Price Schedule.xlsx

XLSX spreadsheet 56 KB Posted Jun 9, 2023

Attached to: Q522--Marshalltown CBOC XRay Services 8/1/2023-7/31/2024
Solicitation number: 36C26323Q0667
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23

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36C26323Q0667_1.docx	DOCX document	Jun 9, 2023
Wage Determination.pdf	PDF	Jun 9, 2023
S02 - 36C26323Q0667 Marshalltown Solicitation.pdf	PDF	Jun 9, 2023
P09 Marshalltown QASP.pdf	PDF	Jun 9, 2023
Attachment 5 S02 Contractor Rules of Behavior.pdf	PDF	Jun 9, 2023
Attachment 3 S02 Immigration and Nationality Act of 1952.pdf	PDF	Jun 9, 2023
Attachment 2 S02 Organizational Conflicts of Interest.pdf	PDF	Jun 9, 2023

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Price Schedule

										PROPOSED PERCENTAGE OF MEDICARE RATES FOR BASE YEAR:							0%
										PROPOSED PERCENT ANNUAL INCREASE:							0%
										TOTAL PROPOSED COST (GIVEN ESTIMATED QUANTITIES):							$0.00
CPT Code	Description	Current Medicare Cost	Base Year			Option Year 1			Option Year 2			Option Year 3			Option Year 4
			Proposed Cost	Est Qty	Est Total Cost	Proposed Cost	Est Qty	Est Total Cost	Proposed Cost	Est Qty	Est Total Cost	Proposed Cost	Est Qty	Est Total Cost	Proposed Cost	Est Qty	Est Total Cost
	TOTAL			518	$0.00		607	$0.00		671	$0.00		671	$0.00		769	$0.00
70130	Facial Bones 5 view	$42.71	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
70250	Skull 2 view	$25.13	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
70260	Skull 4 view	$28.83	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	5	$0.00
71045	Chest 1 view	$15.88	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	5	$0.00
71046	Chest 2 view	$21.43	$0.00	72	$0.00	$0.00	75	$0.00	$0.00	77	$0.00	$0.00	77	$0.00	$0.00	80	$0.00
71100	Uni Ribs	$24.20	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	12	$0.00
71101	Ribs w chest	$27.29	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	15	$0.00
71111	B/L Ribs w chest	$34.38	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	7	$0.00	$0.00	7	$0.00	$0.00	8	$0.00
72050	Cervical 4 views	$37.15	$0.00	60	$0.00	$0.00	62	$0.00	$0.00	65	$0.00	$0.00	65	$0.00	$0.00	68	$0.00
72052	Cervical 6 view	$44.25	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	13	$0.00
72070	Thoracic 2 view	$21.43	$0.00	6	$0.00	$0.00	7	$0.00	$0.00	8	$0.00	$0.00	8	$0.00	$0.00	10	$0.00
72072	Thoracic 3 view	$26.36	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	5	$0.00
72100	Lumbar 3 view	$26.98	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	12	$0.00
72110	Lumbar obliques	$35.92	$0.00	66	$0.00	$0.00	72	$0.00	$0.00	75	$0.00	$0.00	75	$0.00	$0.00	78	$0.00
72114	Lumbar 6 views	$43.63	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	14	$0.00	$0.00	14	$0.00	$0.00	15	$0.00
72170	Pelvis 1 view	$18.04	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	15	$0.00
72220	Sacrum/Coccyx	$22.35	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	5	$0.00
73000	Clavicle 2 view	$22.35	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	5	$0.00
73010	Scapula	$13.72	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	5	$0.00
73030	Shoulder 2 view	$23.59	$0.00	6	$0.00	$0.00	12	$0.00	$0.00	15	$0.00	$0.00	15	$0.00	$0.00	20	$0.00
73060	Humerus 2 view	$22.35	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00
73070	Elbow 2 view	$19.58	$0.00	12	$0.00	$0.00	14	$0.00	$0.00	18	$0.00	$0.00	18	$0.00	$0.00	20	$0.00
73080	Elbow 3 view	$22.35	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	7	$0.00
73090	Forearm 2 view	$19.89	$0.00	6	$0.00	$0.00	7	$0.00	$0.00	8	$0.00	$0.00	8	$0.00	$0.00	10	$0.00
73110	Wrist 3 view	$30.06	$0.00	6	$0.00	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	15	$0.00
73130	Hand 3 view	$26.36	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	12	$0.00
73140	Finger(s)	$28.83	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	7	$0.00
73502	Hip 2 view	$33.45	$0.00	5	$0.00	$0.00	10	$0.00	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	15	$0.00
73521	B/L Hips 2 views	$28.21	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	4	$0.00
73523	B/L Hips 5 views	$43.32	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	4	$0.00
73552	Femur 2 view	$24.82	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	7	$0.00
73560	Knee 2 view	$24.20	$0.00	18	$0.00	$0.00	20	$0.00	$0.00	20	$0.00	$0.00	20	$0.00	$0.00	25	$0.00
73562	Knee 3 view Upright	$29.14	$0.00	18	$0.00	$0.00	21	$0.00	$0.00	25	$0.00	$0.00	25	$0.00	$0.00	27	$0.00
73564	Knee Complete	$32.84	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	15	$0.00
73565	B/L Standing Knee 4 view	$29.14	$0.00	12	$0.00	$0.00	15	$0.00	$0.00	13	$0.00	$0.00	13	$0.00	$0.00	15	$0.00
73590	Lower Leg 2 view	$22.04	$0.00	6	$0.00	$0.00	8	$0.00	$0.00	9	$0.00	$0.00	9	$0.00	$0.00	12	$0.00
73610	Ankle 3 view	$26.36	$0.00	42	$0.00	$0.00	45	$0.00	$0.00	48	$0.00	$0.00	48	$0.00	$0.00	50	$0.00
73620	Foot 2 views	$19.27	$0.00	12	$0.00	$0.00	13	$0.00	$0.00	15	$0.00	$0.00	15	$0.00	$0.00	18	$0.00
73630	Foot 3 view	$24.20	$0.00	54	$0.00	$0.00	55	$0.00	$0.00	57	$0.00	$0.00	57	$0.00	$0.00	60	$0.00
73650	Oscalcis 2 view	$19.27	$0.00	12	$0.00	$0.00	13	$0.00	$0.00	12	$0.00	$0.00	12	$0.00	$0.00	15	$0.00
73660	Toe 3 view	$21.12	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	7	$0.00
74018	Abd 1 view	$19.58	$0.00	18	$0.00	$0.00	20	$0.00	$0.00	22	$0.00	$0.00	22	$0.00	$0.00	25	$0.00
74019	Abdomen 2V	$23.89	$0.00	7	$0.00	$0.00	9	$0.00	$0.00	10	$0.00	$0.00	10	$0.00	$0.00	15	$0.00

