Addendum BB -- Proposed ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2012 (Including Ancillary Services for Which Payment is Packaged)					
HCPCS Code	Short Descriptor	CY 2012 Comment Indicator	CY 2012 Payment Indicator	CY 2012 Payment Weight  	CY 2012 Payment 
0042T	Ct perfusion w/contrast cbf		N1		
0073T	Delivery comp imrt		Z2	6.0383	$255.60
0126T	Chd risk imt study		N1		
0159T	Cad breast mri		N1		
0174T	Cad cxr with interp		N1		
0175T	Cad cxr remote		N1		
0182T	Hdr elect brachytherapy		Z2	9.2473	$391.43
0185T	Comptr probability analysis		N1		
70010	Contrast x-ray of brain		N1		
70015	Contrast x-ray of brain		N1		
70030	X-ray eye for foreign body		Z3		$14.62
70100	X-ray exam of jaw		Z3		$17.97
70110	X-ray exam of jaw		Z3		$19.41
70120	X-ray exam of mastoids		Z3		$19.17
70130	X-ray exam of mastoids		Z2	0.6016	$25.47
70134	X-ray exam of middle ear		Z3		$27.32
70140	X-ray exam of facial bones		Z3		$14.38
70150	X-ray exam of facial bones		Z3		$21.09
70160	X-ray exam of nasal bones		Z3		$17.49
70170	X-ray exam of tear duct		N1		
70190	X-ray exam of eye sockets		Z3		$17.97
70200	X-ray exam of eye sockets		Z3		$21.33
70210	X-ray exam of sinuses		Z3		$16.06
70220	X-ray exam of sinuses		Z3		$19.17
70240	X-ray exam pituitary saddle		Z3		$14.38
70250	X-ray exam of skull		Z3		$17.73
70260	X-ray exam of skull		Z3		$21.57
70300	X-ray exam of teeth		Z3		$6.23
70310	X-ray exam of teeth		Z2	0.4358	$18.45
70320	Full mouth x-ray of teeth		Z2	0.4358	$18.45
70328	X-ray exam of jaw joint		Z3		$15.58
70330	X-ray exam of jaw joints		Z2	0.6016	$25.47
70332	X-ray exam of jaw joint		N1		
70336	Magnetic image jaw joint		Z2	4.5196	$191.31
70350	X-ray head for orthodontia		Z3		$8.15
70355	Panoramic x-ray of jaws		Z3		$7.19
70360	X-ray exam of neck		Z3		$13.42
70370	Throat x-ray & fluoroscopy		Z2	1.1698	$49.52
70371	Speech evaluation complex		Z3		$37.38
70373	Contrast x-ray of larynx		N1		
70380	X-ray exam of salivary gland		Z3		$22.05
70390	X-ray exam of salivary duct		N1		
70450	Ct head/brain w/o dye		Z3		$99.45
70460	Ct head/brain w/dye		Z3		$129.40
70470	Ct head/brain w/o & w/dye		Z3		$159.60
70480	Ct orbit/ear/fossa w/o dye		Z2	2.5705	$108.81
70481	Ct orbit/ear/fossa w/dye		Z2	4.0122	$169.83
70482	Ct orbit/ear/fossa w/o&w/dye		Z2	4.4724	$189.31
70486	Ct maxillofacial w/o dye		Z2	2.5705	$108.81
70487	Ct maxillofacial w/dye		Z3		$165.83
70488	Ct maxillofacial w/o & w/dye		Z2	4.4724	$189.31
70490	Ct soft tissue neck w/o dye		Z2	2.5705	$108.81
70491	Ct soft tissue neck w/dye		Z3		$158.16
70492	Ct sft tsue nck w/o & w/dye		Z2	4.4724	$189.31
70496	Ct angiography head		Z2	4.5395	$192.15
70498	Ct angiography neck		Z2	4.5395	$192.15
70540	Mri orbit/face/neck w/o dye		Z2	4.5196	$191.31
70542	Mri orbit/face/neck w/dye		Z2	5.7993	$245.48
70543	Mri orbt/fac/nck w/o & w/dye		Z2	7.1603	$303.09
70544	Mr angiography head w/o dye		Z2	4.5196	$191.31
70545	Mr angiography head w/dye		Z2	5.7993	$245.48
70546	Mr angiograph head w/o&w/dye		Z2	7.1603	$303.09
70547	Mr angiography neck w/o dye		Z2	4.5196	$191.31
70548	Mr angiography neck w/dye		Z2	5.7993	$245.48
70549	Mr angiograph neck w/o&w/dye		Z2	7.1603	$303.09
70551	Mri brain w/o dye		Z2	4.5196	$191.31
70552	Mri brain w/dye		Z2	5.7993	$245.48
70553	Mri brain w/o & w/dye		Z2	7.1603	$303.09
70554	Fmri brain by tech		Z2	4.5196	$191.31
70555	Fmri brain by phys/psych		Z2	4.5196	$191.31
70557	Mri brain w/o dye		Z2	4.5196	$191.31
70558	Mri brain w/dye		Z2	5.7993	$245.48
70559	Mri brain w/o & w/dye		Z2	7.1603	$303.09
71010	Chest x-ray		Z3		$10.30
71015	Chest x-ray		Z3		$14.38
71020	Chest x-ray		Z3		$13.90
71021	Chest x-ray		Z3		$17.25
71022	Chest x-ray		Z3		$22.77
71023	Chest x-ray and fluoroscopy		Z3		$34.99
71030	Chest x-ray		Z3		$22.05
71034	Chest x-ray and fluoroscopy		Z3		$46.01
71035	Chest x-ray		Z3		$18.93
71040	Contrast x-ray of bronchi		N1		
71060	Contrast x-ray of bronchi		N1		
71090	X-ray & pacemaker insertion		N1		
71100	X-ray exam of ribs		Z3		$15.34
71101	X-ray exam of ribs/chest		Z3		$18.69
71110	X-ray exam of ribs		Z3		$19.41
71111	X-ray exam of ribs/chest		Z3		$26.60
71120	X-ray exam of breastbone		Z3		$15.58
71130	X-ray exam of breastbone		Z3		$18.69
71250	Ct thorax w/o dye		Z2	2.5705	$108.81
71260	Ct thorax w/dye		Z3		$161.27
71270	Ct thorax w/o & w/dye		Z2	4.4724	$189.31
71275	Ct angiography chest		Z2	4.5395	$192.15
71550	Mri chest w/o dye		Z2	4.5196	$191.31
71551	Mri chest w/dye		Z2	5.7993	$245.48
71552	Mri chest w/o & w/dye		Z2	7.1603	$303.09
72010	X-ray exam of spine		Z3		$38.82
72020	X-ray exam of spine		Z3		$11.26
72040	X-ray exam of neck spine		Z3		$19.89
72050	X-ray exam of neck spine		Z3		$26.60
72052	X-ray exam of neck spine		Z3		$35.47
72069	X-ray exam of trunk spine		Z3		$18.69
72070	X-ray exam of thoracic spine		Z3		$16.06
72072	X-ray exam of thoracic spine		Z3		$18.93
72074	X-ray exam of thoracic spine		Z3		$23.96
72080	X-ray exam of trunk spine		Z3		$17.73
72090	X-ray exam of trunk spine		Z3		$25.40
72100	X-ray exam of lower spine		Z3		$21.09
72110	X-ray exam of lower spine		Z3		$28.52
72114	X-ray exam of lower spine		Z3		$40.50
72120	X-ray exam of lower spine		Z2	0.6016	$25.47
72125	Ct neck spine w/o dye		Z2	2.5705	$108.81
72126	Ct neck spine w/dye		Z3		$162.23
72127	Ct neck spine w/o & w/dye		Z2	4.4724	$189.31
72128	Ct chest spine w/o dye		Z2	2.5705	$108.81
72129	Ct chest spine w/dye		Z3		$162.23
72130	Ct chest spine w/o & w/dye		Z2	4.4724	$189.31
72131	Ct lumbar spine w/o dye		Z2	2.5705	$108.81
72132	Ct lumbar spine w/dye		Z3		$161.75
72133	Ct lumbar spine w/o & w/dye		Z2	4.4724	$189.31
72141	Mri neck spine w/o dye		Z2	4.5196	$191.31
72142	Mri neck spine w/dye		Z2	5.7993	$245.48
72146	Mri chest spine w/o dye		Z2	4.5196	$191.31
72147	Mri chest spine w/dye		Z2	5.7993	$245.48
72148	Mri lumbar spine w/o dye		Z2	4.5196	$191.31
72149	Mri lumbar spine w/dye		Z2	5.7993	$245.48
72156	Mri neck spine w/o & w/dye		Z2	7.1603	$303.09
72157	Mri chest spine w/o & w/dye		Z2	7.1603	$303.09
72158	Mri lumbar spine w/o & w/dye		Z2	7.1603	$303.09
72170	X-ray exam of pelvis		Z3		$12.70
72190	X-ray exam of pelvis		Z3		$22.53
72191	Ct angiograph pelv w/o&w/dye		Z2	4.5395	$192.15
72192	Ct pelvis w/o dye		Z2	2.5705	$108.81
72193	Ct pelvis w/dye		Z3		$153.13
72194	Ct pelvis w/o & w/dye		Z2	4.4724	$189.31
72195	Mri pelvis w/o dye		Z2	4.5196	$191.31
72196	Mri pelvis w/dye		Z2	5.7993	$245.48
72197	Mri pelvis w/o & w/dye		Z2	7.1603	$303.09
72200	X-ray exam sacroiliac joints		Z3		$15.10
72202	X-ray exam sacroiliac joints		Z3		$17.97
72220	X-ray exam of tailbone		Z3		$14.62
72240	Contrast x-ray of neck spine		N1		
72255	Contrast x-ray thorax spine		N1		
72265	Contrast x-ray lower spine		N1		
72270	Contrast x-ray spine		N1		
72275	Epidurography		N1		
72285	X-ray c/t spine disk		N1		
72291	Perq verte/sacroplsty fluor		N1		
72292	Perq verte/sacroplsty ct		N1		
72295	X-ray of lower spine disk		N1		
73000	X-ray exam of collar bone		Z3		$14.62
73010	X-ray exam of shoulder blade		Z3		$15.58
73020	X-ray exam of shoulder		Z3		$11.50
73030	X-ray exam of shoulder		Z3		$14.86
73040	Contrast x-ray of shoulder		N1		
73050	X-ray exam of shoulders		Z3		$20.61
73060	X-ray exam of humerus		Z3		$14.62
73070	X-ray exam of elbow		Z3		$14.62
73080	X-ray exam of elbow		Z3		$17.97
73085	Contrast x-ray of elbow		N1		
73090	X-ray exam of forearm		Z3		$13.90
73092	X-ray exam of arm infant		Z3		$17.73
73100	X-ray exam of wrist		Z3		$16.06
73110	X-ray exam of wrist		Z3		$20.37
73115	Contrast x-ray of wrist		N1		
73120	X-ray exam of hand		Z3		$13.90
