/2299	N
73201	CT UPPER EXTREMITY W/DYE	MAXFEE	DEF	TC				140.84	1/1/2018	12/31/2299	N
73202	CT UPPR EXTREMITY W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73202	CT UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF					233.86	1/1/2018	12/31/2299	N
73202	CT UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF	26				46.77	1/1/2018	12/31/2299	N
73202	CT UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF	TC				187.09	1/1/2018	12/31/2299	N
73206	CT ANGIO UPR EXTRM W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73206	CT ANGIO UPR EXTRM W/O&W/DYE	MAXFEE	DEF					260.23	1/1/2018	12/31/2299	N
73206	CT ANGIO UPR EXTRM W/O&W/DYE	MAXFEE	DEF	26				78.07	1/1/2018	12/31/2299	N
73206	CT ANGIO UPR EXTRM W/O&W/DYE	MAXFEE	DEF	TC				182.16	1/1/2018	12/31/2299	N
73218	MRI UPPER EXTREMITY W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73218	MRI UPPER EXTREMITY W/O DYE	MAXFEE	DEF					296.54	1/1/2018	12/31/2299	N
73218	MRI UPPER EXTREMITY W/O DYE	MAXFEE	DEF	26				59.31	1/1/2018	12/31/2299	N
73218	MRI UPPER EXTREMITY W/O DYE	MAXFEE	DEF	TC				237.23	1/1/2018	12/31/2299	N
73219	MRI UPPER EXTREMITY W/DYE	PRXOVR	DEF					NA	NA	NA	N
73219	MRI UPPER EXTREMITY W/DYE	MAXFEE	DEF					337.50	1/1/2018	12/31/2299	N
73219	MRI UPPER EXTREMITY W/DYE	MAXFEE	DEF	26				67.50	1/1/2018	12/31/2299	N
73219	MRI UPPER EXTREMITY W/DYE	MAXFEE	DEF	TC				270	1/1/2018	12/31/2299	N
73220	MRI UPPR EXTREMITY W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73220	MRI UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF					359.06	1/1/2018	12/31/2299	N
73220	MRI UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF	26				71.81	1/1/2018	12/31/2299	N
73220	MRI UPPR EXTREMITY W/O&W/DYE	MAXFEE	DEF	TC				287.25	1/1/2018	12/31/2299	N
73221	MRI JOINT UPR EXTREM W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73221	MRI JOINT UPR EXTREM W/O DYE	MAXFEE	DEF					199.27	1/1/2018	12/31/2299	N
73221	MRI JOINT UPR EXTREM W/O DYE	MAXFEE	DEF	26				49.82	1/1/2018	12/31/2299	N
73221	MRI JOINT UPR EXTREM W/O DYE	MAXFEE	DEF	TC				149.45	1/1/2018	12/31/2299	N
73222	MRI JOINT UPR EXTREM W/DYE	PRXOVR	DEF					NA	NA	NA	N
73222	MRI JOINT UPR EXTREM W/DYE	MAXFEE	DEF					315.45	1/1/2018	12/31/2299	N
73222	MRI JOINT UPR EXTREM W/DYE	MAXFEE	DEF	26				63.09	1/1/2018	12/31/2299	N
73222	MRI JOINT UPR EXTREM W/DYE	MAXFEE	DEF	TC				252.36	1/1/2018	12/31/2299	N
73223	MRI JOINT UPR EXTR W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73223	MRI JOINT UPR EXTR W/O&W/DYE	MAXFEE	DEF					391.11	1/1/2018	12/31/2299	N
73223	MRI JOINT UPR EXTR W/O&W/DYE	MAXFEE	DEF	26				78.22	1/1/2018	12/31/2299	N
73223	MRI JOINT UPR EXTR W/O&W/DYE	MAXFEE	DEF	TC				312.89	1/1/2018	12/31/2299	N
73225	MR ANGIO UPR EXTR W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73225	MR ANGIO UPR EXTR W/O&W/DYE	MAXFEE	DEF					340.22	1/1/2018	12/31/2299	N
73225	MR ANGIO UPR EXTR W/O&W/DYE	MAXFEE	DEF	26				68.04	1/1/2018	12/31/2299	N
73225	MR ANGIO UPR EXTR W/O&W/DYE	MAXFEE	DEF	TC				272.18	1/1/2018	12/31/2299	N
73500	X-RAY EXAM OF HIP	PRXOVR	DEF					NA	NA	NA	N
73500	X-RAY EXAM OF HIP	MAXFEE	DEF					NA			N
73501	X-RAY EXAM HIP UNI 1 VIEW	PRXOVR	DEF					NA	NA	NA	N
73501	X-RAY EXAM HIP UNI 1 VIEW	MAXFEE	DEF					21.44	1/1/2018	12/31/2299	N
73501	X-RAY EXAM HIP UNI 1 VIEW	MAXFEE	DEF	26				6.43	1/1/2018	12/31/2299	N
73501	X-RAY EXAM HIP UNI 1 VIEW	MAXFEE	DEF	TC				15.01	1/1/2018	12/31/2299	N
73502	X-RAY EXAM HIP UNI 2-3 VIEWS	PRXOVR	DEF					NA	NA	NA	N
73502	X-RAY EXAM HIP UNI 2-3 VIEWS	MAXFEE	DEF					29.53	1/1/2018	12/31/2299	N
73502	X-RAY EXAM HIP UNI 2-3 VIEWS	MAXFEE	DEF	26				8.86	1/1/2018	12/31/2299	N
73502	X-RAY EXAM HIP UNI 2-3 VIEWS	MAXFEE	DEF	TC				20.67	1/1/2018	12/31/2299	N
73503	X-RAY EXAM HIP UNI 4/> VIEWS	PRXOVR	DEF					NA	NA	NA	N
73503	X-RAY EXAM HIP UNI 4/> VIEWS	MAXFEE	DEF					36.91	1/1/2018	12/31/2299	N
73503	X-RAY EXAM HIP UNI 4/> VIEWS	MAXFEE	DEF	26				11.07	1/1/2018	12/31/2299	N
73503	X-RAY EXAM HIP UNI 4/> VIEWS	MAXFEE	DEF	TC				25.84	1/1/2018	12/31/2299	N
73510	X-RAY EXAM OF HIP	PRXOVR	DEF					NA	NA	NA	N
73510	X-RAY EXAM OF HIP	MAXFEE	DEF					NA			N
73520	X-RAY EXAM OF HIPS	PRXOVR	DEF					NA	NA	NA	N
73520	X-RAY EXAM OF HIPS	MAXFEE	DEF					NA			N
73521	X-RAY EXAM HIPS BI 2 VIEWS	PRXOVR	DEF					NA	NA	NA	N
73521	X-RAY EXAM HIPS BI 2 VIEWS	MAXFEE	DEF					28.53	1/1/2018	12/31/2299	N
73521	X-RAY EXAM HIPS BI 2 VIEWS	MAXFEE	DEF	26				8.56	1/1/2018	12/31/2299	N
73521	X-RAY EXAM HIPS BI 2 VIEWS	MAXFEE	DEF	TC				19.97	1/1/2018	12/31/2299	N
73522	X-RAY EXAM HIPS BI 3-4 VIEWS	PRXOVR	DEF					NA	NA	NA	N
73522	X-RAY EXAM HIPS BI 3-4 VIEWS	MAXFEE	DEF					34.95	1/1/2018	12/31/2299	N
73522	X-RAY EXAM HIPS BI 3-4 VIEWS	MAXFEE	DEF	26				10.49	1/1/2018	12/31/2299	N
73522	X-RAY EXAM HIPS BI 3-4 VIEWS	MAXFEE	DEF	TC				24.47	1/1/2018	12/31/2299	N
73523	X-RAY EXAM HIPS BI 5/> VIEWS	PRXOVR	DEF					NA	NA	NA	N
73523	X-RAY EXAM HIPS BI 5/> VIEWS	MAXFEE	DEF					40.50	1/1/2018	12/31/2299	N
73523	X-RAY EXAM HIPS BI 5/> VIEWS	MAXFEE	DEF	26				12.15	1/1/2018	12/31/2299	N
73523	X-RAY EXAM HIPS BI 5/> VIEWS	MAXFEE	DEF	TC				28.35	1/1/2018	12/31/2299	N
73525	CONTRAST X-RAY OF HIP	PRXOVR	DEF					NA	NA	NA	N
73525	CONTRAST X-RAY OF HIP	MAXFEE	DEF					77.53	1/1/2018	12/31/2299	N
73525	CONTRAST X-RAY OF HIP	MAXFEE	DEF	26				23.26	1/1/2018	12/31/2299	N
73525	CONTRAST X-RAY OF HIP	MAXFEE	DEF	TC				54.27	1/1/2018	12/31/2299	N
73530	X-RAY EXAM OF HIP	PRXOVR	DEF					NA	NA	NA	N
73530	X-RAY EXAM OF HIP	MAXFEE	DEF					65.96	1/1/2016	12/31/2299	N
73530	X-RAY EXAM OF HIP	MAXFEE	DEF	26				32.98	1/1/2016	12/31/2299	N
73530	X-RAY EXAM OF HIP	MAXFEE	DEF	TC				32.98	1/1/2016	12/31/2299	N
73540	X-RAY EXAM OF PELVIS & HIPS	PRXOVR	DEF					NA	NA	NA	N
73540	X-RAY EXAM OF PELVIS & HIPS	MAXFEE	DEF					NA			N
73550	X-RAY EXAM OF THIGH	PRXOVR	DEF					NA	NA	NA	N
73550	X-RAY EXAM OF THIGH	MAXFEE	DEF					NA			N
73551	X-RAY EXAM OF FEMUR 1	PRXOVR	DEF					NA	NA	NA	N
73551	X-RAY EXAM OF FEMUR 1	MAXFEE	DEF					19.89	1/1/2018	12/31/2299	N
73551	X-RAY EXAM OF FEMUR 1	MAXFEE	DEF	26				5.97	1/1/2018	12/31/2299	N
73551	X-RAY EXAM OF FEMUR 1	MAXFEE	DEF	TC				13.92	1/1/2018	12/31/2299	N
73552	X-RAY EXAM OF FEMUR 2/>	PRXOVR	DEF					NA	NA	NA	N
73552	X-RAY EXAM OF FEMUR 2/>	MAXFEE	DEF					23.19	1/1/2018	12/31/2299	N
73552	X-RAY EXAM OF FEMUR 2/>	MAXFEE	DEF	26				6.96	1/1/2018	12/31/2299	N
73552	X-RAY EXAM OF FEMUR 2/>	MAXFEE	DEF	TC				16.23	1/1/2018	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	PRXOVR	DEF					NA	NA	NA	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF					19.92	1/1/2018	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF	26				6.97	1/1/2018	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF	TC				12.95	1/1/2018	12/31/2299	N
73562	X-RAY EXAM OF KNEE 3	PRXOVR	DEF					NA	NA	NA	N
73562	X-RAY EXAM OF KNEE 3	MAXFEE	DEF					22.63	1/1/2018	12/31/2299	N
73562	X-RAY EXAM OF KNEE 3	MAXFEE	DEF	26				7.92	1/1/2018	12/31/2299	N
73562	X-RAY EXAM OF KNEE 3	MAXFEE	DEF	TC				14.71	1/1/2018	12/31/2299	N
73564	X-RAY EXAM KNEE 4 OR MORE	PRXOVR	DEF					NA	NA	NA	N
73564	X-RAY EXAM KNEE 4 OR MORE	MAXFEE	DEF					25.45	1/1/2018	12/31/2299	N
73564	X-RAY EXAM KNEE 4 OR MORE	MAXFEE	DEF	26				8.91	1/1/2018	12/31/2299	N
73564	X-RAY EXAM KNEE 4 OR MORE	MAXFEE	DEF	TC				16.54	1/1/2018	12/31/2299	N
73565	X-RAY EXAM OF KNEES	PRXOVR	DEF					NA	NA	NA	N
73565	X-RAY EXAM OF KNEES	MAXFEE	DEF					19.73	1/1/2018	12/31/2299	N
73565	X-RAY EXAM OF KNEES	MAXFEE	DEF	26				6.91	1/1/2018	12/31/2299	N
73565	X-RAY EXAM OF KNEES	MAXFEE	DEF	TC				12.82	1/1/2018	12/31/2299	N
73580	CONTRAST X-RAY OF KNEE JOINT	PRXOVR	DEF					NA	NA	NA	N
73580	CONTRAST X-RAY OF KNEE JOINT	MAXFEE	DEF					91.83	1/1/2018	12/31/2299	N
73580	CONTRAST X-RAY OF KNEE JOINT	MAXFEE	DEF	26				22.96	1/1/2018	12/31/2299	N
73580	CONTRAST X-RAY OF KNEE JOINT	MAXFEE	DEF	TC				68.87	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF					19.86	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF	26				6.95	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF	TC				12.91	1/1/2018	12/31/2299	N
73592	X-RAY EXAM OF LEG INFANT	PRXOVR	DEF					NA	NA	NA	N
73592	X-RAY EXAM OF LEG INFANT	MAXFEE	DEF					19.41	1/1/2018	12/31/2299	N
73592	X-RAY EXAM OF LEG INFANT	MAXFEE	DEF	26				6.79	1/1/2018	12/31/2299	N
73592	X-RAY EXAM OF LEG INFANT	MAXFEE	DEF	TC				12.62	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	PRXOVR	DEF					NA	NA	NA	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF					19.41	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF	26				6.79	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF	TC				12.62	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	PRXOVR	DEF					NA	NA	NA	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73615	CONTRAST X-RAY OF ANKLE	PRXOVR	DEF					NA	NA	NA	N
73615	CONTRAST X-RAY OF ANKLE	MAXFEE	DEF					77.72	1/1/2018	12/31/2299	N
73615	CONTRAST X-RAY OF ANKLE	MAXFEE	DEF	26				23.32	1/1/2018	12/31/2299	N
73615	CONTRAST X-RAY OF ANKLE	MAXFEE	DEF	TC				54.40	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	PRXOVR	DEF					NA	NA	NA	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF					18.83	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF	26				6.59	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF	TC				12.24	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	PRXOVR	DEF					NA	NA	NA	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	PRXOVR	DEF					NA	NA	NA	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF					18.91	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF	26				6.62	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF	TC				12.29	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	PRXOVR	DEF					NA	NA	NA	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF					16.45	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF	26				5.76	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF	TC				10.69	1/1/2018	12/31/2299	N
73700	CT LOWER EXTREMITY W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73700	CT LOWER EXTREMITY W/O DYE	MAXFEE	DEF					144.39	1/1/2018	12/31/2299	N
73700	CT LOWER EXTREMITY W/O DYE	MAXFEE	DEF	26				36.10	1/1/2018	12/31/2299	N
73700	CT LOWER EXTREMITY W/O DYE	MAXFEE	DEF	TC				108.29	1/1/2018	12/31/2299	N
73701	CT LOWER EXTREMITY W/DYE	PRXOVR	DEF					NA	NA	NA	N
73701	CT LOWER EXTREMITY W/DYE	MAXFEE	DEF					190.45	1/1/2018	12/31/2299	N
73701	CT LOWER EXTREMITY W/DYE	MAXFEE	DEF	26				47.61	1/1/2018	12/31/2299	N
73701	CT LOWER EXTREMITY W/DYE	MAXFEE	DEF	TC				142.84	1/1/2018	12/31/2299	N
73702	CT LWR EXTREMITY W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73702	CT LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF					229.98	1/1/2018	12/31/2299	N
73702	CT LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF	26				46	1/1/2018	12/31/2299	N
73702	CT LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF	TC				183.98	1/1/2018	12/31/2299	N
73706	CT ANGIO LWR EXTR W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73706	CT ANGIO LWR EXTR W/O&W/DYE	MAXFEE	DEF					260.23	1/1/2018	12/31/2299	N
73706	CT ANGIO LWR EXTR W/O&W/DYE	MAXFEE	DEF	26				78.07	1/1/2018	12/31/2299	N
73706	CT ANGIO LWR EXTR W/O&W/DYE	MAXFEE	DEF	TC				182.16	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF					296.60	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF	26				59.32	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF	TC				237.28	1/1/2018	12/31/2299	N
73719	MRI LOWER EXTREMITY W/DYE	PRXOVR	DEF					NA	NA	NA	N
73719	MRI LOWER EXTREMITY W/DYE	MAXFEE	DEF					338.63	1/1/2018	12/31/2299	N
73719	MRI LOWER EXTREMITY W/DYE	MAXFEE	DEF	26				67.73	1/1/2018	12/31/2299	N
73719	MRI LOWER EXTREMITY W/DYE	MAXFEE	DEF	TC				270.90	1/1/2018	12/31/2299	N
73720	MRI LWR EXTREMITY W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73720	MRI LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF					359.01	1/1/2018	12/31/2299	N
73720	MRI LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF	26				71.80	1/1/2018	12/31/2299	N
73720	MRI LWR EXTREMITY W/O&W/DYE	MAXFEE	DEF	TC				287.21	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF					198.97	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF	26				49.74	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF	TC				149.23	1/1/2018	12/31/2299	N
73722	MRI JOINT OF LWR EXTR W/DYE	PRXOVR	DEF					NA	NA	NA	N
73722	MRI JOINT OF LWR EXTR W/DYE	MAXFEE	DEF					319.74	1/1/2018	12/31/2299	N
73722	MRI JOINT OF LWR EXTR W/DYE	MAXFEE	DEF	26				63.95	1/1/2018	12/31/2299	N
73722	MRI JOINT OF LWR EXTR W/DYE	MAXFEE	DEF	TC				255.79	1/1/2018	12/31/2299	N
73723	MRI JOINT LWR EXTR W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
73723	MRI JOINT LWR EXTR W/O&W/DYE	MAXFEE	DEF					392.24	1/1/2018	12/31/2299	N
73723	MRI JOINT LWR EXTR W/O&W/DYE	MAXFEE	DEF	26				78.45	1/1/2018	12/31/2299	N
73723	MRI JOINT LWR EXTR W/O&W/DYE	MAXFEE	DEF	TC				313.79	1/1/2018	12/31/2299	N
73725	MR ANG LWR EXT W OR W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73725	MR ANG LWR EXT W OR W/O DYE	MAXFEE	DEF					339.85	1/1/2018	12/31/2299	N
73725	MR ANG LWR EXT W OR W/O DYE	MAXFEE	DEF	26				67.97	1/1/2018	12/31/2299	N
73725	MR ANG LWR EXT W OR W/O DYE	MAXFEE	DEF	TC				271.88	1/1/2018	12/31/2299	N
74000	X-RAY EXAM OF ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
74000	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF					20.35	1/1/2018	12/31/2299	N
74000	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	26				7.12	1/1/2018	12/31/2299	N
74000	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	TC				13.23	1/1/2018	12/31/2299	N
74010	X-RAY EXAM OF ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
74010	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	TC				14.79	1/1/2018	12/31/2299	N
74010	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF					24.65	1/1/2018	12/31/2299	N
74010	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	26				9.86	1/1/2018	12/31/2299	N
74018	X-RAY EXAM ABDOMEN 1 VIEW	PRXOVR	DEF					NA	NA	NA	N
74018	X-RAY EXAM ABDOMEN 1 VIEW	MAXFEE	DEF					19.47	1/1/2018	12/31/2299	N
74018	X-RAY EXAM ABDOMEN 1 VIEW	MAXFEE	DEF	26				6.82	1/1/2018	12/31/2299	N
74018	X-RAY EXAM ABDOMEN 1 VIEW	MAXFEE	DEF	TC				12.65	1/1/2018	12/31/2299	N
74019	X-RAY EXAM ABDOMEN 2 VIEWS	PRXOVR	DEF					NA	NA	NA	N
74019	X-RAY EXAM ABDOMEN 2 VIEWS	MAXFEE	DEF					23.77	1/1/2018	12/31/2299	N
74019	X-RAY EXAM ABDOMEN 2 VIEWS	MAXFEE	DEF	26				8.65	1/1/2018	12/31/2299	N
74019	X-RAY EXAM ABDOMEN 2 VIEWS	MAXFEE	DEF	TC				15.13	1/1/2018	12/31/2299	N
74020	X-RAY EXAM OF ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
74020	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF					26.55	1/1/2018	12/31/2299	N
74020	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	26				10.62	1/1/2018	12/31/2299	N
74020	X-RAY EXAM OF ABDOMEN	MAXFEE	DEF	TC				15.93	1/1/2018	12/31/2299	N
74021	X-RAY EXAM ABDOMEN 3+ VIEWS	PRXOVR	DEF					NA	NA	NA	N
74021	X-RAY EXAM ABDOMEN 3+ VIEWS	MAXFEE	DEF					27.84	1/1/2018	12/31/2299	N
74021	X-RAY EXAM ABDOMEN 3+ VIEWS	MAXFEE	DEF	26				10.24	1/1/2018	12/31/2299	N
74021	X-RAY EXAM ABDOMEN 3+ VIEWS	MAXFEE	DEF	TC				17.60	1/1/2018	12/31/2299	N
74022	X-RAY EXAM COMPLETE ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
74022	X-RAY EXAM COMPLETE ABDOMEN	MAXFEE	DEF					32.31	1/1/2018	12/31/2299	N
74022	X-RAY EXAM COMPLETE ABDOMEN	MAXFEE	DEF	26				12.92	1/1/2018	12/31/2299	N
74022	X-RAY EXAM COMPLETE ABDOMEN	MAXFEE	DEF	TC				19.39	1/1/2018	12/31/2299	N
74150	CT ABDOMEN W/O DYE	PRXOVR	DEF					NA	NA	NA	N
74150	CT ABDOMEN W/O DYE	MAXFEE	DEF					126.54	1/1/2018	12/31/2299	N
74150	CT ABDOMEN W/O DYE	MAXFEE	DEF	26				50.62	1/1/2018	12/31/2299	N
74150	CT ABDOMEN W/O DYE	MAXFEE	DEF	TC				75.92	1/1/2018	12/31/2299	N
74160	CT ABDOMEN W/DYE	PRXOVR	DEF					NA	NA	NA	N
74160	CT ABDOMEN W/DYE	MAXFEE	DEF					194.86	1/1/2018	12/31/2299	N
74160	CT ABDOMEN W/DYE	MAXFEE	DEF	26				48.72	1/1/2018	12/31/2299	N
74160	CT ABDOMEN W/DYE	MAXFEE	DEF	TC				146.15	1/1/2018	12/31/2299	N
74170	CT ABDOMEN W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
74170	CT ABDOMEN W/O & W/DYE	MAXFEE	DEF					224.91	1/1/2018	12/31/2299	N
74170	CT ABDOMEN W/O & W/DYE	MAXFEE	DEF	26				67.47	1/1/2018	12/31/2299	N
74170	CT ABDOMEN W/O & W/DYE	MAXFEE	DEF	TC				157.44	1/1/2018	12/31/2299	N
74174	CT ANGIO ABD&PELV W/O&W/DYE	PRXOVR	DEF					NA	NA	NA	N
74174	CT ANGIO ABD&PELV W/O&W/DYE	MAXFEE	DEF					264	1/1/2018	12/31/2299	N
74174	CT ANGIO ABD&PELV W/O&W/DYE	MAXFEE	DEF	26				52.80	1/1/2018	12/31/2299	N
74174	CT ANGIO ABD&PELV W/O&W/DYE	MAXFEE	DEF	TC				211.20	1/1/2018	12/31/2299	N
74175	CT ANGIO ABDOM W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
74175	CT ANGIO ABDOM W/O & W/DYE	MAXFEE	DEF					259.86	1/1/2018	12/31/2299	N
74175	CT ANGIO ABDOM W/O & W/DYE	MAXFEE	DEF	26				64.97	1/1/2018	12/31/2299	N
74175	CT ANGIO ABDOM W/O & W/DYE	MAXFEE	DEF	TC				194.90	1/1/2018	12/31/2299	N
74176	CT ABD & PELVIS W/O CONTRAST	PRXOVR	DEF					NA	NA	NA	N
74176	CT ABD & PELVIS W/O CONTRAST	MAXFEE	DEF					122.29	1/1/2018	12/31/2299	N
74176	CT ABD & PELVIS W/O CONTRAST	MAXFEE	DEF	26				48.92	1/1/2018	12/31/2299	N
74176	CT ABD & PELVIS W/O CONTRAST	MAXFEE	DEF	TC				73.37	1/1/2018	12/31/2299	N
74177	CT ABD & PELV W/CONTRAST	PRXOVR	DEF					NA	NA	NA	N
74177	CT ABD & PELV W/CONTRAST	MAXFEE	DEF					176.29	1/1/2018	12/31/2299	N
74177	CT ABD & PELV W/CONTRAST	MAXFEE	DEF	26				44.07	1/1/2018	12/31/2299	N
74177	CT ABD & PELV W/CONTRAST	MAXFEE	DEF	TC				132.22	1/1/2018	12/31/2299	N
74178	CT ABD & PELV 1/> REGNS	PRXOVR	DEF					NA	NA	NA	N
74178	CT ABD & PELV 1/> REGNS	MAXFEE	DEF					209.21	1/1/2018	12/31/2299	N
74178	CT ABD & PELV 1/> REGNS	MAXFEE	DEF	26				62.76	1/1/2018	12/31/2299	N
74178	CT ABD & PELV 1/> REGNS	MAXFEE	DEF	TC				146.45	1/1/2018	12/31/2299	N
74181	MRI ABDOMEN W/O DYE	PRXOVR	DEF					NA	NA	NA	N
74181	MRI ABDOMEN W/O DYE	MAXFEE	DEF					272.54	1/1/2018	12/31/2299	N
74181	MRI ABDOMEN W/O DYE	MAXFEE	DEF	26				54.51	1/1/2018	12/31/2299	N
74181	MRI ABDOMEN W/O DYE	MAXFEE	DEF	TC				218.03	1/1/2018	12/31/2299	N
74182	MRI ABDOMEN W/DYE	PRXOVR	DEF					NA	NA	NA	N
74182	MRI ABDOMEN W/DYE	MAXFEE	DEF					374.79	1/1/2018	12/31/2299	N
74182	MRI ABDOMEN W/DYE	MAXFEE	DEF	26				74.96	1/1/2018	12/31/2299	N
74182	MRI ABDOMEN W/DYE	MAXFEE	DEF	TC				299.83	1/1/2018	12/31/2299	N
74183	MRI ABDOMEN W/O & W/DYE	PRXOVR	DEF					NA	NA	NA	N
74183	MRI ABDOMEN W/O & W/DYE	MAXFEE	DEF					420.19	1/1/2018	12/31/2299	N
74183	MRI ABDOMEN W/O & W/DYE	MAXFEE	DEF	26				84.04	1/1/2018	12/31/2299	N
74183	MRI ABDOMEN W/O & W/DYE	MAXFEE	DEF	TC				336.15	1/1/2018	12/31/2299	N
74185	MRI ANGIO ABDOM W ORW/O DYE	PRXOVR	DEF					NA	NA	NA	N
74185	MRI ANGIO ABDOM W ORW/O DYE	MAXFEE	DEF					339.79	1/1/2018	12/31/2299	N
74185	MRI ANGIO ABDOM W ORW/O DYE	MAXFEE	DEF	26				67.96	1/1/2018	12/31/2299	N
74185	MRI ANGIO ABDOM W ORW/O DYE	MAXFEE	DEF	TC				271.83	1/1/2018	12/31/2299	N
74190	X-RAY EXAM OF PERITONEUM	PRXOVR	DEF					NA	NA	NA	N
74190	X-RAY EXAM OF PERITONEUM	MAXFEE	DEF					143.45	1/1/2018	12/31/2299	N
74190	X-RAY EXAM OF PERITONEUM	MAXFEE	DEF	26				28.69	1/1/2018	12/31/2299	N
74190	X-RAY EXAM OF PERITONEUM	MAXFEE	DEF	TC				114.76	1/1/2018	12/31/2299	N
74210	X-RAY XM PHRNX&/CRV ESOPH C+	PRXOVR	DEF					NA	NA	NA	N
74210	X-RAY XM PHRNX&/CRV ESOPH C+	MAXFEE	DEF					45.60	1/1/2018	12/31/2299	N
74210	X-RAY XM PHRNX&/CRV ESOPH C+	MAXFEE	DEF	26				11.40	1/1/2018	12/31/2299	N
74210	X-RAY XM PHRNX&/CRV ESOPH C+	MAXFEE	DEF	TC				34.20	1/1/2018	12/31/2299	N
74220	X-RAY XM ESOPHAGUS 1CNTRST	PRXOVR	DEF					NA	NA	NA	N
74220	X-RAY XM ESOPHAGUS 1CNTRST	MAXFEE	DEF					49.51	1/1/2018	12/31/2299	N
74220	X-RAY XM ESOPHAGUS 1CNTRST	MAXFEE	DEF	26				14.85	1/1/2018	12/31/2299	N
74220	X-RAY XM ESOPHAGUS 1CNTRST	MAXFEE	DEF	TC				34.66	1/1/2018	12/31/2299	N
74221	X-RAY XM ESOPHAGUS 2CNTRST	PRXOVR	DEF					NA	NA	NA	N
74221	X-RAY XM ESOPHAGUS 2CNTRST	MAXFEE	DEF					82.54	1/1/2020	12/31/2299	N
74221	X-RAY XM ESOPHAGUS 2CNTRST	MAXFEE	DEF	TC				54.72	1/1/2020	12/31/2299	N
74221	X-RAY XM ESOPHAGUS 2CNTRST	MAXFEE	DEF	26				27.82	1/1/2020	12/31/2299	N
74230	X-RAY XM SWLNG FUNCJ C+	PRXOVR	DEF					NA	NA	NA	N
74230	X-RAY XM SWLNG FUNCJ C+	MAXFEE	DEF					55.69	1/1/2018	12/31/2299	N
74230	X-RAY XM SWLNG FUNCJ C+	MAXFEE	DEF	26				16.71	1/1/2018	12/31/2299	N
74230	X-RAY XM SWLNG FUNCJ C+	MAXFEE	DEF	TC				38.98	1/1/2018	12/31/2299	N
74240	X-RAY XM UPR GI TRC 1CNTRST	PRXOVR	DEF					NA	NA	NA	N
74240	X-RAY XM UPR GI TRC 1CNTRST	MAXFEE	DEF					66.32	1/1/2018	12/31/2299	N
74240	X-RAY XM UPR GI TRC 1CNTRST	MAXFEE	DEF	26				26.53	1/1/2018	12/31/2299	N
74240	X-RAY XM UPR GI TRC 1CNTRST	MAXFEE	DEF	TC				39.79	1/1/2018	12/31/2299	N
74241	X-RAY UPPER GI DELAY W/KUB	PRXOVR	DEF					NA	NA	NA	N
74241	X-RAY UPPER GI DELAY W/KUB	MAXFEE	DEF					NA			N
74245	X-RAY UPPER GI&SMALL INTEST	PRXOVR	DEF					NA	NA	NA	N
74245	X-RAY UPPER GI&SMALL INTEST	MAXFEE	DEF					NA			N
74246	X-RAY XM UPR GI TRC 2CNTRST	PRXOVR	DEF					NA	NA	NA	N
74246	X-RAY XM UPR GI TRC 2CNTRST	MAXFEE	DEF					71.25	1/1/2018	12/31/2299	N
74246	X-RAY XM UPR GI TRC 2CNTRST	MAXFEE	DEF	26				21.38	1/1/2018	12/31/2299	N
74246	X-RAY XM UPR GI TRC 2CNTRST	MAXFEE	DEF	TC				49.88	1/1/2018	12/31/2299	N
74247	CONTRST X-RAY UPPR GI TRACT	PRXOVR	DEF					NA	NA	NA	N
74247	CONTRST X-RAY UPPR GI TRACT	MAXFEE	DEF					NA			N
74248	X-RAY SM INT F-THRU STD	PRXOVR	DEF					NA	NA	NA	N
74248	X-RAY SM INT F-THRU STD	MAXFEE	DEF					62.95	1/1/2020	12/31/2299	N
74248	X-RAY SM INT F-THRU STD	MAXFEE	DEF	TC				35.13	1/1/2020	12/31/2299	N
74248	X-RAY SM INT F-THRU STD	MAXFEE	DEF	26				27.82	1/1/2020	12/31/2299	N
74249	CONTRST X-RAY UPPR GI TRACT	PRXOVR	DEF					NA	NA	NA	N
74249	CONTRST X-RAY UPPR GI TRACT	MAXFEE	DEF					NA			N
74250	X-RAY XM SM INT 1CNTRST STD	PRXOVR	DEF					NA	NA	NA	N
74250	X-RAY XM SM INT 1CNTRST STD	MAXFEE	DEF					52.97	1/1/2018	12/31/2299	N
74250	X-RAY XM SM INT 1CNTRST STD	MAXFEE	DEF	26				15.89	1/1/2018	12/31/2299	N
74250	X-RAY XM SM INT 1CNTRST STD	MAXFEE	DEF	TC				37.08	1/1/2018	12/31/2299	N
74251	X-RAY XM SM INT 2CNTRST STD	PRXOVR	DEF					NA	NA	NA	N
74251	X-RAY XM SM INT 2CNTRST STD	MAXFEE	DEF					156.57	1/1/2018	12/31/2299	N
74251	X-RAY XM SM INT 2CNTRST STD	MAXFEE	DEF	26				31.31	1/1/2018	12/31/2299	N
