Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
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
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
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
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
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
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
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
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
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
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
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
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
73030	X-RAY EXAM OF SHOULDER	PRXOVR	DEF					NA	NA	NA	N
73030	X-RAY EXAM OF SHOULDER	MAXFEE	DEF					21.77	1/1/2018	12/31/2299	N
73030	X-RAY EXAM OF SHOULDER	MAXFEE	DEF	26				7.62	1/1/2018	12/31/2299	N
73030	X-RAY EXAM OF SHOULDER	MAXFEE	DEF	TC				14.15	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
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
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
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
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
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
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
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
76090	MAMMOGRAM; ONE BREAST	PRXOVR	DEF					NA	NA	NA	N
76090	MAMMOGRAM; ONE BREAST	MAXFEE	DEF					NA			N
76091	MAMMOGRAM; BOTH BREASTS	PRXOVR	DEF					NA	NA	NA	N
76091	MAMMOGRAM; BOTH BREASTS	MAXFEE	DEF					NA			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
R0070	TRANSPORT PORTABLE X-RAY	PRXOVR	DEF					NA	NA	NA	N
R0070	TRANSPORT PORTABLE X-RAY	MAXFEE	DEF					131.02	12/31/2014	12/31/2299	N
R0075	TRANSPORT PORT X-RAY MULTIPL	PRXOVR	DEF					NA	NA	NA	N
R0075	TRANSPORT PORT X-RAY MULTIPL	MAXFEE	DEF					131.02	12/31/2014	12/31/2299	N