73130	X-ray exam of hand		Z3		$17.01
73140	X-ray exam of finger(s)		Z3		$18.45
73200	Ct upper extremity w/o dye		Z2	2.5705	$108.81
73201	Ct upper extremity w/dye		Z3		$158.16
73202	Ct uppr extremity w/o&w/dye		Z2	4.4724	$189.31
73206	Ct angio upr extrm w/o&w/dye		Z2	4.5395	$192.15
73218	Mri upper extremity w/o dye		Z2	4.5196	$191.31
73219	Mri upper extremity w/dye		Z2	5.7993	$245.48
73220	Mri uppr extremity w/o&w/dye		Z2	7.1603	$303.09
73221	Mri joint upr extrem w/o dye		Z2	4.5196	$191.31
73222	Mri joint upr extrem w/dye		Z2	5.7993	$245.48
73223	Mri joint upr extr w/o&w/dye		Z2	7.1603	$303.09
73500	X-ray exam of hip		Z3		$12.70
73510	X-ray exam of hip		Z3		$19.65
73520	X-ray exam of hips		Z3		$19.65
73525	Contrast x-ray of hip		N1		
73530	X-ray exam of hip		N1		
73540	X-ray exam of pelvis & hips		Z3		$23.72
73542	X-ray exam sacroiliac joint		N1		
73550	X-ray exam of thigh		Z3		$13.90
73560	X-ray exam of knee 1 or 2		Z3		$15.34
73562	X-ray exam of knee 3		Z3		$19.41
73564	X-ray exam knee 4 or more		Z3		$22.29
73565	X-ray exam of knees		Z3		$18.21
73580	Contrast x-ray of knee joint		N1		
73590	X-ray exam of lower leg		Z3		$13.42
73592	X-ray exam of leg infant		Z3		$17.01
73600	X-ray exam of ankle		Z3		$14.62
73610	X-ray exam of ankle		Z3		$17.49
73615	Contrast x-ray of ankle		N1		
73620	X-ray exam of foot		Z3		$14.14
73630	X-ray exam of foot		Z3		$16.53
73650	X-ray exam of heel		Z3		$14.38
73660	X-ray exam of toe(s)		Z3		$16.53
73700	Ct lower extremity w/o dye		Z2	2.5705	$108.81
73701	Ct lower extremity w/dye		Z3		$160.32
73702	Ct lwr extremity w/o&w/dye		Z2	4.4724	$189.31
73706	Ct angio lwr extr w/o&w/dye		Z2	4.5395	$192.15
73718	Mri lower extremity w/o dye		Z2	4.5196	$191.31
73719	Mri lower extremity w/dye		Z2	5.7993	$245.48
73720	Mri lwr extremity w/o&w/dye		Z2	7.1603	$303.09
73721	Mri jnt of lwr extre w/o dye		Z2	4.5196	$191.31
73722	Mri joint of lwr extr w/dye		Z2	5.7993	$245.48
73723	Mri joint lwr extr w/o&w/dye		Z2	7.1603	$303.09
74000	X-ray exam of abdomen		Z3		$11.02
74010	X-ray exam of abdomen		Z3		$19.17
74020	X-ray exam of abdomen		Z3		$19.17
74022	X-ray exam series abdomen		Z3		$23.24
74150	Ct abdomen w/o dye		Z2	2.5705	$108.81
74160	Ct abdomen w/dye		Z2	4.0122	$169.83
74170	Ct abdomen w/o & w/dye		Z2	4.4724	$189.31
74175	Ct angio abdom w/o & w/dye		Z2	4.5395	$192.15
74176	Ct abd & pelvis		Z3		$96.57
74177	Ct abd & pelv w/contrast	CH	Z2	7.7175	$326.67
74178	Ct abd & pelv 1/>regns		Z3		$243.71
74181	Mri abdomen w/o dye		Z2	4.5196	$191.31
74182	Mri abdomen w/dye		Z2	5.7993	$245.48
74183	Mri abdomen w/o & w/dye		Z2	7.1603	$303.09
74190	X-ray exam of peritoneum		N1		
74210	Contrst x-ray exam of throat		Z3		$43.85
74220	Contrast x-ray esophagus	CH	Z2	1.1519	$48.76
74230	Cine/vid x-ray throat/esoph		Z3		$46.97
74235	Remove esophagus obstruction		N1		
74240	X-ray exam upper gi tract		Z2	1.1519	$48.76
74241	X-ray exam upper gi tract		Z2	1.1519	$48.76
74245	X-ray exam upper gi tract		Z2	1.8824	$79.68
74246	Contrst x-ray uppr gi tract		Z2	1.1519	$48.76
74247	Contrst x-ray uppr gi tract		Z2	1.1519	$48.76
74249	Contrst x-ray uppr gi tract		Z2	1.8824	$79.68
74250	X-ray exam of small bowel		Z2	1.1519	$48.76
74251	X-ray exam of small bowel		Z2	1.8824	$79.68
74260	X-ray exam of small bowel		Z2	1.1519	$48.76
74261	Ct colonography dx		Z2	2.5705	$108.81
74262	Ct colonography dx w/dye		Z2	4.0122	$169.83
74270	Contrast x-ray exam of colon		Z2	1.1519	$48.76
74280	Contrast x-ray exam of colon		Z2	1.8824	$79.68
74283	Contrast x-ray exam of colon		Z2	1.1519	$48.76
74290	Contrast x-ray gallbladder	CH	Z2	1.1519	$48.76
74291	Contrast x-rays gallbladder	CH	Z2	1.1519	$48.76
74300	X-ray bile ducts/pancreas		N1		
74301	X-rays at surgery add-on		N1		
74305	X-ray bile ducts/pancreas		N1		
74320	Contrast x-ray of bile ducts		N1		
74327	X-ray bile stone removal		N1		
74328	X-ray bile duct endoscopy		N1		
74329	X-ray for pancreas endoscopy		N1		
74330	X-ray bile/panc endoscopy		N1		
74340	X-ray guide for GI tube		N1		
74355	X-ray guide intestinal tube		N1		
74360	X-ray guide gi dilation		N1		
74363	X-ray bile duct dilation		N1		
74400	Contrst x-ray urinary tract		Z3		$63.02
74410	Contrst x-ray urinary tract		Z3		$63.50
74415	Contrst x-ray urinary tract		Z3		$80.52
74420	Contrst x-ray urinary tract		Z2	2.4272	$102.74
74425	Contrst x-ray urinary tract		N1		
74430	Contrast x-ray bladder		N1		
74440	X-ray male genital tract		N1		
74445	X-ray exam of penis		N1		
74450	X-ray urethra/bladder		N1		
74455	X-ray urethra/bladder		N1		
74470	X-ray exam of kidney lesion		N1		
74475	X-ray control cath insert		N1		
74480	X-ray control cath insert		N1		
74485	X-ray guide gu dilation		N1		
74710	X-ray measurement of pelvis		Z3		$15.10
74740	X-ray female genital tract		N1		
74742	X-ray fallopian tube		N1		
74775	X-ray exam of perineum		Z2	2.4272	$102.74
75557	Cardiac mri for morph		Z2	4.5196	$191.31
75559	Cardiac mri w/stress img		Z2	4.5196	$191.31
75561	Cardiac mri for morph w/dye		Z3		$300.50
75563	Card mri w/stress img & dye		Z2	7.1603	$303.09
75565	Card mri veloc flow mapping		N1		
75571	Ct hrt w/o dye w/ca test		Z2	0.6316	$26.73
75572	Ct hrt w/3d image		Z2	3.4956	$147.97
75573	Ct hrt w/3d image congen		Z2	3.4956	$147.97
75574	Ct angio hrt w/3d image		Z2	3.4956	$147.97
75600	Contrast x-ray exam of aorta		N1		
75605	Contrast x-ray exam of aorta		N1		
75625	Contrast x-ray exam of aorta		N1		
75630	X-ray aorta leg arteries		N1		
75635	Ct angio abdominal arteries		N1		
75650	Artery x-rays head & neck		N1		
75658	Artery x-rays arm		N1		
75660	Artery x-rays head & neck		N1		
75662	Artery x-rays head & neck		N1		
75665	Artery x-rays head & neck		N1		
75671	Artery x-rays head & neck		N1		
75676	Artery x-rays neck		N1		
75680	Artery x-rays neck		N1		
75685	Artery x-rays spine		N1		
75705	Artery x-rays spine		N1		
75710	Artery x-rays arm/leg		N1		
75716	Artery x-rays arms/legs		N1		
75722	Artery x-rays kidney		N1		
75724	Artery x-rays kidneys		N1		
75726	Artery x-rays abdomen		N1		
75731	Artery x-rays adrenal gland		N1		
75733	Artery x-rays adrenals		N1		
75736	Artery x-rays pelvis		N1		
75741	Artery x-rays lung		N1		
75743	Artery x-rays lungs		N1		
75746	Artery x-rays lung		N1		
75756	Artery x-rays chest		N1		
75774	Artery x-ray each vessel		N1		
75791	Av dialysis shunt imaging		N1		
75801	Lymph vessel x-ray arm/leg		N1		
75803	Lymph vessel x-ray arms/legs		N1		
75805	Lymph vessel x-ray trunk		N1		
75807	Lymph vessel x-ray trunk		N1		
75809	Nonvascular shunt x-ray		N1		
75810	Vein x-ray spleen/liver		N1		
75820	Vein x-ray arm/leg		N1		
75822	Vein x-ray arms/legs		N1		
75825	Vein x-ray trunk		N1		
75827	Vein x-ray chest		N1		
75831	Vein x-ray kidney		N1		
75833	Vein x-ray kidneys		N1		
75840	Vein x-ray adrenal gland		N1		
75842	Vein x-ray adrenal glands		N1		
75860	Vein x-ray neck		N1		
75870	Vein x-ray skull		N1		
75872	Vein x-ray skull		N1		
75880	Vein x-ray eye socket		N1		
75885	Vein x-ray liver		N1		
75887	Vein x-ray liver		N1		
75889	Vein x-ray liver		N1		
75891	Vein x-ray liver		N1		
75893	Venous sampling by catheter		N1		
75894	X-rays transcath therapy		N1		
75896	X-rays transcath therapy		N1		
75898	Follow-up angiography		N1		
75901	Remove cva device obstruct		N1		
75902	Remove cva lumen obstruct		N1		
75940	X-ray placement vein filter		N1		
75945	Intravascular us		N1		
75946	Intravascular us add-on		N1		
75960	Transcath iv stent rs&i		N1		
75961	Retrieval broken catheter		N1		
75962	Repair arterial blockage		N1		