74251	X-RAY XM SM INT 2CNTRST STD	MAXFEE	DEF	TC				125.26	1/1/2018	12/31/2299	N
74260	X-RAY EXAM OF SMALL BOWEL	PRXOVR	DEF					NA	NA	NA	N
74260	X-RAY EXAM OF SMALL BOWEL	MAXFEE	DEF					NA			N
74261	CT COLONOGRAPHY DX	PRXOVR	DEF					NA	NA	NA	N
74261	CT COLONOGRAPHY DX	MAXFEE	DEF					208.47	1/1/2018	12/31/2299	N
74261	CT COLONOGRAPHY DX	MAXFEE	DEF	26				83.39	1/1/2018	12/31/2299	N
74261	CT COLONOGRAPHY DX	MAXFEE	DEF	TC				125.08	1/1/2018	12/31/2299	N
74262	CT COLONOGRAPHY DX W/DYE	PRXOVR	DEF					NA	NA	NA	N
74262	CT COLONOGRAPHY DX W/DYE	MAXFEE	DEF					313.03	1/1/2018	12/31/2299	N
74262	CT COLONOGRAPHY DX W/DYE	MAXFEE	DEF	26				62.61	1/1/2018	12/31/2299	N
74262	CT COLONOGRAPHY DX W/DYE	MAXFEE	DEF	TC				250.42	1/1/2018	12/31/2299	N
74263	CT COLONOGRAPHY SCREENING	PRXOVR	DEF					NA	NA	NA	N
74263	CT COLONOGRAPHY SCREENING	MAXFEE	DEF					362.56	1/1/2018	12/31/2299	N
74263	CT COLONOGRAPHY SCREENING	MAXFEE	DEF	26				72.51	1/1/2018	12/31/2299	N
74263	CT COLONOGRAPHY SCREENING	MAXFEE	DEF	TC				290.05	1/1/2018	12/31/2299	N
74270	X-RAY XM COLON 1CNTRST STD	PRXOVR	DEF					NA	NA	NA	N
74270	X-RAY XM COLON 1CNTRST STD	MAXFEE	DEF					73.08	1/1/2018	12/31/2299	N
74270	X-RAY XM COLON 1CNTRST STD	MAXFEE	DEF	26				21.92	1/1/2018	12/31/2299	N
74270	X-RAY XM COLON 1CNTRST STD	MAXFEE	DEF	TC				51.16	1/1/2018	12/31/2299	N
74280	X-RAY XM COLON 2CNTRST STD	PRXOVR	DEF					NA	NA	NA	N
74280	X-RAY XM COLON 2CNTRST STD	MAXFEE	DEF					130.57	1/1/2018	12/31/2299	N
74280	X-RAY XM COLON 2CNTRST STD	MAXFEE	DEF	26				39.17	1/1/2018	12/31/2299	N
74280	X-RAY XM COLON 2CNTRST STD	MAXFEE	DEF	TC				91.40	1/1/2018	12/31/2299	N
74283	THER NMA RDCTJ INTUS/OBSTRCJ	PRXOVR	DEF					NA	NA	NA	N
74283	THER NMA RDCTJ INTUS/OBSTRCJ	MAXFEE	DEF					146.83	1/1/2018	12/31/2299	N
74283	THER NMA RDCTJ INTUS/OBSTRCJ	MAXFEE	DEF	26				73.42	1/1/2018	12/31/2299	N
74283	THER NMA RDCTJ INTUS/OBSTRCJ	MAXFEE	DEF	TC				73.41	1/1/2018	12/31/2299	N
74290	CONTRAST X-RAY GALLBLADDER	PRXOVR	DEF					NA	NA	NA	N
74290	CONTRAST X-RAY GALLBLADDER	MAXFEE	DEF					32.31	1/1/2018	12/31/2299	N
74290	CONTRAST X-RAY GALLBLADDER	MAXFEE	DEF	26				9.69	1/1/2018	12/31/2299	N
74290	CONTRAST X-RAY GALLBLADDER	MAXFEE	DEF	TC				22.62	1/1/2018	12/31/2299	N
74291	CONTRAST X-RAYS GALLBLADDER	PRXOVR	DEF					NA	NA	NA	N
74291	CONTRAST X-RAYS GALLBLADDER	MAXFEE	DEF					NA			N
74305	X-RAY BILE DUCTS/PANCREAS	PRXOVR	DEF					NA	NA	NA	N
74305	X-RAY BILE DUCTS/PANCREAS	MAXFEE	DEF					87.54	1/1/2018	12/31/2299	N
74305	X-RAY BILE DUCTS/PANCREAS	MAXFEE	DEF	26				43.77	1/1/2018	12/31/2299	N
74305	X-RAY BILE DUCTS/PANCREAS	MAXFEE	DEF	TC				43.77	1/1/2018	12/31/2299	N
74320	CONTRAST X-RAY OF BILE DUCTS	PRXOVR	DEF					NA	NA	NA	N
74320	CONTRAST X-RAY OF BILE DUCTS	MAXFEE	DEF					NA			N
74400	UROGRAPHY IV +-KUB TOMOG	PRXOVR	DEF					NA	NA	NA	N
74400	UROGRAPHY IV +-KUB TOMOG	MAXFEE	DEF	TC				48.24	1/1/2018	12/31/2299	N
74400	UROGRAPHY IV +-KUB TOMOG	MAXFEE	DEF					64.32	1/1/2018	12/31/2299	N
74400	UROGRAPHY IV +-KUB TOMOG	MAXFEE	DEF	26				16.08	1/1/2018	12/31/2299	N
74410	UROGRAPHY NFS DRIP&/BOLUS	PRXOVR	DEF					NA	NA	NA	N
74410	UROGRAPHY NFS DRIP&/BOLUS	MAXFEE	DEF					71.26	1/1/2018	12/31/2299	N
74410	UROGRAPHY NFS DRIP&/BOLUS	MAXFEE	DEF	26				21.38	1/1/2018	12/31/2299	N
74410	UROGRAPHY NFS DRIP&/BOLUS	MAXFEE	DEF	TC				49.88	1/1/2018	12/31/2299	N
74415	UROGRAPHY NFS DRIP&/BLS W/NF	PRXOVR	DEF					NA	NA	NA	N
74415	UROGRAPHY NFS DRIP&/BLS W/NF	MAXFEE	DEF					75.82	1/1/2018	12/31/2299	N
74415	UROGRAPHY NFS DRIP&/BLS W/NF	MAXFEE	DEF	26				15.16	1/1/2018	12/31/2299	N
74415	UROGRAPHY NFS DRIP&/BLS W/NF	MAXFEE	DEF	TC				60.66	1/1/2018	12/31/2299	N
74420	UROGRAPHY RTRGR +-KUB	PRXOVR	DEF					NA	NA	NA	N
74420	UROGRAPHY RTRGR +-KUB	MAXFEE	DEF					84.73	1/1/2018	12/31/2299	N
74420	UROGRAPHY RTRGR +-KUB	MAXFEE	DEF	26				16.95	1/1/2018	12/31/2299	N
74420	UROGRAPHY RTRGR +-KUB	MAXFEE	DEF	TC				67.78	1/1/2018	12/31/2299	N
74425	UROGRAPHY ANTEGRADE RS&I	PRXOVR	DEF					NA	NA	NA	N
74425	UROGRAPHY ANTEGRADE RS&I	MAXFEE	DEF					116.03	1/1/2018	12/31/2299	N
74425	UROGRAPHY ANTEGRADE RS&I	MAXFEE	DEF	26				34.81	1/1/2018	12/31/2299	N
74425	UROGRAPHY ANTEGRADE RS&I	MAXFEE	DEF	TC				81.22	1/1/2018	12/31/2299	N
74430	CONTRAST X-RAY BLADDER	PRXOVR	DEF					NA	NA	NA	N
74430	CONTRAST X-RAY BLADDER	MAXFEE	DEF					31.70	1/1/2018	12/31/2299	N
74430	CONTRAST X-RAY BLADDER	MAXFEE	DEF	26				7.93	1/1/2018	12/31/2299	N
74430	CONTRAST X-RAY BLADDER	MAXFEE	DEF	TC				23.78	1/1/2018	12/31/2299	N
74440	X-RAY MALE GENITAL TRACT	PRXOVR	DEF					NA	NA	NA	N
74440	X-RAY MALE GENITAL TRACT	MAXFEE	DEF					44.94	1/1/2018	12/31/2299	N
74440	X-RAY MALE GENITAL TRACT	MAXFEE	DEF	26				11.24	1/1/2018	12/31/2299	N
74440	X-RAY MALE GENITAL TRACT	MAXFEE	DEF	TC				33.71	1/1/2018	12/31/2299	N
74445	X-RAY EXAM OF PENIS	PRXOVR	DEF					NA	NA	NA	N
74445	X-RAY EXAM OF PENIS	MAXFEE	DEF					144.43	1/1/2018	12/31/2299	N
74445	X-RAY EXAM OF PENIS	MAXFEE	DEF	26				86.66	1/1/2018	12/31/2299	N
74445	X-RAY EXAM OF PENIS	MAXFEE	DEF	TC				57.77	1/1/2018	12/31/2299	N
74450	X-RAY URETHRA/BLADDER	PRXOVR	DEF					NA	NA	NA	N
74450	X-RAY URETHRA/BLADDER	MAXFEE	DEF					115.04	1/1/2018	12/31/2299	N
74450	X-RAY URETHRA/BLADDER	MAXFEE	DEF	26				28.76	1/1/2018	12/31/2299	N
74450	X-RAY URETHRA/BLADDER	MAXFEE	DEF	TC				86.28	1/1/2018	12/31/2299	N
74455	X-RAY URETHRA/BLADDER	PRXOVR	DEF					NA	NA	NA	N
74455	X-RAY URETHRA/BLADDER	MAXFEE	DEF					55.39	1/1/2018	12/31/2299	N
74455	X-RAY URETHRA/BLADDER	MAXFEE	DEF	26				13.85	1/1/2018	12/31/2299	N
74455	X-RAY URETHRA/BLADDER	MAXFEE	DEF	TC				41.54	1/1/2018	12/31/2299	N
74470	X-RAY EXAM OF KIDNEY LESION	PRXOVR	DEF					NA	NA	NA	N
74470	X-RAY EXAM OF KIDNEY LESION	MAXFEE	DEF					91.25	1/1/2018	12/31/2299	N
74470	X-RAY EXAM OF KIDNEY LESION	MAXFEE	DEF	26				36.50	1/1/2018	12/31/2299	N
74470	X-RAY EXAM OF KIDNEY LESION	MAXFEE	DEF	TC				54.75	1/1/2018	12/31/2299	N
74710	X-RAY MEASUREMENT OF PELVIS	PRXOVR	DEF					NA	NA	NA	N
74710	X-RAY MEASUREMENT OF PELVIS	MAXFEE	DEF					27.60	1/1/2018	12/31/2299	N
74710	X-RAY MEASUREMENT OF PELVIS	MAXFEE	DEF	26				13.80	1/1/2018	12/31/2299	N
74710	X-RAY MEASUREMENT OF PELVIS	MAXFEE	DEF	TC				13.80	1/1/2018	12/31/2299	N
74712	MRI FETAL SNGL/1ST GESTATION	PRXOVR	DEF					NA	NA	NA	N
74712	MRI FETAL SNGL/1ST GESTATION	MAXFEE	DEF					345.29	1/1/2018	12/31/2299	N
74712	MRI FETAL SNGL/1ST GESTATION	MAXFEE	DEF	26				103.59	1/1/2018	12/31/2299	N
74712	MRI FETAL SNGL/1ST GESTATION	MAXFEE	DEF	TC				241.70	1/1/2018	12/31/2299	N
74713	MRI FETAL EA ADDL GESTATION	PRXOVR	DEF					NA	NA	NA	N
74713	MRI FETAL EA ADDL GESTATION	MAXFEE	DEF					166.68	1/1/2018	12/31/2299	N
74713	MRI FETAL EA ADDL GESTATION	MAXFEE	DEF	26				66.67	1/1/2018	12/31/2299	N
74713	MRI FETAL EA ADDL GESTATION	MAXFEE	DEF	TC				100.01	1/1/2018	12/31/2299	N
74740	X-RAY FEMALE GENITAL TRACT	PRXOVR	DEF					NA	NA	NA	N
74740	X-RAY FEMALE GENITAL TRACT	MAXFEE	DEF					49.56	1/1/2018	12/31/2299	N
74740	X-RAY FEMALE GENITAL TRACT	MAXFEE	DEF	26				14.87	1/1/2018	12/31/2299	N
74740	X-RAY FEMALE GENITAL TRACT	MAXFEE	DEF	TC				34.69	1/1/2018	12/31/2299	N
74742	X-RAY FALLOPIAN TUBE	PRXOVR	DEF					NA	NA	NA	N
74742	X-RAY FALLOPIAN TUBE	MAXFEE	DEF					148.65	1/1/2018	12/31/2299	N
74742	X-RAY FALLOPIAN TUBE	MAXFEE	DEF	26				37.16	1/1/2018	12/31/2299	N
74742	X-RAY FALLOPIAN TUBE	MAXFEE	DEF	TC				111.49	1/1/2018	12/31/2299	N
74775	X-RAY EXAM OF PERINEUM	PRXOVR	DEF					NA	NA	NA	N
74775	X-RAY EXAM OF PERINEUM	MAXFEE	DEF					125.73	1/1/2018	12/31/2299	N
74775	X-RAY EXAM OF PERINEUM	MAXFEE	DEF	26				50.29	1/1/2018	12/31/2299	N
74775	X-RAY EXAM OF PERINEUM	MAXFEE	DEF	TC				75.44	1/1/2018	12/31/2299	N
75557	CARDIAC MRI FOR MORPH	PRXOVR	DEF					NA	NA	NA	N
75557	CARDIAC MRI FOR MORPH	MAXFEE	DEF					270.77	1/1/2018	12/31/2299	N
75557	CARDIAC MRI FOR MORPH	MAXFEE	DEF	26				108.31	1/1/2018	12/31/2299	N
75557	CARDIAC MRI FOR MORPH	MAXFEE	DEF	TC				162.46	1/1/2018	12/31/2299	N
75559	CARDIAC MRI W/STRESS IMG	PRXOVR	DEF					NA	NA	NA	N
75559	CARDIAC MRI W/STRESS IMG	MAXFEE	DEF					361.62	1/1/2018	12/31/2299	N
75559	CARDIAC MRI W/STRESS IMG	MAXFEE	DEF	26				108.49	1/1/2018	12/31/2299	N
75559	CARDIAC MRI W/STRESS IMG	MAXFEE	DEF	TC				253.13	1/1/2018	12/31/2299	N
75561	CARDIAC MRI FOR MORPH W/DYE	PRXOVR	DEF					NA	NA	NA	N
75561	CARDIAC MRI FOR MORPH W/DYE	MAXFEE	DEF					351.74	1/1/2018	12/31/2299	N
75561	CARDIAC MRI FOR MORPH W/DYE	MAXFEE	DEF	26				105.52	1/1/2018	12/31/2299	N
75561	CARDIAC MRI FOR MORPH W/DYE	MAXFEE	DEF	TC				246.22	1/1/2018	12/31/2299	N
75563	CARD MRI W/STRESS IMG & DYE	PRXOVR	DEF					NA	NA	NA	N
75563	CARD MRI W/STRESS IMG & DYE	MAXFEE	DEF					414.60	1/1/2018	12/31/2299	N
75563	CARD MRI W/STRESS IMG & DYE	MAXFEE	DEF	26				124.38	1/1/2018	12/31/2299	N
75563	CARD MRI W/STRESS IMG & DYE	MAXFEE	DEF	TC				290.22	1/1/2018	12/31/2299	N
75565	CARD MRI VELOC FLOW MAPPING	PRXOVR	DEF					NA	NA	NA	N
75565	CARD MRI VELOC FLOW MAPPING	MAXFEE	DEF					47.08	1/1/2018	12/31/2299	N
75565	CARD MRI VELOC FLOW MAPPING	MAXFEE	DEF	26				4.71	1/1/2018	12/31/2299	N
75565	CARD MRI VELOC FLOW MAPPING	MAXFEE	DEF	TC				42.37	1/1/2018	12/31/2299	N
75571	CT HRT W/O DYE W/CA TEST	PRXOVR	DEF					NA	NA	NA	N
75571	CT HRT W/O DYE W/CA TEST	MAXFEE	DEF					50.22	1/1/2018	12/31/2299	N
75571	CT HRT W/O DYE W/CA TEST	MAXFEE	DEF	26				12.56	1/1/2018	12/31/2299	N
75571	CT HRT W/O DYE W/CA TEST	MAXFEE	DEF	TC				37.67	1/1/2018	12/31/2299	N
75572	CT HRT W/3D IMAGE	PRXOVR	DEF					NA	NA	NA	N
75572	CT HRT W/3D IMAGE	MAXFEE	DEF					168.62	1/1/2018	12/31/2299	N
75572	CT HRT W/3D IMAGE	MAXFEE	DEF	26				50.59	1/1/2018	12/31/2299	N
75572	CT HRT W/3D IMAGE	MAXFEE	DEF	TC				118.03	1/1/2018	12/31/2299	N
75573	CT HRT C+ STRUX CGEN HRT DS	PRXOVR	DEF					NA	NA	NA	N
75573	CT HRT C+ STRUX CGEN HRT DS	MAXFEE	DEF					232.18	1/1/2018	12/31/2299	N
75573	CT HRT C+ STRUX CGEN HRT DS	MAXFEE	DEF	26				69.65	1/1/2018	12/31/2299	N
75573	CT HRT C+ STRUX CGEN HRT DS	MAXFEE	DEF	TC				162.53	1/1/2018	12/31/2299	N
75574	CT ANGIO HRT W/3D IMAGE	PRXOVR	DEF					NA	NA	NA	N
75574	CT ANGIO HRT W/3D IMAGE	MAXFEE	DEF					298.75	1/1/2018	12/31/2299	N
75574	CT ANGIO HRT W/3D IMAGE	MAXFEE	DEF	26				89.63	1/1/2018	12/31/2299	N
75574	CT ANGIO HRT W/3D IMAGE	MAXFEE	DEF	TC				209.13	1/1/2018	12/31/2299	N
75600	CONTRAST EXAM THORACIC AORTA	PRXOVR	DEF					NA	NA	NA	N
75600	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF					173.44	1/1/2018	12/31/2299	N
75600	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF	26				17.34	1/1/2018	12/31/2299	N
75600	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF	TC				156.10	1/1/2018	12/31/2299	N
75605	CONTRAST EXAM THORACIC AORTA	PRXOVR	DEF					NA	NA	NA	N
75605	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF					119.45	1/1/2018	12/31/2299	N
75605	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF	26				41.81	1/1/2018	12/31/2299	N
75605	CONTRAST EXAM THORACIC AORTA	MAXFEE	DEF	TC				77.64	1/1/2018	12/31/2299	N
75625	CONTRAST EXAM ABDOMINL AORTA	PRXOVR	DEF					NA	NA	NA	N
75625	CONTRAST EXAM ABDOMINL AORTA	MAXFEE	DEF					119.55	1/1/2018	12/31/2299	N
75625	CONTRAST EXAM ABDOMINL AORTA	MAXFEE	DEF	26				41.84	1/1/2018	12/31/2299	N
75625	CONTRAST EXAM ABDOMINL AORTA	MAXFEE	DEF	TC				77.71	1/1/2018	12/31/2299	N
75630	X-RAY AORTA LEG ARTERIES	PRXOVR	DEF					NA	NA	NA	N
75630	X-RAY AORTA LEG ARTERIES	MAXFEE	DEF					152.58	1/1/2018	12/31/2299	N
75630	X-RAY AORTA LEG ARTERIES	MAXFEE	DEF	26				76.29	1/1/2018	12/31/2299	N
75630	X-RAY AORTA LEG ARTERIES	MAXFEE	DEF	TC				76.29	1/1/2018	12/31/2299	N
75635	CT ANGIO ABDOMINAL ARTERIES	PRXOVR	DEF					NA	NA	NA	N
75635	CT ANGIO ABDOMINAL ARTERIES	MAXFEE	DEF					316.64	1/1/2018	12/31/2299	N
75635	CT ANGIO ABDOMINAL ARTERIES	MAXFEE	DEF	26				79.16	1/1/2018	12/31/2299	N
75635	CT ANGIO ABDOMINAL ARTERIES	MAXFEE	DEF	TC				237.48	1/1/2018	12/31/2299	N
75650	ARTERY X-RAYS HEAD & NECK	PRXOVR	DEF					NA	NA	NA	N
75650	ARTERY X-RAYS HEAD & NECK	MAXFEE	DEF					NA			N
75658	ARTERY X-RAYS ARM	PRXOVR	DEF					NA	NA	NA	N
75658	ARTERY X-RAYS ARM	MAXFEE	DEF					143.24	1/1/2018	12/31/2299	N
75658	ARTERY X-RAYS ARM	MAXFEE	DEF	26				50.13	1/1/2018	12/31/2299	N
75658	ARTERY X-RAYS ARM	MAXFEE	DEF	TC				93.11	1/1/2018	12/31/2299	N
75660	ARTERY X-RAYS HEAD & NECK	PRXOVR	DEF					NA	NA	NA	N
75660	ARTERY X-RAYS HEAD & NECK	MAXFEE	DEF					NA			N
75662	ARTERY X-RAYS HEAD & NECK	PRXOVR	DEF					NA	NA	NA	N
75662	ARTERY X-RAYS HEAD & NECK	MAXFEE	DEF					NA			N
75665	ARTERY X-RAYS HEAD & NECK	PRXOVR	DEF					NA	NA	NA	N
75665	ARTERY X-RAYS HEAD & NECK	MAXFEE	DEF					NA			N
75671	ARTERY X-RAYS HEAD & NECK	PRXOVR	DEF					NA	NA	NA	N
75671	ARTERY X-RAYS HEAD & NECK	MAXFEE	DEF					NA			N
75676	ARTERY X-RAYS NECK	PRXOVR	DEF					NA	NA	NA	N
75676	ARTERY X-RAYS NECK	MAXFEE	DEF					NA			N
75680	ARTERY X-RAYS NECK	PRXOVR	DEF					NA	NA	NA	N
75680	ARTERY X-RAYS NECK	MAXFEE	DEF					NA			N
75685	ARTERY X-RAYS SPINE	PRXOVR	DEF					NA	NA	NA	N
75685	ARTERY X-RAYS SPINE	MAXFEE	DEF					NA			N
75705	ARTERY X-RAYS SPINE	PRXOVR	DEF					NA	NA	NA	N
75705	ARTERY X-RAYS SPINE	MAXFEE	DEF					203.28	1/1/2018	12/31/2299	N
75705	ARTERY X-RAYS SPINE	MAXFEE	DEF	26				81.31	1/1/2018	12/31/2299	N
75705	ARTERY X-RAYS SPINE	MAXFEE	DEF	TC				121.97	1/1/2018	12/31/2299	N
75710	ARTERY X-RAYS ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
75710	ARTERY X-RAYS ARM/LEG	MAXFEE	DEF					137.42	1/1/2018	12/31/2299	N
75710	ARTERY X-RAYS ARM/LEG	MAXFEE	DEF	26				41.23	1/1/2018	12/31/2299	N
75710	ARTERY X-RAYS ARM/LEG	MAXFEE	DEF	TC				96.19	1/1/2018	12/31/2299	N
75716	ARTERY X-RAYS ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
75716	ARTERY X-RAYS ARMS/LEGS	MAXFEE	DEF					159.40	1/1/2018	12/31/2299	N
75716	ARTERY X-RAYS ARMS/LEGS	MAXFEE	DEF	26				47.82	1/1/2018	12/31/2299	N
75716	ARTERY X-RAYS ARMS/LEGS	MAXFEE	DEF	TC				111.58	1/1/2018	12/31/2299	N
75722	ARTERY X-RAYS KIDNEY	PRXOVR	DEF					NA	NA	NA	N
75722	ARTERY X-RAYS KIDNEY	MAXFEE	DEF					220.26	1/1/2012	12/31/2299	N
75722	ARTERY X-RAYS KIDNEY	MAXFEE	DEF	TC				198.23	1/1/2012	12/31/2299	N
75722	ARTERY X-RAYS KIDNEY	MAXFEE	DEF	26				22.03	1/1/2012	12/31/2299	N
75724	ARTERY X-RAYS KIDNEYS	PRXOVR	DEF					NA	NA	NA	N
75724	ARTERY X-RAYS KIDNEYS	MAXFEE	DEF					261.19	1/1/2012	12/31/2299	N
75724	ARTERY X-RAYS KIDNEYS	MAXFEE	DEF	TC				208.95	1/1/2012	12/31/2299	N
75724	ARTERY X-RAYS KIDNEYS	MAXFEE	DEF	26				52.24	1/1/2012	12/31/2299	N
75726	ARTERY X-RAYS ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
75726	ARTERY X-RAYS ABDOMEN	MAXFEE	DEF					128.61	1/1/2018	12/31/2299	N
75726	ARTERY X-RAYS ABDOMEN	MAXFEE	DEF	26				38.58	1/1/2018	12/31/2299	N
75726	ARTERY X-RAYS ABDOMEN	MAXFEE	DEF	TC				90.03	1/1/2018	12/31/2299	N
75731	ARTERY X-RAYS ADRENAL GLAND	PRXOVR	DEF					NA	NA	NA	N
75731	ARTERY X-RAYS ADRENAL GLAND	MAXFEE	DEF					137.17	1/1/2018	12/31/2299	N
75731	ARTERY X-RAYS ADRENAL GLAND	MAXFEE	DEF	26				41.15	1/1/2018	12/31/2299	N
75731	ARTERY X-RAYS ADRENAL GLAND	MAXFEE	DEF	TC				96.02	1/1/2018	12/31/2299	N
75733	ARTERY X-RAYS ADRENALS	PRXOVR	DEF					NA	NA	NA	N
75733	ARTERY X-RAYS ADRENALS	MAXFEE	DEF					155.90	1/1/2018	12/31/2299	N
75733	ARTERY X-RAYS ADRENALS	MAXFEE	DEF	26				46.77	1/1/2018	12/31/2299	N
75733	ARTERY X-RAYS ADRENALS	MAXFEE	DEF	TC				109.13	1/1/2018	12/31/2299	N
75736	ARTERY X-RAYS PELVIS	PRXOVR	DEF					NA	NA	NA	N
75736	ARTERY X-RAYS PELVIS	MAXFEE	DEF					143.18	1/1/2018	12/31/2299	N
75736	ARTERY X-RAYS PELVIS	MAXFEE	DEF	26				42.95	1/1/2018	12/31/2299	N
75736	ARTERY X-RAYS PELVIS	MAXFEE	DEF	TC				100.23	1/1/2018	12/31/2299	N
75741	ARTERY X-RAYS LUNG	PRXOVR	DEF					NA	NA	NA	N
75741	ARTERY X-RAYS LUNG	MAXFEE	DEF					134.11	1/1/2018	12/31/2299	N
75741	ARTERY X-RAYS LUNG	MAXFEE	DEF	26				53.64	1/1/2018	12/31/2299	N
75741	ARTERY X-RAYS LUNG	MAXFEE	DEF	TC				80.47	1/1/2018	12/31/2299	N
75743	ARTERY X-RAYS LUNGS	PRXOVR	DEF					NA	NA	NA	N
75743	ARTERY X-RAYS LUNGS	MAXFEE	DEF					146.58	1/1/2018	12/31/2299	N
75743	ARTERY X-RAYS LUNGS	MAXFEE	DEF	26				58.63	1/1/2018	12/31/2299	N
75743	ARTERY X-RAYS LUNGS	MAXFEE	DEF	TC				87.95	1/1/2018	12/31/2299	N
75746	ARTERY X-RAYS LUNG	PRXOVR	DEF					NA	NA	NA	N
75746	ARTERY X-RAYS LUNG	MAXFEE	DEF					130.81	1/1/2018	12/31/2299	N
75746	ARTERY X-RAYS LUNG	MAXFEE	DEF	26				39.24	1/1/2018	12/31/2299	N
75746	ARTERY X-RAYS LUNG	MAXFEE	DEF	TC				91.57	1/1/2018	12/31/2299	N
75756	ARTERY X-RAYS CHEST	PRXOVR	DEF					NA	NA	NA	N
75756	ARTERY X-RAYS CHEST	MAXFEE	DEF					145.71	1/1/2018	12/31/2299	N
75756	ARTERY X-RAYS CHEST	MAXFEE	DEF	26				43.71	1/1/2018	12/31/2299	N
75756	ARTERY X-RAYS CHEST	MAXFEE	DEF	TC				102	1/1/2018	12/31/2299	N
75774	ARTERY X-RAY EACH VESSEL	PRXOVR	DEF					NA	NA	NA	N
75774	ARTERY X-RAY EACH VESSEL	MAXFEE	DEF					74.24	1/1/2018	12/31/2299	N
75774	ARTERY X-RAY EACH VESSEL	MAXFEE	DEF	26				14.85	1/1/2018	12/31/2299	N
75774	ARTERY X-RAY EACH VESSEL	MAXFEE	DEF	TC				59.39	1/1/2018	12/31/2299	N
75790	VISUALIZE A-V SHUNT	PRXOVR	DEF					NA	NA	NA	N
75790	VISUALIZE A-V SHUNT	MAXFEE	DEF					NA			N
75791	AV DIALYSIS SHUNT IMAGING	PRXOVR	DEF					NA	NA	NA	N
75791	AV DIALYSIS SHUNT IMAGING	MAXFEE	DEF					NA			N
75801	LYMPH VESSEL X-RAY ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
75801	LYMPH VESSEL X-RAY ARM/LEG	MAXFEE	DEF					177.46	1/1/2018	12/31/2299	N
75801	LYMPH VESSEL X-RAY ARM/LEG	MAXFEE	DEF	26				35.49	1/1/2018	12/31/2299	N
75801	LYMPH VESSEL X-RAY ARM/LEG	MAXFEE	DEF	TC				141.97	1/1/2018	12/31/2299	N
75803	LYMPH VESSEL X-RAY ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
75803	LYMPH VESSEL X-RAY ARMS/LEGS	MAXFEE	DEF	26				47.68	1/1/2018	12/31/2299	N
75803	LYMPH VESSEL X-RAY ARMS/LEGS	MAXFEE	DEF	TC				143.03	1/1/2018	12/31/2299	N
75803	LYMPH VESSEL X-RAY ARMS/LEGS	MAXFEE	DEF					190.71	1/1/2018	12/31/2299	N
75805	LYMPH VESSEL X-RAY TRUNK	PRXOVR	DEF					NA	NA	NA	N
75805	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF					195.84	1/1/2018	12/31/2299	N
75805	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF	26				39.17	1/1/2018	12/31/2299	N
75805	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF	TC				156.67	1/1/2018	12/31/2299	N
75807	LYMPH VESSEL X-RAY TRUNK	PRXOVR	DEF					NA	NA	NA	N
75807	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF					209.16	1/1/2018	12/31/2299	N
75807	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF	26				52.29	1/1/2018	12/31/2299	N
75807	LYMPH VESSEL X-RAY TRUNK	MAXFEE	DEF	TC				156.87	1/1/2018	12/31/2299	N
75809	NONVASCULAR SHUNT X-RAY	PRXOVR	DEF					NA	NA	NA	N
75809	NONVASCULAR SHUNT X-RAY	MAXFEE	DEF					60.59	1/1/2018	12/31/2299	N
75809	NONVASCULAR SHUNT X-RAY	MAXFEE	DEF	26				21.21	1/1/2018	12/31/2299	N
75809	NONVASCULAR SHUNT X-RAY	MAXFEE	DEF	TC				39.38	1/1/2018	12/31/2299	N
75810	VEIN X-RAY SPLEEN/LIVER	PRXOVR	DEF					NA	NA	NA	N
75810	VEIN X-RAY SPLEEN/LIVER	MAXFEE	DEF					383.38	1/1/2018	12/31/2299	N
75810	VEIN X-RAY SPLEEN/LIVER	MAXFEE	DEF	26				76.68	1/1/2018	12/31/2299	N
75810	VEIN X-RAY SPLEEN/LIVER	MAXFEE	DEF	TC				306.70	1/1/2018	12/31/2299	N
75820	VEIN X-RAY ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
75820	VEIN X-RAY ARM/LEG	MAXFEE	DEF					73.28	1/1/2018	12/31/2299	N
75820	VEIN X-RAY ARM/LEG	MAXFEE	DEF	26				29.31	1/1/2018	12/31/2299	N
75820	VEIN X-RAY ARM/LEG	MAXFEE	DEF	TC				43.97	1/1/2018	12/31/2299	N
75822	VEIN X-RAY ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
75822	VEIN X-RAY ARMS/LEGS	MAXFEE	DEF					80.36	1/1/2018	12/31/2299	N
75822	VEIN X-RAY ARMS/LEGS	MAXFEE	DEF	26				32.14	1/1/2018	12/31/2299	N
75822	VEIN X-RAY ARMS/LEGS	MAXFEE	DEF	TC				48.22	1/1/2018	12/31/2299	N
75825	VEIN X-RAY TRUNK	PRXOVR	DEF					NA	NA	NA	N
75825	VEIN X-RAY TRUNK	MAXFEE	DEF					123.24	1/1/2018	12/31/2299	N
75825	VEIN X-RAY TRUNK	MAXFEE	DEF	26				43.13	1/1/2018	12/31/2299	N
75825	VEIN X-RAY TRUNK	MAXFEE	DEF	TC				80.11	1/1/2018	12/31/2299	N
75827	VEIN X-RAY CHEST	PRXOVR	DEF					NA	NA	NA	N
75827	VEIN X-RAY CHEST	MAXFEE	DEF					118.56	1/1/2018	12/31/2299	N
75827	VEIN X-RAY CHEST	MAXFEE	DEF	26				41.50	1/1/2018	12/31/2299	N
75827	VEIN X-RAY CHEST	MAXFEE	DEF	TC				77.06	1/1/2018	12/31/2299	N
75831	VEIN X-RAY KIDNEY	PRXOVR	DEF					NA	NA	NA	N
75831	VEIN X-RAY KIDNEY	MAXFEE	DEF					120.52	1/1/2018	12/31/2299	N
75831	VEIN X-RAY KIDNEY	MAXFEE	DEF	26				48.21	1/1/2018	12/31/2299	N
75831	VEIN X-RAY KIDNEY	MAXFEE	DEF	TC				72.31	1/1/2018	12/31/2299	N
75833	VEIN X-RAY KIDNEYS	PRXOVR	DEF					NA	NA	NA	N
75833	VEIN X-RAY KIDNEYS	MAXFEE	DEF					145.42	1/1/2018	12/31/2299	N
75833	VEIN X-RAY KIDNEYS	MAXFEE	DEF	26				58.17	1/1/2018	12/31/2299	N
75833	VEIN X-RAY KIDNEYS	MAXFEE	DEF	TC				87.25	1/1/2018	12/31/2299	N
75840	VEIN X-RAY ADRENAL GLAND	PRXOVR	DEF					NA	NA	NA	N
75840	VEIN X-RAY ADRENAL GLAND	MAXFEE	DEF					127.32	1/1/2018	12/31/2299	N
75840	VEIN X-RAY ADRENAL GLAND	MAXFEE	DEF	26				50.93	1/1/2018	12/31/2299	N
75840	VEIN X-RAY ADRENAL GLAND	MAXFEE	DEF	TC				76.39	1/1/2018	12/31/2299	N
75842	VEIN X-RAY ADRENAL GLANDS	PRXOVR	DEF					NA	NA	NA	N
75842	VEIN X-RAY ADRENAL GLANDS	MAXFEE	DEF					158.22	1/1/2018	12/31/2299	N
75842	VEIN X-RAY ADRENAL GLANDS	MAXFEE	DEF	26				63.29	1/1/2018	12/31/2299	N
75842	VEIN X-RAY ADRENAL GLANDS	MAXFEE	DEF	TC				94.93	1/1/2018	12/31/2299	N
75860	VEIN X-RAY NECK	PRXOVR	DEF					NA	NA	NA	N
75860	VEIN X-RAY NECK	MAXFEE	DEF					127.82	1/1/2018	12/31/2299	N
75860	VEIN X-RAY NECK	MAXFEE	DEF	26				44.74	1/1/2018	12/31/2299	N
75860	VEIN X-RAY NECK	MAXFEE	DEF	TC				83.08	1/1/2018	12/31/2299	N
75870	VEIN X-RAY SKULL	PRXOVR	DEF					NA	NA	NA	N
75870	VEIN X-RAY SKULL	MAXFEE	DEF					127.46	1/1/2018	12/31/2299	N
75870	VEIN X-RAY SKULL	MAXFEE	DEF	26				44.61	1/1/2018	12/31/2299	N
75870	VEIN X-RAY SKULL	MAXFEE	DEF	TC				82.85	1/1/2018	12/31/2299	N
75872	VEIN X-RAY SKULL EPIDURAL	PRXOVR	DEF					NA	NA	NA	N
75872	VEIN X-RAY SKULL EPIDURAL	MAXFEE	DEF					127.15	1/1/2018	12/31/2299	N
75872	VEIN X-RAY SKULL EPIDURAL	MAXFEE	DEF	26				50.86	1/1/2018	12/31/2299	N
75872	VEIN X-RAY SKULL EPIDURAL	MAXFEE	DEF	TC				76.29	1/1/2018	12/31/2299	N
75880	VEIN X-RAY EYE SOCKET	PRXOVR	DEF					NA	NA	NA	N
75880	VEIN X-RAY EYE SOCKET	MAXFEE	DEF					79.61	1/1/2018	12/31/2299	N
75880	VEIN X-RAY EYE SOCKET	MAXFEE	DEF	26				31.84	1/1/2018	12/31/2299	N
75880	VEIN X-RAY EYE SOCKET	MAXFEE	DEF	TC				47.77	1/1/2018	12/31/2299	N
75885	VEIN X-RAY LIVER W/HEMODYNAM	PRXOVR	DEF					NA	NA	NA	N