CMS PFS 2023 Iowa

HCPCS Code	Modifier	Short Description	Mac Locality	Non-Facility Price	Facility Price	Non-Facility Limiting Charge	Facility Limiting Charge	GPCI Work	GPCI PE	GPCI MP	Proc Stat	Work RVU	NA Flag for Trans Non-FAC PE RVU	Transitioned Non-FAC PE RVU	NA Flag for Fully IMP Non-FAC PE RVU	Fully Implemented Non-FAC PE RVU	NA Flag for Trans facility PE RVU	Transitioned Facility PE RVU	NA Flag for Fully IMP FAC PE RVU	Fully Implemented Facility PE RVU	MP RVU	Transitioned Non-FAC Total	Transitioned Facility Total	Fully Implemented Non-Fac Total	Fully Implemented Facility Total	PCTC	Global	Pre Op	Intra Op	Post Op	Mult Surg	Bilt Surg	Asst Surg	Co Surg	Team Surg	Phys Supv	Endobase	Conv Fact	Not Used for Medicare	Diag Imaging Family Ind	Opps Non-Facility Payment Amount	Opps Facility Payment Amount	Non-Fac PE Used For Opps PMT AMT	Facility PE Used For Opps PMT AMT	Malpractice Used For Opps PMT AMT
70130	TC	X-ray exam of mastoids	510200	$42.71	NA	$46.66	NA	1	0.91	0.441	A	0		1.38		1.38	NA	1.38	NA	1.38	0.01	1.39	1.39	1.39	1.39	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$96.82	$96.82	3.13	3.13	0.02
70134	TC	X-ray exam of middle ear	510200	$41.16	NA	$44.97	NA	1	0.91	0.441	A	0		1.33		1.33	NA	1.33	NA	1.33	0.01	1.34	1.34	1.34	1.34	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$456.19	$456.19	14.74	14.74	0.11
70140	TC	X-ray exam of facial bones	510200	$20.81	NA	$22.74	NA	1	0.91	0.441	A	0		0.67		0.67	NA	0.67	NA	0.67	0.01	0.68	0.68	0.68	0.68	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.62	$78.62	2.53	2.53	0.04
70150	TC	X-ray exam of facial bones	510200	$31.91	NA	$34.86	NA	1	0.91	0.441	A	0		1.03		1.03	NA	1.03	NA	1.03	0.01	1.04	1.04	1.04	1.04	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
70160	TC	X-ray exam of nasal bones	510200	$27.60	NA	$30.15	NA	1	0.91	0.441	A	0		0.89		0.89	NA	0.89	NA	0.89	0.01	0.9	0.9	0.9	0.9	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
70190	TC	X-ray exam of eye sockets	510200	$24.82	NA	$27.12	NA	1	0.91	0.441	A	0		0.8		0.8	NA	0.8	NA	0.8	0.01	0.81	0.81	0.81	0.81	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
70200	TC	X-ray exam of eye sockets	510200	$31.91	NA	$34.86	NA	1	0.91	0.441	A	0		1.03		1.03	NA	1.03	NA	1.03	0.01	1.04	1.04	1.04	1.04	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
70210	TC	X-ray exam of sinuses	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
70220	TC	X-ray exam of sinuses	510200	$25.13	NA	$27.45	NA	1	0.91	0.441	A	0		0.81		0.81	NA	0.81	NA	0.81	0.01	0.82	0.82	0.82	0.82	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
70240	TC	X-ray exam pituitary saddle	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
70250	TC	X-ray exam of skull	510200	$25.13	NA	$27.45	NA	1	0.91	0.441	A	0		0.81		0.81	NA	0.81	NA	0.81	0.01	0.82	0.82	0.82	0.82	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.81	$96.81	3.12	3.12	0.04
70260	TC	X-ray exam of skull	510200	$28.83	NA	$31.50	NA	1	0.91	0.441	A	0		0.93		0.93	NA	0.93	NA	0.93	0.01	0.94	0.94	0.94	0.94	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
70300	TC	X-ray exam of teeth	510200	$7.24	NA	$7.91	NA	1	0.91	0.441	A	0		0.23		0.23	NA	0.23	NA	0.23	0.01	0.24	0.24	0.24	0.24	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$77.35	$77.35	2.46	2.46	0.1
70310	TC	X-ray exam of teeth	510200	$29.14	NA	$31.83	NA	1	0.91	0.441	A	0		0.94		0.94	NA	0.94	NA	0.94	0.01	0.95	0.95	0.95	0.95	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$211.36	$211.36	6.82	6.82	0.07
70320	TC	Full mouth x-ray of teeth	510200	$38.70	NA	$42.28	NA	1	0.91	0.441	A	0		1.25		1.25	NA	1.25	NA	1.25	0.01	1.26	1.26	1.26	1.26	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$211.68	$211.68	6.84	6.84	0.05
70328	TC	X-ray exam of jaw joint	510200	$23.89	NA	$26.10	NA	1	0.91	0.441	A	0		0.77		0.77	NA	0.77	NA	0.77	0.01	0.78	0.78	0.78	0.78	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
70330	TC	X-ray exam of jaw joints	510200	$38.39	NA	$41.94	NA	1	0.91	0.441	A	0		1.24		1.24	NA	1.24	NA	1.24	0.01	1.25	1.25	1.25	1.25	1	XXX	0	0	0	0	2	0	0	0	1		33.8872		99	$78.63	$78.63	2.54	2.54	0.02
70332	TC	X-ray exam of jaw joint	510200	$54.42	NA	$59.46	NA	1	0.91	0.441	A	0		1.76		1.76	NA	1.76	NA	1.76	0.01	1.77	1.77	1.77	1.77	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$211.83	$211.83	6.85	6.85	0.04
70336	TC	Magnetic image jaw joint	510200	$191.80	NA	$209.54	NA	1	0.91	0.441	A	0		6.21		6.21	NA	6.21	NA	6.21	0.02	6.23	6.23	6.23	6.23	1	XXX	0	0	0	4	2	0	0	0	1		33.8872		88	$212.15	$212.15	6.87	6.87	0.02
70350	TC	X-ray head for orthodontia	510200	$7.24	NA	$7.91	NA	1	0.91	0.441	A	0		0.23		0.23	NA	0.23	NA	0.23	0.01	0.24	0.24	0.24	0.24	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$77.35	$77.35	2.46	2.46	0.1
70355	TC	Panoramic x-ray of jaws	510200	$7.55	NA	$8.25	NA	1	0.91	0.441	A	0		0.24		0.24	NA	0.24	NA	0.24	0.01	0.25	0.25	0.25	0.25	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$77.35	$77.35	2.46	2.46	0.1
70360	TC	X-ray exam of neck	510200	$21.12	NA	$23.07	NA	1	0.91	0.441	A	0		0.68		0.68	NA	0.68	NA	0.68	0.01	0.69	0.69	0.69	0.69	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.62	$78.62	2.53	2.53	0.04
70370	TC	Throat x-ray & fluoroscopy	510200	$80.64	NA	$88.09	NA	1	0.91	0.441	A	0		2.61		2.61	NA	2.61	NA	2.61	0.01	2.62	2.62	2.62	2.62	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$78.79	$78.79	2.55	2.55	0.01
70371	TC	Speech evaluation complex	510200	$62.44	NA	$68.22	NA	1	0.91	0.441	A	0		2.02		2.02	NA	2.02	NA	2.02	0.01	2.03	2.03	2.03	2.03	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$211.99	$211.99	6.86	6.86	0.03