75964	Repair artery blockage each		N1		
75966	Repair arterial blockage		N1		
75968	Repair artery blockage each		N1		
75970	Vascular biopsy		N1		
75978	Repair venous blockage		N1		
75980	Contrast xray exam bile duct		N1		
75982	Contrast xray exam bile duct		N1		
75984	Xray control catheter change		N1		
75989	Abscess drainage under x-ray		N1		
76000	Fluoroscope examination		N1		
76001	Fluoroscope exam extensive		N1		
76010	X-ray nose to rectum		Z3		$12.94
76080	X-ray exam of fistula		N1		
76098	X-ray exam breast specimen		N1		
76100	X-ray exam of body section		Z2	1.0152	$42.97
76101	Complex body section x-ray		Z3		$92.50
76102	Complex body section x-rays		Z3		$133.00
76120	Cine/video x-rays		Z3		$41.22
76125	Cine/video x-rays add-on		N1		
76376	3d render w/o postprocess		N1		
76377	3d rendering w/postprocess		N1		
76380	CAT scan follow-up study		Z2	1.4484	$61.31
76496	Fluoroscopic procedure		Z2	1.1698	$49.52
76497	Ct procedure		Z2	1.4484	$61.31
76498	Mri procedure		Z2	4.5196	$191.31
76499	Radiographic procedure		Z2	0.6016	$25.47
76506	Echo exam of head		Z2	0.8431	$35.69
76510	Ophth us b & quant a		Z3		$54.64
76511	Ophth us quant a only		Z3		$34.27
76512	Ophth us b w/non-quant a		Z3		$28.04
76513	Echo exam of eye water bath		Z3		$39.78
76514	Echo exam of eye thickness		Z3		$3.35
76516	Echo exam of eye		Z3		$31.63
76519	Echo exam of eye		Z3		$35.23
76529	Echo exam of eye		Z3		$30.91
76536	Us exam of head and neck		Z2	1.2851	$54.40
76604	Us exam chest		Z2	0.8431	$35.69
76645	Us exam breast(s)		Z2	0.8431	$35.69
76700	Us exam abdom complete		Z2	1.2851	$54.40
76705	Echo exam of abdomen		Z2	1.2851	$54.40
76770	Us exam abdo back wall comp		Z2	1.2851	$54.40
76775	Us exam abdo back wall lim		Z2	1.2851	$54.40
76776	Us exam k transpl w/doppler		Z2	1.2851	$54.40
76800	Us exam spinal canal		Z2	1.2851	$54.40
76801	Ob us < 14 wks single fetus		Z2	1.2851	$54.40
76802	Ob us < 14 wks addl fetus		Z3		$19.89
76805	Ob us >/= 14 wks sngl fetus		Z2	1.2851	$54.40
76810	Ob us >/= 14 wks addl fetus		Z3		$35.71
76811	Ob us detailed sngl fetus		Z3		$69.01
76812	Ob us detailed addl fetus		Z2	0.8431	$35.69
76813	Ob us nuchal meas 1 gest		Z2	0.8431	$35.69
76814	Ob us nuchal meas add-on		Z3		$23.00
76815	Ob us limited fetus(s)		Z2	0.8431	$35.69
76816	Ob us follow-up per fetus		Z2	0.8431	$35.69
76817	Transvaginal us obstetric		Z2	0.8431	$35.69
76818	Fetal biophys profile w/nst		Z3		$51.04
76819	Fetal biophys profil w/o nst		Z3		$37.86
76820	Umbilical artery echo		Z3		$13.42
76821	Middle cerebral artery echo		Z2	0.8431	$35.69
76825	Echo exam of fetal heart		Z3		$98.73
76826	Echo exam of fetal heart		Z3		$63.02
76827	Echo exam of fetal heart		Z3		$25.40
76828	Echo exam of fetal heart		Z3		$13.66
76830	Transvaginal us non-ob		Z2	1.2851	$54.40
76831	Echo exam uterus		Z3		$65.66
76856	Us exam pelvic complete		Z2	1.2851	$54.40
76857	Us exam pelvic limited		Z2	0.8431	$35.69
76870	Us exam scrotum		Z2	1.2851	$54.40
76872	Us transrectal		Z2	1.2851	$54.40
76873	Echograp trans r pros study		Z2	1.2851	$54.40
76881	Us xtr non-vasc complete		Z2	1.2851	$54.40
76882	Us xtr non-vasc lmtd		Z3		$7.43
76885	Us exam infant hips dynamic		Z2	0.8431	$35.69
76886	Us exam infant hips static		Z2	0.8431	$35.69
76930	Echo guide cardiocentesis		N1		
76932	Echo guide for heart biopsy		N1		
76936	Echo guide for artery repair		Z2	1.4363	$60.80
76937	Us guide vascular access		N1		
76940	Us guide tissue ablation		N1		
76941	Echo guide for transfusion		N1		
76942	Echo guide for biopsy		N1		
76945	Echo guide villus sampling		N1		
76946	Echo guide for amniocentesis		N1		
76948	Echo guide ova aspiration		N1		
76950	Echo guidance radiotherapy		N1		
76965	Echo guidance radiotherapy		N1		
76970	Ultrasound exam follow-up		Z2	0.8431	$35.69
76975	GI endoscopic ultrasound		N1		
76977**	Us bone density measure		Z3		$4.07
76998	Us guide intraop		N1		
76999	Echo examination procedure		Z2	0.8431	$35.69
77001	Fluoroguide for vein device		N1		
77002	Needle localization by xray		N1		
77003	Fluoroguide for spine inject		N1		
77011	Ct scan for localization		N1		
77012	Ct scan for needle biopsy		N1		
77013	Ct guide for tissue ablation		N1		
77014	Ct scan for therapy guide		N1		
77021	Mr guidance for needle place		N1		
77022	Mri for tissue ablation		N1		
77031	Stereotact guide for brst bx		N1		
77032	Guidance for needle breast		N1		
77053	X-ray of mammary duct		N1		
77054	X-ray of mammary ducts		N1		
77071	X-ray stress view		Z3		$23.72
77072	X-rays for bone age		Z3		$9.83
77073	X-rays bone length studies		Z3		$17.25
77074	X-rays bone survey limited		Z3		$33.55
77075	X-rays bone survey complete		Z2	1.0152	$42.97
77076	X-rays bone survey infant		Z2	1.0152	$42.97
77077	Joint survey single view		Z3		$17.73
77078**	Ct bone density axial		Z2	0.9575	$40.53
77079**	Ct bone density peripheral		Z3		$24.68
77080**	Dxa bone density axial		Z3		$32.59
77081**	Dxa bone density/peripheral		Z3		$12.22
77082	Dxa bone density vert fx		Z3		$13.90
77083**	Radiographic absorptiometry		Z3		$10.30
77084	Magnetic image bone marrow		Z2	4.5196	$191.31
77280	Set radiation therapy field		Z2	1.4009	$59.30
77285	Set radiation therapy field		Z2	3.4689	$146.84
77290	Set radiation therapy field		Z2	3.4689	$146.84
77295	Set radiation therapy field		Z3		$188.83
77299	Radiation therapy planning		Z2	1.4009	$59.30
77300	Radiation therapy dose plan		Z3		$25.40
77301	Radiotherapy dose plan imrt		Z2	12.4155	$525.54
77305	Teletx isodose plan simple		Z3		$18.93
77310	Teletx isodose plan intermed		Z3		$25.40
77315	Teletx isodose plan complex		Z3		$41.70
77321	Special teletx port plan		Z3		$35.23
77326	Brachytx isodose calc simp		Z2	1.4009	$59.30
77327	Brachytx isodose calc interm		Z3		$91.30
77328	Brachytx isodose plan compl		Z3		$115.02
77331	Special radiation dosimetry		Z3		$12.94
77332	Radiation treatment aid(s)		Z3		$34.75
77333	Radiation treatment aid(s)		Z3		$9.11
77334	Radiation treatment aid(s)		Z3		$60.15
77336	Radiation physics consult		Z3		$31.87
77338	Design mlc device for imrt		Z2	3.4689	$146.84
77370	Radiation physics consult		Z2	1.4009	$59.30
77371	Srs multisource		Z2	99.4751	"$4,210.68"
77399	External radiation dosimetry		Z2	1.4009	$59.30
77401	Radiation treatment delivery		Z3		$15.10
77402	Radiation treatment delivery		Z2	1.2774	$54.07
77403	Radiation treatment delivery		Z2	1.2774	$54.07
77404	Radiation treatment delivery		Z2	1.2774	$54.07
77406	Radiation treatment delivery		Z2	1.2774	$54.07
77407	Radiation treatment delivery		Z2	1.2774	$54.07
77408	Radiation treatment delivery		Z2	2.2195	$93.95
77409	Radiation treatment delivery		Z2	2.2195	$93.95
77411	Radiation treatment delivery		Z2	2.2195	$93.95
77412	Radiation treatment delivery		Z2	2.2195	$93.95
77413	Radiation treatment delivery		Z2	2.2195	$93.95
77414	Radiation treatment delivery		Z2	2.2195	$93.95
77416	Radiation treatment delivery		Z2	2.2195	$93.95
77417	Radiology port film(s)		N1		
77418	Radiation tx delivery imrt		Z2	6.0383	$255.60
77421	Stereoscopic x-ray guidance		N1		
77422	Neutron beam tx simple		Z2	2.2195	$93.95
77423	Neutron beam tx complex		Z2	2.2195	$93.95
77435	Sbrt management		N1		
77470	Special radiation treatment		Z3		$48.89
77520	Proton trmt simple w/o comp		Z2	13.3989	$567.16
77522	Proton trmt simple w/comp		Z2	13.3989	$567.16
77523	Proton trmt intermediate		Z2	17.5276	$741.93
77525	Proton treatment complex		Z2	17.5276	$741.93
77600	Hyperthermia treatment		Z2	5.2577	$222.55
77605	Hyperthermia treatment		Z2	5.2577	$222.55
77610	Hyperthermia treatment		Z2	5.2577	$222.55