75885	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF					140.06	1/1/2018	12/31/2299	N
75885	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF	26				56.02	1/1/2018	12/31/2299	N
75885	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF	TC				84.04	1/1/2018	12/31/2299	N
75887	VEIN X-RAY LIVER W/O HEMODYN	PRXOVR	DEF					NA	NA	NA	N
75887	VEIN X-RAY LIVER W/O HEMODYN	MAXFEE	DEF					138.43	1/1/2018	12/31/2299	N
75887	VEIN X-RAY LIVER W/O HEMODYN	MAXFEE	DEF	26				55.37	1/1/2018	12/31/2299	N
75887	VEIN X-RAY LIVER W/O HEMODYN	MAXFEE	DEF	TC				83.06	1/1/2018	12/31/2299	N
75889	VEIN X-RAY LIVER W/HEMODYNAM	PRXOVR	DEF					NA	NA	NA	N
75889	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF					128.54	1/1/2018	12/31/2299	N
75889	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF	26				44.99	1/1/2018	12/31/2299	N
75889	VEIN X-RAY LIVER W/HEMODYNAM	MAXFEE	DEF	TC				83.55	1/1/2018	12/31/2299	N
75891	VEIN X-RAY LIVER	PRXOVR	DEF					NA	NA	NA	N
75891	VEIN X-RAY LIVER	MAXFEE	DEF					128.54	1/1/2018	12/31/2299	N
75891	VEIN X-RAY LIVER	MAXFEE	DEF	26				44.99	1/1/2018	12/31/2299	N
75891	VEIN X-RAY LIVER	MAXFEE	DEF	TC				83.55	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	PRXOVR	DEF					NA	NA	NA	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF					41.56	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF	26				4.16	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF	TC				37.40	1/1/2018	12/31/2299	N
76001	FLUOROSCOPE EXAM EXTENSIVE	PRXOVR	DEF					NA	NA	NA	N
76001	FLUOROSCOPE EXAM EXTENSIVE	MAXFEE	DEF					NA			N
76010	X-RAY NOSE TO RECTUM	PRXOVR	DEF					NA	NA	NA	N
76010	X-RAY NOSE TO RECTUM	MAXFEE	DEF					20.99	1/1/2018	12/31/2299	N
76010	X-RAY NOSE TO RECTUM	MAXFEE	DEF	26				7.35	1/1/2018	12/31/2299	N
76010	X-RAY NOSE TO RECTUM	MAXFEE	DEF	TC				13.64	1/1/2018	12/31/2299	N
76080	X-RAY EXAM OF FISTULA	PRXOVR	DEF					NA	NA	NA	N
76080	X-RAY EXAM OF FISTULA	MAXFEE	DEF					49.22	1/1/2018	12/31/2299	N
76080	X-RAY EXAM OF FISTULA	MAXFEE	DEF	26				19.69	1/1/2018	12/31/2299	N
76080	X-RAY EXAM OF FISTULA	MAXFEE	DEF	TC				29.53	1/1/2018	12/31/2299	N
76098	X-RAY EXAM SURGICAL SPECIMEN	PRXOVR	DEF					NA	NA	NA	N
76098	X-RAY EXAM SURGICAL SPECIMEN	MAXFEE	DEF					14.10	1/1/2018	12/31/2299	N
76098	X-RAY EXAM SURGICAL SPECIMEN	MAXFEE	DEF	26				5.64	1/1/2018	12/31/2299	N
76098	X-RAY EXAM SURGICAL SPECIMEN	MAXFEE	DEF	TC				8.46	1/1/2018	12/31/2299	N
76100	X-RAY EXAM OF BODY SECTION	PRXOVR	DEF					NA	NA	NA	N
76100	X-RAY EXAM OF BODY SECTION	MAXFEE	DEF					62.13	1/1/2018	12/31/2299	N
76100	X-RAY EXAM OF BODY SECTION	MAXFEE	DEF	26				18.64	1/1/2018	12/31/2299	N
76100	X-RAY EXAM OF BODY SECTION	MAXFEE	DEF	TC				43.49	1/1/2018	12/31/2299	N
76101	COMPLEX BODY SECTION X-RAY	PRXOVR	DEF					NA	NA	NA	N
76101	COMPLEX BODY SECTION X-RAY	MAXFEE	DEF					NA			N
76102	COMPLEX BODY SECTION X-RAYS	PRXOVR	DEF					NA	NA	NA	N
76102	COMPLEX BODY SECTION X-RAYS	MAXFEE	DEF					NA			N
76120	CINE/VIDEO X-RAYS	PRXOVR	DEF					NA	NA	NA	N
76120	CINE/VIDEO X-RAYS	MAXFEE	DEF					60.53	1/1/2018	12/31/2299	N
76120	CINE/VIDEO X-RAYS	MAXFEE	DEF	26				18.16	1/1/2018	12/31/2299	N
76120	CINE/VIDEO X-RAYS	MAXFEE	DEF	TC				42.37	1/1/2018	12/31/2299	N
76125	CINE/VIDEO X-RAYS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
76125	CINE/VIDEO X-RAYS ADD-ON	MAXFEE	DEF					31.81	1/1/2018	12/31/2299	N
76125	CINE/VIDEO X-RAYS ADD-ON	MAXFEE	DEF	26				11.13	1/1/2018	12/31/2299	N
76125	CINE/VIDEO X-RAYS ADD-ON	MAXFEE	DEF	TC				20.68	1/1/2018	12/31/2299	N
76150	X-RAY EXAM; DRY PROCESS	PRXOVR	DEF					NA	NA	NA	N
76150	X-RAY EXAM; DRY PROCESS	MAXFEE	DEF					NA			N
76350	SPECIAL X-RAY CONTRAST STUDY	PRXOVR	DEF					NA	NA	NA	N
76350	SPECIAL X-RAY CONTRAST STUDY	MANUAL	DEF					NA	NA	NA	N
76376	3D RENDER W/INTRP POSTPROCES	PRXOVR	DEF					NA	NA	NA	N
76376	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF					19.54	1/1/2018	12/31/2299	N
76376	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF	26				3.91	1/1/2018	12/31/2299	N
76376	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF	TC				15.63	1/1/2018	12/31/2299	N
76377	3D RENDER W/INTRP POSTPROCES	PRXOVR	DEF					NA	NA	NA	N
76377	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF					55.53	1/1/2018	12/31/2299	N
76377	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF	26				27.77	1/1/2018	12/31/2299	N
76377	3D RENDER W/INTRP POSTPROCES	MAXFEE	DEF	TC				27.76	1/1/2018	12/31/2299	N
76380	CAT SCAN FOLLOW-UP STUDY	PRXOVR	DEF					NA	NA	NA	N
76380	CAT SCAN FOLLOW-UP STUDY	MAXFEE	DEF					93.08	1/1/2018	12/31/2299	N
76380	CAT SCAN FOLLOW-UP STUDY	MAXFEE	DEF	26				27.92	1/1/2018	12/31/2299	N
76380	CAT SCAN FOLLOW-UP STUDY	MAXFEE	DEF	TC				65.16	1/1/2018	12/31/2299	N
76390	MR SPECTROSCOPY	PRXOVR	DEF					NA	NA	NA	N
76390	MR SPECTROSCOPY	MAXFEE	DEF					357.78	1/1/2018	12/31/2299	N
76390	MR SPECTROSCOPY	MAXFEE	DEF	26				71.56	1/1/2018	12/31/2299	N
76390	MR SPECTROSCOPY	MAXFEE	DEF	TC				286.22	1/1/2018	12/31/2299	N
76391	MR ELASTOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
76391	MR ELASTOGRAPHY	MAXFEE	DEF	26				44.56	1/1/2019	12/31/2299	N
76391	MR ELASTOGRAPHY	MAXFEE	DEF	TC				134.33	1/1/2019	12/31/2299	N
76391	MR ELASTOGRAPHY	MAXFEE	DEF					178.89	1/1/2019	12/31/2299	N
76496	UNLISTED FLUOROSCOPIC PX	PRXOVR	DEF					NA	NA	NA	N
76496	UNLISTED FLUOROSCOPIC PX	MAXFEE	DEF	26				30.39	1/1/2018	12/31/2299	N
76496	UNLISTED FLUOROSCOPIC PX	MAXFEE	DEF					75.98	1/1/2018	12/31/2299	N
76496	UNLISTED FLUOROSCOPIC PX	MAXFEE	DEF	TC				45.59	1/1/2018	12/31/2299	N
76497	UNLISTED CT PROCEDURE	PRXOVR	DEF					NA	NA	NA	N
76497	UNLISTED CT PROCEDURE	MAXFEE	DEF					140.91	1/1/2018	12/31/2299	N
76497	UNLISTED CT PROCEDURE	MAXFEE	DEF	26				35.23	1/1/2018	12/31/2299	N
76497	UNLISTED CT PROCEDURE	MAXFEE	DEF	TC				105.68	1/1/2018	12/31/2299	N
76498	UNLISTED MR PROCEDURE	PRXOVR	DEF					NA	NA	NA	N
76498	UNLISTED MR PROCEDURE	MAXFEE	DEF					73.62	1/1/2018	12/31/2299	N
76498	UNLISTED MR PROCEDURE	MAXFEE	DEF	26				14.72	1/1/2018	12/31/2299	N
76498	UNLISTED MR PROCEDURE	MAXFEE	DEF	TC				58.90	1/1/2018	12/31/2299	N
76499	UNLISTED DX RADIOGRAPHIC PX	PRXOVR	DEF					NA	NA	NA	N
76499	UNLISTED DX RADIOGRAPHIC PX	MANUAL	DEF					NA	NA	NA	N
76506	ECHO EXAM OF HEAD	PRXOVR	DEF					NA	NA	NA	N
76506	ECHO EXAM OF HEAD	MAXFEE	DEF					62.86	1/1/2018	12/31/2299	N
76506	ECHO EXAM OF HEAD	MAXFEE	DEF	26				25.14	1/1/2018	12/31/2299	N
76506	ECHO EXAM OF HEAD	MAXFEE	DEF	TC				37.72	1/1/2018	12/31/2299	N
76510	OPH US DX B-SCAN&QUAN A-SCAN	PRXOVR	DEF					NA	NA	NA	N
76510	OPH US DX B-SCAN&QUAN A-SCAN	MAXFEE	DEF					121.06	1/1/2018	12/31/2299	N
76510	OPH US DX B-SCAN&QUAN A-SCAN	MAXFEE	DEF	26				72.64	1/1/2018	12/31/2299	N
76510	OPH US DX B-SCAN&QUAN A-SCAN	MAXFEE	DEF	TC				48.42	1/1/2018	12/31/2299	N
76511	OPH US DX QUAN A-SCAN ONLY	PRXOVR	DEF					NA	NA	NA	N
76511	OPH US DX QUAN A-SCAN ONLY	MAXFEE	DEF					66.65	1/1/2018	12/31/2299	N
76511	OPH US DX QUAN A-SCAN ONLY	MAXFEE	DEF	26				33.33	1/1/2018	12/31/2299	N
76511	OPH US DX QUAN A-SCAN ONLY	MAXFEE	DEF	TC				33.32	1/1/2018	12/31/2299	N
76512	OPH US DX B-SCAN	PRXOVR	DEF					NA	NA	NA	N
76512	OPH US DX B-SCAN	MAXFEE	DEF					65.71	1/1/2018	12/31/2299	N
76512	OPH US DX B-SCAN	MAXFEE	DEF	26				39.43	1/1/2018	12/31/2299	N
76512	OPH US DX B-SCAN	MAXFEE	DEF	TC				26.28	1/1/2018	12/31/2299	N
76513	OPH US DX ANT SGM US UNI/BI	PRXOVR	DEF					NA	NA	NA	N
76513	OPH US DX ANT SGM US UNI/BI	MAXFEE	DEF					67.68	1/1/2018	12/31/2299	N
76513	OPH US DX ANT SGM US UNI/BI	MAXFEE	DEF	26				27.07	1/1/2018	12/31/2299	N
76513	OPH US DX ANT SGM US UNI/BI	MAXFEE	DEF	TC				40.61	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	PRXOVR	DEF					NA	NA	NA	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF					8.28	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF	26				5.80	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF	TC				2.48	1/1/2018	12/31/2299	N
76516	ECHO EXAM OF EYE	PRXOVR	DEF					NA	NA	NA	N
76516	ECHO EXAM OF EYE	MAXFEE	DEF					54.85	1/1/2018	12/31/2299	N
76516	ECHO EXAM OF EYE	MAXFEE	DEF	26				21.94	1/1/2018	12/31/2299	N
76516	ECHO EXAM OF EYE	MAXFEE	DEF	TC				32.91	1/1/2018	12/31/2299	N
76519	ECHO EXAM OF EYE	PRXOVR	DEF					NA	NA	NA	N
76519	ECHO EXAM OF EYE	MAXFEE	DEF					53.73	1/1/2018	12/31/2299	N
76519	ECHO EXAM OF EYE	MAXFEE	DEF	26				21.49	1/1/2018	12/31/2299	N
76519	ECHO EXAM OF EYE	MAXFEE	DEF	TC				32.24	1/1/2018	12/31/2299	N
76529	ECHO EXAM OF EYE	PRXOVR	DEF					NA	NA	NA	N
76529	ECHO EXAM OF EYE	MAXFEE	DEF					59.50	1/1/2018	12/31/2299	N
76529	ECHO EXAM OF EYE	MAXFEE	DEF	26				23.80	1/1/2018	12/31/2299	N
76529	ECHO EXAM OF EYE	MAXFEE	DEF	TC				35.70	1/1/2018	12/31/2299	N
76536	US EXAM OF HEAD AND NECK	PRXOVR	DEF					NA	NA	NA	N
76536	US EXAM OF HEAD AND NECK	MAXFEE	DEF					60.04	1/1/2018	12/31/2299	N
76536	US EXAM OF HEAD AND NECK	MAXFEE	DEF	26				18.01	1/1/2018	12/31/2299	N
76536	US EXAM OF HEAD AND NECK	MAXFEE	DEF	TC				42.03	1/1/2018	12/31/2299	N
76604	US EXAM CHEST	PRXOVR	DEF					NA	NA	NA	N
76604	US EXAM CHEST	MAXFEE	DEF					56.46	1/1/2018	12/31/2299	N
76604	US EXAM CHEST	MAXFEE	DEF	26				22.58	1/1/2018	12/31/2299	N
76604	US EXAM CHEST	MAXFEE	DEF	TC				33.88	1/1/2018	12/31/2299	N
76641	ULTRASOUND BREAST COMPLETE	PRXOVR	DEF					NA	NA	NA	N
76641	ULTRASOUND BREAST COMPLETE	MAXFEE	DEF					77.12	1/1/2018	12/31/2299	N
76641	ULTRASOUND BREAST COMPLETE	MAXFEE	DEF	26				26.99	1/1/2018	12/31/2299	N
76641	ULTRASOUND BREAST COMPLETE	MAXFEE	DEF	TC				50.13	1/1/2018	12/31/2299	N
76642	ULTRASOUND BREAST LIMITED	PRXOVR	DEF					NA	NA	NA	N
76642	ULTRASOUND BREAST LIMITED	MAXFEE	DEF					63.52	1/1/2018	12/31/2299	N
76642	ULTRASOUND BREAST LIMITED	MAXFEE	DEF	26				25.41	1/1/2018	12/31/2299	N
76642	ULTRASOUND BREAST LIMITED	MAXFEE	DEF	TC				38.11	1/1/2018	12/31/2299	N
76645	US EXAM BREAST(S)	PRXOVR	DEF					NA	NA	NA	N
76645	US EXAM BREAST(S)	MAXFEE	DEF					NA			N
76700	US EXAM ABDOM COMPLETE	PRXOVR	DEF					NA	NA	NA	N
76700	US EXAM ABDOM COMPLETE	MAXFEE	DEF					84.27	1/1/2018	12/31/2299	N
76700	US EXAM ABDOM COMPLETE	MAXFEE	DEF	26				33.71	1/1/2018	12/31/2299	N
76700	US EXAM ABDOM COMPLETE	MAXFEE	DEF	TC				50.56	1/1/2018	12/31/2299	N
76705	ECHO EXAM OF ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
76705	ECHO EXAM OF ABDOMEN	MAXFEE	DEF					61.01	1/1/2018	12/31/2299	N
76705	ECHO EXAM OF ABDOMEN	MAXFEE	DEF	26				18.30	1/1/2018	12/31/2299	N
76705	ECHO EXAM OF ABDOMEN	MAXFEE	DEF	TC				42.71	1/1/2018	12/31/2299	N
76706	US ABDL AORTA SCREEN AAA	PRXOVR	DEF					NA	NA	NA	N
76706	US ABDL AORTA SCREEN AAA	MAXFEE	DEF					67.92	1/1/2018	12/31/2299	N
76706	US ABDL AORTA SCREEN AAA	MAXFEE	DEF	26				20.38	1/1/2018	12/31/2299	N
76706	US ABDL AORTA SCREEN AAA	MAXFEE	DEF	TC				47.54	1/1/2018	12/31/2299	N
76770	US EXAM ABDO BACK WALL COMP	PRXOVR	DEF					NA	NA	NA	N
76770	US EXAM ABDO BACK WALL COMP	MAXFEE	DEF					81.77	1/1/2018	12/31/2299	N
76770	US EXAM ABDO BACK WALL COMP	MAXFEE	DEF	26				24.53	1/1/2018	12/31/2299	N
76770	US EXAM ABDO BACK WALL COMP	MAXFEE	DEF	TC				57.24	1/1/2018	12/31/2299	N
76775	US EXAM ABDO BACK WALL LIM	PRXOVR	DEF					NA	NA	NA	N
76775	US EXAM ABDO BACK WALL LIM	MAXFEE	DEF					49.59	1/1/2018	12/31/2299	N
76775	US EXAM ABDO BACK WALL LIM	MAXFEE	DEF	26				24.80	1/1/2018	12/31/2299	N
76775	US EXAM ABDO BACK WALL LIM	MAXFEE	DEF	TC				24.79	1/1/2018	12/31/2299	N
76776	US EXAM K TRANSPL W/DOPPLER	PRXOVR	DEF					NA	NA	NA	N
76776	US EXAM K TRANSPL W/DOPPLER	MAXFEE	DEF					100.55	1/1/2018	12/31/2299	N
76776	US EXAM K TRANSPL W/DOPPLER	MAXFEE	DEF	26				25.14	1/1/2018	12/31/2299	N
76776	US EXAM K TRANSPL W/DOPPLER	MAXFEE	DEF	TC				75.41	1/1/2018	12/31/2299	N
76800	US EXAM SPINAL CANAL	PRXOVR	DEF					NA	NA	NA	N
76800	US EXAM SPINAL CANAL	MAXFEE	DEF					81.67	1/1/2018	12/31/2299	N
76800	US EXAM SPINAL CANAL	MAXFEE	DEF	26				40.84	1/1/2018	12/31/2299	N
76800	US EXAM SPINAL CANAL	MAXFEE	DEF	TC				40.83	1/1/2018	12/31/2299	N
76801	OB US < 14 WKS SINGLE FETUS	PRXOVR	DEF					NA	NA	NA	N
76801	OB US < 14 WKS SINGLE FETUS	MAXFEE	DEF					71.57	1/1/2018	12/31/2299	N
76801	OB US < 14 WKS SINGLE FETUS	MAXFEE	DEF	26				28.63	1/1/2018	12/31/2299	N
76801	OB US < 14 WKS SINGLE FETUS	MAXFEE	DEF	TC				42.94	1/1/2018	12/31/2299	N
76802	OB US < 14 WKS ADDL FETUS	PRXOVR	DEF					NA	NA	NA	N
76802	OB US < 14 WKS ADDL FETUS	MAXFEE	DEF					50.22	1/1/2018	12/31/2299	N
76802	OB US < 14 WKS ADDL FETUS	MAXFEE	DEF	26				25.11	1/1/2018	12/31/2299	N
76802	OB US < 14 WKS ADDL FETUS	MAXFEE	DEF	TC				25.11	1/1/2018	12/31/2299	N
76805	OB US >= 14 WKS SNGL FETUS	PRXOVR	DEF					NA	NA	NA	N
76805	OB US >= 14 WKS SNGL FETUS	MAXFEE	DEF					94.88	1/1/2018	12/31/2299	N
76805	OB US >= 14 WKS SNGL FETUS	MAXFEE	DEF	26				37.95	1/1/2018	12/31/2299	N
76805	OB US >= 14 WKS SNGL FETUS	MAXFEE	DEF	TC				56.93	1/1/2018	12/31/2299	N
76810	OB US >= 14 WKS ADDL FETUS	PRXOVR	DEF					NA	NA	NA	N
76810	OB US >= 14 WKS ADDL FETUS	MAXFEE	DEF					73.09	1/1/2018	12/31/2299	N
76810	OB US >= 14 WKS ADDL FETUS	MAXFEE	DEF	26				36.55	1/1/2018	12/31/2299	N
76810	OB US >= 14 WKS ADDL FETUS	MAXFEE	DEF	TC				36.54	1/1/2018	12/31/2299	N
76811	OB US DETAILED SNGL FETUS	PRXOVR	DEF					NA	NA	NA	N
76811	OB US DETAILED SNGL FETUS	MAXFEE	DEF					166.16	1/1/2018	12/31/2299	N
76811	OB US DETAILED SNGL FETUS	MAXFEE	DEF	26				66.46	1/1/2018	12/31/2299	N
76811	OB US DETAILED SNGL FETUS	MAXFEE	DEF	TC				99.70	1/1/2018	12/31/2299	N
76812	OB US DETAILED ADDL FETUS	PRXOVR	DEF					NA	NA	NA	N
76812	OB US DETAILED ADDL FETUS	MAXFEE	DEF					99.64	1/1/2018	12/31/2299	N
76812	OB US DETAILED ADDL FETUS	MAXFEE	DEF	26				59.78	1/1/2018	12/31/2299	N
76812	OB US DETAILED ADDL FETUS	MAXFEE	DEF	TC				39.86	1/1/2018	12/31/2299	N
76813	OB US NUCHAL MEAS 1 GEST	PRXOVR	DEF					NA	NA	NA	N
76813	OB US NUCHAL MEAS 1 GEST	MAXFEE	DEF					85.22	1/1/2018	12/31/2299	N
76813	OB US NUCHAL MEAS 1 GEST	MAXFEE	DEF	26				42.61	1/1/2018	12/31/2299	N
76813	OB US NUCHAL MEAS 1 GEST	MAXFEE	DEF	TC				42.61	1/1/2018	12/31/2299	N
76814	OB US NUCHAL MEAS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
76814	OB US NUCHAL MEAS ADD-ON	MAXFEE	DEF					57.16	1/1/2018	12/31/2299	N
76814	OB US NUCHAL MEAS ADD-ON	MAXFEE	DEF	26				34.30	1/1/2018	12/31/2299	N
76814	OB US NUCHAL MEAS ADD-ON	MAXFEE	DEF	TC				22.86	1/1/2018	12/31/2299	N
76815	OB US LIMITED FETUS(S)	PRXOVR	DEF					NA	NA	NA	N
76815	OB US LIMITED FETUS(S)	MAXFEE	DEF					63.63	1/1/2018	12/31/2299	N
76815	OB US LIMITED FETUS(S)	MAXFEE	DEF	26				25.45	1/1/2018	12/31/2299	N
76815	OB US LIMITED FETUS(S)	MAXFEE	DEF	TC				38.18	1/1/2018	12/31/2299	N
76816	OB US FOLLOW-UP PER FETUS	PRXOVR	DEF					NA	NA	NA	N
76816	OB US FOLLOW-UP PER FETUS	MAXFEE	DEF					68.79	1/1/2018	12/31/2299	N
76816	OB US FOLLOW-UP PER FETUS	MAXFEE	DEF	26				34.40	1/1/2018	12/31/2299	N
76816	OB US FOLLOW-UP PER FETUS	MAXFEE	DEF	TC				34.39	1/1/2018	12/31/2299	N
76817	TRANSVAGINAL US OBSTETRIC	PRXOVR	DEF					NA	NA	NA	N
76817	TRANSVAGINAL US OBSTETRIC	MAXFEE	DEF					65.72	1/1/2018	12/31/2299	N
76817	TRANSVAGINAL US OBSTETRIC	MAXFEE	DEF	26				26.29	1/1/2018	12/31/2299	N
76817	TRANSVAGINAL US OBSTETRIC	MAXFEE	DEF	TC				39.43	1/1/2018	12/31/2299	N
76818	FETAL BIOPHYS PROFILE W/NST	PRXOVR	DEF					NA	NA	NA	N
76818	FETAL BIOPHYS PROFILE W/NST	MAXFEE	DEF					73.59	1/1/2018	12/31/2299	N
76818	FETAL BIOPHYS PROFILE W/NST	MAXFEE	DEF	26				29.44	1/1/2018	12/31/2299	N
76818	FETAL BIOPHYS PROFILE W/NST	MAXFEE	DEF	TC				44.15	1/1/2018	12/31/2299	N
76819	FETAL BIOPHYS PROFIL W/O NST	PRXOVR	DEF					NA	NA	NA	N
76819	FETAL BIOPHYS PROFIL W/O NST	MAXFEE	DEF					71.82	1/1/2018	12/31/2299	N
76819	FETAL BIOPHYS PROFIL W/O NST	MAXFEE	DEF	26				25.14	1/1/2018	12/31/2299	N
76819	FETAL BIOPHYS PROFIL W/O NST	MAXFEE	DEF	TC				46.68	1/1/2018	12/31/2299	N
76820	UMBILICAL ARTERY ECHO	PRXOVR	DEF					NA	NA	NA	N
76820	UMBILICAL ARTERY ECHO	MAXFEE	DEF					33.60	1/1/2018	12/31/2299	N
76820	UMBILICAL ARTERY ECHO	MAXFEE	DEF	26				20.16	1/1/2018	12/31/2299	N
76820	UMBILICAL ARTERY ECHO	MAXFEE	DEF	TC				13.44	1/1/2018	12/31/2299	N
76821	MIDDLE CEREBRAL ARTERY ECHO	PRXOVR	DEF					NA	NA	NA	N
76821	MIDDLE CEREBRAL ARTERY ECHO	MAXFEE	DEF					75.17	1/1/2018	12/31/2299	N
76821	MIDDLE CEREBRAL ARTERY ECHO	MAXFEE	DEF	26				26.31	1/1/2018	12/31/2299	N
76821	MIDDLE CEREBRAL ARTERY ECHO	MAXFEE	DEF	TC				48.86	1/1/2018	12/31/2299	N
76825	ECHO EXAM OF FETAL HEART	PRXOVR	DEF					NA	NA	NA	N
76825	ECHO EXAM OF FETAL HEART	MAXFEE	DEF					187.37	1/1/2018	12/31/2299	N
76825	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	26				93.69	1/1/2018	12/31/2299	N
76825	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	TC				93.68	1/1/2018	12/31/2299	N
76826	ECHO EXAM OF FETAL HEART	PRXOVR	DEF					NA	NA	NA	N
76826	ECHO EXAM OF FETAL HEART	MAXFEE	DEF					110.62	1/1/2018	12/31/2299	N
76826	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	26				55.31	1/1/2018	12/31/2299	N
76826	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	TC				55.31	1/1/2018	12/31/2299	N
76827	ECHO EXAM OF FETAL HEART	PRXOVR	DEF					NA	NA	NA	N
76827	ECHO EXAM OF FETAL HEART	MAXFEE	DEF					49.41	1/1/2018	12/31/2299	N
76827	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	26				24.71	1/1/2018	12/31/2299	N
76827	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	TC				24.70	1/1/2018	12/31/2299	N
76828	ECHO EXAM OF FETAL HEART	PRXOVR	DEF					NA	NA	NA	N
76828	ECHO EXAM OF FETAL HEART	MAXFEE	DEF					36.97	1/1/2018	12/31/2299	N
76828	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	26				22.18	1/1/2018	12/31/2299	N
76828	ECHO EXAM OF FETAL HEART	MAXFEE	DEF	TC				14.79	1/1/2018	12/31/2299	N
76830	TRANSVAGINAL US NON-OB	PRXOVR	DEF					NA	NA	NA	N
76830	TRANSVAGINAL US NON-OB	MAXFEE	DEF					68.10	1/1/2018	12/31/2299	N
76830	TRANSVAGINAL US NON-OB	MAXFEE	DEF	26				27.24	1/1/2018	12/31/2299	N
76830	TRANSVAGINAL US NON-OB	MAXFEE	DEF	TC				40.86	1/1/2018	12/31/2299	N
76831	ECHO EXAM UTERUS	PRXOVR	DEF					NA	NA	NA	N
76831	ECHO EXAM UTERUS	MAXFEE	DEF					68.94	1/1/2018	12/31/2299	N
76831	ECHO EXAM UTERUS	MAXFEE	DEF	26				27.58	1/1/2018	12/31/2299	N
76831	ECHO EXAM UTERUS	MAXFEE	DEF	TC				41.36	1/1/2018	12/31/2299	N
76856	US EXAM PELVIC COMPLETE	PRXOVR	DEF					NA	NA	NA	N
76856	US EXAM PELVIC COMPLETE	MAXFEE	DEF					68.10	1/1/2018	12/31/2299	N
76856	US EXAM PELVIC COMPLETE	MAXFEE	DEF	26				27.24	1/1/2018	12/31/2299	N
76856	US EXAM PELVIC COMPLETE	MAXFEE	DEF	TC				40.86	1/1/2018	12/31/2299	N
76857	US EXAM PELVIC LIMITED	PRXOVR	DEF					NA	NA	NA	N
76857	US EXAM PELVIC LIMITED	MAXFEE	DEF					40.76	1/1/2018	12/31/2299	N
76857	US EXAM PELVIC LIMITED	MAXFEE	DEF	26				16.30	1/1/2018	12/31/2299	N
76857	US EXAM PELVIC LIMITED	MAXFEE	DEF	TC				24.46	1/1/2018	12/31/2299	N
76870	US EXAM SCROTUM	PRXOVR	DEF					NA	NA	NA	N
76870	US EXAM SCROTUM	MAXFEE	DEF	26				22.98	1/1/2018	12/31/2299	N
76870	US EXAM SCROTUM	MAXFEE	DEF	TC				34.47	1/1/2018	12/31/2299	N
76870	US EXAM SCROTUM	MAXFEE	DEF					57.45	1/1/2018	12/31/2299	N
76872	US TRANSRECTAL	PRXOVR	DEF					NA	NA	NA	N
76872	US TRANSRECTAL	MAXFEE	DEF					68.22	1/1/2018	12/31/2299	N
76872	US TRANSRECTAL	MAXFEE	DEF	26				20.47	1/1/2018	12/31/2299	N
76872	US TRANSRECTAL	MAXFEE	DEF	TC				47.75	1/1/2018	12/31/2299	N
76873	ECHOGRAP TRANS R PROS STUDY	PRXOVR	DEF					NA	NA	NA	N
76873	ECHOGRAP TRANS R PROS STUDY	MAXFEE	DEF					103.57	1/1/2018	12/31/2299	N
76873	ECHOGRAP TRANS R PROS STUDY	MAXFEE	DEF	26				51.79	1/1/2018	12/31/2299	N
76873	ECHOGRAP TRANS R PROS STUDY	MAXFEE	DEF	TC				51.78	1/1/2018	12/31/2299	N
76880	US EXAM; EXTREMITY	PRXOVR	DEF					NA	NA	NA	N
76880	US EXAM; EXTREMITY	MAXFEE	DEF					NA			N
76881	US COMPL JOINT R-T W/IMG	PRXOVR	DEF					NA	NA	NA	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF					69.68	1/1/2018	12/31/2299	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF	26				17.42	1/1/2018	12/31/2299	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF	TC				52.26	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	PRXOVR	DEF					NA	NA	NA	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF					21.67	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF	26				6.50	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF	TC				15.17	1/1/2018	12/31/2299	N
76883	US NRV&ACC STRUX 1XTR COMPRE	PRXOVR	DEF					NA	NA	NA	N
76883	US NRV&ACC STRUX 1XTR COMPRE	MAXFEE	FAC					45.43	1/1/2023	12/31/2299	N
76883	US NRV&ACC STRUX 1XTR COMPRE	MAXFEE	NFF					55.08	1/1/2023	12/31/2299	N
76885	US EXAM INFANT HIPS DYNAMIC	PRXOVR	DEF					NA	NA	NA	N
76885	US EXAM INFANT HIPS DYNAMIC	MAXFEE	DEF					69.46	1/1/2018	12/31/2299	N
76885	US EXAM INFANT HIPS DYNAMIC	MAXFEE	DEF	26				27.78	1/1/2018	12/31/2299	N
76885	US EXAM INFANT HIPS DYNAMIC	MAXFEE	DEF	TC				41.68	1/1/2018	12/31/2299	N
76886	US EXAM INFANT HIPS STATIC	PRXOVR	DEF					NA	NA	NA	N
76886	US EXAM INFANT HIPS STATIC	MAXFEE	DEF					61.91	1/1/2018	12/31/2299	N
76886	US EXAM INFANT HIPS STATIC	MAXFEE	DEF	26				24.76	1/1/2018	12/31/2299	N
76886	US EXAM INFANT HIPS STATIC	MAXFEE	DEF	TC				37.15	1/1/2018	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	PRXOVR	DEF					NA	NA	NA	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF					52.25	1/1/2018	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF	26				15.68	1/1/2018	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF	TC				36.58	1/1/2018	12/31/2299	N
76970	ULTRASOUND EXAM FOLLOW-UP	PRXOVR	DEF					NA	NA	NA	N
76970	ULTRASOUND EXAM FOLLOW-UP	MAXFEE	DEF					NA			N
76977	US BONE DENSITY MEASURE	PRXOVR	DEF					NA	NA	NA	N
76977	US BONE DENSITY MEASURE	MAXFEE	DEF					5.95	1/1/2018	12/31/2299	N
76977	US BONE DENSITY MEASURE	MAXFEE	DEF	26				2.38	1/1/2018	12/31/2299	N
76977	US BONE DENSITY MEASURE	MAXFEE	DEF	TC				3.57	1/1/2018	12/31/2299	N
76978	US TRGT DYN MBUBB 1ST LES	PRXOVR	DEF					NA	NA	NA	N
76978	US TRGT DYN MBUBB 1ST LES	MAXFEE	DEF	26				64.94	1/1/2019	12/31/2299	N
76978	US TRGT DYN MBUBB 1ST LES	MAXFEE	DEF	TC				181.92	1/1/2019	12/31/2299	N
76978	US TRGT DYN MBUBB 1ST LES	MAXFEE	DEF					246.86	1/1/2019	12/31/2299	N
76979	US TRGT DYN MBUBB EA ADDL	PRXOVR	DEF					NA	NA	NA	N
76979	US TRGT DYN MBUBB EA ADDL	MAXFEE	DEF	26				34.15	1/1/2019	12/31/2299	N
76979	US TRGT DYN MBUBB EA ADDL	MAXFEE	DEF	TC				132.72	1/1/2019	12/31/2299	N
76979	US TRGT DYN MBUBB EA ADDL	MAXFEE	DEF					166.87	1/1/2019	12/31/2299	N
76981	USE PARENCHYMA	PRXOVR	DEF					NA	NA	NA	N