70380	TC	X-ray exam of salivary gland	510200	$27.29	NA	$29.81	NA	1	0.91	0.441	A	0		0.88		0.88	NA	0.88	NA	0.88	0.01	0.89	0.89	0.89	0.89	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
70390	TC	X-ray exam of salivary duct	510200	$92.66	NA	$101.23	NA	1	0.91	0.441	A	0		3		3	NA	3	NA	3	0.01	3.01	3.01	3.01	3.01	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$212.15	$212.15	6.87	6.87	0.02
70450	TC	Ct head/brain w/o dye	510200	$64.29	NA	$70.24	NA	1	0.91	0.441	A	0		2.08		2.08	NA	2.08	NA	2.08	0.01	2.09	2.09	2.09	2.09	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
70460	TC	Ct head/brain w/dye	510200	$92.05	NA	$100.56	NA	1	0.91	0.441	A	0		2.98		2.98	NA	2.98	NA	2.98	0.01	2.99	2.99	2.99	2.99	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
70470	TC	Ct head/brain w/o & w/dye	510200	$110.70	NA	$120.94	NA	1	0.91	0.441	A	0		3.58		3.58	NA	3.58	NA	3.58	0.02	3.6	3.6	3.6	3.6	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
70480	TC	Ct orbit/ear/fossa w/o dye	510200	$95.44	NA	$104.27	NA	1	0.91	0.441	A	0		3.09		3.09	NA	3.09	NA	3.09	0.01	3.1	3.1	3.1	3.1	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
70481	TC	Ct orbit/ear/fossa w/dye	510200	$123.65	NA	$135.09	NA	1	0.91	0.441	A	0		4		4	NA	4	NA	4	0.02	4.02	4.02	4.02	4.02	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.89	$163.89	5.3	5.3	0.03
70482	TC	Ct orbit/ear/fossa w/o&w/dye	510200	$146.78	NA	$160.35	NA	1	0.91	0.441	A	0		4.75		4.75	NA	4.75	NA	4.75	0.02	4.77	4.77	4.77	4.77	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
70486	TC	Ct maxillofacial w/o dye	510200	$85.26	NA	$93.15	NA	1	0.91	0.441	A	0		2.76		2.76	NA	2.76	NA	2.76	0.01	2.77	2.77	2.77	2.77	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
70487	TC	Ct maxillofacial w/dye	510200	$96.05	NA	$104.94	NA	1	0.91	0.441	A	0		3.11		3.11	NA	3.11	NA	3.11	0.01	3.12	3.12	3.12	3.12	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$164.05	$164.05	5.31	5.31	0.02
70488	TC	Ct maxillofacial w/o & w/dye	510200	$121.49	NA	$132.73	NA	1	0.91	0.441	A	0		3.93		3.93	NA	3.93	NA	3.93	0.02	3.95	3.95	3.95	3.95	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.89	$163.89	5.3	5.3	0.03
70490	TC	Ct soft tissue neck w/o dye	510200	$87.42	NA	$95.51	NA	1	0.91	0.441	A	0		2.83		2.83	NA	2.83	NA	2.83	0.01	2.84	2.84	2.84	2.84	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
70491	TC	Ct soft tissue neck w/dye	510200	$116.25	NA	$127.00	NA	1	0.91	0.441	A	0		3.76		3.76	NA	3.76	NA	3.76	0.02	3.78	3.78	3.78	3.78	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
70492	TC	Ct sft tsue nck w/o & w/dye	510200	$142.15	NA	$155.30	NA	1	0.91	0.441	A	0		4.6		4.6	NA	4.6	NA	4.6	0.02	4.62	4.62	4.62	4.62	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
70496	TC	Ct angiography head	510200	$187.78	NA	$205.15	NA	1	0.91	0.441	A	0		6.07		6.07	NA	6.07	NA	6.07	0.04	6.11	6.11	6.11	6.11	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
70498	TC	Ct angiography neck	510200	$187.47	NA	$204.81	NA	1	0.91	0.441	A	0		6.06		6.06	NA	6.06	NA	6.06	0.04	6.1	6.1	6.1	6.1	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
70540	TC	Mri orbit/face/neck w/o dye	510200	$159.42	NA	$174.17	NA	1	0.91	0.441	A	0		5.16		5.16	NA	5.16	NA	5.16	0.02	5.18	5.18	5.18	5.18	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$212.30	$212.30	6.87	6.87	0.03
70542	TC	Mri orbit/face/neck w/dye	510200	$188.41	NA	$205.83	NA	1	0.91	0.441	A	0		6.1		6.1	NA	6.1	NA	6.1	0.02	6.12	6.12	6.12	6.12	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.73	$334.73	10.84	10.84	0.03
70543	TC	Mri orbt/fac/nck w/o &w/dye	510200	$233.42	NA	$255.01	NA	1	0.91	0.441	A	0		7.55		7.55	NA	7.55	NA	7.55	0.04	7.59	7.59	7.59	7.59	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.56	$334.56	10.82	10.82	0.06
70544	TC	Mr angiography head w/o dye	510200	$154.49	NA	$168.78	NA	1	0.91	0.441	A	0		5		5	NA	5	NA	5	0.02	5.02	5.02	5.02	5.02	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
70545	TC	Mr angiography head w/dye	510200	$166.19	NA	$181.57	NA	1	0.91	0.441	A	0		5.37		5.37	NA	5.37	NA	5.37	0.04	5.41	5.41	5.41	5.41	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$333.93	$333.93	10.79	10.79	0.08
70546	TC	Mr angiograph head w/o&w/dye	510200	$252.23	NA	$275.56	NA	1	0.91	0.441	A	0		8.16		8.16	NA	8.16	NA	8.16	0.04	8.2	8.2	8.2	8.2	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
70547	TC	Mr angiography neck w/o dye	510200	$154.79	NA	$169.11	NA	1	0.91	0.441	A	0		5.01		5.01	NA	5.01	NA	5.01	0.02	5.03	5.03	5.03	5.03	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
70548	TC	Mr angiography neck w/dye	510200	$170.82	NA	$186.62	NA	1	0.91	0.441	A	0		5.52		5.52	NA	5.52	NA	5.52	0.04	5.56	5.56	5.56	5.56	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.24	$334.24	10.8	10.8	0.08
70549	TC	Mr angiograph neck w/o&w/dye	510200	$253.46	NA	$276.91	NA	1	0.91	0.441	A	0		8.2		8.2	NA	8.2	NA	8.2	0.04	8.24	8.24	8.24	8.24	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
70551	TC	Mri brain stem w/o dye	510200	$123.34	NA	$134.75	NA	1	0.91	0.441	A	0		3.99		3.99	NA	3.99	NA	3.99	0.02	4.01	4.01	4.01	4.01	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
70552	TC	Mri brain stem w/dye	510200	$182.23	NA	$199.09	NA	1	0.91	0.441	A	0		5.89		5.89	NA	5.89	NA	5.89	0.04	5.93	5.93	5.93	5.93	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.09	$334.09	10.8	10.8	0.07
70553	TC	Mri brain stem w/o & w/dye	510200	$206.59	NA	$225.70	NA	1	0.91	0.441	A	0		6.68		6.68	NA	6.68	NA	6.68	0.04	6.72	6.72	6.72	6.72	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