77615	Hyperthermia treatment		Z2	5.2577	$222.55
77620	Hyperthermia treatment		Z2	5.2577	$222.55
77750	Infuse radioactive materials		Z3		$70.45
77761	Apply intrcav radiat simple		Z3		$122.21
77762	Apply intrcav radiat interm		Z3		$140.67
77763	Apply intrcav radiat compl		Z3		$182.84
77776	Apply interstit radiat simpl		Z3		$124.61
77777	Apply interstit radiat inter		Z3		$129.88
77778	Apply interstit radiat compl		Z3		$187.15
77785	Hdr brachytx 1 channel		Z3		$111.43
77786	Hdr brachytx 2-12 channel		Z3		$275.34
77787	Hdr brachytx over 12 chan		Z2	9.2473	$391.43
77789	Apply surface radiation		Z3		$37.86
77790	Radiation handling		N1		
77799	Radium/radioisotope therapy		Z2	4.4066	$186.53
78000	Thyroid single uptake		Z2	1.4184	$60.04
78001	Thyroid multiple uptakes		Z2	1.4184	$60.04
78003	Thyroid suppress/stimul		Z2	1.4184	$60.04
78006	Thyroid imaging with uptake		Z2	2.9759	$125.97
78007	Thyroid image mult uptakes		Z2	2.9759	$125.97
78010	Thyroid imaging		Z2	1.749	$74.03
78011	Thyroid imaging with flow		Z2	1.749	$74.03
78015	Thyroid met imaging		Z2	3.7843	$160.19
78016	Thyroid met imaging/studies		Z2	3.7843	$160.19
78018	Thyroid met imaging body		Z2	3.7843	$160.19
78020	Thyroid met uptake		N1		
78070	Parathyroid nuclear imaging		Z2	2.9759	$125.97
78075	Adrenal nuclear imaging		Z2	6.5434	$276.98
78099	Endocrine nuclear procedure		Z2	1.749	$74.03
78102	Bone marrow imaging ltd		Z2	3.4804	$147.32
78103	Bone marrow imaging mult		Z2	3.4804	$147.32
78104	Bone marrow imaging body		Z2	3.4804	$147.32
78110	Plasma volume single		Z2	5.9086	$250.11
78111	Plasma volume multiple		Z2	5.9086	$250.11
78120	Red cell mass single		Z2	5.9086	$250.11
78121	Red cell mass multiple		Z2	5.9086	$250.11
78122	Blood volume		Z2	5.9086	$250.11
78130	Red cell survival study		Z2	5.9086	$250.11
78135	Red cell survival kinetics		Z2	5.9086	$250.11
78140	Red cell sequestration		Z2	5.9086	$250.11
78185	Spleen imaging		Z2	3.4804	$147.32
78190	Platelet survival kinetics		Z2	2.377	$100.62
78191	Platelet survival		Z2	2.377	$100.62
78195	Lymph system imaging		Z2	3.4804	$147.32
78199	Blood/lymph nuclear exam		Z2	3.4804	$147.32
78201	Liver imaging		Z2	3.8979	$164.99
78202	Liver imaging with flow		Z2	3.8979	$164.99
78205	Liver imaging (3D)		Z2	3.8979	$164.99
78206	Liver image (3d) with flow		Z2	3.8979	$164.99
78215	Liver and spleen imaging		Z2	3.8979	$164.99
78216	Liver & spleen image/flow		Z2	3.8979	$164.99
78220	Liver function study		Z2	3.8979	$164.99
78223	Hepatobiliary imaging		Z2	3.8979	$164.99
78230	Salivary gland imaging		Z2	3.2408	$137.18
78231	Serial salivary imaging		Z2	3.2408	$137.18
78232	Salivary gland function exam		Z2	3.2408	$137.18
78258	Esophageal motility study		Z2	3.2408	$137.18
78261	Gastric mucosa imaging		Z2	3.2408	$137.18
78262	Gastroesophageal reflux exam		Z2	3.2408	$137.18
78264	Gastric emptying study		Z2	3.2408	$137.18
78270	Vit B-12 absorption exam		Z2	2.377	$100.62
78271	Vit b-12 absrp exam int fac		Z2	2.377	$100.62
78272	Vit b-12 absorp combined		Z2	2.377	$100.62
78278	Acute GI blood loss imaging		Z2	3.2408	$137.18
78282	GI protein loss exam		Z2	3.2408	$137.18
78290	Meckels divert exam		Z2	3.2408	$137.18
78291	Leveen/shunt patency exam		Z2	3.2408	$137.18
78299	GI nuclear procedure		Z2	3.2408	$137.18
78300	Bone imaging limited area		Z2	3.2937	$139.42
78305	Bone imaging multiple areas		Z2	3.2937	$139.42
78306	Bone imaging whole body		Z2	3.2937	$139.42
78315	Bone imaging 3 phase		Z2	3.2937	$139.42
78320	Bone imaging (3D)		Z2	3.2937	$139.42
78399	Musculoskeletal nuclear exam		Z2	3.2937	$139.42
78414	Non-imaging heart function		Z2	3.9603	$167.64
78428	Cardiac shunt imaging		Z2	3.9603	$167.64
78445	Vascular flow imaging		Z2	2.2701	$96.09
78451	Ht muscle image spect sing		Z2	9.1371	$386.76
78452	Ht muscle image spect mult		Z2	9.1371	$386.76
78453	Ht muscle image planar sing		Z2	9.1371	$386.76
78454	Ht musc image planar mult		Z2	9.1371	$386.76
78456	Acute venous thrombus image		Z2	2.2701	$96.09
78457	Venous thrombosis imaging		Z2	2.2701	$96.09
78458	Ven thrombosis images bilat		Z2	2.2701	$96.09
78459	Heart muscle imaging (PET)		Z2	12.439	$526.53
78466	Heart infarct image		Z2	3.9603	$167.64
78468	Heart infarct image (ef)		Z2	3.9603	$167.64
78469	Heart infarct image (3D)		Z2	3.9603	$167.64
78472	Gated heart planar single		Z2	3.9603	$167.64
78473	Gated heart multiple		Z2	3.9603	$167.64
78481	Heart first pass single		Z2	3.9603	$167.64
78483	Heart first pass multiple		Z2	3.9603	$167.64
78491	Heart image (pet) single		Z2	12.439	$526.53
78492	Heart image (pet) multiple		Z2	12.439	$526.53
78494	Heart image spect		Z2	3.9603	$167.64
78496	Heart first pass add-on		N1		
78499	Cardiovascular nuclear exam		Z2	3.9603	$167.64
78580	Lung perfusion imaging		Z2	2.6643	$112.78
78584	Lung V/Q image single breath		Z2	4.2234	$178.77
78585	Lung V/Q imaging		Z2	4.2234	$178.77
78586	Aerosol lung image single		Z2	2.6643	$112.78
78587	Aerosol lung image multiple		Z2	2.6643	$112.78
78588	Perfusion lung image		Z2	4.2234	$178.77
78591	Vent image 1 breath 1 proj		Z2	2.6643	$112.78
78593	Vent image 1 proj gas		Z2	2.6643	$112.78
78594	Vent image mult proj gas		Z2	2.6643	$112.78
78596	Lung differential function		Z2	4.2234	$178.77
78599	Respiratory nuclear exam		Z2	2.6643	$112.78
78600	Brain image < 4 views		Z2	3.1546	$133.53
78601	Brain image w/flow < 4 views		Z2	8.1621	$345.49
78605	Brain image 4+ views		Z2	3.1546	$133.53
78606	Brain image w/flow 4 + views		Z2	8.1621	$345.49
78607	Brain imaging (3D)		Z2	8.1621	$345.49
78608	Brain imaging (PET)		Z2	13.7006	$579.93
78610	Brain flow imaging only		Z2	3.1546	$133.53
78630	Cerebrospinal fluid scan		Z2	8.1621	$345.49
78635	CSF ventriculography		Z2	8.1621	$345.49
78645	CSF shunt evaluation		Z2	3.1546	$133.53
78647	Cerebrospinal fluid scan		Z2	8.1621	$345.49
78650	CSF leakage imaging		Z2	8.1621	$345.49
78660	Nuclear exam of tear flow		Z2	3.1546	$133.53
78699	Nervous system nuclear exam		Z2	3.1546	$133.53
78700	Kidney imaging morphol		Z2	4.2849	$181.38
78701	Kidney imaging with flow		Z2	4.2849	$181.38
78707	K flow/funct image w/o drug		Z2	4.2849	$181.38
78708	K flow/funct image w/drug		Z2	4.2849	$181.38
78709	K flow/funct image multiple		Z2	4.2849	$181.38
78710	Kidney imaging (3D)		Z2	4.2849	$181.38
78725	Kidney function study		Z2	2.377	$100.62
78730	Urinary bladder retention		Z2	1.4184	$60.04
78740	Ureteral reflux study		Z2	4.2849	$181.38
78761	Testicular imaging w/flow		Z2	4.2849	$181.38
78799	Genitourinary nuclear exam		Z2	4.2849	$181.38
78800	Tumor imaging limited area		Z2	3.7843	$160.19
78801	Tumor imaging mult areas		Z2	6.5434	$276.98
78802	Tumor imaging whole body		Z2	6.5434	$276.98
78803	Tumor imaging (3D)		Z2	6.5434	$276.98
78804	Tumor imaging whole body		Z2	12.8657	$544.59
78805	Abscess imaging ltd area		Z2	6.5434	$276.98
78806	Abscess imaging whole body		Z2	6.5434	$276.98
78807	Nuclear localization/abscess		Z2	6.5434	$276.98
78808	Iv inj ra drug dx study		N1		
78811	Pet image ltd area		Z2	13.7006	$579.93
78812	Pet image skull-thigh		Z2	13.7006	$579.93
78813	Pet image full body		Z2	13.7006	$579.93
78814	Pet image w/ct lmtd		Z2	13.7006	$579.93
78815	Pet image w/ct skull-thigh		Z2	13.7006	$579.93
78816	Pet image w/ct full body		Z2	13.7006	$579.93
78999	Nuclear diagnostic exam		Z2	1.4184	$60.04
79005	Nuclear rx oral admin		Z3		$35.47
79101	Nuclear rx iv admin		Z3		$38.10
79200	Nuclear rx intracav admin		Z3		$46.01
79300	Nuclr rx interstit colloid		Z2	3.0751	$130.17
79403	Hematopoietic nuclear tx		Z3		$58.47
79440	Nuclear rx intra-articular		Z3		$39.54