76981	USE PARENCHYMA	MAXFEE	DEF	26				23.99	1/1/2019	12/31/2299	N
76981	USE PARENCHYMA	MAXFEE	DEF	TC				57.92	1/1/2019	12/31/2299	N
76981	USE PARENCHYMA	MAXFEE	DEF					81.91	1/1/2019	12/31/2299	N
76982	USE 1ST TARGET LESION	PRXOVR	DEF					NA	NA	NA	N
76982	USE 1ST TARGET LESION	MAXFEE	DEF	26				23.99	1/1/2019	12/31/2299	N
76982	USE 1ST TARGET LESION	MAXFEE	DEF	TC				49.46	1/1/2019	12/31/2299	N
76982	USE 1ST TARGET LESION	MAXFEE	DEF					73.45	1/1/2019	12/31/2299	N
76983	USE EA ADDL TARGET LESION	PRXOVR	DEF					NA	NA	NA	N
76983	USE EA ADDL TARGET LESION	MAXFEE	DEF	26				20.31	1/1/2019	12/31/2299	N
76983	USE EA ADDL TARGET LESION	MAXFEE	DEF	TC				25.11	1/1/2019	12/31/2299	N
76983	USE EA ADDL TARGET LESION	MAXFEE	DEF					45.42	1/1/2019	12/31/2299	N
77032	GUIDANCE FOR NEEDLE BREAST	PRXOVR	DEF					NA	NA	NA	N
77032	GUIDANCE FOR NEEDLE BREAST	MAXFEE	DEF					NA			N
77046	MRI BREAST C- UNILATERAL	PRXOVR	DEF					NA	NA	NA	N
77046	MRI BREAST C- UNILATERAL	MAXFEE	DEF	26				58.14	1/1/2019	12/31/2299	N
77046	MRI BREAST C- UNILATERAL	MAXFEE	DEF	TC				131.15	1/1/2019	12/31/2299	N
77046	MRI BREAST C- UNILATERAL	MAXFEE	DEF					189.29	1/1/2019	12/31/2299	N
77047	MRI BREAST C- BILATERAL	PRXOVR	DEF					NA	NA	NA	N
77047	MRI BREAST C- BILATERAL	MAXFEE	DEF	26				64.34	1/1/2019	12/31/2299	N
77047	MRI BREAST C- BILATERAL	MAXFEE	DEF	TC				130.36	1/1/2019	12/31/2299	N
77047	MRI BREAST C- BILATERAL	MAXFEE	DEF					194.70	1/1/2019	12/31/2299	N
77048	MRI BREAST C-+ W/CAD UNI	PRXOVR	DEF					NA	NA	NA	N
77048	MRI BREAST C-+ W/CAD UNI	MAXFEE	DEF	26				84.12	1/1/2019	12/31/2299	N
77048	MRI BREAST C-+ W/CAD UNI	MAXFEE	DEF	TC				216.05	1/1/2019	12/31/2299	N
77048	MRI BREAST C-+ W/CAD UNI	MAXFEE	DEF					300.17	1/1/2019	12/31/2299	N
77049	MRI BREAST C-+ W/CAD BI	PRXOVR	DEF					NA	NA	NA	N
77049	MRI BREAST C-+ W/CAD BI	MAXFEE	DEF	26				92.03	1/1/2019	12/31/2299	N
77049	MRI BREAST C-+ W/CAD BI	MAXFEE	DEF	TC				214.99	1/1/2019	12/31/2299	N
77049	MRI BREAST C-+ W/CAD BI	MAXFEE	DEF					307.02	1/1/2019	12/31/2299	N
77051	COMPUTER DX MAMMOGRAM ADD-ON	PRXOVR	DEF					NA	NA	NA	N
77051	COMPUTER DX MAMMOGRAM ADD-ON	MAXFEE	DEF					NA			N
77052	COMP SCREEN MAMMOGRAM ADD-ON	PRXOVR	DEF					NA	NA	NA	N
77052	COMP SCREEN MAMMOGRAM ADD-ON	MAXFEE	DEF					NA			N
77053	X-RAY OF MAMMARY DUCT	PRXOVR	DEF					NA	NA	NA	N
77053	X-RAY OF MAMMARY DUCT	MAXFEE	DEF					41.12	1/1/2018	12/31/2299	N
77053	X-RAY OF MAMMARY DUCT	MAXFEE	DEF	26				8.22	1/1/2018	12/31/2299	N
77053	X-RAY OF MAMMARY DUCT	MAXFEE	DEF	TC				32.90	1/1/2018	12/31/2299	N
77054	X-RAY OF MAMMARY DUCTS	PRXOVR	DEF					NA	NA	NA	N
77054	X-RAY OF MAMMARY DUCTS	MAXFEE	DEF	26				12.94	1/1/2018	12/31/2299	N
77054	X-RAY OF MAMMARY DUCTS	MAXFEE	DEF					64.68	1/1/2018	12/31/2299	N
77054	X-RAY OF MAMMARY DUCTS	MAXFEE	DEF	TC				51.74	1/1/2018	12/31/2299	N
77055	MAMMOGRAM ONE BREAST	PRXOVR	DEF					NA	NA	NA	N
77055	MAMMOGRAM ONE BREAST	MAXFEE	DEF					NA			N
77056	MAMMOGRAM BOTH BREASTS	PRXOVR	DEF					NA	NA	NA	N
77056	MAMMOGRAM BOTH BREASTS	MAXFEE	DEF					NA			N
77057	MAMMOGRAM SCREENING	PRXOVR	DEF					NA	NA	NA	N
77057	MAMMOGRAM SCREENING	MAXFEE	DEF					NA			N
77058	MRI ONE BREAST	PRXOVR	DEF					NA	NA	NA	N
77058	MRI ONE BREAST	MAXFEE	DEF					NA			N
77059	MRI BOTH BREASTS	PRXOVR	DEF					NA	NA	NA	N
77059	MRI BOTH BREASTS	MAXFEE	DEF					NA			N
77063	BREAST TOMOSYNTHESIS BI	PRXOVR	DEF					NA	NA	NA	N
77063	BREAST TOMOSYNTHESIS BI	MAXFEE	DEF					40.91	1/1/2018	12/31/2299	N
77063	BREAST TOMOSYNTHESIS BI	MAXFEE	DEF	26				24.55	1/1/2018	12/31/2299	N
77063	BREAST TOMOSYNTHESIS BI	MAXFEE	DEF	TC				16.36	1/1/2018	12/31/2299	N
77065	DX MAMMO INCL CAD UNI	PRXOVR	DEF					NA	NA	NA	N
77065	DX MAMMO INCL CAD UNI	MAXFEE	DEF					48.17	1/1/2018	12/31/2299	N
77065	DX MAMMO INCL CAD UNI	MAXFEE	DEF	26				9.63	1/1/2018	12/31/2299	N
77065	DX MAMMO INCL CAD UNI	MAXFEE	DEF	TC				38.54	1/1/2018	12/31/2299	N
77066	DX MAMMO INCL CAD BI	PRXOVR	DEF					NA	NA	NA	N
77066	DX MAMMO INCL CAD BI	MAXFEE	DEF					71.97	1/1/2018	12/31/2299	N
77066	DX MAMMO INCL CAD BI	MAXFEE	DEF	26				28.79	1/1/2018	12/31/2299	N
77066	DX MAMMO INCL CAD BI	MAXFEE	DEF	TC				43.18	1/1/2018	12/31/2299	N
77067	SCR MAMMO BI INCL CAD	PRXOVR	DEF					NA	NA	NA	N
77067	SCR MAMMO BI INCL CAD	MAXFEE	DEF					52.74	1/1/2018	12/31/2299	N
77067	SCR MAMMO BI INCL CAD	MAXFEE	DEF	26				21.10	1/1/2018	12/31/2299	N
77067	SCR MAMMO BI INCL CAD	MAXFEE	DEF	TC				31.64	1/1/2018	12/31/2299	N
77071	X-RAY STRESS VIEW	PRXOVR	DEF					NA	NA	NA	N
77071	X-RAY STRESS VIEW	MAXFEE	DEF					26.50	1/1/2018	12/31/2299	N
77072	X-RAYS FOR BONE AGE	PRXOVR	DEF					NA	NA	NA	N
77072	X-RAYS FOR BONE AGE	MAXFEE	DEF					15.07	1/1/2018	12/31/2299	N
77072	X-RAYS FOR BONE AGE	MAXFEE	DEF	26				6.03	1/1/2018	12/31/2299	N
77072	X-RAYS FOR BONE AGE	MAXFEE	DEF	TC				9.04	1/1/2018	12/31/2299	N
77073	X-RAYS BONE LENGTH STUDIES	PRXOVR	DEF					NA	NA	NA	N
77073	X-RAYS BONE LENGTH STUDIES	MAXFEE	DEF					23.90	1/1/2018	12/31/2299	N
77073	X-RAYS BONE LENGTH STUDIES	MAXFEE	DEF	26				7.17	1/1/2018	12/31/2299	N
77073	X-RAYS BONE LENGTH STUDIES	MAXFEE	DEF	TC				16.73	1/1/2018	12/31/2299	N
77074	X-RAYS BONE SURVEY LIMITED	PRXOVR	DEF					NA	NA	NA	N
77074	X-RAYS BONE SURVEY LIMITED	MAXFEE	DEF					46.25	1/1/2018	12/31/2299	N
77074	X-RAYS BONE SURVEY LIMITED	MAXFEE	DEF	26				16.19	1/1/2018	12/31/2299	N
77074	X-RAYS BONE SURVEY LIMITED	MAXFEE	DEF	TC				30.06	1/1/2018	12/31/2299	N
77075	X-RAYS BONE SURVEY COMPLETE	PRXOVR	DEF					NA	NA	NA	N
77075	X-RAYS BONE SURVEY COMPLETE	MAXFEE	DEF					68.33	1/1/2018	12/31/2299	N
77075	X-RAYS BONE SURVEY COMPLETE	MAXFEE	DEF	26				17.08	1/1/2018	12/31/2299	N
77075	X-RAYS BONE SURVEY COMPLETE	MAXFEE	DEF	TC				51.25	1/1/2018	12/31/2299	N
77076	X-RAYS BONE SURVEY INFANT	PRXOVR	DEF					NA	NA	NA	N
77076	X-RAYS BONE SURVEY INFANT	MAXFEE	DEF					65.80	1/1/2018	12/31/2299	N
77076	X-RAYS BONE SURVEY INFANT	MAXFEE	DEF	26				32.90	1/1/2018	12/31/2299	N
77076	X-RAYS BONE SURVEY INFANT	MAXFEE	DEF	TC				32.90	1/1/2018	12/31/2299	N
77077	JOINT SURVEY SINGLE VIEW	PRXOVR	DEF					NA	NA	NA	N
77077	JOINT SURVEY SINGLE VIEW	MAXFEE	DEF					29.30	1/1/2018	12/31/2299	N
77077	JOINT SURVEY SINGLE VIEW	MAXFEE	DEF	26				8.79	1/1/2018	12/31/2299	N
77077	JOINT SURVEY SINGLE VIEW	MAXFEE	DEF	TC				20.51	1/1/2018	12/31/2299	N
77078	CT BONE DENSITY AXIAL	PRXOVR	DEF					NA	NA	NA	N
77078	CT BONE DENSITY AXIAL	MAXFEE	DEF					60.25	1/1/2018	12/31/2299	N
77078	CT BONE DENSITY AXIAL	MAXFEE	DEF	26				12.05	1/1/2018	12/31/2299	N
77078	CT BONE DENSITY AXIAL	MAXFEE	DEF	TC				48.20	1/1/2018	12/31/2299	N
77079	CT BONE DENSITY PERIPHERAL	PRXOVR	DEF					NA	NA	NA	N
77079	CT BONE DENSITY PERIPHERAL	MAXFEE	DEF					NA			N
77080	DXA BONE DENSITY AXIAL	PRXOVR	DEF					NA	NA	NA	N
77080	DXA BONE DENSITY AXIAL	MAXFEE	DEF					34.90	1/1/2018	12/31/2299	N
77080	DXA BONE DENSITY AXIAL	MAXFEE	DEF	26				3.49	1/1/2018	12/31/2299	N
77080	DXA BONE DENSITY AXIAL	MAXFEE	DEF	TC				31.41	1/1/2018	12/31/2299	N
77081	DXA BONE DENSITY/PERIPHERAL	PRXOVR	DEF					NA	NA	NA	N
77081	DXA BONE DENSITY/PERIPHERAL	MAXFEE	DEF					23.90	1/1/2018	12/31/2299	N
77081	DXA BONE DENSITY/PERIPHERAL	MAXFEE	DEF	26				7.17	1/1/2018	12/31/2299	N
77081	DXA BONE DENSITY/PERIPHERAL	MAXFEE	DEF	TC				16.73	1/1/2018	12/31/2299	N
77082	DXA BONE DENSITY VERT FX	PRXOVR	DEF					NA	NA	NA	N
77082	DXA BONE DENSITY VERT FX	MAXFEE	DEF					NA			N
77083	RADIOGRAPHIC ABSORPTIOMETRY	PRXOVR	DEF					NA	NA	NA	N
77083	RADIOGRAPHIC ABSORPTIOMETRY	MAXFEE	DEF					NA			N
77084	MAGNETIC IMAGE BONE MARROW	PRXOVR	DEF					NA	NA	NA	N
77084	MAGNETIC IMAGE BONE MARROW	MAXFEE	DEF					310.25	1/1/2018	12/31/2299	N
77084	MAGNETIC IMAGE BONE MARROW	MAXFEE	DEF	26				62.05	1/1/2018	12/31/2299	N
77084	MAGNETIC IMAGE BONE MARROW	MAXFEE	DEF	TC				248.20	1/1/2018	12/31/2299	N
77085	DXA BONE DENSITY STUDY	PRXOVR	DEF					NA	NA	NA	N
77085	DXA BONE DENSITY STUDY	MAXFEE	DEF					40.18	1/1/2018	12/31/2299	N
77085	DXA BONE DENSITY STUDY	MAXFEE	DEF	26				12.05	1/1/2018	12/31/2299	N
77085	DXA BONE DENSITY STUDY	MAXFEE	DEF	TC				28.13	1/1/2018	12/31/2299	N
77086	FRACTURE ASSESSMENT VIA DXA	PRXOVR	DEF					NA	NA	NA	N
77086	FRACTURE ASSESSMENT VIA DXA	MAXFEE	DEF					25.40	1/1/2018	12/31/2299	N
77086	FRACTURE ASSESSMENT VIA DXA	MAXFEE	DEF	26				6.35	1/1/2018	12/31/2299	N
77086	FRACTURE ASSESSMENT VIA DXA	MAXFEE	DEF	TC				19.05	1/1/2018	12/31/2299	N
77089	TBS DXA CAL W/I&R FX RISK	PRXOVR	DEF					NA	NA	NA	N
77089	TBS DXA CAL W/I&R FX RISK	MAXFEE	DEF					12.88	1/1/2022	12/31/2299	N
77090	TBS TECHL PREP&TRANSMIS DATA	PRXOVR	DEF					NA	NA	NA	N
77090	TBS TECHL PREP&TRANSMIS DATA	MAXFEE	DEF					1.77	1/1/2022	12/31/2299	N
77091	TBS TECHL CALCULATION ONLY	PRXOVR	DEF					NA	NA	NA	N
77091	TBS TECHL CALCULATION ONLY	MAXFEE	DEF					3.24	1/1/2022	12/31/2299	N
77092	TBS I&R FX RSK QHP	PRXOVR	DEF					NA	NA	NA	N
77092	TBS I&R FX RSK QHP	MAXFEE	DEF					7.88	1/1/2022	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
78000	THYROID SINGLE UPTAKE	PRXOVR	DEF					NA	NA	NA	N
78000	THYROID SINGLE UPTAKE	MAXFEE	DEF					NA			N
78001	THYROID MULTIPLE UPTAKES	PRXOVR	DEF					NA	NA	NA	N
78001	THYROID MULTIPLE UPTAKES	MAXFEE	DEF					NA			N
78003	THYROID SUPPRESS/STIMUL	PRXOVR	DEF					NA	NA	NA	N
78003	THYROID SUPPRESS/STIMUL	MAXFEE	DEF					NA			N
78006	THYROID IMAGING WITH UPTAKE	PRXOVR	DEF					NA	NA	NA	N
78006	THYROID IMAGING WITH UPTAKE	MAXFEE	DEF					NA			N
78007	THYROID IMAGE MULT UPTAKES	PRXOVR	DEF					NA	NA	NA	N
78007	THYROID IMAGE MULT UPTAKES	MAXFEE	DEF					NA			N
78010	THYROID IMAGING	PRXOVR	DEF					NA	NA	NA	N
78010	THYROID IMAGING	MAXFEE	DEF					NA			N
78011	THYROID IMAGING WITH FLOW	PRXOVR	DEF					NA	NA	NA	N
78011	THYROID IMAGING WITH FLOW	MAXFEE	DEF					NA			N
78012	THYROID UPTAKE MEASUREMENT	PRXOVR	DEF					NA	NA	NA	N
78012	THYROID UPTAKE MEASUREMENT	MAXFEE	DEF					54.41	1/1/2018	12/31/2299	N
78012	THYROID UPTAKE MEASUREMENT	MAXFEE	DEF	26				5.44	1/1/2018	12/31/2299	N
78012	THYROID UPTAKE MEASUREMENT	MAXFEE	DEF	TC				48.97	1/1/2018	12/31/2299	N
78013	THYROID IMAGING W/BLOOD FLOW	PRXOVR	DEF					NA	NA	NA	N
78013	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF					137.21	1/1/2018	12/31/2299	N
78013	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF	26				13.72	1/1/2018	12/31/2299	N
78013	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF	TC				123.49	1/1/2018	12/31/2299	N
78014	THYROID IMAGING W/BLOOD FLOW	PRXOVR	DEF					NA	NA	NA	N
78014	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF					159.15	1/1/2018	12/31/2299	N
78014	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF	26				15.92	1/1/2018	12/31/2299	N
78014	THYROID IMAGING W/BLOOD FLOW	MAXFEE	DEF	TC				143.24	1/1/2018	12/31/2299	N
78015	THYROID MET IMAGING	PRXOVR	DEF					NA	NA	NA	N
78015	THYROID MET IMAGING	MAXFEE	DEF					128.23	1/1/2018	12/31/2299	N
78015	THYROID MET IMAGING	MAXFEE	DEF	26				25.65	1/1/2018	12/31/2299	N
78015	THYROID MET IMAGING	MAXFEE	DEF	TC				102.58	1/1/2018	12/31/2299	N
78016	THYROID MET IMAGING/STUDIES	PRXOVR	DEF					NA	NA	NA	N
78016	THYROID MET IMAGING/STUDIES	MAXFEE	DEF					164.99	1/1/2018	12/31/2299	N
78016	THYROID MET IMAGING/STUDIES	MAXFEE	DEF	26				33	1/1/2018	12/31/2299	N
78016	THYROID MET IMAGING/STUDIES	MAXFEE	DEF	TC				131.99	1/1/2018	12/31/2299	N
78018	THYROID MET IMAGING BODY	PRXOVR	DEF					NA	NA	NA	N
78018	THYROID MET IMAGING BODY	MAXFEE	DEF					180.72	1/1/2018	12/31/2299	N
78018	THYROID MET IMAGING BODY	MAXFEE	DEF	26				36.14	1/1/2018	12/31/2299	N
78018	THYROID MET IMAGING BODY	MAXFEE	DEF	TC				144.58	1/1/2018	12/31/2299	N
78020	THYROID MET UPTAKE	PRXOVR	DEF					NA	NA	NA	N
78020	THYROID MET UPTAKE	MAXFEE	DEF					49.38	1/1/2018	12/31/2299	N
78020	THYROID MET UPTAKE	MAXFEE	DEF	26				19.75	1/1/2018	12/31/2299	N
78020	THYROID MET UPTAKE	MAXFEE	DEF	TC				29.63	1/1/2018	12/31/2299	N
78070	PARATHYROID PLANAR IMAGING	PRXOVR	DEF					NA	NA	NA	N
78070	PARATHYROID PLANAR IMAGING	MAXFEE	DEF					175.01	1/1/2018	12/31/2299	N
78070	PARATHYROID PLANAR IMAGING	MAXFEE	DEF	26				35	1/1/2018	12/31/2299	N
78070	PARATHYROID PLANAR IMAGING	MAXFEE	DEF	TC				140.01	1/1/2018	12/31/2299	N
78071	PARATHYRD PLANAR W/WO SUBTRJ	PRXOVR	DEF					NA	NA	NA	N
78071	PARATHYRD PLANAR W/WO SUBTRJ	MAXFEE	DEF					237.83	1/1/2018	12/31/2299	N
78071	PARATHYRD PLANAR W/WO SUBTRJ	MAXFEE	DEF	26				39.02	1/1/2018	12/31/2299	N
78071	PARATHYRD PLANAR W/WO SUBTRJ	MAXFEE	DEF	TC				198.81	1/1/2018	12/31/2299	N
78072	PARATHYRD PLANAR W/SPECT&CT	PRXOVR	DEF					NA	NA	NA	N
78072	PARATHYRD PLANAR W/SPECT&CT	MAXFEE	DEF					326.13	1/1/2018	12/31/2299	N
78072	PARATHYRD PLANAR W/SPECT&CT	MAXFEE	DEF	26				53.72	1/1/2018	12/31/2299	N
78072	PARATHYRD PLANAR W/SPECT&CT	MAXFEE	DEF	TC				272.41	1/1/2018	12/31/2299	N
78075	ADRENAL CORTEX & MEDULLA IMG	PRXOVR	DEF					NA	NA	NA	N
78075	ADRENAL CORTEX & MEDULLA IMG	MAXFEE	DEF					249.06	1/1/2018	12/31/2299	N
78075	ADRENAL CORTEX & MEDULLA IMG	MAXFEE	DEF	26				49.81	1/1/2018	12/31/2299	N
78075	ADRENAL CORTEX & MEDULLA IMG	MAXFEE	DEF	TC				199.25	1/1/2018	12/31/2299	N
78102	BONE MARROW IMAGING LTD	PRXOVR	DEF					NA	NA	NA	N
78102	BONE MARROW IMAGING LTD	MAXFEE	DEF					99.61	1/1/2018	12/31/2299	N
78102	BONE MARROW IMAGING LTD	MAXFEE	DEF	26				19.92	1/1/2018	12/31/2299	N
78102	BONE MARROW IMAGING LTD	MAXFEE	DEF	TC				79.69	1/1/2018	12/31/2299	N
78103	BONE MARROW IMAGING MULT	PRXOVR	DEF					NA	NA	NA	N
78103	BONE MARROW IMAGING MULT	MAXFEE	DEF					114.47	1/1/2018	12/31/2299	N
78103	BONE MARROW IMAGING MULT	MAXFEE	DEF	26				22.89	1/1/2018	12/31/2299	N
78103	BONE MARROW IMAGING MULT	MAXFEE	DEF	TC				91.58	1/1/2018	12/31/2299	N
78104	BONE MARROW IMAGING BODY	PRXOVR	DEF					NA	NA	NA	N
78104	BONE MARROW IMAGING BODY	MAXFEE	DEF					140.92	1/1/2018	12/31/2299	N
78104	BONE MARROW IMAGING BODY	MAXFEE	DEF	26				35.23	1/1/2018	12/31/2299	N
78104	BONE MARROW IMAGING BODY	MAXFEE	DEF	TC				105.69	1/1/2018	12/31/2299	N
78110	PLASMA VOLUME SINGLE	PRXOVR	DEF					NA	NA	NA	N
78110	PLASMA VOLUME SINGLE	MAXFEE	DEF					55.21	1/1/2018	12/31/2299	N
78110	PLASMA VOLUME SINGLE	MAXFEE	DEF	26				13.80	1/1/2018	12/31/2299	N
78110	PLASMA VOLUME SINGLE	MAXFEE	DEF	TC				41.41	1/1/2018	12/31/2299	N
78111	PLASMA VOLUME MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78111	PLASMA VOLUME MULTIPLE	MAXFEE	DEF					69.60	1/1/2018	12/31/2299	N
78111	PLASMA VOLUME MULTIPLE	MAXFEE	DEF	26				6.96	1/1/2018	12/31/2299	N
78111	PLASMA VOLUME MULTIPLE	MAXFEE	DEF	TC				62.64	1/1/2018	12/31/2299	N
78120	RED CELL MASS SINGLE	PRXOVR	DEF					NA	NA	NA	N
78120	RED CELL MASS SINGLE	MAXFEE	DEF					56.16	1/1/2018	12/31/2299	N
78120	RED CELL MASS SINGLE	MAXFEE	DEF	26				11.23	1/1/2018	12/31/2299	N
78120	RED CELL MASS SINGLE	MAXFEE	DEF	TC				44.93	1/1/2018	12/31/2299	N
78121	RED CELL MASS MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78121	RED CELL MASS MULTIPLE	MAXFEE	DEF					63.88	1/1/2018	12/31/2299	N
78121	RED CELL MASS MULTIPLE	MAXFEE	DEF	26				12.78	1/1/2018	12/31/2299	N
78121	RED CELL MASS MULTIPLE	MAXFEE	DEF	TC				51.10	1/1/2018	12/31/2299	N
78122	BLOOD VOLUME	PRXOVR	DEF					NA	NA	NA	N
78122	BLOOD VOLUME	MAXFEE	DEF					81.42	1/1/2018	12/31/2299	N
78122	BLOOD VOLUME	MAXFEE	DEF	26				16.28	1/1/2018	12/31/2299	N
78122	BLOOD VOLUME	MAXFEE	DEF	TC				65.14	1/1/2018	12/31/2299	N
78130	RED CELL SURVIVAL STUDY	PRXOVR	DEF					NA	NA	NA	N
78130	RED CELL SURVIVAL STUDY	MAXFEE	DEF					100.35	1/1/2018	12/31/2299	N
78130	RED CELL SURVIVAL STUDY	MAXFEE	DEF	26				25.09	1/1/2018	12/31/2299	N
78130	RED CELL SURVIVAL STUDY	MAXFEE	DEF	TC				75.26	1/1/2018	12/31/2299	N
78135	RED CELL SURVIVAL KINETICS	PRXOVR	DEF					NA	NA	NA	N
78135	RED CELL SURVIVAL KINETICS	MAXFEE	DEF					NA			N
78140	RED CELL SEQUESTRATION	PRXOVR	DEF					NA	NA	NA	N
78140	RED CELL SEQUESTRATION	MAXFEE	DEF					111.69	1/1/2018	12/31/2299	N
78140	RED CELL SEQUESTRATION	MAXFEE	DEF	26				22.34	1/1/2018	12/31/2299	N
78140	RED CELL SEQUESTRATION	MAXFEE	DEF	TC				89.35	1/1/2018	12/31/2299	N
78185	SPLEEN IMAGING	PRXOVR	DEF					NA	NA	NA	N
78185	SPLEEN IMAGING	MAXFEE	DEF					123.36	1/1/2018	12/31/2299	N
78185	SPLEEN IMAGING	MAXFEE	DEF	26				24.67	1/1/2018	12/31/2299	N
78185	SPLEEN IMAGING	MAXFEE	DEF	TC				98.69	1/1/2018	12/31/2299	N
78190	PLATELET SURVIVAL KINETICS	PRXOVR	DEF					NA	NA	NA	N
78190	PLATELET SURVIVAL KINETICS	MAXFEE	DEF					232.87	1/1/2018	12/31/2299	N
78190	PLATELET SURVIVAL KINETICS	MAXFEE	DEF	26				58.22	1/1/2018	12/31/2299	N
78190	PLATELET SURVIVAL KINETICS	MAXFEE	DEF	TC				174.65	1/1/2018	12/31/2299	N
78191	PLATELET SURVIVAL	PRXOVR	DEF					NA	NA	NA	N
78191	PLATELET SURVIVAL	MAXFEE	DEF					133.09	1/1/2018	12/31/2299	N
78191	PLATELET SURVIVAL	MAXFEE	DEF	26				26.62	1/1/2018	12/31/2299	N
78191	PLATELET SURVIVAL	MAXFEE	DEF	TC				106.47	1/1/2018	12/31/2299	N
78195	LYMPH SYSTEM IMAGING	PRXOVR	DEF					NA	NA	NA	N
78195	LYMPH SYSTEM IMAGING	MAXFEE	DEF					210.12	1/1/2018	12/31/2299	N
78195	LYMPH SYSTEM IMAGING	MAXFEE	DEF	26				42.02	1/1/2018	12/31/2299	N
78195	LYMPH SYSTEM IMAGING	MAXFEE	DEF	TC				168.10	1/1/2018	12/31/2299	N
78201	LIVER IMAGING	PRXOVR	DEF					NA	NA	NA	N
78201	LIVER IMAGING	MAXFEE	DEF	26				20.17	1/1/2018	12/31/2299	N
78201	LIVER IMAGING	MAXFEE	DEF					80.66	1/1/2018	12/31/2299	N
78201	LIVER IMAGING	MAXFEE	DEF	TC				60.50	1/1/2018	12/31/2299	N
78202	LIVER IMAGING WITH FLOW	PRXOVR	DEF					NA	NA	NA	N
78202	LIVER IMAGING WITH FLOW	MAXFEE	DEF					97.30	1/1/2018	12/31/2299	N
78202	LIVER IMAGING WITH FLOW	MAXFEE	DEF	26				24.33	1/1/2018	12/31/2299	N
78202	LIVER IMAGING WITH FLOW	MAXFEE	DEF	TC				72.98	1/1/2018	12/31/2299	N
78205	LIVER IMAGING (3D)	PRXOVR	DEF					NA	NA	NA	N
78205	LIVER IMAGING (3D)	MAXFEE	DEF					NA			N
78206	LIVER IMAGE (3D) WITH FLOW	PRXOVR	DEF					NA	NA	NA	N
78206	LIVER IMAGE (3D) WITH FLOW	MAXFEE	DEF					NA			N
78215	LIVER AND SPLEEN IMAGING	PRXOVR	DEF					NA	NA	NA	N
78215	LIVER AND SPLEEN IMAGING	MAXFEE	DEF					97.74	1/1/2018	12/31/2299	N
78215	LIVER AND SPLEEN IMAGING	MAXFEE	DEF	26				19.55	1/1/2018	12/31/2299	N
78215	LIVER AND SPLEEN IMAGING	MAXFEE	DEF	TC				78.19	1/1/2018	12/31/2299	N
78216	LIVER & SPLEEN IMAGE/FLOW	PRXOVR	DEF					NA	NA	NA	N
78216	LIVER & SPLEEN IMAGE/FLOW	MAXFEE	DEF					100.64	1/1/2018	12/31/2299	N
78216	LIVER & SPLEEN IMAGE/FLOW	MAXFEE	DEF	26				20.13	1/1/2018	12/31/2299	N
78216	LIVER & SPLEEN IMAGE/FLOW	MAXFEE	DEF	TC				80.51	1/1/2018	12/31/2299	N
78220	LIVER FUNCTION STUDY	PRXOVR	DEF					NA	NA	NA	N
78220	LIVER FUNCTION STUDY	MAXFEE	DEF					NA			N
78223	HEPATOBILIARY IMAGING	PRXOVR	DEF					NA	NA	NA	N
78223	HEPATOBILIARY IMAGING	MAXFEE	DEF					NA			N
78226	HEPATOBILIARY SYSTEM IMAGING	PRXOVR	DEF					NA	NA	NA	N
78226	HEPATOBILIARY SYSTEM IMAGING	MAXFEE	DEF					153.55	1/1/2018	12/31/2299	N
78226	HEPATOBILIARY SYSTEM IMAGING	MAXFEE	DEF	26				15.36	1/1/2018	12/31/2299	N
78226	HEPATOBILIARY SYSTEM IMAGING	MAXFEE	DEF	TC				138.20	1/1/2018	12/31/2299	N
78227	HEPATOBIL SYST IMAGE W/DRUG	PRXOVR	DEF					NA	NA	NA	N
78227	HEPATOBIL SYST IMAGE W/DRUG	MAXFEE	DEF					209.98	1/1/2018	12/31/2299	N
78227	HEPATOBIL SYST IMAGE W/DRUG	MAXFEE	DEF	26				21	1/1/2018	12/31/2299	N
78227	HEPATOBIL SYST IMAGE W/DRUG	MAXFEE	DEF	TC				188.98	1/1/2018	12/31/2299	N
78230	SALIVARY GLAND IMAGING	PRXOVR	DEF					NA	NA	NA	N
78230	SALIVARY GLAND IMAGING	MAXFEE	DEF					118.16	1/1/2018	12/31/2299	N
78230	SALIVARY GLAND IMAGING	MAXFEE	DEF	26				29.54	1/1/2018	12/31/2299	N
78230	SALIVARY GLAND IMAGING	MAXFEE	DEF	TC				88.62	1/1/2018	12/31/2299	N
78231	SERIAL SALIVARY IMAGING	PRXOVR	DEF					NA	NA	NA	N
78231	SERIAL SALIVARY IMAGING	MAXFEE	DEF					105.69	1/1/2018	12/31/2299	N
78231	SERIAL SALIVARY IMAGING	MAXFEE	DEF	26				21.14	1/1/2018	12/31/2299	N
78231	SERIAL SALIVARY IMAGING	MAXFEE	DEF	TC				84.55	1/1/2018	12/31/2299	N
78232	SALIVARY GLAND FUNCTION EXAM	PRXOVR	DEF					NA	NA	NA	N
78232	SALIVARY GLAND FUNCTION EXAM	MAXFEE	DEF					80.56	1/1/2018	12/31/2299	N
78232	SALIVARY GLAND FUNCTION EXAM	MAXFEE	DEF	26				16.11	1/1/2018	12/31/2299	N
78232	SALIVARY GLAND FUNCTION EXAM	MAXFEE	DEF	TC				64.45	1/1/2018	12/31/2299	N
78258	ESOPHAGEAL MOTILITY STUDY	PRXOVR	DEF					NA	NA	NA	N
78258	ESOPHAGEAL MOTILITY STUDY	MAXFEE	DEF					106.32	1/1/2018	12/31/2299	N
78258	ESOPHAGEAL MOTILITY STUDY	MAXFEE	DEF	26				31.90	1/1/2018	12/31/2299	N
78258	ESOPHAGEAL MOTILITY STUDY	MAXFEE	DEF	TC				74.42	1/1/2018	12/31/2299	N
78261	GASTRIC MUCOSA IMAGING	PRXOVR	DEF					NA	NA	NA	N
78261	GASTRIC MUCOSA IMAGING	MAXFEE	DEF					137.73	1/1/2018	12/31/2299	N
78261	GASTRIC MUCOSA IMAGING	MAXFEE	DEF	26				27.55	1/1/2018	12/31/2299	N
78261	GASTRIC MUCOSA IMAGING	MAXFEE	DEF	TC				110.18	1/1/2018	12/31/2299	N
78262	GASTROESOPHAGEAL REFLUX EXAM	PRXOVR	DEF					NA	NA	NA	N
78262	GASTROESOPHAGEAL REFLUX EXAM	MAXFEE	DEF					141.26	1/1/2018	12/31/2299	N
78262	GASTROESOPHAGEAL REFLUX EXAM	MAXFEE	DEF	26				28.25	1/1/2018	12/31/2299	N
78262	GASTROESOPHAGEAL REFLUX EXAM	MAXFEE	DEF	TC				113.01	1/1/2018	12/31/2299	N
78264	GASTRIC EMPTYING IMAG STUDY	PRXOVR	DEF					NA	NA	NA	N
78264	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF					141.76	1/1/2018	12/31/2299	N
78264	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	26				35.44	1/1/2018	12/31/2299	N
78264	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	TC				106.32	1/1/2018	12/31/2299	N
78265	GASTRIC EMPTYING IMAG STUDY	PRXOVR	DEF					NA	NA	NA	N
78265	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF					292.35	1/1/2018	12/31/2299	N
78265	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	26				29.24	1/1/2018	12/31/2299	N
78265	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	TC				263.11	1/1/2018	12/31/2299	N
78266	GASTRIC EMPTYING IMAG STUDY	PRXOVR	DEF					NA	NA	NA	N
78266	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF					346.59	1/1/2018	12/31/2299	N
78266	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	26				34.66	1/1/2018	12/31/2299	N
78266	GASTRIC EMPTYING IMAG STUDY	MAXFEE	DEF	TC				311.93	1/1/2018	12/31/2299	N
78268	BREATH TEST ANALYSIS C-14	PRXOVR	DEF					NA	NA	NA	N
78268	BREATH TEST ANALYSIS C-14	MAXFEE	DEF					70.81	4/1/2019	12/31/2299	N
78270	VIT B-12 ABSORPTION EXAM	PRXOVR	DEF					NA	NA	NA	N
78270	VIT B-12 ABSORPTION EXAM	MAXFEE	DEF					NA			N
78271	VIT B-12 ABSRP EXAM INT FAC	PRXOVR	DEF					NA	NA	NA	N
78271	VIT B-12 ABSRP EXAM INT FAC	MAXFEE	DEF					NA			N
78272	VIT B-12 ABSORP COMBINED	PRXOVR	DEF					NA	NA	NA	N