70554	TC	Fmri brain by tech	510200	$272.89	NA	$298.13	NA	1	0.91	0.441	A	0		8.83		8.83	NA	8.83	NA	8.83	0.04	8.87	8.87	8.87	8.87	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	NA	NA	0	0	0
71045	TC	X-ray exam chest 1 view	510200	$15.88	NA	$17.35	NA	1	0.91	0.441	A	0		0.51		0.51	NA	0.51	NA	0.51	0.01	0.52	0.52	0.52	0.52	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.46	$78.46	2.52	2.52	0.05
71046	TC	X-ray exam chest 2 views	510200	$21.43	NA	$23.41	NA	1	0.91	0.441	A	0		0.69		0.69	NA	0.69	NA	0.69	0.01	0.7	0.7	0.7	0.7	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.62	$78.62	2.53	2.53	0.04
71047	TC	X-ray exam chest 3 views	510200	$26.98	NA	$29.47	NA	1	0.91	0.441	A	0		0.87		0.87	NA	0.87	NA	0.87	0.01	0.88	0.88	0.88	0.88	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
71048	TC	X-ray exam chest 4+ views	510200	$29.14	NA	$31.83	NA	1	0.91	0.441	A	0		0.94		0.94	NA	0.94	NA	0.94	0.01	0.95	0.95	0.95	0.95	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
71100	TC	X-ray exam ribs uni 2 views	510200	$24.20	NA	$26.44	NA	1	0.91	0.441	A	0		0.78		0.78	NA	0.78	NA	0.78	0.01	0.79	0.79	0.79	0.79	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
71101	TC	X-ray exam unilat ribs/chest	510200	$27.29	NA	$29.81	NA	1	0.91	0.441	A	0		0.88		0.88	NA	0.88	NA	0.88	0.01	0.89	0.89	0.89	0.89	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
71110	TC	X-ray exam ribs bil 3 views	510200	$27.90	NA	$30.48	NA	1	0.91	0.441	A	0		0.9		0.9	NA	0.9	NA	0.9	0.01	0.91	0.91	0.91	0.91	1	XXX	0	0	0	0	2	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
71111	TC	X-ray exam ribs/chest4/> vws	510200	$34.38	NA	$37.56	NA	1	0.91	0.441	A	0		1.11		1.11	NA	1.11	NA	1.11	0.01	1.12	1.12	1.12	1.12	1	XXX	0	0	0	0	2	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
71120	TC	X-ray exam breastbone 2/>vws	510200	$22.35	NA	$24.42	NA	1	0.91	0.441	A	0		0.72		0.72	NA	0.72	NA	0.72	0.01	0.73	0.73	0.73	0.73	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
71130	TC	X-ray strenoclavic jt 3/>vws	510200	$28.52	NA	$31.16	NA	1	0.91	0.441	A	0		0.92		0.92	NA	0.92	NA	0.92	0.01	0.93	0.93	0.93	0.93	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
71250	TC	Ct thorax dx c-	510200	$80.02	NA	$87.42	NA	1	0.91	0.441	A	0		2.59		2.59	NA	2.59	NA	2.59	0.01	2.6	2.6	2.6	2.6	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
71260	TC	Ct thorax dx c+	510200	$108.54	NA	$118.58	NA	1	0.91	0.441	A	0		3.51		3.51	NA	3.51	NA	3.51	0.02	3.53	3.53	3.53	3.53	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
71270	TC	Ct thorax dx c-/c+	510200	$133.82	NA	$146.20	NA	1	0.91	0.441	A	0		4.33		4.33	NA	4.33	NA	4.33	0.02	4.35	4.35	4.35	4.35	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
71271	TC	Ct thorax lung cancer scr c-	510200	$84.34	NA	$92.14	NA	1	0.91	0.441	A	0		2.73		2.73	NA	2.73	NA	2.73	0.01	2.74	2.74	2.74	2.74	1	XXX	0	0	0	4	0	0	0	0	9		33.8872		88	NA	NA	0	0	0
71275	TC	Ct angiography chest	510200	$189.94	NA	$207.51	NA	1	0.91	0.441	A	0		6.14		6.14	NA	6.14	NA	6.14	0.04	6.18	6.18	6.18	6.18	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
71550	TC	Mri chest w/o dye	510200	$263.33	NA	$287.69	NA	1	0.91	0.441	A	0		8.52		8.52	NA	8.52	NA	8.52	0.04	8.56	8.56	8.56	8.56	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
71551	TC	Mri chest w/dye	510200	$286.15	NA	$312.62	NA	1	0.91	0.441	A	0		9.26		9.26	NA	9.26	NA	9.26	0.04	9.3	9.3	9.3	9.3	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$672.67	$672.67	21.77	21.77	0.09
71552	TC	Mri chest w/o & w/dye	510200	$358.31	NA	$391.46	NA	1	0.91	0.441	A	0		11.6		11.6	NA	11.6	NA	11.6	0.04	11.64	11.64	11.64	11.64	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
71555	TC	Mri angio chest w or w/o dye	510200	$242.98	NA	$265.46	NA	1	0.91	0.441	R	0		7.86		7.86	NA	7.86	NA	7.86	0.04	7.9	7.9	7.9	7.9	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
72020	TC	X-ray exam of spine 1 view	510200	$15.57	NA	$17.01	NA	1	0.91	0.441	A	0		0.5		0.5	NA	0.5	NA	0.5	0.01	0.51	0.51	0.51	0.51	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.15	$78.15	2.51	2.51	0.05
72040	TC	X-ray exam neck spine 2-3 vw	510200	$26.67	NA	$29.14	NA	1	0.91	0.441	A	0		0.86		0.86	NA	0.86	NA	0.86	0.01	0.87	0.87	0.87	0.87	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
72050	TC	X-ray exam neck spine 4/5vws	510200	$37.15	NA	$40.59	NA	1	0.91	0.441	A	0		1.2		1.2	NA	1.2	NA	1.2	0.01	1.21	1.21	1.21	1.21	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
72052	TC	X-ray exam neck spine 6/>vws	510200	$44.25	NA	$48.34	NA	1	0.91	0.441	A	0		1.43		1.43	NA	1.43	NA	1.43	0.01	1.44	1.44	1.44	1.44	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.82	$96.82	3.13	3.13	0.02
72070	TC	X-ray exam thorac spine 2vws	510200	$21.43	NA	$23.41	NA	1	0.91	0.441	A	0		0.69		0.69	NA	0.69	NA	0.69	0.01	0.7	0.7	0.7	0.7	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.50	$96.50	3.11	3.11	0.04
72072	TC	X-ray exam thorac spine 3vws	510200	$26.36	NA	$28.80	NA	1	0.91	0.441	A	0		0.85		0.85	NA	0.85	NA	0.85	0.01	0.86	0.86	0.86	0.86	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.81	$96.81	3.12	3.12	0.04
72074	TC	X-ray exam thorac spine4/>vw	510200	$30.06	NA	$32.84	NA	1	0.91	0.441	A	0		0.97		0.97	NA	0.97	NA	0.97	0.01	0.98	0.98	0.98	0.98	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
72080	TC	X-ray exam thoracolmb 2/> vw	510200	$22.66	NA	$24.76	NA	1	0.91	0.441	A	0		0.73		0.73	NA	0.73	NA	0.73	0.01	0.74	0.74	0.74	0.74	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