79445	Nuclear rx intra-arterial		Z2	3.0751	$130.17
79999	Nuclear medicine therapy		Z2	3.0751	$130.17
90371	Hep b ig im		K2		$112.16
90375	Rabies ig im/sc		K2		$159.86
90376	Rabies ig heat treated		K2		$154.18
90378	Rsv mab im 50mg	CH	N1		
90385	Rh ig minidose im		N1		
90396	Varicella-zoster ig im		K2		$129.48
90476	Adenovirus vaccine type 4	CH	N1		
90585	Bcg vaccine percut		K2		$112.46
90632	Hep a vaccine adult im		N1		
90633	Hep a vacc ped/adol 2 dose		N1		
90634	Hep a vacc ped/adol 3 dose		N1		
90636	Hep a/hep b vacc adult im		N1		
90645	Hib vaccine hboc im		N1		
90646	Hib vaccine prp-d im		N1		
90647	Hib vaccine prp-omp im		N1		
90648	Hib vaccine prp-t im		N1		
90655**	Flu vaccine no preserv 6-35m		L1		
90656**	Flu vaccine no preserv 3 & >		L1		
90657**	Flu vaccine 3 yrs im		L1		
90660**	Flu vaccine nasal		L1		
90662**	Flu vacc prsv free inc antig		L1		
90665	Lyme disease vaccine im		N1		
90669**	Pneumococcal vacc 7 val im		L1		
90670**	Pneumococcal vacc 13 val im		L1		
90675	Rabies vaccine im		K2		$190.82
90676	Rabies vaccine id		K2		$107.83
90680	Rotovirus vacc 3 dose oral	CH	N1		
90681	Rotavirus vacc 2 dose oral		K2		$100.56
90690	Typhoid vaccine oral		N1		
90691	Typhoid vaccine im		N1		
90692	Typhoid vaccine h-p sc/id		N1		
90696	Dtap-ipv vacc 4-6 yr im		N1		
90698	Dtap-hib-ip vaccine im		N1		
90700	Dtap vaccine < 7 yrs im		N1		
90701	Dtp vaccine im		N1		
90702	Dt vaccine < 7 im		N1		
90703	Tetanus vaccine im		N1		
90704	Mumps vaccine sc		N1		
90705	Measles vaccine sc		N1		
90706	Rubella vaccine sc		N1		
90707	Mmr vaccine sc		N1		
90708	Measles-rubella vaccine sc		N1		
90710	Mmrv vaccine sc		N1		
90712	Oral poliovirus vaccine		N1		
90713	Poliovirus ipv sc/im		N1		
90714	Td vaccine no prsrv >/= 7 im		N1		
90715	Tdap vaccine >7 im		N1		
90717	Yellow fever vaccine sc		N1		
90718	Td vaccine > 7 im		N1		
90719	Diphtheria vaccine im		N1		
90720	Dtp/hib vaccine im		N1		
90721	Dtap/hib vaccine im		N1		
90732**	Pneumococcal vaccine		L1		
90733	Meningococcal vaccine sc		K2		$104.49
90734	Meningococcal vaccine im		K2		$83.39
90735	Encephalitis vaccine sc		K2		$100.16
90740**	Hepb vacc ill pat 3 dose im		F4		
90743**	Hep b vacc adol 2 dose im		F4		
90744**	Hepb vacc ped/adol 3 dose im		F4		
90746**	Hep b vaccine adult im		F4		
90747**	Hepb vacc ill pat 4 dose im		F4		
90749	Vaccine toxoid		N1		
A4218	Sterile saline or water		N1		
A4220	Infusion pump refill kit		N1		
A4248	Chlorhexidine antisept		N1		
A4262	Temporary tear duct plug		N1		
A4263	Permanent tear duct plug		N1		
A4270	Disposable endoscope sheath		N1		
A4300	Cath impl vasc access portal		N1		
A4301	Implantable access syst perc		N1		
A4305	Drug delivery system >=50 ML		N1		
A4306	Drug delivery system <=50 ml		N1		
A4641	Radiopharm dx agent noc		N1		
A4642	In111 satumomab		N1		
A4648	Implantable tissue marker		N1		
A4650	Implant radiation dosimeter		N1		
A9500	Tc99m sestamibi		N1		
A9501	Technetium TC-99m teboroxime		N1		
A9502	Tc99m tetrofosmin		N1		
A9503	Tc99m medronate		N1		
A9504	Tc99m apcitide		N1		
A9505	TL201 thallium		N1		
A9507	In111 capromab		N1		
A9508	"I131 iodobenguate, dx"		N1		
A9509	Iodine I-123 sod iodide mil		N1		
A9510	Tc99m disofenin		N1		
A9512	Tc99m pertechnetate		N1		
A9516	Iodine I-123 sod iodide mic		N1		
A9521	Tc99m exametazime		N1		
A9524	"I131 serum albumin, dx"		N1		
A9526	Nitrogen N-13 ammonia		N1		
A9527	Iodine I-125 sodium iodide		H2		$19.91
A9528	"Iodine I-131 iodide cap, dx"		N1		
A9529	"I131 iodide sol, dx"		N1		
A9531	I131 max 100uCi		N1		
A9532	"I125 serum albumin, dx"		N1		
A9536	Tc99m depreotide		N1		
A9537	Tc99m mebrofenin		N1		
A9538	Tc99m pyrophosphate		N1		
A9539	Tc99m pentetate		N1		
A9540	Tc99m MAA		N1		
A9541	Tc99m sulfur colloid		N1		
A9542	"In111 ibritumomab, dx"		N1		
A9544	"I131 tositumomab, dx"		N1		
A9546	Co57/58		N1		
A9547	In111 oxyquinoline		N1		
A9548	In111 pentetate		N1		
A9550	Tc99m gluceptate		N1		
A9551	Tc99m succimer		N1		
A9552	F18 fdg		N1		
A9553	Cr51 chromate		N1		
A9554	"I125 iothalamate, dx"		N1		
A9555	Rb82 rubidium		N1		
A9556	Ga67 gallium		N1		
A9557	Tc99m bicisate		N1		
A9558	Xe133 xenon 10mci		N1		
A9559	Co57 cyano		N1		
A9560	Tc99m labeled rbc		N1		
A9561	Tc99m oxidronate		N1		
A9562	Tc99m mertiatide		N1		
A9566	Tc99m fanolesomab		N1		
A9567	Technetium TC-99m aerosol		N1		
A9568	Technetium tc99m arcitumomab		N1		
A9569	Technetium TC-99m auto WBC		N1		
A9570	Indium In-111 auto WBC		N1		
A9571	Indium IN-111 auto platelet		N1		
A9572	Indium In-111 pentetreotide		N1		
A9576	Inj prohance multipack		N1		
A9577	Inj multihance		N1		
A9578	Inj multihance multipack		N1		
A9579	"Gad-base MR contrast NOS,1ml"		N1		
A9580	Sodium fluoride F-18		N1		
A9581	Gadoxetate disodium inj		N1		
A9582	Iodine I-123 iobenguane	CH	N1		
A9583	Gadofosveset trisodium inj	CH	N1		
A9698	Non-rad contrast materialNOC		N1		
C1713	"Anchor/screw bn/bn,tis/bn"		N1		
C1714	"Cath, trans atherectomy, dir"		N1		
C1715	Brachytherapy needle		N1		
C1716	"Brachytx, non-str, Gold-198"		H2		$70.25
C1717	"Brachytx, non-str,HDR Ir-192"		H2		$219.93
C1719	"Brachytx, NS, Non-HDRIr-192"		H2		$31.14
C1721	"AICD, dual chamber"		N1		
C1722	"AICD, single chamber"		N1		
C1724	"Cath, trans atherec,rotation"		N1		
C1725	"Cath, translumin non-laser"		N1		
C1726	"Cath, bal dil, non-vascular"		N1		
C1727	"Cath, bal tis dis, non-vas"		N1		
C1728	"Cath, brachytx seed adm"		N1		
C1729	"Cath, drainage"		N1		
C1730	"Cath, EP, 19 or few elect"		N1		
C1731	"Cath, EP, 20 or more elec"		N1		
C1732	"Cath, EP, diag/abl, 3D/vect"		N1		
C1733	"Cath, EP, othr than cool-tip"		N1		
C1749	"Endo, colon, retro imaging"		J7		
C1750	"Cath, hemodialysis,long-term"		N1		
C1751	"Cath, inf, per/cent/midline"		N1		
C1752	"Cath,hemodialysis,short-term"		N1		
C1753	"Cath, intravas ultrasound"		N1		
C1754	"Catheter, intradiscal"		N1		
C1755	"Catheter, intraspinal"		N1		
C1756	"Cath, pacing, transesoph"		N1		
C1757	"Cath, thrombectomy/embolect"		N1		
C1758	"Catheter, ureteral"		N1		
C1759	"Cath, intra echocardiography"		N1		
C1760	"Closure dev, vasc"		N1		
C1762	"Conn tiss, human(inc fascia)"		N1		
C1763	"Conn tiss, non-human"		N1		
C1764	"Event recorder, cardiac"		N1		
C1765	Adhesion barrier		N1		
C1766	"Intro/sheath,strble,non-peel"		N1		
C1767	"Generator, neuro non-recharg"		N1		
C1768	"Graft, vascular"		N1		
C1769	Guide wire		N1		
C1770	"Imaging coil, MR, insertable"		N1		
C1771	"Rep dev, urinary, w/sling"		N1		
C1772	"Infusion pump, programmable"		N1		
C1773	"Ret dev, insertable"		N1		
C1776	Joint device (implantable)		N1		
C1777	"Lead, AICD, endo single coil"		N1		
C1778	"Lead, neurostimulator"		N1		
C1779	"Lead, pmkr, transvenous VDD"		N1		
C1780	"Lens, intraocular (new tech)"		N1		
C1781	Mesh (implantable)		N1		
C1782	Morcellator		N1		
C1783	"Ocular imp, aqueous drain de"		N1		
C1784	"Ocular dev, intraop, det ret"		N1		
C1785	"Pmkr, dual, rate-resp"		N1		
C1786	"Pmkr, single, rate-resp"		N1		
C1787	"Patient progr, neurostim"		N1		
C1788	"Port, indwelling, imp"		N1		
C1789	"Prosthesis, breast, imp"		N1		
C1813	"Prosthesis, penile, inflatab"		N1		
C1814	"Retinal tamp, silicone oil"		N1		
C1815	"Pros, urinary sph, imp"		N1		
C1816	"Receiver/transmitter, neuro"		N1		
C1817	Septal defect imp sys		N1		
C1818	Integrated keratoprosthesis		N1		
C1819	Tissue localization-excision		N1		
C1820	Generator neuro rechg bat sy		N1		
C1821	Interspinous implant		N1		
C1874	"Stent, coated/cov w/del sys"		N1		
C1875	"Stent, coated/cov w/o del sy"		N1		
C1876	"Stent, non-coa/non-cov w/del"		N1		