78272	VIT B-12 ABSORP COMBINED	MAXFEE	DEF					NA			N
78282	GI PROTEIN LOSS EXAM	PRXOVR	DEF					NA	NA	NA	N
78282	GI PROTEIN LOSS EXAM	MAXFEE	DEF					169.65	1/1/2018	12/31/2299	N
78282	GI PROTEIN LOSS EXAM	MAXFEE	DEF	26				33.93	1/1/2018	12/31/2299	N
78282	GI PROTEIN LOSS EXAM	MAXFEE	DEF	TC				135.72	1/1/2018	12/31/2299	N
78290	MECKELS DIVERT EXAM	PRXOVR	DEF					NA	NA	NA	N
78290	MECKELS DIVERT EXAM	MAXFEE	DEF					196.04	1/1/2018	12/31/2299	N
78290	MECKELS DIVERT EXAM	MAXFEE	DEF	26				49.01	1/1/2018	12/31/2299	N
78290	MECKELS DIVERT EXAM	MAXFEE	DEF	TC				147.03	1/1/2018	12/31/2299	N
78291	LEVEEN/SHUNT PATENCY EXAM	PRXOVR	DEF					NA	NA	NA	N
78291	LEVEEN/SHUNT PATENCY EXAM	MAXFEE	DEF					116.25	1/1/2018	12/31/2299	N
78291	LEVEEN/SHUNT PATENCY EXAM	MAXFEE	DEF	26				34.88	1/1/2018	12/31/2299	N
78291	LEVEEN/SHUNT PATENCY EXAM	MAXFEE	DEF	TC				81.37	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	PRXOVR	DEF					NA	NA	NA	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF					123.72	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF	26				37.12	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF	TC				86.60	1/1/2018	12/31/2299	N
78305	BONE IMAGING MULTIPLE AREAS	PRXOVR	DEF					NA	NA	NA	N
78305	BONE IMAGING MULTIPLE AREAS	MAXFEE	DEF					130.98	1/1/2018	12/31/2299	N
78305	BONE IMAGING MULTIPLE AREAS	MAXFEE	DEF	26				32.75	1/1/2018	12/31/2299	N
78305	BONE IMAGING MULTIPLE AREAS	MAXFEE	DEF	TC				98.23	1/1/2018	12/31/2299	N
78306	BONE IMAGING WHOLE BODY	PRXOVR	DEF					NA	NA	NA	N
78306	BONE IMAGING WHOLE BODY	MAXFEE	DEF					148.47	1/1/2018	12/31/2299	N
78306	BONE IMAGING WHOLE BODY	MAXFEE	DEF	26				37.12	1/1/2018	12/31/2299	N
78306	BONE IMAGING WHOLE BODY	MAXFEE	DEF	TC				111.35	1/1/2018	12/31/2299	N
78315	BONE IMAGING 3 PHASE	PRXOVR	DEF					NA	NA	NA	N
78315	BONE IMAGING 3 PHASE	MAXFEE	DEF					167.94	1/1/2018	12/31/2299	N
78315	BONE IMAGING 3 PHASE	MAXFEE	DEF	26				41.99	1/1/2018	12/31/2299	N
78315	BONE IMAGING 3 PHASE	MAXFEE	DEF	TC				125.95	1/1/2018	12/31/2299	N
78350	BONE MINERAL SINGLE PHOTON	PRXOVR	DEF					NA	NA	NA	N
78350	BONE MINERAL SINGLE PHOTON	MAXFEE	DEF					29.38	1/1/2018	12/31/2299	N
78350	BONE MINERAL SINGLE PHOTON	MAXFEE	DEF	26				8.81	1/1/2018	12/31/2299	N
78350	BONE MINERAL SINGLE PHOTON	MAXFEE	DEF	TC				20.57	1/1/2018	12/31/2299	N
78414	NON-IMAGING HEART FUNCTION	PRXOVR	DEF					NA	NA	NA	N
78414	NON-IMAGING HEART FUNCTION	MAXFEE	DEF					74.39	1/1/2018	12/31/2299	N
78414	NON-IMAGING HEART FUNCTION	MAXFEE	DEF	26				18.60	1/1/2018	12/31/2299	N
78414	NON-IMAGING HEART FUNCTION	MAXFEE	DEF	TC				55.79	1/1/2018	12/31/2299	N
78428	CARDIAC SHUNT IMAGING	PRXOVR	DEF					NA	NA	NA	N
78428	CARDIAC SHUNT IMAGING	MAXFEE	DEF					124.29	1/1/2018	12/31/2299	N
78428	CARDIAC SHUNT IMAGING	MAXFEE	DEF	26				31.07	1/1/2018	12/31/2299	N
78428	CARDIAC SHUNT IMAGING	MAXFEE	DEF	TC				93.22	1/1/2018	12/31/2299	N
78429	MYOCRD IMG PET 1 STD W/CT	PRXOVR	DEF					NA	NA	NA	N
78429	MYOCRD IMG PET 1 STD W/CT	MANUAL	DEF					NA	NA	NA	N
78430	MYOCRD IMG PET RST/STRS W/CT	PRXOVR	DEF					NA	NA	NA	N
78430	MYOCRD IMG PET RST/STRS W/CT	MANUAL	DEF					NA	NA	NA	N
78431	MYOCRD IMG PET RST&STRS CT	PRXOVR	DEF					NA	NA	NA	N
78431	MYOCRD IMG PET RST&STRS CT	MANUAL	DEF					NA	NA	NA	N
78432	MYOCRD IMG PET 2RTRACER	PRXOVR	DEF					NA	NA	NA	N
78432	MYOCRD IMG PET 2RTRACER	MANUAL	DEF					NA	NA	NA	N
78433	MYOCRD IMG PET 2RTRACER CT	PRXOVR	DEF					NA	NA	NA	N
78433	MYOCRD IMG PET 2RTRACER CT	MANUAL	DEF					NA	NA	NA	N
78434	AQMBF PET REST & RX STRESS	PRXOVR	DEF					NA	NA	NA	N
78434	AQMBF PET REST & RX STRESS	MANUAL	DEF					NA	NA	NA	N
78445	VASCULAR FLOW IMAGING	PRXOVR	DEF					NA	NA	NA	N
78445	VASCULAR FLOW IMAGING	MAXFEE	DEF					100.84	1/1/2018	12/31/2299	N
78445	VASCULAR FLOW IMAGING	MAXFEE	DEF	26				20.17	1/1/2018	12/31/2299	N
78445	VASCULAR FLOW IMAGING	MAXFEE	DEF	TC				80.67	1/1/2018	12/31/2299	N
78451	HT MUSCLE IMAGE SPECT SING	PRXOVR	DEF					NA	NA	NA	N
78451	HT MUSCLE IMAGE SPECT SING	MAXFEE	DEF					202.58	1/1/2018	12/31/2299	N
78451	HT MUSCLE IMAGE SPECT SING	MAXFEE	DEF	26				60.77	1/1/2018	12/31/2299	N
78451	HT MUSCLE IMAGE SPECT SING	MAXFEE	DEF	TC				141.81	1/1/2018	12/31/2299	N
78452	HT MUSCLE IMAGE SPECT MULT	PRXOVR	DEF					NA	NA	NA	N
78452	HT MUSCLE IMAGE SPECT MULT	MAXFEE	DEF					280.41	1/1/2018	12/31/2299	N
78452	HT MUSCLE IMAGE SPECT MULT	MAXFEE	DEF	26				56.08	1/1/2018	12/31/2299	N
78452	HT MUSCLE IMAGE SPECT MULT	MAXFEE	DEF	TC				224.33	1/1/2018	12/31/2299	N
78453	HT MUSCLE IMAGE PLANAR SING	PRXOVR	DEF					NA	NA	NA	N
78453	HT MUSCLE IMAGE PLANAR SING	MAXFEE	DEF					180.50	1/1/2018	12/31/2299	N
78453	HT MUSCLE IMAGE PLANAR SING	MAXFEE	DEF	26				45.13	1/1/2018	12/31/2299	N
78453	HT MUSCLE IMAGE PLANAR SING	MAXFEE	DEF	TC				135.38	1/1/2018	12/31/2299	N
78454	HT MUSC IMAGE PLANAR MULT	PRXOVR	DEF					NA	NA	NA	N
78454	HT MUSC IMAGE PLANAR MULT	MAXFEE	DEF					256.66	1/1/2018	12/31/2299	N
78454	HT MUSC IMAGE PLANAR MULT	MAXFEE	DEF	26				51.33	1/1/2018	12/31/2299	N
78454	HT MUSC IMAGE PLANAR MULT	MAXFEE	DEF	TC				205.33	1/1/2018	12/31/2299	N
78456	ACUTE VENOUS THROMBUS IMAGE	PRXOVR	DEF					NA	NA	NA	N
78456	ACUTE VENOUS THROMBUS IMAGE	MAXFEE	DEF					148.87	1/1/2018	12/31/2299	N
78456	ACUTE VENOUS THROMBUS IMAGE	MAXFEE	DEF	26				37.22	1/1/2018	12/31/2299	N
78456	ACUTE VENOUS THROMBUS IMAGE	MAXFEE	DEF	TC				111.65	1/1/2018	12/31/2299	N
78457	VENOUS THROMBOSIS IMAGING	PRXOVR	DEF					NA	NA	NA	N
78457	VENOUS THROMBOSIS IMAGING	MAXFEE	DEF					101.59	1/1/2018	12/31/2299	N
78457	VENOUS THROMBOSIS IMAGING	MAXFEE	DEF	26				30.48	1/1/2018	12/31/2299	N
78457	VENOUS THROMBOSIS IMAGING	MAXFEE	DEF	TC				71.11	1/1/2018	12/31/2299	N
78458	VEN THROMBOSIS IMAGES BILAT	PRXOVR	DEF					NA	NA	NA	N
78458	VEN THROMBOSIS IMAGES BILAT	MAXFEE	DEF					143.16	1/1/2018	12/31/2299	N
78458	VEN THROMBOSIS IMAGES BILAT	MAXFEE	DEF	26				35.79	1/1/2018	12/31/2299	N
78458	VEN THROMBOSIS IMAGES BILAT	MAXFEE	DEF	TC				107.37	1/1/2018	12/31/2299	N
78459	MYOCRD IMG PET SINGLE STUDY	PRXOVR	DEF					NA	NA	NA	N
78459	MYOCRD IMG PET SINGLE STUDY	MAXFEE	DEF	26				71.30	1/1/2018	12/31/2299	N
78459	MYOCRD IMG PET SINGLE STUDY	MAXFEE	DEF	TC				641.73	1/1/2018	12/31/2299	N
78459	MYOCRD IMG PET SINGLE STUDY	MAXFEE	DEF					713.03	1/1/2018	12/31/2299	N
78460	HEART MUSCLE BLOOD; SINGLE	PRXOVR	DEF					NA	NA	NA	N
78460	HEART MUSCLE BLOOD; SINGLE	MAXFEE	DEF					NA			N
78461	HEART MUSCLE BLOOD; MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78461	HEART MUSCLE BLOOD; MULTIPLE	MAXFEE	DEF					NA			N
78464	HEART IMAGE (3D); SINGLE	PRXOVR	DEF					NA	NA	NA	N
78464	HEART IMAGE (3D); SINGLE	MAXFEE	DEF					NA			N
78465	HEART IMAGE (3D); MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78465	HEART IMAGE (3D); MULTIPLE	MAXFEE	DEF					NA			N
78466	HEART INFARCT IMAGE	PRXOVR	DEF					NA	NA	NA	N
78466	HEART INFARCT IMAGE	MAXFEE	DEF					97.89	1/1/2018	12/31/2299	N
78466	HEART INFARCT IMAGE	MAXFEE	DEF	26				29.37	1/1/2018	12/31/2299	N
78466	HEART INFARCT IMAGE	MAXFEE	DEF	TC				68.52	1/1/2018	12/31/2299	N
78468	HEART INFARCT IMAGE (EF)	PRXOVR	DEF					NA	NA	NA	N
78468	HEART INFARCT IMAGE (EF)	MAXFEE	DEF					129.60	1/1/2018	12/31/2299	N
78468	HEART INFARCT IMAGE (EF)	MAXFEE	DEF	26				32.40	1/1/2018	12/31/2299	N
78468	HEART INFARCT IMAGE (EF)	MAXFEE	DEF	TC				97.20	1/1/2018	12/31/2299	N
78469	HEART INFARCT IMAGE (3D)	PRXOVR	DEF					NA	NA	NA	N
78469	HEART INFARCT IMAGE (3D)	MAXFEE	DEF					176.42	1/1/2018	12/31/2299	N
78469	HEART INFARCT IMAGE (3D)	MAXFEE	DEF	26				35.28	1/1/2018	12/31/2299	N
78469	HEART INFARCT IMAGE (3D)	MAXFEE	DEF	TC				141.14	1/1/2018	12/31/2299	N
78472	GATED HEART PLANAR SINGLE	PRXOVR	DEF					NA	NA	NA	N
78472	GATED HEART PLANAR SINGLE	MAXFEE	DEF					186.87	1/1/2018	12/31/2299	N
78472	GATED HEART PLANAR SINGLE	MAXFEE	DEF	26				37.37	1/1/2018	12/31/2299	N
78472	GATED HEART PLANAR SINGLE	MAXFEE	DEF	TC				149.50	1/1/2018	12/31/2299	N
78473	GATED HEART MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78473	GATED HEART MULTIPLE	MAXFEE	DEF					243.58	1/1/2018	12/31/2299	N
78473	GATED HEART MULTIPLE	MAXFEE	DEF	26				60.90	1/1/2018	12/31/2299	N
78473	GATED HEART MULTIPLE	MAXFEE	DEF	TC				182.68	1/1/2018	12/31/2299	N
78478	HEART WALL MOTION ADD-ON	PRXOVR	DEF					NA	NA	NA	N
78478	HEART WALL MOTION ADD-ON	MAXFEE	DEF					NA			N
78480	HEART FUNCTION ADD-ON	PRXOVR	DEF					NA	NA	NA	N
78480	HEART FUNCTION ADD-ON	MAXFEE	DEF					NA			N
78481	HEART FIRST PASS SINGLE	PRXOVR	DEF					NA	NA	NA	N
78481	HEART FIRST PASS SINGLE	MAXFEE	DEF	26				37.83	1/1/2018	12/31/2299	N
78481	HEART FIRST PASS SINGLE	MAXFEE	DEF	TC				113.47	1/1/2018	12/31/2299	N
78481	HEART FIRST PASS SINGLE	MAXFEE	DEF					151.30	1/1/2018	12/31/2299	N
78483	HEART FIRST PASS MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78483	HEART FIRST PASS MULTIPLE	MAXFEE	DEF					202.60	1/1/2018	12/31/2299	N
78483	HEART FIRST PASS MULTIPLE	MAXFEE	DEF	26				50.65	1/1/2018	12/31/2299	N
78483	HEART FIRST PASS MULTIPLE	MAXFEE	DEF	TC				151.95	1/1/2018	12/31/2299	N
78491	MYOCRD IMG PET 1STD RST/STRS	PRXOVR	DEF					NA	NA	NA	N
78491	MYOCRD IMG PET 1STD RST/STRS	MAXFEE	DEF					560.72	1/1/2018	12/31/2299	N
78491	MYOCRD IMG PET 1STD RST/STRS	MAXFEE	DEF	26				56.07	1/1/2018	12/31/2299	N
78491	MYOCRD IMG PET 1STD RST/STRS	MAXFEE	DEF	TC				504.65	1/1/2018	12/31/2299	N
78492	MYOCRD IMG PET MLT RST&STRS	PRXOVR	DEF					NA	NA	NA	N
78492	MYOCRD IMG PET MLT RST&STRS	MAXFEE	DEF					573.90	1/1/2018	12/31/2299	N
78492	MYOCRD IMG PET MLT RST&STRS	MAXFEE	DEF	26				57.39	1/1/2018	12/31/2299	N
78492	MYOCRD IMG PET MLT RST&STRS	MAXFEE	DEF	TC				516.51	1/1/2018	12/31/2299	N
78494	HEART IMAGE SPECT	PRXOVR	DEF					NA	NA	NA	N
78494	HEART IMAGE SPECT	MAXFEE	DEF					190.62	1/1/2018	12/31/2299	N
78494	HEART IMAGE SPECT	MAXFEE	DEF	26				38.12	1/1/2018	12/31/2299	N
78494	HEART IMAGE SPECT	MAXFEE	DEF	TC				152.50	1/1/2018	12/31/2299	N
78496	HEART FIRST PASS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
78496	HEART FIRST PASS ADD-ON	MAXFEE	DEF					37.11	1/1/2018	12/31/2299	N
78496	HEART FIRST PASS ADD-ON	MAXFEE	DEF	26				18.56	1/1/2018	12/31/2299	N
78496	HEART FIRST PASS ADD-ON	MAXFEE	DEF	TC				18.55	1/1/2018	12/31/2299	N
78579	LUNG VENTILATION IMAGING	PRXOVR	DEF					NA	NA	NA	N
78579	LUNG VENTILATION IMAGING	MAXFEE	DEF					109.67	1/1/2018	12/31/2299	N
78579	LUNG VENTILATION IMAGING	MAXFEE	DEF	26				10.97	1/1/2018	12/31/2299	N
78579	LUNG VENTILATION IMAGING	MAXFEE	DEF	TC				98.70	1/1/2018	12/31/2299	N
78580	LUNG PERFUSION IMAGING	PRXOVR	DEF					NA	NA	NA	N
78580	LUNG PERFUSION IMAGING	MAXFEE	DEF					121.24	1/1/2018	12/31/2299	N
78580	LUNG PERFUSION IMAGING	MAXFEE	DEF	26				30.31	1/1/2018	12/31/2299	N
78580	LUNG PERFUSION IMAGING	MAXFEE	DEF	TC				90.93	1/1/2018	12/31/2299	N
78582	LUNG VENTILAT&PERFUS IMAGING	PRXOVR	DEF					NA	NA	NA	N
78582	LUNG VENTILAT&PERFUS IMAGING	MAXFEE	DEF					197.55	1/1/2018	12/31/2299	N
78582	LUNG VENTILAT&PERFUS IMAGING	MAXFEE	DEF	26				39.51	1/1/2018	12/31/2299	N
78582	LUNG VENTILAT&PERFUS IMAGING	MAXFEE	DEF	TC				158.04	1/1/2018	12/31/2299	N
78584	LUNG V/Q IMAGE SINGLE BREATH	PRXOVR	DEF					NA	NA	NA	N
78584	LUNG V/Q IMAGE SINGLE BREATH	MAXFEE	DEF					NA			N
78585	LUNG V/Q IMAGING	PRXOVR	DEF					NA	NA	NA	N
78585	LUNG V/Q IMAGING	MAXFEE	DEF					NA			N
78586	AEROSOL LUNG IMAGE SINGLE	PRXOVR	DEF					NA	NA	NA	N
78586	AEROSOL LUNG IMAGE SINGLE	MAXFEE	DEF					NA			N
78587	AEROSOL LUNG IMAGE MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78587	AEROSOL LUNG IMAGE MULTIPLE	MAXFEE	DEF					NA			N
78588	PERFUSION LUNG IMAGE	PRXOVR	DEF					NA	NA	NA	N
78588	PERFUSION LUNG IMAGE	MAXFEE	DEF					NA			N
78591	VENT IMAGE 1 BREATH 1 PROJ	PRXOVR	DEF					NA	NA	NA	N
78591	VENT IMAGE 1 BREATH 1 PROJ	MAXFEE	DEF					NA			N
78593	VENT IMAGE 1 PROJ GAS	PRXOVR	DEF					NA	NA	NA	N
78593	VENT IMAGE 1 PROJ GAS	MAXFEE	DEF					NA			N
78594	VENT IMAGE MULT PROJ GAS	PRXOVR	DEF					NA	NA	NA	N
78594	VENT IMAGE MULT PROJ GAS	MAXFEE	DEF					NA			N
78596	LUNG DIFFERENTIAL FUNCTION	PRXOVR	DEF					NA	NA	NA	N
78596	LUNG DIFFERENTIAL FUNCTION	MAXFEE	DEF					NA			N
78597	LUNG PERFUSION DIFFERENTIAL	PRXOVR	DEF					NA	NA	NA	N
78597	LUNG PERFUSION DIFFERENTIAL	MAXFEE	DEF					92.33	1/1/2018	12/31/2299	N
78597	LUNG PERFUSION DIFFERENTIAL	MAXFEE	DEF	26				16.95	1/1/2018	12/31/2299	N
78597	LUNG PERFUSION DIFFERENTIAL	MAXFEE	DEF	TC				75.38	1/1/2018	12/31/2299	N
78598	LUNG PERF&VENTILAT DIFERENTL	PRXOVR	DEF					NA	NA	NA	N
78598	LUNG PERF&VENTILAT DIFERENTL	MAXFEE	DEF					141.48	1/1/2018	12/31/2299	N
78598	LUNG PERF&VENTILAT DIFERENTL	MAXFEE	DEF	26				14.15	1/1/2018	12/31/2299	N
78598	LUNG PERF&VENTILAT DIFERENTL	MAXFEE	DEF	TC				127.33	1/1/2018	12/31/2299	N
78600	BRAIN IMAGE < 4 VIEWS	PRXOVR	DEF					NA	NA	NA	N
78600	BRAIN IMAGE < 4 VIEWS	MAXFEE	DEF					94.57	1/1/2018	12/31/2299	N
78600	BRAIN IMAGE < 4 VIEWS	MAXFEE	DEF	26				9.46	1/1/2018	12/31/2299	N
78600	BRAIN IMAGE < 4 VIEWS	MAXFEE	DEF	TC				85.11	1/1/2018	12/31/2299	N
78601	BRAIN IMAGE W/FLOW < 4 VIEWS	PRXOVR	DEF					NA	NA	NA	N
78601	BRAIN IMAGE W/FLOW < 4 VIEWS	MAXFEE	DEF					111.66	1/1/2018	12/31/2299	N
78601	BRAIN IMAGE W/FLOW < 4 VIEWS	MAXFEE	DEF	26				22.33	1/1/2018	12/31/2299	N
78601	BRAIN IMAGE W/FLOW < 4 VIEWS	MAXFEE	DEF	TC				89.33	1/1/2018	12/31/2299	N
78605	BRAIN IMAGE 4+ VIEWS	PRXOVR	DEF					NA	NA	NA	N
78605	BRAIN IMAGE 4+ VIEWS	MAXFEE	DEF					112.43	1/1/2018	12/31/2299	N
78605	BRAIN IMAGE 4+ VIEWS	MAXFEE	DEF	26				22.49	1/1/2018	12/31/2299	N
78605	BRAIN IMAGE 4+ VIEWS	MAXFEE	DEF	TC				89.94	1/1/2018	12/31/2299	N
78606	BRAIN IMAGE W/FLOW 4 + VIEWS	PRXOVR	DEF					NA	NA	NA	N
78606	BRAIN IMAGE W/FLOW 4 + VIEWS	MAXFEE	DEF					192.98	1/1/2018	12/31/2299	N
78606	BRAIN IMAGE W/FLOW 4 + VIEWS	MAXFEE	DEF	26				38.60	1/1/2018	12/31/2299	N
78606	BRAIN IMAGE W/FLOW 4 + VIEWS	MAXFEE	DEF	TC				154.38	1/1/2018	12/31/2299	N
78607	BRAIN IMAGING (3D)	PRXOVR	DEF					NA	NA	NA	N
78607	BRAIN IMAGING (3D)	MAXFEE	DEF					NA			N
78608	BRAIN IMAGING (PET)	PRXOVR	DEF					NA	NA	NA	N
78608	BRAIN IMAGING (PET)	MAXFEE	DEF					515.65	1/1/2018	12/31/2299	N
78608	BRAIN IMAGING (PET)	MAXFEE	DEF	26				51.57	1/1/2018	12/31/2299	N
78608	BRAIN IMAGING (PET)	MAXFEE	DEF	TC				464.08	1/1/2018	12/31/2299	N
78610	BRAIN FLOW IMAGING ONLY	PRXOVR	DEF					NA	NA	NA	N
78610	BRAIN FLOW IMAGING ONLY	MAXFEE	DEF					102.16	1/1/2018	12/31/2299	N
78610	BRAIN FLOW IMAGING ONLY	MAXFEE	DEF	26				25.54	1/1/2018	12/31/2299	N
78610	BRAIN FLOW IMAGING ONLY	MAXFEE	DEF	TC				76.62	1/1/2018	12/31/2299	N
78630	CEREBROSPINAL FLUID SCAN	PRXOVR	DEF					NA	NA	NA	N
78630	CEREBROSPINAL FLUID SCAN	MAXFEE	DEF					162.40	1/1/2018	12/31/2299	N
78630	CEREBROSPINAL FLUID SCAN	MAXFEE	DEF	26				16.24	1/1/2018	12/31/2299	N
78630	CEREBROSPINAL FLUID SCAN	MAXFEE	DEF	TC				146.16	1/1/2018	12/31/2299	N
78635	CSF VENTRICULOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
78635	CSF VENTRICULOGRAPHY	MAXFEE	DEF					198.44	1/1/2018	12/31/2299	N
78635	CSF VENTRICULOGRAPHY	MAXFEE	DEF	26				39.69	1/1/2018	12/31/2299	N
78635	CSF VENTRICULOGRAPHY	MAXFEE	DEF	TC				158.75	1/1/2018	12/31/2299	N
78645	CSF SHUNT EVALUATION	PRXOVR	DEF					NA	NA	NA	N
78645	CSF SHUNT EVALUATION	MAXFEE	DEF					189.27	1/1/2018	12/31/2299	N
78645	CSF SHUNT EVALUATION	MAXFEE	DEF	26				37.85	1/1/2018	12/31/2299	N
78645	CSF SHUNT EVALUATION	MAXFEE	DEF	TC				151.42	1/1/2018	12/31/2299	N
78647	CEREBROSPINAL FLUID SCAN	PRXOVR	DEF					NA	NA	NA	N
78647	CEREBROSPINAL FLUID SCAN	MAXFEE	DEF					NA			N
78650	CSF LEAKAGE IMAGING	PRXOVR	DEF					NA	NA	NA	N
78650	CSF LEAKAGE IMAGING	MAXFEE	DEF					196.94	1/1/2018	12/31/2299	N
78650	CSF LEAKAGE IMAGING	MAXFEE	DEF	26				39.39	1/1/2018	12/31/2299	N
78650	CSF LEAKAGE IMAGING	MAXFEE	DEF	TC				157.55	1/1/2018	12/31/2299	N
78660	NUCLEAR EXAM OF TEAR FLOW	PRXOVR	DEF					NA	NA	NA	N
78660	NUCLEAR EXAM OF TEAR FLOW	MAXFEE	DEF					109.57	1/1/2018	12/31/2299	N
78660	NUCLEAR EXAM OF TEAR FLOW	MAXFEE	DEF	26				21.91	1/1/2018	12/31/2299	N
78660	NUCLEAR EXAM OF TEAR FLOW	MAXFEE	DEF	TC				87.66	1/1/2018	12/31/2299	N
78700	KIDNEY IMAGING MORPHOL	PRXOVR	DEF					NA	NA	NA	N
78700	KIDNEY IMAGING MORPHOL	MAXFEE	DEF					99.20	1/1/2018	12/31/2299	N
78700	KIDNEY IMAGING MORPHOL	MAXFEE	DEF	26				19.84	1/1/2018	12/31/2299	N
78700	KIDNEY IMAGING MORPHOL	MAXFEE	DEF	TC				79.36	1/1/2018	12/31/2299	N
78701	KIDNEY IMAGING WITH FLOW	PRXOVR	DEF					NA	NA	NA	N
78701	KIDNEY IMAGING WITH FLOW	MAXFEE	DEF					114.51	1/1/2018	12/31/2299	N
78701	KIDNEY IMAGING WITH FLOW	MAXFEE	DEF	26				22.90	1/1/2018	12/31/2299	N
78701	KIDNEY IMAGING WITH FLOW	MAXFEE	DEF	TC				91.61	1/1/2018	12/31/2299	N
78707	K FLOW/FUNCT IMAGE W/O DRUG	PRXOVR	DEF					NA	NA	NA	N
78707	K FLOW/FUNCT IMAGE W/O DRUG	MAXFEE	DEF					157.25	1/1/2018	12/31/2299	N
78707	K FLOW/FUNCT IMAGE W/O DRUG	MAXFEE	DEF	26				39.31	1/1/2018	12/31/2299	N
78707	K FLOW/FUNCT IMAGE W/O DRUG	MAXFEE	DEF	TC				117.94	1/1/2018	12/31/2299	N
78708	K FLOW/FUNCT IMAGE W/DRUG	PRXOVR	DEF					NA	NA	NA	N
78708	K FLOW/FUNCT IMAGE W/DRUG	MAXFEE	DEF					142.17	1/1/2018	12/31/2299	N
78708	K FLOW/FUNCT IMAGE W/DRUG	MAXFEE	DEF	26				49.76	1/1/2018	12/31/2299	N
78708	K FLOW/FUNCT IMAGE W/DRUG	MAXFEE	DEF	TC				92.41	1/1/2018	12/31/2299	N
78709	K FLOW/FUNCT IMAGE MULTIPLE	PRXOVR	DEF					NA	NA	NA	N
78709	K FLOW/FUNCT IMAGE MULTIPLE	MAXFEE	DEF					169.76	1/1/2018	12/31/2299	N
78709	K FLOW/FUNCT IMAGE MULTIPLE	MAXFEE	DEF	26				50.93	1/1/2018	12/31/2299	N
78709	K FLOW/FUNCT IMAGE MULTIPLE	MAXFEE	DEF	TC				118.83	1/1/2018	12/31/2299	N
78710	KIDNEY IMAGING (3D)	PRXOVR	DEF					NA	NA	NA	N
78710	KIDNEY IMAGING (3D)	MAXFEE	DEF					NA			N
78725	KIDNEY FUNCTION STUDY	PRXOVR	DEF					NA	NA	NA	N
78725	KIDNEY FUNCTION STUDY	MAXFEE	DEF					62.68	1/1/2018	12/31/2299	N
78725	KIDNEY FUNCTION STUDY	MAXFEE	DEF	26				15.67	1/1/2018	12/31/2299	N
78725	KIDNEY FUNCTION STUDY	MAXFEE	DEF	TC				47.01	1/1/2018	12/31/2299	N
78730	URINARY BLADDER RETENTION	PRXOVR	DEF					NA	NA	NA	N
78730	URINARY BLADDER RETENTION	MAXFEE	DEF					44.09	1/1/2018	12/31/2299	N
78730	URINARY BLADDER RETENTION	MAXFEE	DEF	26				8.82	1/1/2018	12/31/2299	N
78730	URINARY BLADDER RETENTION	MAXFEE	DEF	TC				35.27	1/1/2018	12/31/2299	N
78740	URETERAL REFLUX STUDY	PRXOVR	DEF					NA	NA	NA	N
78740	URETERAL REFLUX STUDY	MAXFEE	DEF					129.25	1/1/2018	12/31/2299	N
78740	URETERAL REFLUX STUDY	MAXFEE	DEF	26				25.85	1/1/2018	12/31/2299	N
78740	URETERAL REFLUX STUDY	MAXFEE	DEF	TC				103.40	1/1/2018	12/31/2299	N
78761	TESTICULAR IMAGING W/FLOW	PRXOVR	DEF					NA	NA	NA	N
78761	TESTICULAR IMAGING W/FLOW	MAXFEE	DEF					114.04	1/1/2018	12/31/2299	N
78761	TESTICULAR IMAGING W/FLOW	MAXFEE	DEF	26				28.51	1/1/2018	12/31/2299	N
78761	TESTICULAR IMAGING W/FLOW	MAXFEE	DEF	TC				85.53	1/1/2018	12/31/2299	N
78800	RP LOCLZJ TUM 1 AREA 1 D IMG	PRXOVR	DEF					NA	NA	NA	N
78800	RP LOCLZJ TUM 1 AREA 1 D IMG	MAXFEE	DEF					117.19	1/1/2018	12/31/2299	N
78800	RP LOCLZJ TUM 1 AREA 1 D IMG	MAXFEE	DEF	26				29.30	1/1/2018	12/31/2299	N
78800	RP LOCLZJ TUM 1 AREA 1 D IMG	MAXFEE	DEF	TC				87.89	1/1/2018	12/31/2299	N
78801	RP LOCLZJ TUM 2+AREA 1+D IMG	PRXOVR	DEF					NA	NA	NA	N
78801	RP LOCLZJ TUM 2+AREA 1+D IMG	MAXFEE	DEF					144.44	1/1/2018	12/31/2299	N
78801	RP LOCLZJ TUM 2+AREA 1+D IMG	MAXFEE	DEF	26				36.11	1/1/2018	12/31/2299	N
78801	RP LOCLZJ TUM 2+AREA 1+D IMG	MAXFEE	DEF	TC				108.33	1/1/2018	12/31/2299	N
78802	RP LOCLZJ TUM WHBDY 1 D IMG	PRXOVR	DEF					NA	NA	NA	N
78802	RP LOCLZJ TUM WHBDY 1 D IMG	MAXFEE	DEF					182.74	1/1/2018	12/31/2299	N
78802	RP LOCLZJ TUM WHBDY 1 D IMG	MAXFEE	DEF	26				36.55	1/1/2018	12/31/2299	N
78802	RP LOCLZJ TUM WHBDY 1 D IMG	MAXFEE	DEF	TC				146.19	1/1/2018	12/31/2299	N
78803	RP LOCLZJ TUM SPECT 1 AREA	PRXOVR	DEF					NA	NA	NA	N
78803	RP LOCLZJ TUM SPECT 1 AREA	MAXFEE	DEF					218.58	1/1/2018	12/31/2299	N
78803	RP LOCLZJ TUM SPECT 1 AREA	MAXFEE	DEF	26				43.72	1/1/2018	12/31/2299	N
78803	RP LOCLZJ TUM SPECT 1 AREA	MAXFEE	DEF	TC				174.86	1/1/2018	12/31/2299	N
78804	RP LOCLZJ TUM WHBDY 2+D IMG	PRXOVR	DEF					NA	NA	NA	N
78804	RP LOCLZJ TUM WHBDY 2+D IMG	MAXFEE	DEF					332.41	1/1/2018	12/31/2299	N
78804	RP LOCLZJ TUM WHBDY 2+D IMG	MAXFEE	DEF	26				33.24	1/1/2018	12/31/2299	N
78804	RP LOCLZJ TUM WHBDY 2+D IMG	MAXFEE	DEF	TC				299.17	1/1/2018	12/31/2299	N
78805	ABSCESS IMAGING LTD AREA	PRXOVR	DEF					NA	NA	NA	N
78805	ABSCESS IMAGING LTD AREA	MAXFEE	DEF					NA			N
78806	ABSCESS IMAGING WHOLE BODY	PRXOVR	DEF					NA	NA	NA	N
78806	ABSCESS IMAGING WHOLE BODY	MAXFEE	DEF					NA			N
78807	NUCLEAR LOCALIZATION/ABSCESS	PRXOVR	DEF					NA	NA	NA	N
78807	NUCLEAR LOCALIZATION/ABSCESS	MAXFEE	DEF					NA			N
78808	IV INJ RA DRUG DX STUDY	PRXOVR	DEF					NA	NA	NA	N
78808	IV INJ RA DRUG DX STUDY	MAXFEE	DEF					32.75	1/1/2018	12/31/2299	N
78811	PET IMAGE LTD AREA	PRXOVR	DEF					NA	NA	NA	N
78811	PET IMAGE LTD AREA	MAXFEE	DEF					594.04	1/1/2018	12/31/2299	N
78811	PET IMAGE LTD AREA	MAXFEE	DEF	26				59.41	1/1/2018	12/31/2299	N
78811	PET IMAGE LTD AREA	MAXFEE	DEF	TC				534.64	1/1/2018	12/31/2299	N
78812	PET IMAGE SKULL-THIGH	PRXOVR	DEF					NA	NA	NA	N
78812	PET IMAGE SKULL-THIGH	MAXFEE	DEF					734.45	1/1/2018	12/31/2299	N
78812	PET IMAGE SKULL-THIGH	MAXFEE	DEF	26				73.45	1/1/2018	12/31/2299	N
78812	PET IMAGE SKULL-THIGH	MAXFEE	DEF	TC				661	1/1/2018	12/31/2299	N
78813	PET IMAGE FULL BODY	PRXOVR	DEF					NA	NA	NA	N
78813	PET IMAGE FULL BODY	MAXFEE	DEF					759.62	1/1/2018	12/31/2299	N
78813	PET IMAGE FULL BODY	MAXFEE	DEF	26				75.96	1/1/2018	12/31/2299	N
78813	PET IMAGE FULL BODY	MAXFEE	DEF	TC				683.66	1/1/2018	12/31/2299	N
78814	PET IMAGE W/CT LMTD	PRXOVR	DEF					NA	NA	NA	N
78814	PET IMAGE W/CT LMTD	MAXFEE	DEF					831.63	1/1/2018	12/31/2299	N
78814	PET IMAGE W/CT LMTD	MAXFEE	DEF	TC				748.47	1/1/2018	12/31/2299	N
78814	PET IMAGE W/CT LMTD	MAXFEE	DEF	26				83.16	1/1/2018	12/31/2299	N
78815	PET IMAGE W/CT SKULL-THIGH	PRXOVR	DEF					NA	NA	NA	N
78815	PET IMAGE W/CT SKULL-THIGH	MAXFEE	DEF					918.08	1/1/2018	12/31/2299	N
78815	PET IMAGE W/CT SKULL-THIGH	MAXFEE	DEF	26				91.81	1/1/2018	12/31/2299	N
78815	PET IMAGE W/CT SKULL-THIGH	MAXFEE	DEF	TC				826.27	1/1/2018	12/31/2299	N
78816	PET IMAGE W/CT FULL BODY	PRXOVR	DEF					NA	NA	NA	N
78816	PET IMAGE W/CT FULL BODY	MAXFEE	DEF					939.65	1/1/2018	12/31/2299	N
78816	PET IMAGE W/CT FULL BODY	MAXFEE	DEF	26				93.97	1/1/2018	12/31/2299	N