72081	TC	X-ray exam entire spi 1 vw	510200	$27.90	NA	$30.48	NA	1	0.91	0.441	A	0		0.9		0.9	NA	0.9	NA	0.9	0.01	0.91	0.91	0.91	0.91	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
72082	TC	X-ray exam entire spi 2/3 vw	510200	$51.03	NA	$55.75	NA	1	0.91	0.441	A	0		1.65		1.65	NA	1.65	NA	1.65	0.01	1.66	1.66	1.66	1.66	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$97.13	$97.13	3.14	3.14	0.02
72083	TC	X-ray exam entire spi 4/5 vw	510200	$57.20	NA	$62.49	NA	1	0.91	0.441	A	0		1.85		1.85	NA	1.85	NA	1.85	0.01	1.86	1.86	1.86	1.86	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$97.13	$97.13	3.14	3.14	0.02
72084	TC	X-ray exam entire spi 6/> vw	510200	$73.08	NA	$79.83	NA	1	0.91	0.441	A	0		2.36		2.36	NA	2.36	NA	2.36	0.02	2.38	2.38	2.38	2.38	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
72100	TC	X-ray exam l-s spine 2/3 vws	510200	$26.98	NA	$29.47	NA	1	0.91	0.441	A	0		0.87		0.87	NA	0.87	NA	0.87	0.01	0.88	0.88	0.88	0.88	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.81	$96.81	3.12	3.12	0.04
72110	TC	X-ray exam l-2 spine 4/>vws	510200	$35.92	NA	$39.24	NA	1	0.91	0.441	A	0		1.16		1.16	NA	1.16	NA	1.16	0.01	1.17	1.17	1.17	1.17	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
72114	TC	X-ray exam l-s spine bending	510200	$43.63	NA	$47.67	NA	1	0.91	0.441	A	0		1.41		1.41	NA	1.41	NA	1.41	0.01	1.42	1.42	1.42	1.42	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.82	$96.82	3.13	3.13	0.02
72120	TC	X-ray bend only l-s spine	510200	$27.60	NA	$30.15	NA	1	0.91	0.441	A	0		0.89		0.89	NA	0.89	NA	0.89	0.01	0.9	0.9	0.9	0.9	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
72125	TC	Ct neck spine w/o dye	510200	$80.64	NA	$88.09	NA	1	0.91	0.441	A	0		2.61		2.61	NA	2.61	NA	2.61	0.01	2.62	2.62	2.62	2.62	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
72126	TC	Ct neck spine w/dye	510200	$108.23	NA	$118.24	NA	1	0.91	0.441	A	0		3.5		3.5	NA	3.5	NA	3.5	0.02	3.52	3.52	3.52	3.52	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
72127	TC	Ct neck spine w/o & w/dye	510200	$133.82	NA	$146.20	NA	1	0.91	0.441	A	0		4.33		4.33	NA	4.33	NA	4.33	0.02	4.35	4.35	4.35	4.35	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
72128	TC	Ct chest spine w/o dye	510200	$80.64	NA	$88.09	NA	1	0.91	0.441	A	0		2.61		2.61	NA	2.61	NA	2.61	0.01	2.62	2.62	2.62	2.62	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
72129	TC	Ct chest spine w/dye	510200	$109.16	NA	$119.25	NA	1	0.91	0.441	A	0		3.53		3.53	NA	3.53	NA	3.53	0.02	3.55	3.55	3.55	3.55	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
72130	TC	Ct chest spine w/o & w/dye	510200	$135.37	NA	$147.89	NA	1	0.91	0.441	A	0		4.38		4.38	NA	4.38	NA	4.38	0.02	4.4	4.4	4.4	4.4	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
72131	TC	Ct lumbar spine w/o dye	510200	$80.02	NA	$87.42	NA	1	0.91	0.441	A	0		2.59		2.59	NA	2.59	NA	2.59	0.01	2.6	2.6	2.6	2.6	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
72132	TC	Ct lumbar spine w/dye	510200	$108.54	NA	$118.58	NA	1	0.91	0.441	A	0		3.51		3.51	NA	3.51	NA	3.51	0.02	3.53	3.53	3.53	3.53	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
72133	TC	Ct lumbar spine w/o & w/dye	510200	$134.13	NA	$146.54	NA	1	0.91	0.441	A	0		4.34		4.34	NA	4.34	NA	4.34	0.02	4.36	4.36	4.36	4.36	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
72141	TC	Mri neck spine w/o dye	510200	$118.10	NA	$129.02	NA	1	0.91	0.441	A	0		3.82		3.82	NA	3.82	NA	3.82	0.02	3.84	3.84	3.84	3.84	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$212.14	$212.14	6.86	6.86	0.04
72142	TC	Mri neck spine w/dye	510200	$186.87	NA	$204.15	NA	1	0.91	0.441	A	0		6.05		6.05	NA	6.05	NA	6.05	0.02	6.07	6.07	6.07	6.07	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
72146	TC	Mri chest spine w/o dye	510200	$118.10	NA	$129.02	NA	1	0.91	0.441	A	0		3.82		3.82	NA	3.82	NA	3.82	0.02	3.84	3.84	3.84	3.84	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$212.14	$212.14	6.86	6.86	0.04
72147	TC	Mri chest spine w/dye	510200	$185.02	NA	$202.13	NA	1	0.91	0.441	A	0		5.99		5.99	NA	5.99	NA	5.99	0.02	6.01	6.01	6.01	6.01	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
72148	TC	Mri lumbar spine w/o dye	510200	$118.71	NA	$129.70	NA	1	0.91	0.441	A	0		3.84		3.84	NA	3.84	NA	3.84	0.02	3.86	3.86	3.86	3.86	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
72149	TC	Mri lumbar spine w/dye	510200	$182.55	NA	$199.43	NA	1	0.91	0.441	A	0		5.91		5.91	NA	5.91	NA	5.91	0.02	5.93	5.93	5.93	5.93	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
72156	TC	Mri neck spine w/o & w/dye	510200	$208.13	NA	$227.39	NA	1	0.91	0.441	A	0		6.73		6.73	NA	6.73	NA	6.73	0.04	6.77	6.77	6.77	6.77	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
72157	TC	Mri chest spine w/o & w/dye	510200	$208.75	NA	$228.06	NA	1	0.91	0.441	A	0		6.75		6.75	NA	6.75	NA	6.75	0.04	6.79	6.79	6.79	6.79	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
72158	TC	Mri lumbar spine w/o & w/dye	510200	$207.52	NA	$226.71	NA	1	0.91	0.441	A	0		6.71		6.71	NA	6.71	NA	6.71	0.04	6.75	6.75	6.75	6.75	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.25	$334.25	10.81	10.81	0.06
72159	TC	Mr angio spine w/o&w/dye	510200	$254.39	NA	$277.92	NA	1	0.91	0.441	R	0		8.23		8.23	NA	8.23	NA	8.23	0.04	8.27	8.27	8.27	8.27	1	XXX	0	0	0	4	0	9	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
72170	TC	X-ray exam of pelvis	510200	$18.04	NA	$19.70	NA	1	0.91	0.441	A	0		0.58		0.58	NA	0.58	NA	0.58	0.01	0.59	0.59	0.59	0.59	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.34	$96.34	3.1	3.1	0.05