C1877	"Stent, non-coat/cov w/o del"		N1		
C1878	Matrl for vocal cord		N1		
C1879	"Tissue marker, implantable"		N1		
C1880	Vena cava filter		N1		
C1881	Dialysis access system		N1		
C1882	"AICD, other than sing/dual"		N1		
C1883	"Adapt/ext, pacing/neuro lead"		N1		
C1884	Embolization Protect syst		N1		
C1885	"Cath, translumin angio laser"		N1		
C1887	"Catheter, guiding"		N1		
C1888	Endovas non-cardiac abl cath		N1		
C1891	"Infusion pump,non-prog, perm"		N1		
C1892	"Intro/sheath,fixed,peel-away"		N1		
C1893	"Intro/sheath, fixed,non-peel"		N1		
C1894	"Intro/sheath, non-laser"		N1		
C1895	"Lead, AICD, endo dual coil"		N1		
C1896	"Lead, AICD, non sing/dual"		N1		
C1897	"Lead, neurostim test kit"		N1		
C1898	"Lead, pmkr, other than trans"		N1		
C1899	"Lead, pmkr/AICD combination"		N1		
C1900	"Lead, coronary venous"		N1		
C2614	"Probe, perc lumb disc"		N1		
C2615	"Sealant, pulmonary, liquid"		N1		
C2616	"Brachytx, non-str,Yttrium-90"		H2		"$16,126.38"
C2617	"Stent, non-cor, tem w/o del"		N1		
C2618	"Probe, cryoablation"		N1		
C2619	"Pmkr, dual, non rate-resp"		N1		
C2620	"Pmkr, single, non rate-resp"		N1		
C2621	"Pmkr, other than sing/dual"		N1		
C2622	"Prosthesis, penile, non-inf"		N1		
C2625	"Stent, non-cor, tem w/del sy"		N1		
C2626	"Infusion pump, non-prog,temp"		N1		
C2627	"Cath, suprapubic/cystoscopic"		N1		
C2628	"Catheter, occlusion"		N1		
C2629	"Intro/sheath, laser"		N1		
C2630	"Cath, EP, cool-tip"		N1		
C2631	"Rep dev, urinary, w/o sling"		N1		
C2634	"Brachytx, non-str, HA, I-125"		H2		$54.90
C2635	"Brachytx, non-str, HA, P-103"		H2		$23.87
C2636	"Brachy linear, non-str,P-103"		H2		$35.49
C2638	"Brachytx, stranded, I-125"		H2		$43.21
C2639	"Brachytx, non-stranded,I-125"		H2		$34.65
C2640	"Brachytx, stranded, P-103"		H2		$73.65
C2641	"Brachytx, non-stranded,P-103"		H2		$64.30
C2642	"Brachytx, stranded, C-131"		H2		$117.47
C2643	"Brachytx, non-stranded,C-131"		H2		$74.52
C2698	"Brachytx, stranded, NOS"		H2		$43.21
C2699	"Brachytx, non-stranded, NOS"		H2		$23.87
C8900	"MRA w/cont, abd"		Z2	5.7993	$245.48
C8901	"MRA w/o cont, abd"		Z2	4.5196	$191.31
C8902	"MRA w/o fol w/cont, abd"		Z2	7.1603	$303.09
C8903	"MRI w/cont, breast,  uni"		Z2	5.7993	$245.48
C8904	"MRI w/o cont, breast, uni"		Z2	4.5196	$191.31
C8905	"MRI w/o fol w/cont, brst, un"		Z2	7.1603	$303.09
C8906	"MRI w/cont, breast,  bi"		Z2	5.7993	$245.48
C8907	"MRI w/o cont, breast, bi"		Z2	4.5196	$191.31
C8908	"MRI w/o fol w/cont, breast,"		Z2	7.1603	$303.09
C8909	"MRA w/cont, chest"		Z2	5.7993	$245.48
C8910	"MRA w/o cont, chest"		Z2	4.5196	$191.31
C8911	"MRA w/o fol w/cont, chest"		Z2	7.1603	$303.09
C8912	"MRA w/cont, lwr ext"		Z2	5.7993	$245.48
C8913	"MRA w/o cont, lwr ext"		Z2	4.5196	$191.31
C8914	"MRA w/o fol w/cont, lwr ext"		Z2	7.1603	$303.09
C8918	"MRA w/cont, pelvis"		Z2	5.7993	$245.48
C8919	"MRA w/o cont, pelvis"		Z2	4.5196	$191.31
C8920	"MRA w/o fol w/cont, pelvis"		Z2	7.1603	$303.09
C8931	"MRA, w/dye, spinal canal"		Z2	5.7993	$245.48
C8932	"MRA, w/o dye, spinal canal"		Z2	4.5196	$191.31
C8933	"MRA, w/o&w/dye, spinal canal"		Z2	7.1603	$303.09
C8934	"MRA, w/dye, upper extremity"		Z2	5.7993	$245.48
C8935	"MRA, w/o dye, upper extr"		Z2	4.5196	$191.31
C8936	"MRA, w/o&w/dye, upper extr"		Z2	7.1603	$303.09
C9113	"Inj pantoprazole sodium, via"		N1		
C9121	"Injection, argatroban"		K2		$18.71
C9248	"Inj, clevidipine butyrate"		K2		$6.03
C9250	Artiss fibrin sealant		K2		$121.80
C9254	"Injection, lacosamide"		K2		$0.15
C9257	Bevacizumab injection		K2		$1.47
C9270	Gammaplex IVIG		K2		$37.29
C9272	"Inj, denosumab"		K2		$14.52
C9273	"Sipuleucel-T, per infusion"		K2		"$32,860.00"
C9274	Crotalidae Poly Immune Fab		K2		"$2,111.36"
C9275	Hexaminolevulinate HCl		K2		$636.00
C9276	Cabazitaxel injection		K2		$135.05
C9277	"Lumizyme, 1 mg"		K2		$14.83
C9279	"Injection, ibuprofen"		K2		$1.39
C9280	"Injection, eribulin mesylate"		K2		$901.00
C9281	"Injection, pegloticase"		K2		$304.75
C9282	"Inj, ceftaroline fosamil"		K2		$0.72
C9352	"Neuragen nerve guide, per cm"		N1		
C9353	"Neurawrap nerve protector,cm"		N1		
C9354	"Veritas collagen matrix, cm2"		N1		
C9355	"Neuromatrix nerve cuff, cm"		N1		
C9356	"TenoGlide tendon prot, cm2"		N1		
C9358	"SurgiMend, fetal"		K2		$11.09
C9359	"Implnt,bon void filler-putty"		N1		
C9360	"SurgiMend, neonatal"		K2		$11.59
C9361	NeuroMend nerve wrap	CH	N1		
C9362	"Implnt,bon void filler-strip"	CH	N1		
C9363	Integra Meshed Bil Wound Mat		K2		$19.17
C9364	"Porcine implant, Permacol"	CH	N1		
C9367	Endoform Dermal Template		K2		$4.35
C9399	Unclassified drugs or biolog		K7		
E0616	Cardiac event recorder		N1		
E0749	Elec osteogen stim implanted		N1		
E0782	Non-programble infusion pump		N1		
E0783	Programmable infusion pump		N1		
E0785	Replacement impl pump cathet		N1		
E0786	Implantable pump replacement		N1		
G0130**	Single energy x-ray study		Z3		$15.82
G0173	Linear acc stereo radsur com		Z2	43.8918	"$1,857.90"
G0251	Linear acc based stero radio		Z2	11.6706	$494.00
G0288	"Recon, CTA for surg plan"		N1		
G0339	"Robot lin-radsurg com, first"		Z2	43.8918	"$1,857.90"
G0340	Robt lin-radsurg fractx 2-5		Z2	33.0358	"$1,398.37"
J0120	Tetracyclin injection		N1		
J0129	Abatacept injection		K2		$20.26
J0130	Abciximab injection		K2		$515.32
J0132	Acetylcysteine injection		K2		$2.67
J0133	Acyclovir injection		N1		
J0135	Adalimumab injection		K2		$394.16
J0150	Injection adenosine 6 MG		N1		
J0152	Adenosine injection		K2		$89.99
J0171	Adrenalin epinephrine inject		N1		
J0180	Agalsidase beta injection		K2		$133.65
J0200	Alatrofloxacin mesylate		N1		
J0205	Alglucerase injection		K2		$41.19
J0207	Amifostine		K2		$314.05
J0210	Methyldopate hcl injection		K2		$39.24
J0215	Alefacept		K2		$35.86
J0220	Alglucosidase alfa injection		K2		$155.84
J0256	Alpha 1 proteinase inhibitor		K2		$3.79
J0278	Amikacin sulfate injection		N1		
J0280	Aminophyllin 250 MG inj		N1		
J0282	Amiodarone HCl		N1		
J0285	Amphotericin B		N1		
J0287	Amphotericin b lipid complex		K2		$8.76
J0288	Ampho b cholesteryl sulfate		K2		$13.74
J0289	Amphotericin b liposome inj		K2		$14.77
J0290	Ampicillin 500 MG inj		N1		
J0295	Ampicillin sodium per 1.5 gm		N1		
J0300	Amobarbital 125 MG inj	CH	K2		$23.38
J0330	Succinycholine chloride inj		N1		
J0348	Anidulafungin injection		K2		$1.29
J0360	Hydralazine hcl injection		N1		
J0364	Apomorphine hydrochloride		N1		
J0365	"Aprotonin, 10,000 kiu"		N1		
J0380	Inj metaraminol bitartrate		N1		
J0390	Chloroquine injection		N1		
J0400	Aripiprazole injection		N1		
J0456	Azithromycin		N1		
J0461	Atropine sulfate injection		N1		
J0470	Dimecaprol injection		N1		
J0475	Baclofen 10 MG injection		K2		$200.54
J0476	Baclofen intrathecal trial		K2		$72.18
J0480	Basiliximab		K2		"$2,027.27"
J0500	Dicyclomine injection		N1		
J0515	Inj benztropine mesylate	CH	N1		
J0520	Bethanechol chloride inject		N1		
J0558	PenG benzathine/procaine inj		N1		
J0561	Penicillin g benzathine inj		N1		
J0583	Bivalirudin		K2		$2.54
J0585	"Injection,onabotulinumtoxinA"		K2		$5.38
J0586	AbobotulinumtoxinA		K2		$7.41
J0587	"Inj, rimabotulinumtoxinB"		K2		$10.33
J0592	Buprenorphine hydrochloride		N1		
J0594	Busulfan injection		K2		$16.29
J0595	Butorphanol tartrate 1 mg		N1		
J0597	"C-1 esterase, berinert"		K2		$27.53
J0598	"C-1 esterase, cinryze"		K2		$43.78
J0600	Edetate calcium disodium inj		K2		$192.07
J0610	Calcium gluconate injection		N1		
J0620	Calcium glycer & lact/10 ML		N1		
J0630	Calcitonin salmon injection	CH	N1		
J0636	Inj calcitriol per 0.1 mcg		N1		
J0637	Caspofungin acetate		K2		$12.13