78816	PET IMAGE W/CT FULL BODY	MAXFEE	DEF	TC				845.68	1/1/2018	12/31/2299	N
78830	RP LOCLZJ TUM SPECT W/CT 1	PRXOVR	DEF					NA	NA	NA	N
78830	RP LOCLZJ TUM SPECT W/CT 1	MAXFEE	DEF					375.41	1/1/2020	12/31/2299	N
78830	RP LOCLZJ TUM SPECT W/CT 1	MAXFEE	DEF	TC				317.98	1/1/2020	12/31/2299	N
78830	RP LOCLZJ TUM SPECT W/CT 1	MAXFEE	DEF	26				57.42	1/1/2020	12/31/2299	N
78831	RP LOCLZJ TUM SPECT 2 AREAS	PRXOVR	DEF					NA	NA	NA	N
78831	RP LOCLZJ TUM SPECT 2 AREAS	MAXFEE	DEF					542.27	1/1/2020	12/31/2299	N
78831	RP LOCLZJ TUM SPECT 2 AREAS	MAXFEE	DEF	TC				472.15	1/1/2020	12/31/2299	N
78831	RP LOCLZJ TUM SPECT 2 AREAS	MAXFEE	DEF	26				70.12	1/1/2020	12/31/2299	N
78832	RP LOCLZJ TUM SPECT W/CT 2	PRXOVR	DEF					NA	NA	NA	N
78832	RP LOCLZJ TUM SPECT W/CT 2	MAXFEE	DEF					704.90	1/1/2020	12/31/2299	N
78832	RP LOCLZJ TUM SPECT W/CT 2	MAXFEE	DEF	TC				623.25	1/1/2020	12/31/2299	N
78832	RP LOCLZJ TUM SPECT W/CT 2	MAXFEE	DEF	26				81.65	1/1/2020	12/31/2299	N
78835	RP QUAN MEAS SINGLE AREA	PRXOVR	DEF					NA	NA	NA	N
78835	RP QUAN MEAS SINGLE AREA	MAXFEE	DEF					79.09	1/1/2020	12/31/2299	N
78835	RP QUAN MEAS SINGLE AREA	MAXFEE	DEF	TC				61.06	1/1/2020	12/31/2299	N
78835	RP QUAN MEAS SINGLE AREA	MAXFEE	DEF	26				18.03	1/1/2020	12/31/2299	N
90471	IMMUNIZATION ADMIN	MAXFLT	DEF					NA	NA	NA	N
90471	IMMUNIZATION ADMIN	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90473	IMMUNE ADMIN ORAL/NASAL	MAXFLT	DEF					NA	NA	NA	N
90473	IMMUNE ADMIN ORAL/NASAL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90655	IIV3 VACC NO PRSV 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90655	IIV3 VACC NO PRSV 0.25 ML IM	MAXFEE	DEF					NA			N
90656	IIV3 VACC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	MAXFEE	DEF					19.77	11/1/2018	12/31/2299	N
90657	IIV3 VACCINE SPLT 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90657	IIV3 VACCINE SPLT 0.25 ML IM	MAXFEE	DEF					NA			N
90658	IIV3 VACCINE SPLT 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	MAXFEE	DEF					10.39	9/1/2013	12/31/2299	N
90660	LAIV3 VACCINE INTRANASAL	PRXOVR	DEF					NA	NA	NA	N
90660	LAIV3 VACCINE INTRANASAL	MAXFEE	DEF					23.46	9/1/2013	12/31/2299	N
91000	ESOPHAGEAL INTUBATION	PRXOVR	DEF					NA	NA	NA	N
91000	ESOPHAGEAL INTUBATION	MAXFEE	DEF					NA			N
91010	ESOPHAGUS MOTILITY STUDY	PRXOVR	DEF					NA	NA	NA	N
91010	ESOPHAGUS MOTILITY STUDY	MAXFEE	DEF					117.71	7/1/2008	12/31/2299	N
91010	ESOPHAGUS MOTILITY STUDY	MAXFEE	DEF	TC				82.40	7/1/2008	12/31/2299	N
91010	ESOPHAGUS MOTILITY STUDY	MAXFEE	DEF	26				35.31	7/1/2008	12/31/2299	N
91011	ESOPHAGUS MOTILITY STUDY	PRXOVR	DEF					NA	NA	NA	N
91011	ESOPHAGUS MOTILITY STUDY	MAXFEE	DEF					NA			N
91012	ESOPHAGUS MOTILITY STUDY	PRXOVR	DEF					NA	NA	NA	N
91012	ESOPHAGUS MOTILITY STUDY	MAXFEE	DEF					NA			N
91020	GASTRIC MOTILITY STUDIES	PRXOVR	DEF					NA	NA	NA	N
91020	GASTRIC MOTILITY STUDIES	MAXFEE	DEF					129.67	7/1/2008	12/31/2299	N
91020	GASTRIC MOTILITY STUDIES	MAXFEE	DEF	TC				90.77	7/1/2008	12/31/2299	N
91020	GASTRIC MOTILITY STUDIES	MAXFEE	DEF	26				38.90	7/1/2008	12/31/2299	N
91022	DUODENAL MOTILITY STUDY	PRXOVR	DEF					NA	NA	NA	N
91022	DUODENAL MOTILITY STUDY	MAXFEE	DEF					159.06	1/1/2010	12/31/2299	N
91022	DUODENAL MOTILITY STUDY	MAXFEE	DEF	TC				103.39	1/1/2010	12/31/2299	N
91022	DUODENAL MOTILITY STUDY	MAXFEE	DEF	26				55.67	1/1/2010	12/31/2299	N
91030	ACID PERFUSION OF ESOPHAGUS	PRXOVR	DEF					NA	NA	NA	N
91030	ACID PERFUSION OF ESOPHAGUS	MAXFEE	DEF					74.11	7/1/2008	12/31/2299	N
91030	ACID PERFUSION OF ESOPHAGUS	MAXFEE	DEF	TC				48.17	7/1/2008	12/31/2299	N
91030	ACID PERFUSION OF ESOPHAGUS	MAXFEE	DEF	26				25.94	7/1/2008	12/31/2299	N
91034	GASTROESOPHAGEAL REFLUX TEST	PRXOVR	DEF					NA	NA	NA	N
91034	GASTROESOPHAGEAL REFLUX TEST	MAXFEE	DEF					165.37	1/1/2010	12/31/2299	N
91034	GASTROESOPHAGEAL REFLUX TEST	MAXFEE	DEF	TC				132.30	1/1/2010	12/31/2299	N
91034	GASTROESOPHAGEAL REFLUX TEST	MAXFEE	DEF	26				33.07	1/1/2010	12/31/2299	N
91035	G-ESOPH REFLX TST W/ELECTROD	PRXOVR	DEF					NA	NA	NA	N
91035	G-ESOPH REFLX TST W/ELECTROD	MAXFEE	DEF					385	1/1/2010	12/31/2299	N
91035	G-ESOPH REFLX TST W/ELECTROD	MAXFEE	DEF	TC				308	1/1/2010	12/31/2299	N
91035	G-ESOPH REFLX TST W/ELECTROD	MAXFEE	DEF	26				77	1/1/2010	12/31/2299	N
91037	ESOPH IMPED FUNCTION TEST	PRXOVR	DEF					NA	NA	NA	N
91037	ESOPH IMPED FUNCTION TEST	MAXFEE	DEF					130.97	1/1/2005	12/31/2299	N
91037	ESOPH IMPED FUNCTION TEST	MAXFEE	DEF	TC				85.13	1/1/2005	12/31/2299	N
91037	ESOPH IMPED FUNCTION TEST	MAXFEE	DEF	26				45.84	1/1/2005	12/31/2299	N
91038	ESOPH IMPED FUNCT TEST > 1HR	PRXOVR	DEF					NA	NA	NA	N
91038	ESOPH IMPED FUNCT TEST > 1HR	MAXFEE	DEF					112.56	1/1/2005	12/31/2299	N
91038	ESOPH IMPED FUNCT TEST > 1HR	MAXFEE	DEF	TC				56.28	1/1/2005	12/31/2299	N
91038	ESOPH IMPED FUNCT TEST > 1HR	MAXFEE	DEF	26				56.28	1/1/2005	12/31/2299	N
91040	ESOPH BALLOON DISTENSION TST	PRXOVR	DEF					NA	NA	NA	N
91040	ESOPH BALLOON DISTENSION TST	MAXFEE	DEF					258.30	9/1/2013	12/31/2299	N
91040	ESOPH BALLOON DISTENSION TST	MAXFEE	DEF	TC				206.64	9/1/2013	12/31/2299	N
91040	ESOPH BALLOON DISTENSION TST	MAXFEE	DEF	26				51.66	9/1/2013	12/31/2299	N
91052	GASTRIC ANALYSIS TEST	PRXOVR	DEF					NA	NA	NA	N
91052	GASTRIC ANALYSIS TEST	MAXFEE	DEF					NA			N
91055	GASTRIC INTUBATION FOR SMEAR	PRXOVR	DEF					NA	NA	NA	N
91055	GASTRIC INTUBATION FOR SMEAR	MAXFEE	DEF					NA			N
91065	BREATH HYDROGEN/METHANE TEST	PRXOVR	DEF					NA	NA	NA	N
91065	BREATH HYDROGEN/METHANE TEST	MAXFEE	DEF					34.91	7/1/2008	12/31/2299	N
91065	BREATH HYDROGEN/METHANE TEST	MAXFEE	DEF	TC				27.93	7/1/2008	12/31/2299	N
91065	BREATH HYDROGEN/METHANE TEST	MAXFEE	DEF	26				6.98	7/1/2008	12/31/2299	N
91110	GI TRC IMG INTRAL ESOPH-ILE	PRXOVR	DEF					NA	NA	NA	N
91110	GI TRC IMG INTRAL ESOPH-ILE	MAXFEE	DEF					741.41	1/1/2010	12/31/2299	N
91110	GI TRC IMG INTRAL ESOPH-ILE	MAXFEE	DEF	TC				593.13	1/1/2010	12/31/2299	N
91110	GI TRC IMG INTRAL ESOPH-ILE	MAXFEE	DEF	26				148.28	1/1/2010	12/31/2299	N
91111	GI TRC IMG INTRAL ESOPHAGUS	PRXOVR	DEF					NA	NA	NA	N
91111	GI TRC IMG INTRAL ESOPHAGUS	MAXFEE	DEF					471.64	1/1/2007	12/31/2299	N
91111	GI TRC IMG INTRAL ESOPHAGUS	MAXFEE	DEF	TC				424.48	1/1/2007	12/31/2299	N
91111	GI TRC IMG INTRAL ESOPHAGUS	MAXFEE	DEF	26				47.16	1/1/2007	12/31/2299	N
91112	GI WIRELESS CAPSULE MEASURE	PRXOVR	DEF					NA	NA	NA	N
91112	GI WIRELESS CAPSULE MEASURE	MAXFEE	DEF	26				80.68	1/1/2013	12/31/2299	N
91112	GI WIRELESS CAPSULE MEASURE	MAXFEE	DEF	TC				733.36	1/1/2013	12/31/2299	N
91112	GI WIRELESS CAPSULE MEASURE	MAXFEE	DEF					814.04	1/1/2013	12/31/2299	N
91113	GI TRC IMG INTRAL COLON I&R	PRXOVR	DEF					NA	NA	NA	N
91113	GI TRC IMG INTRAL COLON I&R	MAXFEE	DEF					134.10	1/1/2022	12/31/2299	N
91113	GI TRC IMG INTRAL COLON I&R	MAXFEE	DEF	TC				62.28	1/1/2022	12/31/2299	N
91113	GI TRC IMG INTRAL COLON I&R	MAXFEE	DEF	26				71.82	1/1/2022	12/31/2299	N
91120	RECTAL SENSATION TEST	PRXOVR	DEF					NA	NA	NA	N
91120	RECTAL SENSATION TEST	MAXFEE	DEF	26				37.19	1/1/2012	12/31/2299	N
91120	RECTAL SENSATION TEST	MAXFEE	DEF					371.87	1/1/2012	12/31/2299	N
91120	RECTAL SENSATION TEST	MAXFEE	DEF	TC				334.68	1/1/2012	12/31/2299	N
91122	ANAL PRESSURE RECORD	PRXOVR	DEF					NA	NA	NA	N
91122	ANAL PRESSURE RECORD	MAXFEE	DEF					141.83	7/1/2008	12/31/2299	N
91122	ANAL PRESSURE RECORD	MAXFEE	DEF	TC				92.19	7/1/2008	12/31/2299	N
91122	ANAL PRESSURE RECORD	MAXFEE	DEF	26				49.64	7/1/2008	12/31/2299	N
91132	ELECTROGASTROGRAPHY	PRXOVR	DEF					NA	NA	NA	N
91132	ELECTROGASTROGRAPHY	MAXFEE	DEF					112.52	9/1/2013	12/31/2299	N
91132	ELECTROGASTROGRAPHY	MAXFEE	DEF	TC				90.02	9/1/2013	12/31/2299	N
91132	ELECTROGASTROGRAPHY	MAXFEE	DEF	26				22.51	9/1/2013	12/31/2299	N
91133	ELECTROGASTROGRAPHY W/TEST	PRXOVR	DEF					NA	NA	NA	N
91133	ELECTROGASTROGRAPHY W/TEST	MAXFEE	DEF					130.84	9/1/2013	12/31/2299	N
91133	ELECTROGASTROGRAPHY W/TEST	MAXFEE	DEF	TC				104.67	9/1/2013	12/31/2299	N
91133	ELECTROGASTROGRAPHY W/TEST	MAXFEE	DEF	26				26.17	9/1/2013	12/31/2299	N
91200	LIVER ELASTOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
91200	LIVER ELASTOGRAPHY	MAXFEE	DEF					27.16	1/1/2017	12/31/2299	N
91200	LIVER ELASTOGRAPHY	MAXFEE	DEF	TC				13.58	1/1/2017	12/31/2299	N
91200	LIVER ELASTOGRAPHY	MAXFEE	DEF	26				13.58	1/1/2017	12/31/2299	N
93000	ELECTROCARDIOGRAM COMPLETE	PRXOVR	DEF					NA	NA	NA	N
93000	ELECTROCARDIOGRAM COMPLETE	MAXFEE	DEF					15.90	9/1/2013	12/31/2299	N
93005	ELECTROCARDIOGRAM TRACING	PRXOVR	DEF					NA	NA	NA	N
93005	ELECTROCARDIOGRAM TRACING	MAXFEE	DEF					6.90	12/31/2014	12/31/2299	N
93012	TRANSMISSION OF ECG	PRXOVR	DEF					NA	NA	NA	N
93012	TRANSMISSION OF ECG	MAXFEE	DEF					NA			N
93014	REPORT ON TRANSMITTED ECG	PRXOVR	DEF					NA	NA	NA	N
93014	REPORT ON TRANSMITTED ECG	MAXFEE	DEF					NA			N
93015	CARDIOVASCULAR STRESS TEST	PRXOVR	DEF					NA	NA	NA	N
93015	CARDIOVASCULAR STRESS TEST	MAXFEE	DEF					68.38	9/1/2013	12/31/2299	N
93016	CARDIOVASCULAR STRESS TEST	PRXOVR	DEF					NA	NA	NA	N
93016	CARDIOVASCULAR STRESS TEST	MAXFEE	DEF					20.97	1/1/2000	12/31/2299	N
93017	CARDIOVASCULAR STRESS TEST	PRXOVR	DEF					NA	NA	NA	N
93017	CARDIOVASCULAR STRESS TEST	MAXFEE	DEF					32.50	12/31/2014	12/31/2299	N
93018	CARDIOVASCULAR STRESS TEST	PRXOVR	DEF					NA	NA	NA	N
93018	CARDIOVASCULAR STRESS TEST	MAXFEE	DEF					12.69	9/1/2013	12/31/2299	N
93024	CARDIAC DRUG STRESS TEST	PRXOVR	DEF					NA	NA	NA	N
93024	CARDIAC DRUG STRESS TEST	MAXFEE	DEF					92.26	7/26/2007	12/31/2299	N
93024	CARDIAC DRUG STRESS TEST	MAXFEE	DEF	TC				46.13	7/26/2007	12/31/2299	N
93024	CARDIAC DRUG STRESS TEST	MAXFEE	DEF	26				46.13	7/26/2007	12/31/2299	N
93040	RHYTHM ECG WITH REPORT	PRXOVR	DEF					NA	NA	NA	N
93040	RHYTHM ECG WITH REPORT	MAXFEE	DEF					10.98	1/1/2000	12/31/2299	N
93041	RHYTHM ECG TRACING	PRXOVR	DEF					NA	NA	NA	N
93041	RHYTHM ECG TRACING	MAXFEE	DEF					3.89	1/1/2000	12/31/2299	N
93042	RHYTHM ECG REPORT	PRXOVR	DEF					NA	NA	NA	N
93042	RHYTHM ECG REPORT	MAXFEE	DEF					6.39	12/31/2014	12/31/2299	N
93050	ART PRESSURE WAVEFORM ANALYS	PRXOVR	DEF					NA	NA	NA	N
93050	ART PRESSURE WAVEFORM ANALYS	MAXFEE	DEF	26				6.80	1/1/2016	12/31/2299	N
93050	ART PRESSURE WAVEFORM ANALYS	MAXFEE	DEF	TC				6.80	1/1/2016	12/31/2299	N
93050	ART PRESSURE WAVEFORM ANALYS	MAXFEE	DEF					13.60	1/1/2016	12/31/2299	N
93224	ECG MONIT/REPRT UP TO 48 HRS	PRXOVR	DEF					NA	NA	NA	N
93224	ECG MONIT/REPRT UP TO 48 HRS	MAXFEE	DEF					79.79	9/1/2013	12/31/2299	N
93225	ECG MONIT/REPRT UP TO 48 HRS	PRXOVR	DEF					NA	NA	NA	N
93225	ECG MONIT/REPRT UP TO 48 HRS	MAXFEE	DEF					23.65	9/1/2013	12/31/2299	N
93226	ECG MONIT/REPRT UP TO 48 HRS	PRXOVR	DEF					NA	NA	NA	N
93226	ECG MONIT/REPRT UP TO 48 HRS	MAXFEE	DEF					33.31	9/1/2013	12/31/2299	N
93229	REMOTE 30 DAY ECG TECH SUPP	PRXOVR	DEF					NA	NA	NA	N
93229	REMOTE 30 DAY ECG TECH SUPP	MAXFEE	DEF					514.78	9/1/2013	12/31/2299	N
93230	ECG MONITOR/REPORT; 24 HRS	PRXOVR	DEF					NA	NA	NA	N
93230	ECG MONITOR/REPORT; 24 HRS	MAXFEE	DEF					NA			N
93231	ECG MONITOR/RECORD; 24 HRS	PRXOVR	DEF					NA	NA	NA	N
93231	ECG MONITOR/RECORD; 24 HRS	MAXFEE	DEF					NA			N
93232	ECG MONITOR/REPORT; 24 HRS	PRXOVR	DEF					NA	NA	NA	N
93232	ECG MONITOR/REPORT; 24 HRS	MAXFEE	DEF					NA			N
93235	ECG MONITOR/REPORT; 24 HRS	PRXOVR	DEF					NA	NA	NA	N
93235	ECG MONITOR/REPORT; 24 HRS	MAXFEE	DEF					NA			N
93236	ECG MONITOR/REPORT; 24 HRS	PRXOVR	DEF					NA	NA	NA	N
93236	ECG MONITOR/REPORT; 24 HRS	MAXFEE	DEF					NA			N
93241	EXT ECG>48HR<7D REC SCAN A/R	PRXOVR	DEF					NA	NA	NA	N
93241	EXT ECG>48HR<7D REC SCAN A/R	MANUAL	DEF					NA	NA	NA	N
93242	EXT ECG>48HR<7D RECORDING	PRXOVR	DEF					NA	NA	NA	N
93242	EXT ECG>48HR<7D RECORDING	MAXFEE	DEF					10.70	1/1/2021	12/31/2299	N
93243	EXT ECG>48HR<7D SCAN A/R	PRXOVR	DEF					NA	NA	NA	N
93243	EXT ECG>48HR<7D SCAN A/R	MANUAL	DEF					NA	NA	NA	N
93244	EXT ECG>48HR<7D REV&INTERPJ	PRXOVR	DEF					NA	NA	NA	N
93244	EXT ECG>48HR<7D REV&INTERPJ	MAXFEE	DEF					18.04	1/1/2021	12/31/2299	N
93245	EXT ECG>7D<15D REC SCAN A/R	PRXOVR	DEF					NA	NA	NA	N
93245	EXT ECG>7D<15D REC SCAN A/R	MANUAL	DEF					NA	NA	NA	N
93246	EXT ECG>7D<15D RECORDING	PRXOVR	DEF					NA	NA	NA	N
93246	EXT ECG>7D<15D RECORDING	MAXFEE	DEF					10.70	1/1/2021	12/31/2299	N
93247	EXT ECG>7D<15D SCAN A/R	PRXOVR	DEF					NA	NA	NA	N
93247	EXT ECG>7D<15D SCAN A/R	MANUAL	DEF					NA	NA	NA	N
93248	EXT ECG>7D<15D REV&INTERPJ	PRXOVR	DEF					NA	NA	NA	N
93248	EXT ECG>7D<15D REV&INTERPJ	MAXFEE	DEF					19.79	1/1/2021	12/31/2299	N
93260	PRGRMG DEV EVAL IMPLTBL SYS	PRXOVR	DEF					NA	NA	NA	N
93260	PRGRMG DEV EVAL IMPLTBL SYS	MAXFEE	DEF					50.72	1/1/2015	12/31/2299	N
93260	PRGRMG DEV EVAL IMPLTBL SYS	MAXFEE	DEF	TC				15.53	1/1/2015	12/31/2299	N
93260	PRGRMG DEV EVAL IMPLTBL SYS	MAXFEE	DEF	26				35.19	1/1/2015	12/31/2299	N
93261	INTERROGATE SUBQ DEFIB	PRXOVR	DEF					NA	NA	NA	N
93261	INTERROGATE SUBQ DEFIB	MAXFEE	DEF					46.26	1/1/2015	12/31/2299	N
93261	INTERROGATE SUBQ DEFIB	MAXFEE	DEF	TC				15.53	1/1/2015	12/31/2299	N
93261	INTERROGATE SUBQ DEFIB	MAXFEE	DEF	26				30.73	1/1/2015	12/31/2299	N
93268	ECG RECORD/REVIEW	PRXOVR	DEF					NA	NA	NA	N
93268	ECG RECORD/REVIEW	MAXFEE	DEF					165.89	7/1/2008	12/31/2299	N
93270	REMOTE 30 DAY ECG REV/REPORT	PRXOVR	DEF					NA	NA	NA	N
93270	REMOTE 30 DAY ECG REV/REPORT	MAXFEE	DEF					8.05	9/1/2013	12/31/2299	N
93271	ECG/MONITORING AND ANALYSIS	PRXOVR	DEF					NA	NA	NA	N
93271	ECG/MONITORING AND ANALYSIS	MAXFEE	DEF					127.53	7/1/2008	12/31/2299	N
93278	ECG/SIGNAL-AVERAGED	PRXOVR	DEF					NA	NA	NA	N
93278	ECG/SIGNAL-AVERAGED	MAXFEE	DEF					26.58	9/1/2013	12/31/2299	N
93278	ECG/SIGNAL-AVERAGED	MAXFEE	DEF	TC				15.95	9/1/2013	12/31/2299	N
93278	ECG/SIGNAL-AVERAGED	MAXFEE	DEF	26				10.63	9/1/2013	12/31/2299	N
93303	ECHO TRANSTHORACIC	PRXOVR	DEF					NA	NA	NA	N
93303	ECHO TRANSTHORACIC	MAXFEE	DEF					162.25	7/26/2007	12/31/2299	N
93303	ECHO TRANSTHORACIC	MAXFEE	DEF	TC				113.58	7/26/2007	12/31/2299	N
93303	ECHO TRANSTHORACIC	MAXFEE	DEF	26				48.68	7/26/2007	12/31/2299	N
93304	ECHO TRANSTHORACIC	PRXOVR	DEF					NA	NA	NA	N
93304	ECHO TRANSTHORACIC	MAXFEE	DEF					88.11	7/26/2007	12/31/2299	N
93304	ECHO TRANSTHORACIC	MAXFEE	DEF	TC				61.68	7/26/2007	12/31/2299	N
93304	ECHO TRANSTHORACIC	MAXFEE	DEF	26				26.43	7/26/2007	12/31/2299	N
93306	TTE W/DOPPLER COMPLETE	PRXOVR	DEF					NA	NA	NA	N
93306	TTE W/DOPPLER COMPLETE	MAXFEE	DEF					161.50	9/1/2013	12/31/2299	N
93306	TTE W/DOPPLER COMPLETE	MAXFEE	DEF	TC				113.05	9/1/2013	12/31/2299	N
93306	TTE W/DOPPLER COMPLETE	MAXFEE	DEF	26				48.45	9/1/2013	12/31/2299	N
93307	TTE W/O DOPPLER COMPLETE	PRXOVR	DEF					NA	NA	NA	N
93307	TTE W/O DOPPLER COMPLETE	MAXFEE	DEF					97.81	9/1/2013	12/31/2299	N
93307	TTE W/O DOPPLER COMPLETE	MAXFEE	DEF	TC				58.69	9/1/2013	12/31/2299	N
93307	TTE W/O DOPPLER COMPLETE	MAXFEE	DEF	26				39.12	9/1/2013	12/31/2299	N
93308	TTE F-UP OR LMTD	PRXOVR	DEF					NA	NA	NA	N
93308	TTE F-UP OR LMTD	MAXFEE	DEF					79.87	7/26/2007	12/31/2299	N
93308	TTE F-UP OR LMTD	MAXFEE	DEF	TC				59.90	7/26/2007	12/31/2299	N
93308	TTE F-UP OR LMTD	MAXFEE	DEF	26				19.97	7/26/2007	12/31/2299	N
93312	ECHO TRANSESOPHAGEAL	PRXOVR	DEF					NA	NA	NA	N
93312	ECHO TRANSESOPHAGEAL	MAXFEE	DEF					193.84	1/1/2000	12/31/2299	N
93312	ECHO TRANSESOPHAGEAL	MAXFEE	DEF	TC				116.30	1/1/2000	12/31/2299	N
93312	ECHO TRANSESOPHAGEAL	MAXFEE	DEF	26				77.54	1/1/2000	12/31/2299	N
93315	ECHO TRANSESOPHAGEAL	PRXOVR	DEF					NA	NA	NA	N
93315	ECHO TRANSESOPHAGEAL	MAXFEE	DEF					210.32	1/1/2000	12/31/2299	N
93315	ECHO TRANSESOPHAGEAL	MAXFEE	DEF	TC				105.16	1/1/2000	12/31/2299	N
93315	ECHO TRANSESOPHAGEAL	MAXFEE	DEF	26				105.16	1/1/2000	12/31/2299	N
93320	DOPPLER ECHO EXAM HEART	PRXOVR	DEF					NA	NA	NA	N
93320	DOPPLER ECHO EXAM HEART	MAXFEE	DEF					38.51	9/1/2013	12/31/2299	N
93320	DOPPLER ECHO EXAM HEART	MAXFEE	DEF	TC				23.11	9/1/2013	12/31/2299	N
93320	DOPPLER ECHO EXAM HEART	MAXFEE	DEF	26				15.40	9/1/2013	12/31/2299	N
93321	DOPPLER ECHO EXAM HEART	PRXOVR	DEF					NA	NA	NA	N
93321	DOPPLER ECHO EXAM HEART	MAXFEE	DEF					20.39	9/1/2013	12/31/2299	N
93321	DOPPLER ECHO EXAM HEART	MAXFEE	DEF	TC				14.27	9/1/2013	12/31/2299	N
93321	DOPPLER ECHO EXAM HEART	MAXFEE	DEF	26				6.12	9/1/2013	12/31/2299	N
93325	DOPPLER COLOR FLOW ADD-ON	PRXOVR	DEF					NA	NA	NA	N
93325	DOPPLER COLOR FLOW ADD-ON	MAXFEE	DEF					17.10	9/1/2013	12/31/2299	N
93325	DOPPLER COLOR FLOW ADD-ON	MAXFEE	DEF	TC				13.68	9/1/2013	12/31/2299	N
93325	DOPPLER COLOR FLOW ADD-ON	MAXFEE	DEF	26				3.42	9/1/2013	12/31/2299	N
93350	STRESS TTE ONLY	PRXOVR	DEF					NA	NA	NA	N
93350	STRESS TTE ONLY	MAXFEE	DEF					98.52	7/1/2008	12/31/2299	N
93350	STRESS TTE ONLY	MAXFEE	DEF	TC				49.26	7/1/2008	12/31/2299	N
93350	STRESS TTE ONLY	MAXFEE	DEF	26				49.26	7/1/2008	12/31/2299	N
93351	STRESS TTE COMPLETE	PRXOVR	DEF					NA	NA	NA	N
93351	STRESS TTE COMPLETE	MAXFEE	DEF					225.26	1/1/2009	12/31/2299	N
93351	STRESS TTE COMPLETE	MAXFEE	DEF	TC				180.21	1/1/2009	12/31/2299	N
93351	STRESS TTE COMPLETE	MAXFEE	DEF	26				45.05	1/1/2009	12/31/2299	N
93352	ADMIN ECG CONTRAST AGENT	PRXOVR	DEF					NA	NA	NA	N
93352	ADMIN ECG CONTRAST AGENT	MAXFEE	DEF					31.21	1/1/2009	12/31/2299	N
93355	ECHO TRANSESOPHAGEAL (TEE)	PRXOVR	DEF					NA	NA	NA	N
93355	ECHO TRANSESOPHAGEAL (TEE)	MAXFEE	DEF					179.60	1/1/2015	12/31/2299	N
93356	MYOCRD STRAIN IMG SPCKL TRCK	PRXOVR	DEF					NA	NA	NA	N
93356	MYOCRD STRAIN IMG SPCKL TRCK	MAXFEE	FAC					9.59	1/1/2020	12/31/2299	N
93356	MYOCRD STRAIN IMG SPCKL TRCK	MAXFEE	NFF					30.46	1/1/2020	12/31/2299	N
93600	BUNDLE OF HIS RECORDING	PRXOVR	DEF					NA	NA	NA	N
93600	BUNDLE OF HIS RECORDING	MAXFEE	DEF					164.27	1/1/2000	12/31/2299	N
93600	BUNDLE OF HIS RECORDING	MAXFEE	DEF	TC				41.07	1/1/2000	12/31/2299	N
93600	BUNDLE OF HIS RECORDING	MAXFEE	DEF	26				123.20	1/1/2000	12/31/2299	N
93602	INTRA-ATRIAL RECORDING	PRXOVR	DEF					NA	NA	NA	N
93602	INTRA-ATRIAL RECORDING	MAXFEE	DEF	26				102.58	1/1/2000	12/31/2299	N
93602	INTRA-ATRIAL RECORDING	MAXFEE	DEF					128.22	1/1/2000	12/31/2299	N
93602	INTRA-ATRIAL RECORDING	MAXFEE	DEF	TC				25.64	1/1/2000	12/31/2299	N
93603	RIGHT VENTRICULAR RECORDING	PRXOVR	DEF					NA	NA	NA	N
93603	RIGHT VENTRICULAR RECORDING	MAXFEE	DEF					152.43	1/1/2000	12/31/2299	N
93603	RIGHT VENTRICULAR RECORDING	MAXFEE	DEF	TC				38.11	1/1/2000	12/31/2299	N
93603	RIGHT VENTRICULAR RECORDING	MAXFEE	DEF	26				114.32	1/1/2000	12/31/2299	N
93609	MAP TACHYCARDIA ADD-ON	PRXOVR	DEF					NA	NA	NA	N
93609	MAP TACHYCARDIA ADD-ON	MAXFEE	DEF					351.74	7/1/2002	12/31/2299	N
93609	MAP TACHYCARDIA ADD-ON	MAXFEE	DEF	TC				70.35	7/1/2002	12/31/2299	N
93609	MAP TACHYCARDIA ADD-ON	MAXFEE	DEF	26				281.39	7/1/2002	12/31/2299	N
93610	INTRA-ATRIAL PACING	PRXOVR	DEF					NA	NA	NA	N
93610	INTRA-ATRIAL PACING	MAXFEE	DEF					171.63	1/1/2000	12/31/2299	N
93610	INTRA-ATRIAL PACING	MAXFEE	DEF	TC				34.33	1/1/2000	12/31/2299	N
93610	INTRA-ATRIAL PACING	MAXFEE	DEF	26				137.30	1/1/2000	12/31/2299	N
93612	INTRAVENTRICULAR PACING	PRXOVR	DEF					NA	NA	NA	N
93612	INTRAVENTRICULAR PACING	MAXFEE	DEF					179.06	1/1/2000	12/31/2299	N
93612	INTRAVENTRICULAR PACING	MAXFEE	DEF	TC				44.77	1/1/2000	12/31/2299	N
93612	INTRAVENTRICULAR PACING	MAXFEE	DEF	26				134.30	1/1/2000	12/31/2299	N
93613	ELECTROPHYS MAP 3D ADD-ON	PRXOVR	DEF					NA	NA	NA	N
93613	ELECTROPHYS MAP 3D ADD-ON	MAXFEE	DEF					285.58	9/1/2005	12/31/2299	N
93615	ESOPHAGEAL RECORDING	PRXOVR	DEF					NA	NA	NA	N
93615	ESOPHAGEAL RECORDING	MAXFEE	DEF					42.98	1/1/2000	12/31/2299	N
93615	ESOPHAGEAL RECORDING	MAXFEE	DEF	TC				8.60	1/1/2000	12/31/2299	N
93615	ESOPHAGEAL RECORDING	MAXFEE	DEF	26				34.38	1/1/2000	12/31/2299	N
93616	ESOPHAGEAL RECORDING	PRXOVR	DEF					NA	NA	NA	N
93616	ESOPHAGEAL RECORDING	MAXFEE	DEF	TC				7.83	1/1/2000	12/31/2299	N
93616	ESOPHAGEAL RECORDING	MAXFEE	DEF	26				70.44	1/1/2000	12/31/2299	N
93616	ESOPHAGEAL RECORDING	MAXFEE	DEF					78.27	1/1/2000	12/31/2299	N
93618	HEART RHYTHM PACING	PRXOVR	DEF					NA	NA	NA	N
93618	HEART RHYTHM PACING	MAXFEE	DEF					330.13	1/1/2000	12/31/2299	N
93618	HEART RHYTHM PACING	MAXFEE	DEF	TC				82.53	1/1/2000	12/31/2299	N
93618	HEART RHYTHM PACING	MAXFEE	DEF	26				247.60	1/1/2000	12/31/2299	N
93619	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93619	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					593.13	1/1/2000	12/31/2299	N
93619	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				177.94	1/1/2000	12/31/2299	N
93619	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				415.19	1/1/2000	12/31/2299	N
93620	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93620	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					842.78	1/1/2000	12/31/2299	N
93620	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				210.70	1/1/2000	12/31/2299	N
93620	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				632.09	1/1/2000	12/31/2299	N
93621	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93621	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					825.44	1/1/2000	12/31/2299	N
93621	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				165.09	1/1/2000	12/31/2299	N
93621	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				660.35	1/1/2000	12/31/2299	N
93622	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93622	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					828.73	1/1/2000	12/31/2299	N
93622	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				165.75	1/1/2000	12/31/2299	N
93622	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				662.98	1/1/2000	12/31/2299	N
93623	STIMULATION PACING HEART	PRXOVR	DEF					NA	NA	NA	N
93623	STIMULATION PACING HEART	MAXFEE	DEF					175.74	1/1/2000	12/31/2299	N
93623	STIMULATION PACING HEART	MAXFEE	DEF	TC				35.15	1/1/2000	12/31/2299	N
93623	STIMULATION PACING HEART	MAXFEE	DEF	26				140.59	1/1/2000	12/31/2299	N
93624	ELECTROPHYSIOLOGIC STUDY	PRXOVR	DEF					NA	NA	NA	N
93624	ELECTROPHYSIOLOGIC STUDY	MAXFEE	DEF					253.04	1/1/2000	12/31/2299	N
93624	ELECTROPHYSIOLOGIC STUDY	MAXFEE	DEF	TC				50.61	1/1/2000	12/31/2299	N
93624	ELECTROPHYSIOLOGIC STUDY	MAXFEE	DEF	26				202.43	1/1/2000	12/31/2299	N
93631	HEART PACING MAPPING	PRXOVR	DEF					NA	NA	NA	N
93631	HEART PACING MAPPING	MAXFEE	DEF					515.65	1/1/2000	12/31/2299	N
93631	HEART PACING MAPPING	MAXFEE	DEF	TC				154.69	1/1/2000	12/31/2299	N
93631	HEART PACING MAPPING	MAXFEE	DEF	26				360.96	1/1/2000	12/31/2299	N