72190	TC	X-ray exam of pelvis	510200	$27.90	NA	$30.48	NA	1	0.91	0.441	A	0		0.9		0.9	NA	0.9	NA	0.9	0.01	0.91	0.91	0.91	0.91	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
72191	TC	Ct angiograph pelv w/o&w/dye	510200	$214.61	NA	$234.46	NA	1	0.91	0.441	A	0		6.94		6.94	NA	6.94	NA	6.94	0.04	6.98	6.98	6.98	6.98	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
72192	TC	Ct pelvis w/o dye	510200	$79.71	NA	$87.08	NA	1	0.91	0.441	A	0		2.58		2.58	NA	2.58	NA	2.58	0.01	2.59	2.59	2.59	2.59	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
72193	TC	Ct pelvis w/dye	510200	$170.83	NA	$186.63	NA	1	0.91	0.441	A	0		5.53		5.53	NA	5.53	NA	5.53	0.02	5.55	5.55	5.55	5.55	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
72194	TC	Ct pelvis w/o & w/dye	510200	$191.18	NA	$208.87	NA	1	0.91	0.441	A	0		6.19		6.19	NA	6.19	NA	6.19	0.02	6.21	6.21	6.21	6.21	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$164.05	$164.05	5.31	5.31	0.02
72195	TC	Mri pelvis w/o dye	510200	$156.95	NA	$171.47	NA	1	0.91	0.441	A	0		5.08		5.08	NA	5.08	NA	5.08	0.02	5.1	5.1	5.1	5.1	1	XXX	0	0	0	4	0	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
72196	TC	Mri pelvis w/dye	510200	$183.47	NA	$200.44	NA	1	0.91	0.441	A	0		5.94		5.94	NA	5.94	NA	5.94	0.02	5.96	5.96	5.96	5.96	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
72197	TC	Mri pelvis w/o & w/dye	510200	$229.72	NA	$250.97	NA	1	0.91	0.441	A	0		7.43		7.43	NA	7.43	NA	7.43	0.04	7.47	7.47	7.47	7.47	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.56	$334.56	10.82	10.82	0.06
72198	TC	Mr angio pelvis w/o & w/dye	510200	$247.30	NA	$270.17	NA	1	0.91	0.441	A	0		8		8	NA	8	NA	8	0.04	8.04	8.04	8.04	8.04	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
72200	TC	X-ray exam si joints	510200	$22.97	NA	$25.09	NA	1	0.91	0.441	A	0		0.74		0.74	NA	0.74	NA	0.74	0.01	0.75	0.75	0.75	0.75	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.50	$96.50	3.11	3.11	0.04
72202	TC	X-ray exam si joints 3/> vws	510200	$26.36	NA	$28.80	NA	1	0.91	0.441	A	0		0.85		0.85	NA	0.85	NA	0.85	0.01	0.86	0.86	0.86	0.86	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.81	$96.81	3.12	3.12	0.04
72220	TC	X-ray exam sacrum tailbone	510200	$22.35	NA	$24.42	NA	1	0.91	0.441	A	0		0.72		0.72	NA	0.72	NA	0.72	0.01	0.73	0.73	0.73	0.73	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
72240	TC	Myelography neck spine	510200	$65.53	NA	$71.59	NA	1	0.91	0.441	A	0		2.12		2.12	NA	2.12	NA	2.12	0.01	2.13	2.13	2.13	2.13	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$672.52	$672.52	21.76	21.76	0.1
72255	TC	Myelography thoracic spine	510200	$68.30	NA	$74.62	NA	1	0.91	0.441	A	0		2.21		2.21	NA	2.21	NA	2.21	0.01	2.22	2.22	2.22	2.22	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$672.52	$672.52	21.76	21.76	0.1
72265	TC	Myelography l-s spine	510200	$64.91	NA	$70.91	NA	1	0.91	0.441	A	0		2.1		2.1	NA	2.1	NA	2.1	0.01	2.11	2.11	2.11	2.11	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$672.52	$672.52	21.76	21.76	0.1
72270	TC	Myelogphy 2/> spine regions	510200	$91.74	NA	$100.22	NA	1	0.91	0.441	A	0		2.97		2.97	NA	2.97	NA	2.97	0.01	2.98	2.98	2.98	2.98	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$672.99	$672.99	21.79	21.79	0.07
72285	TC	Discography cerv/thor spine	510200	$67.99	NA	$74.28	NA	1	0.91	0.441	A	0		2.2		2.2	NA	2.2	NA	2.2	0.01	2.21	2.21	2.21	2.21	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$1,631.96	$1,631.96	52.81	52.81	0.23
72295	TC	X-ray of lower spine disk	510200	$66.14	NA	$72.26	NA	1	0.91	0.441	A	0		2.14		2.14	NA	2.14	NA	2.14	0.01	2.15	2.15	2.15	2.15	1	XXX	0	0	0	0	0	0	0	0	3		33.8872		99	$1,631.80	$1,631.80	52.8	52.8	0.24
73000	TC	X-ray exam of collar bone	510200	$22.35	NA	$24.42	NA	1	0.91	0.441	A	0		0.72		0.72	NA	0.72	NA	0.72	0.01	0.73	0.73	0.73	0.73	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73010	TC	X-ray exam of shoulder blade	510200	$13.72	NA	$14.99	NA	1	0.91	0.441	A	0		0.44		0.44	NA	0.44	NA	0.44	0.01	0.45	0.45	0.45	0.45	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$96.33	$96.33	3.09	3.09	0.07
73020	TC	X-ray exam of shoulder	510200	$13.10	NA	$14.31	NA	1	0.91	0.441	A	0		0.42		0.42	NA	0.42	NA	0.42	0.01	0.43	0.43	0.43	0.43	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.30	$78.30	2.51	2.51	0.06
73030	TC	X-ray exam of shoulder	510200	$23.59	NA	$25.77	NA	1	0.91	0.441	A	0		0.76		0.76	NA	0.76	NA	0.76	0.01	0.77	0.77	0.77	0.77	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73040	TC	Contrast x-ray of shoulder	510200	$97.29	NA	$106.29	NA	1	0.91	0.441	A	0		3.15		3.15	NA	3.15	NA	3.15	0.01	3.16	3.16	3.16	3.16	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.73	$334.73	10.84	10.84	0.03
73050	TC	X-ray exam of shoulders	510200	$18.04	NA	$19.70	NA	1	0.91	0.441	A	0		0.58		0.58	NA	0.58	NA	0.58	0.01	0.59	0.59	0.59	0.59	1	XXX	0	0	0	0	2	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
73060	TC	X-ray exam of humerus	510200	$22.35	NA	$24.42	NA	1	0.91	0.441	A	0		0.72		0.72	NA	0.72	NA	0.72	0.01	0.73	0.73	0.73	0.73	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73070	TC	X-ray exam of elbow	510200	$19.58	NA	$21.39	NA	1	0.91	0.441	A	0		0.63		0.63	NA	0.63	NA	0.63	0.01	0.64	0.64	0.64	0.64	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
73080	TC	X-ray exam of elbow	510200	$22.35	NA	$24.42	NA	1	0.91	0.441	A	0		0.72		0.72	NA	0.72	NA	0.72	0.01	0.73	0.73	0.73	0.73	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73085	TC	Contrast x-ray of elbow	510200	$78.48	NA	$85.74	NA	1	0.91	0.441	A	0		2.54		2.54	NA	2.54	NA	2.54	0.01	2.55	2.55	2.55	2.55	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.57	$334.57	10.83	10.83	0.04