J0638	Canakinumab injection		K2		$87.45
J0640	Leucovorin calcium injection		N1		
J0641	Levoleucovorin injection		K2		$1.78
J0670	Inj mepivacaine HCL/10 ml		N1		
J0690	Cefazolin sodium injection		N1		
J0692	Cefepime HCl for injection		N1		
J0694	Cefoxitin sodium injection		N1		
J0696	Ceftriaxone sodium injection		N1		
J0697	Sterile cefuroxime injection		N1		
J0698	Cefotaxime sodium injection		N1		
J0702	Betamethasone acet&sod phosp		N1		
J0706	Caffeine citrate injection		N1		
J0710	Cephapirin sodium injection		N1		
J0713	Inj ceftazidime per 500 mg		N1		
J0715	Ceftizoxime sodium / 500 MG		N1		
J0718	Certolizumab pegol inj		K2		$3.99
J0720	Chloramphenicol sodium injec		N1		
J0725	Chorionic gonadotropin/1000u		N1		
J0735	Clonidine hydrochloride	CH	N1		
J0740	Cidofovir injection		K2		$740.09
J0743	Cilastatin sodium injection		N1		
J0744	Ciprofloxacin iv		N1		
J0745	Inj codeine phosphate /30 MG		N1		
J0760	Colchicine injection		N1		
J0770	Colistimethate sodium inj		N1		
J0775	"Collagenase, clost hist inj"		K2		$37.51
J0780	Prochlorperazine injection		N1		
J0795	Corticorelin ovine triflutal		K2		$5.06
J0800	Corticotropin injection		K2		"$2,395.22"
J0833	Cosyntropin injection NOS		K2		$99.76
J0834	Cosyntropin cortrosyn inj	CH	N1		
J0850	Cytomegalovirus imm IV /vial		K2		$922.07
J0878	Daptomycin injection		K2		$0.45
J0881	"Darbepoetin alfa, non-esrd"		K2		$2.98
J0885	"Epoetin alfa, non-esrd"		K2		$9.57
J0894	Decitabine injection		K2		$30.71
J0895	Deferoxamine mesylate inj		N1		
J0900	Testosterone enanthate inj		N1		
J0945	Brompheniramine maleate inj	CH	N1		
J1000	Depo-estradiol cypionate inj		N1		
J1020	Methylprednisolone 20 MG inj		N1		
J1030	Methylprednisolone 40 MG inj		N1		
J1040	Methylprednisolone 80 MG inj		N1		
J1051	Medroxyprogesterone inj		N1		
J1060	Testosterone cypionate 1 ML		N1		
J1070	Testosterone cypionat 100 MG		N1		
J1080	Testosterone cypionat 200 MG		N1		
J1094	Inj dexamethasone acetate		N1		
J1100	Dexamethasone sodium phos		N1		
J1110	Inj dihydroergotamine mesylt		N1		
J1120	Acetazolamid sodium injectio		N1		
J1160	Digoxin injection		N1		
J1162	Digoxin immune fab (ovine)		K2		$583.90
J1165	Phenytoin sodium injection		N1		
J1170	Hydromorphone injection		N1		
J1180	Dyphylline injection		N1		
J1190	Dexrazoxane HCl injection		K2		$274.42
J1200	Diphenhydramine hcl injectio		N1		
J1205	Chlorothiazide sodium inj		K2		$272.64
J1212	Dimethyl sulfoxide 50% 50 ML		K2		$82.68
J1230	Methadone injection		N1		
J1240	Dimenhydrinate injection		N1		
J1245	Dipyridamole injection		N1		
J1250	Inj dobutamine HCL/250 mg		N1		
J1260	Dolasetron mesylate		N1		
J1265	Dopamine injection		N1		
J1267	Doripenem injection		N1		
J1270	"Injection, doxercalciferol"		N1		
J1290	Ecallantide injection		K2		$275.28
J1300	Eculizumab injection		K2		$183.71
J1320	Amitriptyline injection		N1		
J1324	Enfuvirtide injection		N1		
J1325	Epoprostenol injection		N1		
J1327	Eptifibatide injection		K2		$20.31
J1330	Ergonovine maleate injection		N1		
J1335	Ertapenem injection		N1		
J1364	Erythro lactobionate /500 MG		N1		
J1380	Estradiol valerate 10 MG inj		N1		
J1410	Inj estrogen conjugate 25 MG		K2		$94.03
J1430	Ethanolamine oleate 100 mg		K2		$147.14
J1436	Etidronate disodium inj		N1		
J1438	Etanercept injection		K2		$203.01
J1440	Filgrastim 300 mcg injection		K2		$238.72
J1441	Filgrastim 480 mcg injection		K2		$376.20
J1450	Fluconazole		N1		
J1451	"Fomepizole, 15 mg"		K2		$6.76
J1453	Fosaprepitant injection		K2		$1.71
J1455	Foscarnet sodium injection	CH	K2		$13.06
J1457	Gallium nitrate injection	CH	N1		
J1458	Galsulfase injection		K2		$338.26
J1459	Inj IVIG privigen 500 mg		K2		$34.45
J1460	Gamma globulin 1 CC inj		K2		$17.91
J1559	Hizentra injection		K2		$7.15
J1560	Gamma globulin > 10 CC inj		K2		$179.06
J1561	Gamunex injection		K2		$36.91
J1562	"Vivaglobin, inj"		K2		$7.11
J1566	"Immune globulin, powder"		K2		$30.62
J1568	Octagam injection		K2		$55.80
J1569	Gammagard liquid injection		K2		$37.67
J1570	Ganciclovir sodium injection	CH	K2		$62.51
J1571	Hepagam b im injection		K2		$57.07
J1572	Flebogamma injection		K2		$35.04
J1573	"Hepagam b intravenous, inj"		K2		$57.07
J1580	Garamycin gentamicin inj		N1		
J1590	Gatifloxacin injection		N1		
J1595	Injection glatiramer acetate		K2		$95.57
J1599	"Ivig non-lyophilized, NOS"		N1		
J1600	Gold sodium thiomaleate inj		N1		
J1610	Glucagon hydrochloride/1 MG		K2		$95.59
J1620	Gonadorelin hydroch/ 100 mcg	CH	K2		$94.82
J1626	Granisetron hcl injection		N1		
J1630	Haloperidol injection		N1		
J1631	Haloperidol decanoate inj		N1		
J1640	"Hemin, 1 mg"		K2		$8.33
J1642	Inj heparin sodium per 10 u		N1		
J1644	Inj heparin sodium per 1000u		N1		
J1645	Dalteparin sodium		N1		
J1650	Inj enoxaparin sodium		N1		
J1652	Fondaparinux sodium		N1		
J1655	Tinzaparin sodium injection		N1		
J1670	Tetanus immune globulin inj		K2		$222.97
J1680	Human fibrinogen conc inj		K2		$71.52
J1700	Hydrocortisone acetate inj		N1		
J1710	Hydrocortisone sodium ph inj		N1		
J1720	Hydrocortisone sodium succ i		N1		
J1730	Diazoxide injection	CH	N1		
J1740	Ibandronate sodium injection		K2		$144.36
J1742	Ibutilide fumarate injection		K2		$129.32
J1743	Idursulfase injection		K2		$446.45
J1745	Infliximab injection		K2		$58.90
J1750	Inj iron dextran		K2		$11.59
J1756	Iron sucrose injection	CH	N1		
J1786	Imuglucerase injection		K2		$41.19
J1790	Droperidol injection		N1		
J1800	Propranolol injection		N1		
J1815	Insulin injection		N1		
J1817	Insulin for insulin pump use		N1		
J1830	Interferon beta-1b / .25 MG		K2		$197.14
J1835	Itraconazole injection	CH	K2		$359.59
J1840	Kanamycin sulfate 500 MG inj		N1		
J1850	Kanamycin sulfate 75 MG inj		N1		
J1885	Ketorolac tromethamine inj		N1		
J1890	Cephalothin sodium injection		N1		
J1930	Lanreotide injection		K2		$29.92
J1931	Laronidase injection		K2		$25.08
J1940	Furosemide injection		N1		
J1945	Lepirudin		K2		$299.56
J1950	Leuprolide acetate /3.75 MG		K2		$547.54
J1953	Levetiracetam injection		N1		
J1956	Levofloxacin injection		N1		
J1960	Levorphanol tartrate inj		N1		
J1980	Hyoscyamine sulfate inj		N1		
J1990	Chlordiazepoxide injection		N1		
J2001	Lidocaine injection		N1		
J2010	Lincomycin injection		N1		
J2020	Linezolid injection		K2		$33.99
J2060	Lorazepam injection		N1		
J2150	Mannitol injection		N1		
J2170	Mecasermin injection		K2		$20.18
J2175	Meperidine hydrochl /100 MG		N1		
J2180	Meperidine/promethazine inj		N1		
J2185	Meropenem		N1		
J2210	Methylergonovin maleate inj		N1		
J2248	Micafungin sodium injection		K2		$1.02
J2250	Inj midazolam hydrochloride		N1		
J2260	Inj milrinone lactate / 5 MG		N1		
J2270	Morphine sulfate injection		N1		
J2271	Morphine so4 injection 100mg		N1		
J2275	Morphine sulfate injection		N1		
J2278	Ziconotide injection		K2		$6.48
J2280	"Inj, moxifloxacin 100 mg"		N1		
J2300	Inj nalbuphine hydrochloride		N1		
J2310	Inj naloxone hydrochloride		N1		
J2315	"Naltrexone, depot form"		K2		$2.77
J2320	Nandrolone decanoate 50 MG	CH	N1		
J2323	Natalizumab injection		K2		$9.88
J2325	Nesiritide injection		K2		$43.93
J2353	"Octreotide injection, depot"		K2		$113.48
J2354	"Octreotide inj, non-depot"		N1		
J2355	Oprelvekin injection		K2		$240.88
J2357	Omalizumab injection		K2		$20.64
J2358	Olanzapine long-acting inj		K2		$2.70
J2360	Orphenadrine injection		N1		
J2370	Phenylephrine hcl injection		N1		
J2400	Chloroprocaine hcl injection		N1		
J2405	Ondansetron hcl injection		N1		
J2410	Oxymorphone hcl injection		N1		
J2425	Palifermin injection		K2		$11.15
J2426	Paliperidone palmitate inj		K2		$6.45