93640	EVALUATION HEART DEVICE	PRXOVR	DEF					NA	NA	NA	N
93640	EVALUATION HEART DEVICE	MAXFEE	DEF					382.61	1/1/2000	12/31/2299	N
93640	EVALUATION HEART DEVICE	MAXFEE	DEF	TC				153.04	1/1/2000	12/31/2299	N
93640	EVALUATION HEART DEVICE	MAXFEE	DEF	26				229.57	1/1/2000	12/31/2299	N
93641	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93641	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					503.52	1/1/2000	12/31/2299	N
93641	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				201.41	1/1/2000	12/31/2299	N
93641	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				302.11	1/1/2000	12/31/2299	N
93642	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93642	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					339.07	9/1/2013	12/31/2299	N
93642	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				135.63	9/1/2013	12/31/2299	N
93642	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				203.44	9/1/2013	12/31/2299	N
93644	ELECTROPHYSIOLOGY EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93644	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF					239.12	1/1/2015	12/31/2299	N
93644	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	TC				77.62	1/1/2015	12/31/2299	N
93644	ELECTROPHYSIOLOGY EVALUATION	MAXFEE	DEF	26				161.50	1/1/2015	12/31/2299	N
93653	COMPRE EP EVAL TX SVT	PRXOVR	DEF					NA	NA	NA	N
93653	COMPRE EP EVAL TX SVT	MAXFEE	DEF					581.53	1/1/2013	12/31/2299	N
93654	COMPRE EP EVAL TX VT	PRXOVR	DEF					NA	NA	NA	N
93654	COMPRE EP EVAL TX VT	MAXFEE	DEF					775.96	1/1/2013	12/31/2299	N
93655	ABLATE ARRHYTHMIA ADD ON	PRXOVR	DEF					NA	NA	NA	N
93655	ABLATE ARRHYTHMIA ADD ON	MAXFEE	DEF					290.73	1/1/2013	12/31/2299	N
93656	COMPRE EP EVAL ABLTJ ATR FIB	PRXOVR	DEF					NA	NA	NA	N
93656	COMPRE EP EVAL ABLTJ ATR FIB	MAXFEE	DEF					776.22	1/1/2013	12/31/2299	N
93657	TX L/R ATRIAL FIB ADDL	PRXOVR	DEF					NA	NA	NA	N
93657	TX L/R ATRIAL FIB ADDL	MAXFEE	DEF					291.02	1/1/2013	12/31/2299	N
93660	TILT TABLE EVALUATION	PRXOVR	DEF					NA	NA	NA	N
93660	TILT TABLE EVALUATION	MAXFEE	DEF					107.13	7/26/2007	12/31/2299	N
93660	TILT TABLE EVALUATION	MAXFEE	DEF	TC				42.85	7/26/2007	12/31/2299	N
93660	TILT TABLE EVALUATION	MAXFEE	DEF	26				64.28	7/26/2007	12/31/2299	N
93701	BIOIMPEDANCE CV ANALYSIS	PRXOVR	DEF					NA	NA	NA	N
93701	BIOIMPEDANCE CV ANALYSIS	MAXFEE	DEF					21.11	9/1/2013	12/31/2299	N
93702	BIS XTRACELL FLUID ANALYSIS	PRXOVR	DEF					NA	NA	NA	N
93702	BIS XTRACELL FLUID ANALYSIS	MAXFEE	DEF					84.42	1/1/2015	12/31/2299	N
93720	TOTAL BODY PLETHYSMOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
93720	TOTAL BODY PLETHYSMOGRAPHY	MAXFEE	DEF					NA			N
93721	PLETHYSMOGRAPHY TRACING	PRXOVR	DEF					NA	NA	NA	N
93721	PLETHYSMOGRAPHY TRACING	MAXFEE	DEF					NA			N
93722	PLETHYSMOGRAPHY REPORT	PRXOVR	DEF					NA	NA	NA	N
93722	PLETHYSMOGRAPHY REPORT	MAXFEE	DEF					NA			N
93724	ANALYZE PACEMAKER SYSTEM	PRXOVR	DEF					NA	NA	NA	N
93724	ANALYZE PACEMAKER SYSTEM	MAXFEE	DEF					246.24	9/1/2013	12/31/2299	N
93724	ANALYZE PACEMAKER SYSTEM	MAXFEE	DEF	TC				24.62	9/1/2013	12/31/2299	N
93724	ANALYZE PACEMAKER SYSTEM	MAXFEE	DEF	26				221.62	9/1/2013	12/31/2299	N
93770	MEASURE VENOUS PRESSURE	PRXOVR	DEF					NA	NA	NA	N
93770	MEASURE VENOUS PRESSURE	MAXFEE	DEF					8.66	7/1/2008	12/31/2299	N
93875	EXTRACRANIAL STUDY	PRXOVR	DEF					NA	NA	NA	N
93875	EXTRACRANIAL STUDY	MAXFEE	DEF					NA			N
93880	EXTRACRANIAL BILAT STUDY	PRXOVR	DEF					NA	NA	NA	N
93880	EXTRACRANIAL BILAT STUDY	MAXFEE	DEF					128.08	1/1/2000	12/31/2299	N
93880	EXTRACRANIAL BILAT STUDY	MAXFEE	DEF	TC				102.46	12/31/2014	12/31/2299	N
93880	EXTRACRANIAL BILAT STUDY	MAXFEE	DEF	26				25.62	12/31/2014	12/31/2299	N
93882	EXTRACRANIAL UNI/LTD STUDY	PRXOVR	DEF					NA	NA	NA	N
93882	EXTRACRANIAL UNI/LTD STUDY	MAXFEE	DEF					90.95	7/1/2008	12/31/2299	N
93882	EXTRACRANIAL UNI/LTD STUDY	MAXFEE	DEF	TC				72.76	12/31/2014	12/31/2299	N
93882	EXTRACRANIAL UNI/LTD STUDY	MAXFEE	DEF	26				18.19	12/31/2014	12/31/2299	N
93886	INTRACRANIAL COMPLETE STUDY	PRXOVR	DEF					NA	NA	NA	N
93886	INTRACRANIAL COMPLETE STUDY	MAXFEE	DEF					152.44	1/1/2000	12/31/2299	N
93886	INTRACRANIAL COMPLETE STUDY	MAXFEE	DEF	TC				121.95	12/31/2014	12/31/2299	N
93886	INTRACRANIAL COMPLETE STUDY	MAXFEE	DEF	26				30.49	12/31/2014	12/31/2299	N
93888	INTRACRANIAL LIMITED STUDY	PRXOVR	DEF					NA	NA	NA	N
93888	INTRACRANIAL LIMITED STUDY	MAXFEE	DEF					81.25	9/1/2013	12/31/2299	N
93888	INTRACRANIAL LIMITED STUDY	MAXFEE	DEF	TC				65	12/31/2014	12/31/2299	N
93888	INTRACRANIAL LIMITED STUDY	MAXFEE	DEF	26				16.25	12/31/2014	12/31/2299	N
93890	TCD VASOREACTIVITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93890	TCD VASOREACTIVITY STUDY	MAXFEE	DEF					126.67	9/1/2013	12/31/2299	N
93890	TCD VASOREACTIVITY STUDY	MAXFEE	DEF	TC				101.34	12/31/2014	12/31/2299	N
93890	TCD VASOREACTIVITY STUDY	MAXFEE	DEF	26				25.33	12/31/2014	12/31/2299	N
93892	TCD EMBOLI DETECT W/O INJ	PRXOVR	DEF					NA	NA	NA	N
93892	TCD EMBOLI DETECT W/O INJ	MAXFEE	DEF					133.62	9/1/2013	12/31/2299	N
93892	TCD EMBOLI DETECT W/O INJ	MAXFEE	DEF	TC				106.90	12/31/2014	12/31/2299	N
93892	TCD EMBOLI DETECT W/O INJ	MAXFEE	DEF	26				26.72	12/31/2014	12/31/2299	N
93893	TCD EMBOLI DETECT W/INJ	PRXOVR	DEF					NA	NA	NA	N
93893	TCD EMBOLI DETECT W/INJ	MAXFEE	DEF					134.19	9/1/2013	12/31/2299	N
93893	TCD EMBOLI DETECT W/INJ	MAXFEE	DEF	TC				107.35	12/31/2014	12/31/2299	N
93893	TCD EMBOLI DETECT W/INJ	MAXFEE	DEF	26				26.84	12/31/2014	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	PRXOVR	DEF					NA	NA	NA	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF					67.32	7/1/2008	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF	TC				53.86	12/31/2014	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF	26				13.46	12/31/2014	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	PRXOVR	DEF					NA	NA	NA	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF					103.54	7/1/2008	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF	TC				82.83	12/31/2014	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF	26				20.71	12/31/2014	12/31/2299	N
93924	LWR XTR VASC STDY BILAT	PRXOVR	DEF					NA	NA	NA	N
93924	LWR XTR VASC STDY BILAT	MAXFEE	DEF					124.03	7/1/2008	12/31/2299	N
93924	LWR XTR VASC STDY BILAT	MAXFEE	DEF	TC				99.22	12/31/2014	12/31/2299	N
93924	LWR XTR VASC STDY BILAT	MAXFEE	DEF	26				24.81	12/31/2014	12/31/2299	N
93925	LOWER EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93925	LOWER EXTREMITY STUDY	MAXFEE	DEF					128.06	1/1/2000	12/31/2299	N
93925	LOWER EXTREMITY STUDY	MAXFEE	DEF	TC				102.45	12/31/2014	12/31/2299	N
93925	LOWER EXTREMITY STUDY	MAXFEE	DEF	26				25.61	12/31/2014	12/31/2299	N
93926	LOWER EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF					85.53	7/26/2007	12/31/2299	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF	TC				68.42	7/26/2007	12/31/2299	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF	26				17.11	7/26/2007	12/31/2299	N
93930	UPPER EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93930	UPPER EXTREMITY STUDY	MAXFEE	DEF					131.43	7/26/2007	12/31/2299	N
93930	UPPER EXTREMITY STUDY	MAXFEE	DEF	TC				118.29	7/26/2007	12/31/2299	N
93930	UPPER EXTREMITY STUDY	MAXFEE	DEF	26				13.14	7/26/2007	12/31/2299	N
93931	UPPER EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93931	UPPER EXTREMITY STUDY	MAXFEE	DEF					87.35	1/1/2000	12/31/2299	N
93931	UPPER EXTREMITY STUDY	MAXFEE	DEF	TC				78.61	1/1/2000	12/31/2299	N
93931	UPPER EXTREMITY STUDY	MAXFEE	DEF	26				8.74	1/1/2000	12/31/2299	N
93965	EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93965	EXTREMITY STUDY	MAXFEE	DEF					NA			N
93970	EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93970	EXTREMITY STUDY	MAXFEE	DEF					142.52	1/1/2000	12/31/2299	N
93970	EXTREMITY STUDY	MAXFEE	DEF	TC				114.02	12/31/2014	12/31/2299	N
93970	EXTREMITY STUDY	MAXFEE	DEF	26				28.50	12/31/2014	12/31/2299	N
93971	EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93971	EXTREMITY STUDY	MAXFEE	DEF					94.52	1/1/2000	12/31/2299	N
93971	EXTREMITY STUDY	MAXFEE	DEF	TC				75.62	1/1/2000	12/31/2299	N
93971	EXTREMITY STUDY	MAXFEE	DEF	26				18.90	1/1/2000	12/31/2299	N
93975	VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93975	VASCULAR STUDY	MAXFEE	DEF					189.19	1/1/2000	12/31/2299	N
93975	VASCULAR STUDY	MAXFEE	DEF	TC				141.89	12/31/2014	12/31/2299	N
93975	VASCULAR STUDY	MAXFEE	DEF	26				47.30	12/31/2014	12/31/2299	N
93976	VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93976	VASCULAR STUDY	MAXFEE	DEF					126.21	1/1/2000	12/31/2299	N
93976	VASCULAR STUDY	MAXFEE	DEF	TC				88.35	1/1/2000	12/31/2299	N
93976	VASCULAR STUDY	MAXFEE	DEF	26				37.86	1/1/2000	12/31/2299	N
93978	VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93978	VASCULAR STUDY	MAXFEE	DEF					126.66	7/1/2008	12/31/2299	N
93978	VASCULAR STUDY	MAXFEE	DEF	TC				101.33	12/31/2014	12/31/2299	N
93978	VASCULAR STUDY	MAXFEE	DEF	26				25.33	12/31/2014	12/31/2299	N
93979	VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93979	VASCULAR STUDY	MAXFEE	DEF					88.93	1/1/2000	12/31/2299	N
93979	VASCULAR STUDY	MAXFEE	DEF	TC				71.14	1/1/2000	12/31/2299	N
93979	VASCULAR STUDY	MAXFEE	DEF	26				17.79	1/1/2000	12/31/2299	N
93980	PENILE VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93980	PENILE VASCULAR STUDY	MAXFEE	DEF					106.27	12/31/2014	12/31/2299	N
93980	PENILE VASCULAR STUDY	MAXFEE	DEF	TC				53.13	12/31/2014	12/31/2299	N
93980	PENILE VASCULAR STUDY	MAXFEE	DEF	26				53.14	12/31/2014	12/31/2299	N
93981	PENILE VASCULAR STUDY	PRXOVR	DEF					NA	NA	NA	N
93981	PENILE VASCULAR STUDY	MAXFEE	DEF	26				19.06	9/1/2013	12/31/2299	N
93981	PENILE VASCULAR STUDY	MAXFEE	DEF					63.54	12/31/2014	12/31/2299	N
93981	PENILE VASCULAR STUDY	MAXFEE	DEF	TC				44.48	12/31/2014	12/31/2299	N
93985	DUP-SCAN HEMO COMPL BI STD	PRXOVR	DEF					NA	NA	NA	N
93985	DUP-SCAN HEMO COMPL BI STD	MAXFEE	DEF					201.15	1/1/2020	12/31/2299	N
93985	DUP-SCAN HEMO COMPL BI STD	MAXFEE	DEF	TC				169.97	1/1/2020	12/31/2299	N
93985	DUP-SCAN HEMO COMPL BI STD	MAXFEE	DEF	26				31.18	1/1/2020	12/31/2299	N
93986	DUP-SCAN HEMO COMPL UNI STD	PRXOVR	DEF					NA	NA	NA	N
93986	DUP-SCAN HEMO COMPL UNI STD	MAXFEE	DEF					116.94	1/1/2020	12/31/2299	N
93986	DUP-SCAN HEMO COMPL UNI STD	MAXFEE	DEF	TC				96.76	1/1/2020	12/31/2299	N
93986	DUP-SCAN HEMO COMPL UNI STD	MAXFEE	DEF	26				20.18	1/1/2020	12/31/2299	N
93990	DOPPLER FLOW TESTING	PRXOVR	DEF					NA	NA	NA	N
93990	DOPPLER FLOW TESTING	MAXFEE	DEF					80.51	7/26/2007	12/31/2299	N
93990	DOPPLER FLOW TESTING	MAXFEE	DEF	TC				72.46	7/26/2007	12/31/2299	N
93990	DOPPLER FLOW TESTING	MAXFEE	DEF	26				8.05	7/26/2007	12/31/2299	N
94010	BREATHING CAPACITY TEST	PRXOVR	DEF					NA	NA	NA	N
94010	BREATHING CAPACITY TEST	MAXFEE	DEF					21.89	7/26/2007	12/31/2299	N
94010	BREATHING CAPACITY TEST	MAXFEE	DEF	TC				16.42	7/26/2007	12/31/2299	N
94010	BREATHING CAPACITY TEST	MAXFEE	DEF	26				5.47	7/26/2007	12/31/2299	N
94011	SPIROMETRY UP TO 2 YRS OLD	PRXOVR	DEF					NA	NA	NA	N
94011	SPIROMETRY UP TO 2 YRS OLD	MAXFEE	DEF					55.87	1/1/2010	12/31/2299	N
94012	SPIRMTRY W/BRNCHDIL INF-2 YR	PRXOVR	DEF					NA	NA	NA	N
94012	SPIRMTRY W/BRNCHDIL INF-2 YR	MAXFEE	DEF					86.24	1/1/2010	12/31/2299	N
94013	MEAS LUNG VOL THRU 2 YRS	PRXOVR	DEF					NA	NA	NA	N
94013	MEAS LUNG VOL THRU 2 YRS	MAXFEE	DEF					18.30	1/1/2010	12/31/2299	N
94060	EVALUATION OF WHEEZING	PRXOVR	DEF					NA	NA	NA	N
94060	EVALUATION OF WHEEZING	MAXFEE	DEF					41.02	7/26/2007	12/31/2299	N
94060	EVALUATION OF WHEEZING	MAXFEE	DEF	TC				30.77	7/26/2007	12/31/2299	N
94060	EVALUATION OF WHEEZING	MAXFEE	DEF	26				10.26	7/26/2007	12/31/2299	N
94070	EVALUATION OF WHEEZING	PRXOVR	DEF					NA	NA	NA	N
94070	EVALUATION OF WHEEZING	MAXFEE	DEF					52.96	1/1/2010	12/31/2299	N
94070	EVALUATION OF WHEEZING	MAXFEE	DEF	TC				26.48	1/1/2010	12/31/2299	N
94070	EVALUATION OF WHEEZING	MAXFEE	DEF	26				26.48	1/1/2010	12/31/2299	N
94150	VITAL CAPACITY TEST	PRXOVR	DEF					NA	NA	NA	N
94150	VITAL CAPACITY TEST	MAXFEE	DEF					11.06	7/1/2008	12/31/2299	N
94150	VITAL CAPACITY TEST	MAXFEE	DEF	TC				3.32	7/1/2008	12/31/2299	N
94150	VITAL CAPACITY TEST	MAXFEE	DEF	26				7.74	7/1/2008	12/31/2299	N
94200	LUNG FUNCTION TEST (MBC/MVV)	PRXOVR	DEF					NA	NA	NA	N
94200	LUNG FUNCTION TEST (MBC/MVV)	MAXFEE	DEF					12.60	7/26/2007	12/31/2299	N
94200	LUNG FUNCTION TEST (MBC/MVV)	MAXFEE	DEF	TC				9.45	7/26/2007	12/31/2299	N
94200	LUNG FUNCTION TEST (MBC/MVV)	MAXFEE	DEF	26				3.15	7/26/2007	12/31/2299	N
94240	RESIDUAL LUNG CAPACITY	PRXOVR	DEF					NA	NA	NA	N
94240	RESIDUAL LUNG CAPACITY	MAXFEE	DEF					NA			N
94250	EXPIRED GAS COLLECTION	PRXOVR	DEF					NA	NA	NA	N
94250	EXPIRED GAS COLLECTION	MAXFEE	DEF					NA			N
94260	THORACIC GAS VOLUME	PRXOVR	DEF					NA	NA	NA	N
94260	THORACIC GAS VOLUME	MAXFEE	DEF					NA			N
94350	LUNG NITROGEN WASHOUT CURVE	PRXOVR	DEF					NA	NA	NA	N
94350	LUNG NITROGEN WASHOUT CURVE	MAXFEE	DEF					NA			N
94360	MEASURE AIRFLOW RESISTANCE	PRXOVR	DEF					NA	NA	NA	N
94360	MEASURE AIRFLOW RESISTANCE	MAXFEE	DEF					NA			N
94370	BREATH AIRWAY CLOSING VOLUME	PRXOVR	DEF					NA	NA	NA	N
94370	BREATH AIRWAY CLOSING VOLUME	MAXFEE	DEF					NA			N
94375	RESPIRATORY FLOW VOLUME LOOP	PRXOVR	DEF					NA	NA	NA	N
94375	RESPIRATORY FLOW VOLUME LOOP	MAXFEE	DEF					25.83	7/26/2007	12/31/2299	N
94375	RESPIRATORY FLOW VOLUME LOOP	MAXFEE	DEF	TC				15.50	7/26/2007	12/31/2299	N
94375	RESPIRATORY FLOW VOLUME LOOP	MAXFEE	DEF	26				10.33	7/26/2007	12/31/2299	N
94400	CO2 BREATHING RESPONSE CURVE	PRXOVR	DEF					NA	NA	NA	N
94400	CO2 BREATHING RESPONSE CURVE	MAXFEE	DEF					NA			N
94450	HYPOXIA RESPONSE CURVE	PRXOVR	DEF					NA	NA	NA	N
94450	HYPOXIA RESPONSE CURVE	MAXFEE	DEF					27.96	7/1/2008	12/31/2299	N
94450	HYPOXIA RESPONSE CURVE	MAXFEE	DEF	TC				16.78	7/1/2008	12/31/2299	N
94450	HYPOXIA RESPONSE CURVE	MAXFEE	DEF	26				11.18	7/1/2008	12/31/2299	N
94617	EXERCISE TST BRNCSPSM W/ECG	PRXOVR	DEF					NA	NA	NA	N
94617	EXERCISE TST BRNCSPSM W/ECG	MAXFEE	DEF					72.90	1/1/2018	12/31/2299	N
94617	EXERCISE TST BRNCSPSM W/ECG	MAXFEE	DEF	26				26.64	1/1/2018	12/31/2299	N
94617	EXERCISE TST BRNCSPSM W/ECG	MAXFEE	DEF	TC				46.27	1/1/2018	12/31/2299	N
94618	PULMONARY STRESS TESTING	PRXOVR	DEF					NA	NA	NA	N
94618	PULMONARY STRESS TESTING	MAXFEE	DEF	26				18.23	1/1/2018	12/31/2299	N
94618	PULMONARY STRESS TESTING	MAXFEE	DEF	TC				8.48	1/1/2018	12/31/2299	N
94618	PULMONARY STRESS TESTING	MAXFEE	DEF					26.70	1/1/2018	12/31/2299	N
94619	EXERCISE TST BRNCSPSM WO ECG	PRXOVR	DEF					NA	NA	NA	N
94619	EXERCISE TST BRNCSPSM WO ECG	MAXFEE	DEF	26				16.84	1/1/2021	12/31/2299	N
94619	EXERCISE TST BRNCSPSM WO ECG	MAXFEE	DEF	TC				35.36	1/1/2021	12/31/2299	N
94619	EXERCISE TST BRNCSPSM WO ECG	MAXFEE	DEF					52.21	1/1/2021	12/31/2299	N
94620	PULMONARY STRESS TEST/SIMPLE	PRXOVR	DEF					NA	NA	NA	N
94620	PULMONARY STRESS TEST/SIMPLE	MAXFEE	DEF					NA			N
94621	CARDIOPULM EXERCISE TESTING	PRXOVR	DEF					NA	NA	NA	N
94621	CARDIOPULM EXERCISE TESTING	MAXFEE	DEF					77.58	7/1/2008	12/31/2299	N
94621	CARDIOPULM EXERCISE TESTING	MAXFEE	DEF	TC				38.79	7/1/2008	12/31/2299	N
94621	CARDIOPULM EXERCISE TESTING	MAXFEE	DEF	26				38.79	7/1/2008	12/31/2299	N
94680	EXHALED AIR ANALYSIS O2	PRXOVR	DEF					NA	NA	NA	N
94680	EXHALED AIR ANALYSIS O2	MAXFEE	DEF					38.70	7/1/2008	12/31/2299	N
94680	EXHALED AIR ANALYSIS O2	MAXFEE	DEF	TC				30.96	7/1/2008	12/31/2299	N
94680	EXHALED AIR ANALYSIS O2	MAXFEE	DEF	26				7.74	7/1/2008	12/31/2299	N
94681	EXHALED AIR ANALYSIS O2/CO2	PRXOVR	DEF					NA	NA	NA	N
94681	EXHALED AIR ANALYSIS O2/CO2	MAXFEE	DEF					46.62	9/1/2013	12/31/2299	N
94681	EXHALED AIR ANALYSIS O2/CO2	MAXFEE	DEF	TC				37.30	9/1/2013	12/31/2299	N
94681	EXHALED AIR ANALYSIS O2/CO2	MAXFEE	DEF	26				9.32	9/1/2013	12/31/2299	N
94690	EXHALED AIR ANALYSIS	PRXOVR	DEF					NA	NA	NA	N
94690	EXHALED AIR ANALYSIS	MAXFEE	DEF					36.32	7/1/2008	12/31/2299	N
94690	EXHALED AIR ANALYSIS	MAXFEE	DEF	TC				32.69	7/1/2008	12/31/2299	N
94690	EXHALED AIR ANALYSIS	MAXFEE	DEF	26				3.63	7/1/2008	12/31/2299	N
94720	MONOXIDE DIFFUSING CAPACITY	PRXOVR	DEF					NA	NA	NA	N
94720	MONOXIDE DIFFUSING CAPACITY	MAXFEE	DEF					NA			N
94725	MEMBRANE DIFFUSION CAPACITY	PRXOVR	DEF					NA	NA	NA	N
94725	MEMBRANE DIFFUSION CAPACITY	MAXFEE	DEF					NA			N
94726	PULM FUNCT TST PLETHYSMOGRAP	PRXOVR	DEF					NA	NA	NA	N
94726	PULM FUNCT TST PLETHYSMOGRAP	MAXFEE	DEF					20.29	1/1/2012	12/31/2299	N
94726	PULM FUNCT TST PLETHYSMOGRAP	MAXFEE	DEF	TC				15.46	1/1/2012	12/31/2299	N
94726	PULM FUNCT TST PLETHYSMOGRAP	MAXFEE	DEF	26				4.83	1/1/2012	12/31/2299	N
94727	PULM FUNCTION TEST BY GAS	PRXOVR	DEF					NA	NA	NA	N
94727	PULM FUNCTION TEST BY GAS	MAXFEE	DEF					15.97	1/1/2012	12/31/2299	N
94727	PULM FUNCTION TEST BY GAS	MAXFEE	DEF	TC				11.13	1/1/2012	12/31/2299	N
94727	PULM FUNCTION TEST BY GAS	MAXFEE	DEF	26				4.83	1/1/2012	12/31/2299	N
94728	AIRWY RESIST BY OSCILLOMETRY	PRXOVR	DEF					NA	NA	NA	N
94728	AIRWY RESIST BY OSCILLOMETRY	MAXFEE	DEF					15.97	1/1/2012	12/31/2299	N
94728	AIRWY RESIST BY OSCILLOMETRY	MAXFEE	DEF	TC				11.13	1/1/2012	12/31/2299	N
94728	AIRWY RESIST BY OSCILLOMETRY	MAXFEE	DEF	26				4.83	1/1/2012	12/31/2299	N
94729	CO/MEMBANE DIFFUSE CAPACITY	PRXOVR	DEF					NA	NA	NA	N
94729	CO/MEMBANE DIFFUSE CAPACITY	MAXFEE	DEF					20.04	1/1/2012	12/31/2299	N
94729	CO/MEMBANE DIFFUSE CAPACITY	MAXFEE	DEF	TC				16.81	1/1/2012	12/31/2299	N
94729	CO/MEMBANE DIFFUSE CAPACITY	MAXFEE	DEF	26				3.23	1/1/2012	12/31/2299	N
94750	PULMONARY COMPLIANCE STUDY	PRXOVR	DEF					NA	NA	NA	N
94750	PULMONARY COMPLIANCE STUDY	MAXFEE	DEF					NA			N
94770	EXHALED CARBON DIOXIDE TEST	PRXOVR	DEF					NA	NA	NA	N
94770	EXHALED CARBON DIOXIDE TEST	MAXFEE	DEF					NA			N
94772	BREATH RECORDING INFANT	PRXOVR	DEF					NA	NA	NA	N
94772	BREATH RECORDING INFANT	MAXFEE	DEF					40.70	1/1/2000	12/31/2299	N
94772	BREATH RECORDING INFANT	MAXFEE	DEF	TC				8.14	1/1/2000	12/31/2299	N
94772	BREATH RECORDING INFANT	MAXFEE	DEF	26				32.56	1/1/2000	12/31/2299	N
95004	PERCUT ALLERGY SKIN TESTS	PRXOVR	DEF					NA	NA	NA	N
95004	PERCUT ALLERGY SKIN TESTS	MAXFEE	DEF					2.90	7/1/2008	12/31/2299	N
95010	PERCUT ALLERGY TITRATE TEST	PRXOVR	DEF					NA	NA	NA	N
95010	PERCUT ALLERGY TITRATE TEST	MAXFEE	DEF					NA			N
95012	EXHALED NITRIC OXIDE MEAS	PRXOVR	DEF					NA	NA	NA	N
95012	EXHALED NITRIC OXIDE MEAS	MAXFEE	DEF					11.59	1/1/2007	12/31/2299	N
95015	ID ALLERGY TITRATE-DRUG/BUG	PRXOVR	DEF					NA	NA	NA	N
95015	ID ALLERGY TITRATE-DRUG/BUG	MAXFEE	DEF					NA			N
95017	PERQ & ICUT ALLG TEST VENOMS	PRXOVR	DEF					NA	NA	NA	N
95017	PERQ & ICUT ALLG TEST VENOMS	MAXFEE	FAC					3.33	1/1/2016	12/31/2299	N
95017	PERQ & ICUT ALLG TEST VENOMS	MAXFEE	NFF					7.08	1/1/2016	12/31/2299	N
95018	PERQ&IC ALLG TEST DRUGS/BIOL	PRXOVR	DEF					NA	NA	NA	N
95018	PERQ&IC ALLG TEST DRUGS/BIOL	MAXFEE	FAC					5.66	1/1/2014	12/31/2299	N
95018	PERQ&IC ALLG TEST DRUGS/BIOL	MAXFEE	NFF					16.94	1/1/2016	12/31/2299	N
95024	ICUT ALLERGY TEST DRUG/BUG	PRXOVR	DEF					NA	NA	NA	N
95024	ICUT ALLERGY TEST DRUG/BUG	MAXFEE	FAC					0.86	1/1/2014	12/31/2299	N
95024	ICUT ALLERGY TEST DRUG/BUG	MAXFEE	NFF					4.02	1/1/2014	12/31/2299	N
95027	ICUT ALLERGY TITRATE-AIRBORN	PRXOVR	DEF					NA	NA	NA	N
95027	ICUT ALLERGY TITRATE-AIRBORN	MAXFEE	DEF					4.02	7/1/2008	12/31/2299	N
95028	ICUT ALLERGY TEST-DELAYED	PRXOVR	DEF					NA	NA	NA	N
95028	ICUT ALLERGY TEST-DELAYED	MAXFEE	DEF					6.15	1/1/2000	12/31/2299	N
95044	ALLERGY PATCH TESTS	PRXOVR	DEF					NA	NA	NA	N
95044	ALLERGY PATCH TESTS	MAXFEE	DEF					4.53	12/31/2014	12/31/2299	N
95052	PHOTO PATCH TEST	PRXOVR	DEF					NA	NA	NA	N
95052	PHOTO PATCH TEST	MAXFEE	DEF					5.42	12/31/2014	12/31/2299	N
95056	PHOTOSENSITIVITY TESTS	PRXOVR	DEF					NA	NA	NA	N
95056	PHOTOSENSITIVITY TESTS	MAXFEE	DEF					24.05	12/31/2014	12/31/2299	N
95060	EYE ALLERGY TESTS	PRXOVR	DEF					NA	NA	NA	N
95060	EYE ALLERGY TESTS	MAXFEE	DEF					18.69	12/31/2014	12/31/2299	N
95065	NOSE ALLERGY TEST	PRXOVR	DEF					NA	NA	NA	N
95065	NOSE ALLERGY TEST	MAXFEE	DEF					14.72	12/31/2014	12/31/2299	N
95070	BRONCHIAL ALLERGY TESTS	PRXOVR	DEF					NA	NA	NA	N
95070	BRONCHIAL ALLERGY TESTS	MAXFEE	DEF					26.50	9/1/2013	12/31/2299	N
95071	BRONCHIAL ALLERGY TESTS	PRXOVR	DEF					NA	NA	NA	N
95071	BRONCHIAL ALLERGY TESTS	MAXFEE	DEF					NA			N
95075	INGESTION CHALLENGE TEST	PRXOVR	DEF					NA	NA	NA	N
95075	INGESTION CHALLENGE TEST	MAXFEE	DEF					NA			N
95076	INGEST CHALLENGE INI 120 MIN	PRXOVR	DEF					NA	NA	NA	N
95076	INGEST CHALLENGE INI 120 MIN	MAXFEE	FAC					56.65	1/1/2014	12/31/2299	N
95076	INGEST CHALLENGE INI 120 MIN	MAXFEE	NFF					74.08	1/1/2014	12/31/2299	N
95079	INGEST CHALLENGE ADDL 60 MIN	PRXOVR	DEF					NA	NA	NA	N
95079	INGEST CHALLENGE ADDL 60 MIN	MAXFEE	FAC					38.44	1/1/2014	12/31/2299	N
95079	INGEST CHALLENGE ADDL 60 MIN	MAXFEE	NFF					52.82	1/1/2014	12/31/2299	N
95700	EEG CONT REC W/VID EEG TECH	PRXOVR	DEF					NA	NA	NA	N
95700	EEG CONT REC W/VID EEG TECH	MAXFEE	DEF					166	7/1/2021	12/31/2299	N
95705	EEG W/O VID 2-12 HR UNMNTR	PRXOVR	DEF					NA	NA	NA	N
95705	EEG W/O VID 2-12 HR UNMNTR	MAXFEE	DEF					83	7/1/2021	12/31/2299	N
95706	EEG WO VID 2-12HR INTMT MNTR	PRXOVR	DEF					NA	NA	NA	N
95706	EEG WO VID 2-12HR INTMT MNTR	MAXFEE	DEF					323.70	7/1/2021	12/31/2299	N
95707	EEG W/O VID 2-12HR CONT MNTR	PRXOVR	DEF					NA	NA	NA	N
95707	EEG W/O VID 2-12HR CONT MNTR	MAXFEE	DEF					431.60	7/1/2021	12/31/2299	N
95708	EEG WO VID EA 12-26HR UNMNTR	PRXOVR	DEF					NA	NA	NA	N
95708	EEG WO VID EA 12-26HR UNMNTR	MAXFEE	DEF					124.50	7/1/2021	12/31/2299	N
95709	EEG W/O VID EA 12-26HR INTMT	PRXOVR	DEF					NA	NA	NA	N
95709	EEG W/O VID EA 12-26HR INTMT	MAXFEE	DEF					647.40	7/1/2021	12/31/2299	N
95710	EEG W/O VID EA 12-26HR CONT	PRXOVR	DEF					NA	NA	NA	N
95710	EEG W/O VID EA 12-26HR CONT	MAXFEE	DEF					863.20	7/1/2021	12/31/2299	N
95711	VEEG 2-12 HR UNMONITORED	PRXOVR	DEF					NA	NA	NA	N
95711	VEEG 2-12 HR UNMONITORED	MAXFEE	DEF					103.75	7/1/2021	12/31/2299	N
95712	VEEG 2-12 HR INTMT MNTR	PRXOVR	DEF					NA	NA	NA	N
95712	VEEG 2-12 HR INTMT MNTR	MAXFEE	DEF					389.27	7/1/2021	12/31/2299	N
95713	VEEG 2-12 HR CONT MNTR	PRXOVR	DEF					NA	NA	NA	N
95713	VEEG 2-12 HR CONT MNTR	MAXFEE	DEF					518.75	7/1/2021	12/31/2299	N
95714	VEEG EA 12-26 HR UNMNTR	PRXOVR	DEF					NA	NA	NA	N