73090	TC	X-ray exam of forearm	510200	$19.89	NA	$21.73	NA	1	0.91	0.441	A	0		0.64		0.64	NA	0.64	NA	0.64	0.01	0.65	0.65	0.65	0.65	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.62	$78.62	2.53	2.53	0.04
73092	TC	X-ray exam of arm infant	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$96.50	$96.50	3.11	3.11	0.04
73100	TC	X-ray exam of wrist	510200	$23.89	NA	$26.10	NA	1	0.91	0.441	A	0		0.77		0.77	NA	0.77	NA	0.77	0.01	0.78	0.78	0.78	0.78	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73110	TC	X-ray exam of wrist	510200	$30.06	NA	$32.84	NA	1	0.91	0.441	A	0		0.97		0.97	NA	0.97	NA	0.97	0.01	0.98	0.98	0.98	0.98	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
73115	TC	Contrast x-ray of wrist	510200	$100.68	NA	$109.99	NA	1	0.91	0.441	A	0		3.26		3.26	NA	3.26	NA	3.26	0.01	3.27	3.27	3.27	3.27	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.73	$334.73	10.84	10.84	0.03
73120	TC	X-ray exam of hand	510200	$21.43	NA	$23.41	NA	1	0.91	0.441	A	0		0.69		0.69	NA	0.69	NA	0.69	0.01	0.7	0.7	0.7	0.7	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$96.50	$96.50	3.11	3.11	0.04
73130	TC	X-ray exam of hand	510200	$26.36	NA	$28.80	NA	1	0.91	0.441	A	0		0.85		0.85	NA	0.85	NA	0.85	0.01	0.86	0.86	0.86	0.86	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73140	TC	X-ray exam of finger(s)	510200	$28.83	NA	$31.50	NA	1	0.91	0.441	A	0		0.93		0.93	NA	0.93	NA	0.93	0.01	0.94	0.94	0.94	0.94	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
73200	TC	Ct upper extremity w/o dye	510200	$111.78	NA	$122.12	NA	1	0.91	0.441	A	0		3.62		3.62	NA	3.62	NA	3.62	0.01	3.63	3.63	3.63	3.63	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$97.29	$97.29	3.15	3.15	0.01
73201	TC	Ct upper extremity w/dye	510200	$142.77	NA	$155.97	NA	1	0.91	0.441	A	0		4.62		4.62	NA	4.62	NA	4.62	0.02	4.64	4.64	4.64	4.64	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.72	$334.72	10.83	10.83	0.05
73202	TC	Ct uppr extremity w/o&w/dye	510200	$186.87	NA	$204.15	NA	1	0.91	0.441	A	0		6.05		6.05	NA	6.05	NA	6.05	0.02	6.07	6.07	6.07	6.07	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
73206	TC	Ct angio upr extrm w/o&w/dye	510200	$207.21	NA	$226.38	NA	1	0.91	0.441	A	0		6.7		6.7	NA	6.7	NA	6.7	0.04	6.74	6.74	6.74	6.74	1	XXX	0	0	0	4	0	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
73218	TC	Mri upper extremity w/o dye	510200	$234.65	NA	$256.36	NA	1	0.91	0.441	A	0		7.59		7.59	NA	7.59	NA	7.59	0.04	7.63	7.63	7.63	7.63	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$212.14	$212.14	6.86	6.86	0.04
73219	TC	Mri upper extremity w/dye	510200	$250.38	NA	$273.54	NA	1	0.91	0.441	A	0		8.1		8.1	NA	8.1	NA	8.1	0.04	8.14	8.14	8.14	8.14	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
73220	TC	Mri uppr extremity w/o&w/dye	510200	$303.11	NA	$331.15	NA	1	0.91	0.441	A	0		9.81		9.81	NA	9.81	NA	9.81	0.04	9.85	9.85	9.85	9.85	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.57	$334.57	10.83	10.83	0.04
73221	TC	Mri joint upr extrem w/o dye	510200	$135.06	NA	$147.55	NA	1	0.91	0.441	A	0		4.37		4.37	NA	4.37	NA	4.37	0.02	4.39	4.39	4.39	4.39	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
73222	TC	Mri joint upr extrem w/dye	510200	$231.89	NA	$253.34	NA	1	0.91	0.441	A	0		7.51		7.51	NA	7.51	NA	7.51	0.02	7.53	7.53	7.53	7.53	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$673.15	$673.15	21.8	21.8	0.06
73223	TC	Mri joint upr extr w/o&w/dye	510200	$280.60	NA	$306.56	NA	1	0.91	0.441	A	0		9.08		9.08	NA	9.08	NA	9.08	0.04	9.12	9.12	9.12	9.12	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.72	$334.72	10.83	10.83	0.05
73225	TC	Mr angio upr extr w/o&w/dye	510200	$254.39	NA	$277.92	NA	1	0.91	0.441	R	0		8.23		8.23	NA	8.23	NA	8.23	0.04	8.27	8.27	8.27	8.27	1	XXX	0	0	0	4	0	9	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
73501	TC	X-ray exam hip uni 1 view	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73502	TC	X-ray exam hip uni 2-3 views	510200	$33.45	NA	$36.55	NA	1	0.91	0.441	A	0		1.08		1.08	NA	1.08	NA	1.08	0.01	1.09	1.09	1.09	1.09	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.63	$78.63	2.54	2.54	0.02
73503	TC	X-ray exam hip uni 4/> views	510200	$42.71	NA	$46.66	NA	1	0.91	0.441	A	0		1.38		1.38	NA	1.38	NA	1.38	0.01	1.39	1.39	1.39	1.39	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.82	$96.82	3.13	3.13	0.02
73521	TC	X-ray exam hips bi 2 views	510200	$28.21	NA	$30.82	NA	1	0.91	0.441	A	0		0.91		0.91	NA	0.91	NA	0.91	0.01	0.92	0.92	0.92	0.92	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.66	$96.66	3.12	3.12	0.03
73522	TC	X-ray exam hips bi 3-4 views	510200	$36.54	NA	$39.92	NA	1	0.91	0.441	A	0		1.18		1.18	NA	1.18	NA	1.18	0.01	1.19	1.19	1.19	1.19	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
73523	TC	X-ray exam hips bi 5/> views	510200	$43.32	NA	$47.33	NA	1	0.91	0.441	A	0		1.4		1.4	NA	1.4	NA	1.4	0.01	1.41	1.41	1.41	1.41	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.82	$96.82	3.13	3.13	0.02
73525	TC	Contrast x-ray of hip	510200	$95.44	NA	$104.27	NA	1	0.91	0.441	A	0		3.09		3.09	NA	3.09	NA	3.09	0.01	3.1	3.1	3.1	3.1	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.73	$334.73	10.84	10.84	0.03
73551	TC	X-ray exam of femur 1	510200	$19.58	NA	$21.39	NA	1	0.91	0.441	A	0		0.63		0.63	NA	0.63	NA	0.63	0.01	0.64	0.64	0.64	0.64	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
73552	TC	X-ray exam of femur 2/>	510200	$24.82	NA	$27.12	NA	1	0.91	0.441	A	0		0.8		0.8	NA	0.8	NA	0.8	0.01	0.81	0.81	0.81	0.81	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73560	TC	X-ray exam of knee 1 or 2	510200	$24.20	NA	$26.44	NA	1	0.91	0.441	A	0		0.78		0.78	NA	0.78	NA	0.78	0.01	0.79	0.79	0.79	0.79	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73562	TC	X-ray exam of knee 3	510200	$29.14	NA	$31.83	NA	1	0.91	0.441	A	0		0.94		0.94	NA	0.94	NA	0.94	0.01	0.95	0.95	0.95	0.95	1	XXX	0	0	0	0	3	0	0	0	9		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
73564	TC	X-ray exam knee 4 or more	510200	$32.84	NA	$35.87	NA	1	0.91	0.441	A	0		1.06		1.06	NA	1.06	NA	1.06	0.01	1.07	1.07	1.07	1.07	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$96.97	$96.97	3.13	3.13	0.03
73565	TC	X-ray exam of knees	510200	$29.14	NA	$31.83	NA	1	0.91	0.441	A	0		0.94		0.94	NA	0.94	NA	0.94	0.01	0.95	0.95	0.95	0.95	1	XXX	0	0	0	0	2	0	0	0	1		33.8872		99	$78.78	$78.78	2.54	2.54	0.03
73580	TC	Contrast x-ray of knee joint	510200	$90.50	NA	$98.87	NA	1	0.91	0.441	A	0		2.93		2.93	NA	2.93	NA	2.93	0.01	2.94	2.94	2.94	2.94	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.88	$334.88	10.84	10.84	0.04
73590	TC	X-ray exam of lower leg	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73592	TC	X-ray exam of leg infant	510200	$22.04	NA	$24.08	NA	1	0.91	0.441	A	0		0.71		0.71	NA	0.71	NA	0.71	0.01	0.72	0.72	0.72	0.72	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73600	TC	X-ray exam of ankle	510200	$22.66	NA	$24.76	NA	1	0.91	0.441	A	0		0.73		0.73	NA	0.73	NA	0.73	0.01	0.74	0.74	0.74	0.74	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73610	TC	X-ray exam of ankle	510200	$26.36	NA	$28.80	NA	1	0.91	0.441	A	0		0.85		0.85	NA	0.85	NA	0.85	0.01	0.86	0.86	0.86	0.86	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73615	TC	Contrast x-ray of ankle	510200	$95.13	NA	$103.93	NA	1	0.91	0.441	A	0		3.08		3.08	NA	3.08	NA	3.08	0.01	3.09	3.09	3.09	3.09	1	XXX	0	0	0	0	3	0	0	0	3		33.8872		99	$334.73	$334.73	10.84	10.84	0.03
73620	TC	X-ray exam of foot	510200	$19.27	NA	$21.05	NA	1	0.91	0.441	A	0		0.62		0.62	NA	0.62	NA	0.62	0.01	0.63	0.63	0.63	0.63	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
73630	TC	X-ray exam of foot	510200	$24.20	NA	$26.44	NA	1	0.91	0.441	A	0		0.78		0.78	NA	0.78	NA	0.78	0.01	0.79	0.79	0.79	0.79	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.47	$78.47	2.53	2.53	0.03
73650	TC	X-ray exam of heel	510200	$19.27	NA	$21.05	NA	1	0.91	0.441	A	0		0.62		0.62	NA	0.62	NA	0.62	0.01	0.63	0.63	0.63	0.63	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
73660	TC	X-ray exam of toe(s)	510200	$21.12	NA	$23.07	NA	1	0.91	0.441	A	0		0.68		0.68	NA	0.68	NA	0.68	0.01	0.69	0.69	0.69	0.69	1	XXX	0	0	0	0	3	0	0	0	1		33.8872		99	$78.62	$78.62	2.53	2.53	0.04
73700	TC	Ct lower extremity w/o dye	510200	$80.33	NA	$87.76	NA	1	0.91	0.441	A	0		2.6		2.6	NA	2.6	NA	2.6	0.01	2.61	2.61	2.61	2.61	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$96.98	$96.98	3.14	3.14	0.01
73701	TC	Ct lower extremity w/dye	510200	$108.85	NA	$118.92	NA	1	0.91	0.441	A	0		3.52		3.52	NA	3.52	NA	3.52	0.02	3.54	3.54	3.54	3.54	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
73702	TC	Ct lwr extremity w/o&w/dye	510200	$134.13	NA	$146.54	NA	1	0.91	0.441	A	0		4.34		4.34	NA	4.34	NA	4.34	0.02	4.36	4.36	4.36	4.36	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$163.74	$163.74	5.3	5.3	0.02
73706	TC	Ct angio lwr extr w/o&w/dye	510200	$228.18	NA	$249.28	NA	1	0.91	0.441	A	0		7.38		7.38	NA	7.38	NA	7.38	0.04	7.42	7.42	7.42	7.42	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$163.58	$163.58	5.29	5.29	0.03
73718	TC	Mri lower extremity w/o dye	510200	$156.64	NA	$171.13	NA	1	0.91	0.441	A	0		5.07		5.07	NA	5.07	NA	5.07	0.02	5.09	5.09	5.09	5.09	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
73719	TC	Mri lower extremity w/dye	510200	$182.55	NA	$199.43	NA	1	0.91	0.441	A	0		5.91		5.91	NA	5.91	NA	5.91	0.02	5.93	5.93	5.93	5.93	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.88	$334.88	10.84	10.84	0.04
73720	TC	Mri lwr extremity w/o&w/dye	510200	$231.88	NA	$253.33	NA	1	0.91	0.441	A	0		7.5		7.5	NA	7.5	NA	7.5	0.04	7.54	7.54	7.54	7.54	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.56	$334.56	10.82	10.82	0.06
73721	TC	Mri jnt of lwr extre w/o dye	510200	$135.06	NA	$147.55	NA	1	0.91	0.441	A	0		4.37		4.37	NA	4.37	NA	4.37	0.02	4.39	4.39	4.39	4.39	1	XXX	0	0	0	4	3	0	0	0	1		33.8872		88	$211.99	$211.99	6.86	6.86	0.03
73722	TC	Mri joint of lwr extr w/dye	510200	$232.20	NA	$253.67	NA	1	0.91	0.441	A	0		7.52		7.52	NA	7.52	NA	7.52	0.02	7.54	7.54	7.54	7.54	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$673.15	$673.15	21.8	21.8	0.06
73723	TC	Mri joint lwr extr w/o&w/dye	510200	$279.68	NA	$305.55	NA	1	0.91	0.441	A	0		9.05		9.05	NA	9.05	NA	9.05	0.04	9.09	9.09	9.09	9.09	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.72	$334.72	10.83	10.83	0.05
73725	TC	Mr ang lwr ext w or w/o dye	510200	$244.52	NA	$267.14	NA	1	0.91	0.441	R	0		7.91		7.91	NA	7.91	NA	7.91	0.04	7.95	7.95	7.95	7.95	1	XXX	0	0	0	4	3	0	0	0	2		33.8872		88	$334.41	$334.41	10.82	10.82	0.05
74018	TC	X-ray exam abdomen 1 view	510200	$19.58	NA	$21.39	NA	1	0.91	0.441	A	0		0.63		0.63	NA	0.63	NA	0.63	0.01	0.64	0.64	0.64	0.64	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$78.31	$78.31	2.52	2.52	0.04
74019	TC	X-ray exam abdomen 2 views	510200	$23.89	NA	$26.10	NA	1	0.91	0.441	A	0		0.77		0.77	NA	0.77	NA	0.77	0.01	0.78	0.78	0.78	0.78	1	XXX	0	0	0	0	0	0	0	0	1		33.8872		99	$96.50	$96.50	3.11	3.11	0.04

File details come from the government source that posted it. Updated Jun 9, 2023.