95714	VEEG EA 12-26 HR UNMNTR	MAXFEE	DEF					166	7/1/2021	12/31/2299	N
95715	VEEG EA 12-26HR INTMT MNTR	PRXOVR	DEF					NA	NA	NA	N
95715	VEEG EA 12-26HR INTMT MNTR	MAXFEE	DEF					778.54	7/1/2021	12/31/2299	N
95716	VEEG EA 12-26HR CONT MNTR	PRXOVR	DEF					NA	NA	NA	N
95716	VEEG EA 12-26HR CONT MNTR	MAXFEE	DEF					1037.50	7/1/2021	12/31/2299	N
95717	EEG PHYS/QHP 2-12 HR W/O VID	PRXOVR	DEF					NA	NA	NA	N
95717	EEG PHYS/QHP 2-12 HR W/O VID	MAXFEE	FAC					80.24	7/1/2021	12/31/2299	N
95717	EEG PHYS/QHP 2-12 HR W/O VID	MAXFEE	NFF					81	7/1/2021	12/31/2299	N
95718	EEG PHYS/QHP 2-12 HR W/VEEG	PRXOVR	DEF					NA	NA	NA	N
95718	EEG PHYS/QHP 2-12 HR W/VEEG	MAXFEE	FAC					105.97	7/1/2021	12/31/2299	N
95718	EEG PHYS/QHP 2-12 HR W/VEEG	MAXFEE	NFF					107.75	7/1/2021	12/31/2299	N
95719	EEG PHYS/QHP EA INCR W/O VID	PRXOVR	DEF					NA	NA	NA	N
95719	EEG PHYS/QHP EA INCR W/O VID	MAXFEE	FAC					123.80	7/1/2021	12/31/2299	N
95719	EEG PHYS/QHP EA INCR W/O VID	MAXFEE	NFF					125.07	7/1/2021	12/31/2299	N
95720	EEG PHY/QHP EA INCR W/VEEG	PRXOVR	DEF					NA	NA	NA	N
95720	EEG PHY/QHP EA INCR W/VEEG	MAXFEE	FAC					162.69	7/1/2021	12/31/2299	N
95720	EEG PHY/QHP EA INCR W/VEEG	MAXFEE	NFF					164.98	7/1/2021	12/31/2299	N
95721	EEG PHY/QHP>36<60 HR W/O VID	PRXOVR	DEF					NA	NA	NA	N
95721	EEG PHY/QHP>36<60 HR W/O VID	MAXFEE	FAC					162.94	7/1/2021	12/31/2299	N
95721	EEG PHY/QHP>36<60 HR W/O VID	MAXFEE	NFF					166	7/1/2021	12/31/2299	N
95722	EEG PHY/QHP>36<60 HR W/VEEG	PRXOVR	DEF					NA	NA	NA	N
95722	EEG PHY/QHP>36<60 HR W/VEEG	MAXFEE	FAC					198.77	7/1/2021	12/31/2299	N
95722	EEG PHY/QHP>36<60 HR W/VEEG	MAXFEE	NFF					202.34	7/1/2021	12/31/2299	N
95723	EEG PHY/QHP>60<84 HR W/O VID	PRXOVR	DEF					NA	NA	NA	N
95723	EEG PHY/QHP>60<84 HR W/O VID	MAXFEE	FAC					202	7/1/2021	12/31/2299	N
95723	EEG PHY/QHP>60<84 HR W/O VID	MAXFEE	NFF					206.34	7/1/2021	12/31/2299	N
95724	EEG PHY/QHP>60<84 HR W/VEEG	PRXOVR	DEF					NA	NA	NA	N
95724	EEG PHY/QHP>60<84 HR W/VEEG	MAXFEE	FAC					253.61	7/1/2021	12/31/2299	N
95724	EEG PHY/QHP>60<84 HR W/VEEG	MAXFEE	NFF					258.20	7/1/2021	12/31/2299	N
95725	EEG PHY/QHP>84 HR W/O VID	PRXOVR	DEF					NA	NA	NA	N
95725	EEG PHY/QHP>84 HR W/O VID	MAXFEE	FAC					230.38	7/1/2021	12/31/2299	N
95725	EEG PHY/QHP>84 HR W/O VID	MAXFEE	NFF					235.74	7/1/2021	12/31/2299	N
95726	EEG PHY/QHP>84 HR W/VEEG	PRXOVR	DEF					NA	NA	NA	N
95726	EEG PHY/QHP>84 HR W/VEEG	MAXFEE	FAC					321.10	7/1/2021	12/31/2299	N
95726	EEG PHY/QHP>84 HR W/VEEG	MAXFEE	NFF					327.22	7/1/2021	12/31/2299	N
95782	POLYSOM <6 YRS 4/> PARAMTRS	PRXOVR	DEF					NA	NA	NA	N
95782	POLYSOM <6 YRS 4/> PARAMTRS	MAXFEE	DEF	26				73.85	1/1/2013	12/31/2299	N
95782	POLYSOM <6 YRS 4/> PARAMTRS	MAXFEE	DEF	TC				512.91	1/1/2013	12/31/2299	N
95782	POLYSOM <6 YRS 4/> PARAMTRS	MAXFEE	DEF					586.76	1/1/2013	12/31/2299	N
95783	POLYSOM <6 YRS CPAP/BILVL	PRXOVR	DEF					NA	NA	NA	N
95783	POLYSOM <6 YRS CPAP/BILVL	MAXFEE	DEF	26				80.60	1/1/2013	12/31/2299	N
95783	POLYSOM <6 YRS CPAP/BILVL	MAXFEE	DEF	TC				534.17	1/1/2013	12/31/2299	N
95783	POLYSOM <6 YRS CPAP/BILVL	MAXFEE	DEF					614.77	1/1/2013	12/31/2299	N
95800	SLP STDY UNATTENDED	PRXOVR	DEF					NA	NA	NA	N
95800	SLP STDY UNATTENDED	MAXFEE	DEF					126.70	1/1/2022	12/31/2299	N
95800	SLP STDY UNATTENDED	MAXFEE	DEF	TC				88.69	1/1/2022	12/31/2299	N
95800	SLP STDY UNATTENDED	MAXFEE	DEF	26				38.01	1/1/2022	12/31/2299	N
95801	SLP STDY UNATND W/ANAL	PRXOVR	DEF					NA	NA	NA	N
95801	SLP STDY UNATND W/ANAL	MAXFEE	DEF					69.10	1/1/2022	12/31/2299	N
95801	SLP STDY UNATND W/ANAL	MAXFEE	DEF	TC				34.55	1/1/2022	12/31/2299	N
95801	SLP STDY UNATND W/ANAL	MAXFEE	DEF	26				34.55	1/1/2022	12/31/2299	N
95805	MULTIPLE SLEEP LATENCY TEST	PRXOVR	DEF					NA	NA	NA	N
95805	MULTIPLE SLEEP LATENCY TEST	MAXFEE	DEF					270.01	7/1/2008	12/31/2299	N
95805	MULTIPLE SLEEP LATENCY TEST	MAXFEE	DEF	TC				216.01	7/1/2008	12/31/2299	N
95805	MULTIPLE SLEEP LATENCY TEST	MAXFEE	DEF	26				54	7/1/2008	12/31/2299	N
95807	SLEEP STUDY ATTENDED	PRXOVR	DEF					NA	NA	NA	N
95807	SLEEP STUDY ATTENDED	MAXFEE	DEF					239.98	7/26/2007	12/31/2299	N
95807	SLEEP STUDY ATTENDED	MAXFEE	DEF	TC				191.98	7/26/2007	12/31/2299	N
95807	SLEEP STUDY ATTENDED	MAXFEE	DEF	26				48	7/26/2007	12/31/2299	N
95808	POLYSOM ANY AGE 1-3> PARAM	PRXOVR	DEF					NA	NA	NA	N
95808	POLYSOM ANY AGE 1-3> PARAM	MAXFEE	DEF					276.33	7/26/2007	12/31/2299	N
95808	POLYSOM ANY AGE 1-3> PARAM	MAXFEE	DEF	TC				221.06	7/26/2007	12/31/2299	N
95808	POLYSOM ANY AGE 1-3> PARAM	MAXFEE	DEF	26				55.27	7/26/2007	12/31/2299	N
95810	POLYSOM 6/> YRS 4/> PARAM	PRXOVR	DEF					NA	NA	NA	N
95810	POLYSOM 6/> YRS 4/> PARAM	MAXFEE	DEF					343.10	7/1/2008	12/31/2299	N
95810	POLYSOM 6/> YRS 4/> PARAM	MAXFEE	DEF	TC				274.48	7/1/2008	12/31/2299	N
95810	POLYSOM 6/> YRS 4/> PARAM	MAXFEE	DEF	26				68.62	7/1/2008	12/31/2299	N
95811	POLYSOM 6/>YRS CPAP 4/> PARM	PRXOVR	DEF					NA	NA	NA	N
95811	POLYSOM 6/>YRS CPAP 4/> PARM	MAXFEE	DEF					375.88	7/1/2008	12/31/2299	N
95811	POLYSOM 6/>YRS CPAP 4/> PARM	MAXFEE	DEF	TC				300.70	7/1/2008	12/31/2299	N
95811	POLYSOM 6/>YRS CPAP 4/> PARM	MAXFEE	DEF	26				75.18	7/1/2008	12/31/2299	N
95812	EEG 41-60 MINUTES	PRXOVR	DEF					NA	NA	NA	N
95812	EEG 41-60 MINUTES	MAXFEE	DEF					90.84	7/1/2008	12/31/2299	N
95812	EEG 41-60 MINUTES	MAXFEE	DEF	TC				68.13	7/1/2008	12/31/2299	N
95812	EEG 41-60 MINUTES	MAXFEE	DEF	26				22.71	7/1/2008	12/31/2299	N
95813	EEG EXTND MNTR 61-119 MIN	PRXOVR	DEF					NA	NA	NA	N
95813	EEG EXTND MNTR 61-119 MIN	MAXFEE	DEF					115.89	7/1/2008	12/31/2299	N
95813	EEG EXTND MNTR 61-119 MIN	MAXFEE	DEF	TC				75.33	7/1/2008	12/31/2299	N
95813	EEG EXTND MNTR 61-119 MIN	MAXFEE	DEF	26				40.56	7/1/2008	12/31/2299	N
95816	EEG AWAKE AND DROWSY	PRXOVR	DEF					NA	NA	NA	N
95816	EEG AWAKE AND DROWSY	MAXFEE	DEF					84.47	7/1/2008	12/31/2299	N
95816	EEG AWAKE AND DROWSY	MAXFEE	DEF	TC				59.13	7/1/2008	12/31/2299	N
95816	EEG AWAKE AND DROWSY	MAXFEE	DEF	26				25.34	7/1/2008	12/31/2299	N
95819	EEG AWAKE AND ASLEEP	PRXOVR	DEF					NA	NA	NA	N
95819	EEG AWAKE AND ASLEEP	MAXFEE	DEF					79.05	7/1/2008	12/31/2299	N
95819	EEG AWAKE AND ASLEEP	MAXFEE	DEF	TC				55.34	7/1/2008	12/31/2299	N
95819	EEG AWAKE AND ASLEEP	MAXFEE	DEF	26				23.72	7/1/2008	12/31/2299	N
95822	EEG COMA OR SLEEP ONLY	PRXOVR	DEF					NA	NA	NA	N
95822	EEG COMA OR SLEEP ONLY	MAXFEE	DEF					96.43	7/1/2008	12/31/2299	N
95822	EEG COMA OR SLEEP ONLY	MAXFEE	DEF	TC				72.32	7/1/2008	12/31/2299	N
95822	EEG COMA OR SLEEP ONLY	MAXFEE	DEF	26				24.11	7/1/2008	12/31/2299	N
95827	EEG ALL NIGHT RECORDING	PRXOVR	DEF					NA	NA	NA	N
95827	EEG ALL NIGHT RECORDING	MAXFEE	DEF					NA			N
95829	SURGERY ELECTROCORTICOGRAM	PRXOVR	DEF					NA	NA	NA	N
95829	SURGERY ELECTROCORTICOGRAM	MAXFEE	DEF					574.19	7/1/2008	12/31/2299	N
95829	SURGERY ELECTROCORTICOGRAM	MAXFEE	DEF	TC				430.64	7/1/2008	12/31/2299	N
95829	SURGERY ELECTROCORTICOGRAM	MAXFEE	DEF	26				143.55	7/1/2008	12/31/2299	N
95885	MUSC TST DONE W/NERV TST LIM	PRXOVR	DEF					NA	NA	NA	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF					18.25	1/1/2012	12/31/2299	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF	TC				12.25	1/1/2012	12/31/2299	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF	26				6	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	PRXOVR	DEF					NA	NA	NA	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF					28.94	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF	TC				12.91	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF	26				16.04	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	PRXOVR	DEF					NA	NA	NA	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF					25.69	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF	TC				13.12	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF	26				12.57	1/1/2012	12/31/2299	N
95900	MOTOR NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95900	MOTOR NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95903	MOTOR NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95903	MOTOR NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95904	SENSE NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95904	SENSE NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95905	MOTOR &/ SENS NRVE CNDJ TEST	PRXOVR	DEF					NA	NA	NA	N
95905	MOTOR &/ SENS NRVE CNDJ TEST	MAXFEE	DEF					36.29	1/1/2010	12/31/2299	N
95905	MOTOR &/ SENS NRVE CNDJ TEST	MAXFEE	DEF	TC				32.66	1/1/2010	12/31/2299	N
95905	MOTOR &/ SENS NRVE CNDJ TEST	MAXFEE	DEF	26				3.63	1/1/2010	12/31/2299	N
95907	NVR CNDJ TST 1-2 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF	26				27.93	1/1/2013	12/31/2299	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF	TC				22.08	1/1/2013	12/31/2299	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF					50	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF	26				35.10	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF	TC				26.60	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF					61.69	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF	26				41.86	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF	TC				32.10	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF					73.96	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF	26				56.03	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF	TC				41.37	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF					97.40	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF	26				69.79	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF	TC				48.10	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF					117.89	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF	26				83.96	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF	TC				54.41	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF					138.37	1/1/2013	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	PRXOVR	DEF					NA	NA	NA	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF	TC				94.43	7/1/2019	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF	26				141.65	7/1/2019	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF					236.08	7/1/2019	12/31/2299	N
95921	AUTONOMIC NRV PARASYM INERVJ	PRXOVR	DEF					NA	NA	NA	N
95921	AUTONOMIC NRV PARASYM INERVJ	MAXFEE	DEF					38.41	1/1/2000	12/31/2299	N
95921	AUTONOMIC NRV PARASYM INERVJ	MAXFEE	DEF	TC				19.20	9/1/2013	12/31/2299	N
95921	AUTONOMIC NRV PARASYM INERVJ	MAXFEE	DEF	26				19.21	9/1/2013	12/31/2299	N
95922	AUTONOMIC NRV ADRENRG INERVJ	PRXOVR	DEF					NA	NA	NA	N
95922	AUTONOMIC NRV ADRENRG INERVJ	MAXFEE	DEF					40.37	1/1/2000	12/31/2299	N
95922	AUTONOMIC NRV ADRENRG INERVJ	MAXFEE	DEF	TC				24.22	9/1/2013	12/31/2299	N
95922	AUTONOMIC NRV ADRENRG INERVJ	MAXFEE	DEF	26				16.15	9/1/2013	12/31/2299	N
95923	AUTONOMIC NRV SYST FUNJ TEST	PRXOVR	DEF					NA	NA	NA	N
95923	AUTONOMIC NRV SYST FUNJ TEST	MAXFEE	DEF					46.66	7/1/2008	12/31/2299	N
95923	AUTONOMIC NRV SYST FUNJ TEST	MAXFEE	DEF	TC				37.33	9/1/2013	12/31/2299	N
95923	AUTONOMIC NRV SYST FUNJ TEST	MAXFEE	DEF	26				9.33	9/1/2013	12/31/2299	N
95924	ANS PARASYMP & SYMP W/TILT	PRXOVR	DEF					NA	NA	NA	N
95924	ANS PARASYMP & SYMP W/TILT	MAXFEE	DEF	26				46.92	1/1/2013	12/31/2299	N
95924	ANS PARASYMP & SYMP W/TILT	MAXFEE	DEF	TC				31.17	1/1/2013	12/31/2299	N
95924	ANS PARASYMP & SYMP W/TILT	MAXFEE	DEF					78.09	1/1/2013	12/31/2299	N
95925	SOMATOSENSORY TESTING	PRXOVR	DEF					NA	NA	NA	N
95925	SOMATOSENSORY TESTING	MAXFEE	DEF					48.51	7/26/2007	12/31/2299	N
95925	SOMATOSENSORY TESTING	MAXFEE	DEF	26				4.85	9/1/2013	12/31/2299	N
95925	SOMATOSENSORY TESTING	MAXFEE	DEF	TC				43.66	9/1/2013	12/31/2299	N
95926	SOMATOSENSORY TESTING	PRXOVR	DEF					NA	NA	NA	N
95926	SOMATOSENSORY TESTING	MAXFEE	DEF					48.56	7/26/2007	12/31/2299	N
95926	SOMATOSENSORY TESTING	MAXFEE	DEF	26				4.86	9/1/2013	12/31/2299	N
95926	SOMATOSENSORY TESTING	MAXFEE	DEF	TC				43.70	9/1/2013	12/31/2299	N
95927	SOMATOSENSORY TESTING	PRXOVR	DEF					NA	NA	NA	N
95927	SOMATOSENSORY TESTING	MAXFEE	DEF					48.56	7/26/2007	12/31/2299	N
95927	SOMATOSENSORY TESTING	MAXFEE	DEF	26				9.71	9/1/2013	12/31/2299	N
95927	SOMATOSENSORY TESTING	MAXFEE	DEF	TC				38.85	9/1/2013	12/31/2299	N
95930	VISUAL EP TEST CNS W/I&R	PRXOVR	DEF					NA	NA	NA	N
95930	VISUAL EP TEST CNS W/I&R	MAXFEE	DEF					43.05	7/1/2008	12/31/2299	N
95930	VISUAL EP TEST CNS W/I&R	MAXFEE	DEF	26				4.31	9/1/2013	12/31/2299	N
95930	VISUAL EP TEST CNS W/I&R	MAXFEE	DEF	TC				38.74	9/1/2013	12/31/2299	N
95933	BLINK REFLEX TEST	PRXOVR	DEF					NA	NA	NA	N
95933	BLINK REFLEX TEST	MAXFEE	DEF					44.10	7/26/2007	12/31/2299	N
95933	BLINK REFLEX TEST	MAXFEE	DEF	26				15.44	9/1/2013	12/31/2299	N
95933	BLINK REFLEX TEST	MAXFEE	DEF	TC				28.66	9/1/2013	12/31/2299	N
95934	H-REFLEX TEST	PRXOVR	DEF					NA	NA	NA	N
95934	H-REFLEX TEST	MAXFEE	DEF					NA			N
95936	H-REFLEX TEST	PRXOVR	DEF					NA	NA	NA	N
95936	H-REFLEX TEST	MAXFEE	DEF					NA			N
95937	NEUROMUSCULAR JUNCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF					33.82	1/1/2000	12/31/2299	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF	26				13.53	9/1/2013	12/31/2299	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF	TC				20.29	9/1/2013	12/31/2299	N
95938	SOMATOSENSORY TESTING	PRXOVR	DEF					NA	NA	NA	N
95938	SOMATOSENSORY TESTING	MAXFEE	DEF	26				9.58	9/1/2013	12/31/2299	N
95938	SOMATOSENSORY TESTING	MAXFEE	DEF	TC				86.17	9/1/2013	12/31/2299	N
95938	SOMATOSENSORY TESTING	MAXFEE	DEF					95.75	1/1/2012	12/31/2299	N
95939	C MOTOR EVOKED UPR&LWR LIMBS	PRXOVR	DEF					NA	NA	NA	N
95939	C MOTOR EVOKED UPR&LWR LIMBS	MAXFEE	DEF	26				37.69	9/1/2013	12/31/2299	N
95939	C MOTOR EVOKED UPR&LWR LIMBS	MAXFEE	DEF	TC				113.06	9/1/2013	12/31/2299	N
95939	C MOTOR EVOKED UPR&LWR LIMBS	MAXFEE	DEF					150.75	1/1/2012	12/31/2299	N
95943	PARASYMP&SYMP HRT RATE TEST	PRXOVR	DEF					NA	NA	NA	N
95943	PARASYMP&SYMP HRT RATE TEST	MAXFEE	DEF					NA			N
95950	AMBULATORY EEG MONITORING	PRXOVR	DEF					NA	NA	NA	N
95950	AMBULATORY EEG MONITORING	MAXFEE	DEF					NA			N
95951	EEG MONITORING/VIDEORECORD	PRXOVR	DEF					NA	NA	NA	N
95951	EEG MONITORING/VIDEORECORD	MAXFEE	DEF					NA			N
95953	EEG MONITORING/COMPUTER	PRXOVR	DEF					NA	NA	NA	N
95953	EEG MONITORING/COMPUTER	MAXFEE	DEF					NA			N
95954	EEG MONITORING/GIVING DRUGS	PRXOVR	DEF					NA	NA	NA	N
95954	EEG MONITORING/GIVING DRUGS	MAXFEE	DEF					112.93	7/26/2007	12/31/2299	N
95954	EEG MONITORING/GIVING DRUGS	MAXFEE	DEF	TC				56.47	7/26/2007	12/31/2299	N
95954	EEG MONITORING/GIVING DRUGS	MAXFEE	DEF	26				56.47	7/26/2007	12/31/2299	N
95956	EEG MONITOR TECHNOL ATTENDED	PRXOVR	DEF					NA	NA	NA	N
95956	EEG MONITOR TECHNOL ATTENDED	MAXFEE	DEF					NA			N
95957	EEG DIGITAL ANALYSIS	PRXOVR	DEF					NA	NA	NA	N
95957	EEG DIGITAL ANALYSIS	MAXFEE	DEF					104.62	7/26/2007	12/31/2299	N
95957	EEG DIGITAL ANALYSIS	MAXFEE	DEF	TC				52.31	7/26/2007	12/31/2299	N
95957	EEG DIGITAL ANALYSIS	MAXFEE	DEF	26				52.31	7/26/2007	12/31/2299	N
95958	EEG MONITORING/FUNCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95958	EEG MONITORING/FUNCTION TEST	MAXFEE	DEF					216.99	7/26/2007	12/31/2299	N
95958	EEG MONITORING/FUNCTION TEST	MAXFEE	DEF	TC				65.10	7/26/2007	12/31/2299	N
95958	EEG MONITORING/FUNCTION TEST	MAXFEE	DEF	26				151.89	7/26/2007	12/31/2299	N
95965	MEG SPONTANEOUS	PRXOVR	DEF					NA	NA	NA	N
95965	MEG SPONTANEOUS	MAXFEE	DEF					480.67	1/1/2002	12/31/2299	N
95965	MEG SPONTANEOUS	MAXFEE	DEF	TC				288.40	1/1/2002	12/31/2299	N
95965	MEG SPONTANEOUS	MAXFEE	DEF	26				192.27	1/1/2002	12/31/2299	N
95966	MEG EVOKED SINGLE	PRXOVR	DEF					NA	NA	NA	N
95966	MEG EVOKED SINGLE	MAXFEE	DEF					462.19	1/1/2002	12/31/2299	N
95966	MEG EVOKED SINGLE	MAXFEE	DEF	TC				277.31	1/1/2002	12/31/2299	N
95966	MEG EVOKED SINGLE	MAXFEE	DEF	26				184.88	1/1/2002	12/31/2299	N
95967	MEG EVOKED EACH ADDL	PRXOVR	DEF					NA	NA	NA	N
95967	MEG EVOKED EACH ADDL	MAXFEE	DEF					221.85	1/1/2002	12/31/2299	N
95967	MEG EVOKED EACH ADDL	MAXFEE	DEF	TC				133.11	1/1/2002	12/31/2299	N
95967	MEG EVOKED EACH ADDL	MAXFEE	DEF	26				88.74	1/1/2002	12/31/2299	N
A4641	RADIOPHARM DX AGENT NOC	PRXOVR	DEF					NA	NA	NA	N
A4641	RADIOPHARM DX AGENT NOC	MAXFEE	DEF					50	1/1/1994	12/31/2299	N
A9500	TC99M SESTAMIBI	PRXOVR	DEF					NA	NA	NA	N
A9500	TC99M SESTAMIBI	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9501	TECHNETIUM TC-99M TEBOROXIME	PRXOVR	DEF					NA	NA	NA	N
A9501	TECHNETIUM TC-99M TEBOROXIME	MAXFEE	DEF					78.75	1/1/2008	12/31/2299	N
A9502	TC99M TETROFOSMIN	PRXOVR	DEF					NA	NA	NA	N
A9502	TC99M TETROFOSMIN	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9503	TC99M MEDRONATE	PRXOVR	DEF					NA	NA	NA	N
A9503	TC99M MEDRONATE	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9505	TL201 THALLIUM	PRXOVR	DEF					NA	NA	NA	N
A9505	TL201 THALLIUM	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9507	IN111 CAPROMAB	PRXOVR	DEF					NA	NA	NA	N
A9507	IN111 CAPROMAB	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9508	I131 IODOBENGUATE; DX	PRXOVR	DEF					NA	NA	NA	N
A9508	I131 IODOBENGUATE; DX	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9510	TC99M DISOFENIN	PRXOVR	DEF					NA	NA	NA	N
A9510	TC99M DISOFENIN	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9536	TC99M DEPREOTIDE	PRXOVR	DEF					NA	NA	NA	N
A9536	TC99M DEPREOTIDE	MAXFEE	DEF					78.75	1/1/2006	12/31/2299	N
A9569	TECHNETIUM TC-99M AUTO WBC	PRXOVR	DEF					NA	NA	NA	N
A9569	TECHNETIUM TC-99M AUTO WBC	MAXFEE	DEF					78.75	1/1/2008	12/31/2299	N
A9570	INDIUM IN-111 AUTO WBC	PRXOVR	DEF					NA	NA	NA	N
A9570	INDIUM IN-111 AUTO WBC	MAXFEE	DEF					78.75	1/1/2008	12/31/2299	N
A9571	INDIUM IN-111 AUTO PLATELET	PRXOVR	DEF					NA	NA	NA	N
A9571	INDIUM IN-111 AUTO PLATELET	MAXFEE	DEF					78.75	1/1/2008	12/31/2299	N
A9572	INDIUM IN-111 PENTETREOTIDE	PRXOVR	DEF					NA	NA	NA	N
A9572	INDIUM IN-111 PENTETREOTIDE	MAXFEE	DEF					78.75	1/1/2008	12/31/2299	N
A9575	INJ GADOTERATE MEGLUMI 0.1ML	PRXOVR	DEF					NA	NA	NA	N
A9575	INJ GADOTERATE MEGLUMI 0.1ML	MAXFEE	DEF					0.14	7/1/2023	12/31/2299	N
A9576	INJ PROHANCE MULTIPACK	PRXOVR	DEF					NA	NA	NA	N
A9576	INJ PROHANCE MULTIPACK	MAXFEE	DEF					1.45	7/1/2023	12/31/2299	N
A9577	INJ MULTIHANCE	PRXOVR	DEF					NA	NA	NA	N
A9577	INJ MULTIHANCE	MAXFEE	DEF					1.81	7/1/2023	12/31/2299	N
A9578	INJ MULTIHANCE MULTIPACK	PRXOVR	DEF					NA	NA	NA	N
A9578	INJ MULTIHANCE MULTIPACK	MAXFEE	DEF					1.83	7/1/2023	12/31/2299	N
A9579	GAD-BASE MR CONTRAST NOS;1ML	PRXOVR	DEF					NA	NA	NA	N
A9579	GAD-BASE MR CONTRAST NOS;1ML	MAXFEE	DEF					1.55	7/1/2023	12/31/2299	N
A9580	SODIUM FLUORIDE F-18	PRXOVR	DEF					NA	NA	NA	N
A9580	SODIUM FLUORIDE F-18	MANUAL	DEF					NA	NA	NA	N
A9581	GADOXETATE DISODIUM INJ	PRXOVR	DEF					NA	NA	NA	N
A9581	GADOXETATE DISODIUM INJ	MAXFEE	DEF					14.73	7/1/2023	12/31/2299	N
A9585	GADOBUTROL INJECTION	PRXOVR	DEF					NA	NA	NA	N
A9585	GADOBUTROL INJECTION	MAXFEE	DEF					0.35	7/1/2023	12/31/2299	N
A9590	IODINE I-131 IOBENGUANE 1MCI	PRXOVR	DEF					NA	NA	NA	N
A9590	IODINE I-131 IOBENGUANE 1MCI	MANUAL	DEF					NA	NA	NA	N
A9595	PIFLU F-18; DIA 1 MILLICURIE	PRXOVR	DEF					NA	NA	NA	N
A9595	PIFLU F-18; DIA 1 MILLICURIE	MAXFEE	DEF					5272.45	1/1/2023	12/31/2299	N
A9602	FLUORODOPA F-18 DIAG PER MCI	PRXOVR	DEF					NA	NA	NA	N
A9602	FLUORODOPA F-18 DIAG PER MCI	MANUAL	DEF					NA	NA	NA	N
A9606	RADIUM RA223 DICHLORIDE THER	PRXOVR	DEF					NA	NA	NA	N
A9606	RADIUM RA223 DICHLORIDE THER	MAXFEE	DEF					160.65	4/1/2023	12/31/2299	N
A9607	LUTETIUM LU 177 VIPIVOTIDE	PRXOVR	DEF					NA	NA	NA	N
A9607	LUTETIUM LU 177 VIPIVOTIDE	MAXFEE	DEF					1684.26	10/1/2022	12/31/2299	N
A9699	RADIOPHARM RX AGENT NOC	PRXOVR	DEF					NA	NA	NA	N
A9699	RADIOPHARM RX AGENT NOC	MANUAL	DEF					NA	NA	NA	N
A9700	ECHOCARDIOGRAPHY CONTRAST	PRXOVR	DEF					NA	NA	NA	N
A9700	ECHOCARDIOGRAPHY CONTRAST	MAXFEE	DEF					78.75	9/1/2005	12/31/2299	N
A9800	GALLIUM LOCAMETZ 1 MILLICURI	PRXOVR	DEF					NA	NA	NA	N
A9800	GALLIUM LOCAMETZ 1 MILLICURI	MANUAL	DEF					NA	NA	NA	N
G0202	SCR MAMMO BI INCL CAD	PRXOVR	DEF					NA	NA	NA	N
G0202	SCR MAMMO BI INCL CAD	MAXFEE	DEF					NA			N
G0204	DX MAMMO INCL CAD BI	PRXOVR	DEF					NA	NA	NA	N
G0204	DX MAMMO INCL CAD BI	MAXFEE	DEF					NA			N
G0206	DX MAMMO INCL CAD UNI	PRXOVR	DEF					NA	NA	NA	N
G0206	DX MAMMO INCL CAD UNI	MAXFEE	DEF					NA			N
G0279	TOMOSYNTHESIS; MAMMO	PRXOVR	DEF					NA	NA	NA	N
G0279	TOMOSYNTHESIS; MAMMO	MAXFEE	DEF	26				25.51	1/1/2017	12/31/2299	N
G0279	TOMOSYNTHESIS; MAMMO	MAXFEE	DEF	TC				17.01	1/1/2017	12/31/2299	N
G0279	TOMOSYNTHESIS; MAMMO	MAXFEE	DEF					42.52	1/1/2017	12/31/2299	N
G0297	LDCT FOR LUNG CA SCREEN	PRXOVR	DEF					NA	NA	NA	N
G0297	LDCT FOR LUNG CA SCREEN	MAXFEE	DEF					NA			N
J0150	INJECTION ADENOSINE 6 MG	PRXOVR	DEF					NA	NA	NA	N
J0150	INJECTION ADENOSINE 6 MG	MAXFEE	DEF					NA			N
J0153	ADENOSINE INJ 1MG	PRXOVR	DEF					NA	NA	NA	N
J0153	ADENOSINE INJ 1MG	MAXFEE	DEF					0.54	7/1/2023	12/31/2299	N
J0795	CORTICORELIN OVINE TRIFLUTAL	PRXOVR	DEF					NA	NA	NA	N
J0795	CORTICORELIN OVINE TRIFLUTAL	MAXFEE	DEF					9.67	4/1/2021	12/31/2299	N
J1245	DIPYRIDAMOLE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J1245	DIPYRIDAMOLE INJECTION	MAXFEE	DEF					3.78	7/1/2023	12/31/2299	N
J1250	INJ DOBUTAMINE HCL/250 MG	PRXOVR	DEF					NA	NA	NA	N
J1250	INJ DOBUTAMINE HCL/250 MG	MAXFEE	DEF					8.83	7/1/2023	12/31/2299	N
J2785	REGADENOSON INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2785	REGADENOSON INJECTION	MAXFEE	DEF					62.28	7/1/2023	12/31/2299	N
J2805	SINCALIDE INJECTION	PRXOVR	DEF					NA	NA	NA	N
J2805	SINCALIDE INJECTION	MAXFEE	DEF					133.54	7/1/2023	12/31/2299	N
J2850	INJ SECRETIN SYNTHETIC HUMAN	PRXOVR	DEF					NA	NA	NA	N
J2850	INJ SECRETIN SYNTHETIC HUMAN	MAXFEE	DEF					34.78	11/1/2014	12/31/2299	N
J7674	METHACHOLINE CHLORIDE; NEB	PRXOVR	DEF					NA	NA	NA	N
J7674	METHACHOLINE CHLORIDE; NEB	MAXFEE	DEF					0.86	7/1/2023	12/31/2299	N
K1034	COVID TEST SELF-ADMN/COLLECT	PRXOVR	DEF					NA	NA	NA	N
K1034	COVID TEST SELF-ADMN/COLLECT	MAXFEE	DEF					12	4/4/2022	12/31/2299	N
Q9953	INJ FE-BASED MR CONTRAST;1ML	PRXOVR	DEF					NA	NA	NA	N
Q9953	INJ FE-BASED MR CONTRAST;1ML	MAXFEE	DEF					30.40	7/26/2007	12/31/2299	N
Q9954	ORAL MR CONTRAST; 100 ML	PRXOVR	DEF					NA	NA	NA	N
Q9954	ORAL MR CONTRAST; 100 ML	MAXFEE	DEF					11.66	9/1/2013	12/31/2299	N
Q9955	INJ PERFLEXANE LIP MICROS;ML	PRXOVR	DEF					NA	NA	NA	N
Q9955	INJ PERFLEXANE LIP MICROS;ML	MAXFEE	DEF					13.25	9/1/2005	12/31/2299	N