J2430	Pamidronate disodium /30 MG		N1		
J2440	Papaverin hcl injection		N1		
J2469	Palonosetron hcl		K2		$18.51
J2501	Paricalcitol		N1		
J2503	Pegaptanib sodium injection		K2		"$1,002.20"
J2504	"Pegademase bovine, 25 iu"		K2		$242.67
J2505	"Injection, pegfilgrastim 6mg"		K2		"$2,527.87"
J2510	Penicillin g procaine inj	CH	N1		
J2513	Pentastarch 10% solution		K2		$158.76
J2515	Pentobarbital sodium inj		N1		
J2540	Penicillin g potassium inj		N1		
J2543	Piperacillin/tazobactam		N1		
J2550	Promethazine hcl injection		N1		
J2560	Phenobarbital sodium inj		N1		
J2562	Plerixafor injection		K2		$278.36
J2590	Oxytocin injection		N1		
J2597	Inj desmopressin acetate	CH	K2		$3.93
J2650	Prednisolone acetate inj		N1		
J2670	Totazoline hcl injection		N1		
J2675	Inj progesterone per 50 MG		N1		
J2680	Fluphenazine decanoate 25 MG		N1		
J2690	Procainamide hcl injection		N1		
J2700	Oxacillin sodium injeciton	CH	N1		
J2710	Neostigmine methylslfte inj		N1		
J2720	Inj protamine sulfate/10 MG		N1		
J2724	Protein c concentrate		K2		$12.50
J2725	Inj protirelin per 250 mcg	CH	K2		$27.03
J2730	Pralidoxime chloride inj		K2		$88.57
J2760	Phentolaine mesylate inj	CH	K2		$56.35
J2765	Metoclopramide hcl injection		N1		
J2770	Quinupristin/dalfopristin		K2		$157.23
J2778	Ranibizumab injection		K2		$398.10
J2780	Ranitidine hydrochloride inj		N1		
J2783	Rasburicase		K2		$183.08
J2785	Regadenoson injection		K2		$51.36
J2788	Rho d immune globulin 50 mcg		K2		$24.81
J2790	Rho d immune globulin inj		K2		$82.16
J2791	Rhophylac injection		K2		$5.09
J2792	"Rho(D) immune globulin h, sd"		K2		$18.83
J2793	Rilonacept injection		K2		$23.63
J2794	"Risperidone, long acting"		K2		$4.93
J2795	Ropivacaine HCl injection		N1		
J2796	Romiplostim injection		K2		$44.84
J2800	Methocarbamol injection		N1		
J2805	Sincalide injection	CH	N1		
J2810	Inj theophylline per 40 MG		N1		
J2820	Sargramostim injection		K2		$23.62
J2850	Inj secretin synthetic human		K2		$26.97
J2910	Aurothioglucose injeciton		N1		
J2916	Na ferric gluconate complex		N1		
J2920	Methylprednisolone injection		N1		
J2930	Methylprednisolone injection		N1		
J2941	Somatropin injection		K2		$56.09
J2950	Promazine hcl injection		N1		
J2993	Reteplase injection		K2		"$1,332.35"
J2995	Inj streptokinase /250000 IU		K2		$47.57
J2997	Alteplase recombinant		K2		$39.22
J3000	Streptomycin injection		N1		
J3010	Fentanyl citrate injeciton		N1		
J3030	Sumatriptan succinate / 6 MG		N1		
J3070	Pentazocine injection		N1		
J3095	Televancin injection		K2		$1.96
J3101	Tenecteplase injection		K2		$51.95
J3105	Terbutaline sulfate inj		N1		
J3120	Testosterone enanthate inj		N1		
J3130	Testosterone enanthate inj		N1		
J3140	Testosterone suspension inj		N1		
J3150	Testosteron propionate inj		N1		
J3230	Chlorpromazine hcl injection		N1		
J3240	Thyrotropin injection		K2		"$1,034.03"
J3243	Tigecycline injection		K2		$1.22
J3246	Tirofiban HCl		K2		$8.83
J3250	Trimethobenzamide hcl inj		N1		
J3260	Tobramycin sulfate injection		N1		
J3262	Tocilizumab injection		K2		$3.47
J3265	Injection torsemide 10 mg/ml		N1		
J3280	Thiethylperazine maleate inj		N1		
J3285	Treprostinil injection		K2		$60.08
J3300	Triamcinolone A inj PRS-free		K2		$3.17
J3301	Triamcinolone acet inj NOS		N1		
J3302	Triamcinolone diacetate inj		N1		
J3303	Triamcinolone hexacetonl inj		N1		
J3310	Perphenazine injeciton		K2		$30.91
J3315	Triptorelin pamoate		K2		$193.59
J3350	Urea injection		K2		$82.18
J3355	"Urofollitropin, 75 iu"		K2		$63.60
J3357	Ustekinumab injection		K2		$112.30
J3360	Diazepam injection		N1		
J3364	Urokinase 5000 IU injection		N1		
J3365	"Urokinase 250,000 IU inj"		K2		$449.09
J3370	Vancomycin hcl injection		N1		
J3385	Velaglucerase alfa		K2		$349.88
J3396	Verteporfin injection		K2		$9.55
J3410	Hydroxyzine hcl injection		N1		
J3411	Thiamine hcl 100 mg		N1		
J3415	Pyridoxine hcl 100 mg		N1		
J3420	Vitamin b12 injection		N1		
J3430	Vitamin k phytonadione inj		N1		
J3465	"Injection, voriconazole"		K2		$6.02
J3470	Hyaluronidase injection		N1		
J3471	"Ovine, up to 999 USP units"		N1		
J3472	"Ovine, 1000 USP units"		N1		
J3473	Hyaluronidase recombinant		N1		
J3475	Inj magnesium sulfate		N1		
J3480	Inj potassium chloride		N1		
J3485	Zidovudine		N1		
J3486	Ziprasidone mesylate		N1		
J3487	Zoledronic acid		K2		$219.00
J3488	Reclast injection		K2		$218.47
J3490	Drugs unclassified injection		N1		
J3530	Nasal vaccine inhalation		N1		
J3590	Unclassified biologics		N1		
J7030	Normal saline solution infus		N1		
J7040	Normal saline solution infus		N1		
J7042	5% dextrose/normal saline		N1		
J7050	Normal saline solution infus		N1		
J7060	5% dextrose/water		N1		
J7070	D5w infusion		N1		
J7100	Dextran 40 infusion		N1		
J7110	Dextran 75 infusion		N1		
J7120	Ringers lactate infusion		N1		
J7130	Hypertonic saline solution		N1		
J7184	Wilate injection		K2		$70.14
J7185	Xyntha inj		K2		$1.05
J7186	Antihemophilic viii/vwf comp		K2		$0.90
J7187	"Humate-P, inj"		K2		$0.87
J7189	Factor viia		K2		$1.50
J7190	Factor viii		K2		$0.87
J7191	Factor VIII (porcine)		K2		$1.17
J7192	Factor viii recombinant NOS		K2		$1.09
J7193	Factor IX non-recombinant		K2		$0.88
J7194	Factor ix complex		K2		$0.85
J7195	Factor IX recombinant		K2		$1.13
J7196	Antithrombin recombinant		K2		$101.40
J7197	Antithrombin iii injection		K2		$2.48
J7198	Anti-inhibitor		K2		$1.57
J7308	Aminolevulinic acid hcl top		K2		$138.70
J7309	"Methyl aminolevulinate, top"		K2		$68.27
J7310	Ganciclovir long act implant		K2		"$16,640.00"
J7311	Fluocinolone acetonide implt		K2		"$18,980.00"
J7312	Dexamethasone intra implant		K2		$194.17
J7321	Hyalgan/supartz inj per dose		K2		$88.80
J7323	Euflexxa inj per dose		K2		$147.16
J7324	Orthovisc inj per dose		K2		$167.00
J7325	Synvisc or Synvisc-One		K2		$11.81
J7335	Capsaicin 8% patch		K2		$25.55
J7500	Azathioprine oral 50mg		N1		
J7501	Azathioprine parenteral		K2		$104.77
J7502	Cyclosporine oral 100 mg		N1		
J7504	Lymphocyte immune globulin		K2		$542.36
J7505	Monoclonal antibodies		K2		"$1,112.14"
J7506	Prednisone oral		N1		
J7507	Tacrolimus oral per 1 MG		N1		
J7509	Methylprednisolone oral		N1		
J7510	Prednisolone oral per 5 mg		N1		
J7511	Antithymocyte globuln rabbit		K2		$387.17
J7513	"Daclizumab, parenteral"		K2		$516.41
J7515	Cyclosporine oral 25 mg		N1		
J7516	Cyclosporin parenteral 250mg		N1		
J7517	Mycophenolate mofetil oral		N1		
J7518	Mycophenolic acid		N1		
J7520	"Sirolimus, oral"		N1		
J7525	Tacrolimus injection		K2		$136.85
J7599	Immunosuppressive drug noc		N1		
J7674	"Methacholine chloride, neb"		N1		
J7799	Non-inhalation drug for DME		N1		
J8501	Oral aprepitant		K2		$5.90
J8510	Oral busulfan		K2		$3.59
J8520	"Capecitabine, oral, 150 mg"		K2		$6.81
J8521	"Capecitabine, oral, 500 mg"		K2		$22.48
J8530	Cyclophosphamide oral 25 MG		N1		
J8540	Oral dexamethasone		N1		
J8560	Etoposide oral 50 MG		K2		$34.34
J8562	Oral fludarabine phosphate		K2		$79.44
J8597	Antiemetic drug oral NOS		N1		
J8600	Melphalan oral 2 MG		N1		
J8610	Methotrexate oral 2.5 MG		N1		
J8700	Temozolomide		K2		$9.31
J8705	Topotecan oral		K2		$76.40
J9000	Doxorubicin hcl injection		N1		
J9001	Doxorubicin hcl liposome inj		K2		$504.27
J9010	Alemtuzumab injection		K2		$577.60
J9015	Aldesleukin injection		K2		$915.45
J9017	Arsenic trioxide injection		K2		$40.13
J9020	Asparaginase injection		K2		$62.07
J9025	Azacitidine injection		K2		$5.16
J9027	Clofarabine injection		K2		$114.37
J9031	Bcg live intravesical vac		K2		$114.38
J9033	Bendamustine injection		K2		$18.15
J9035	Bevacizumab injection		K2		$58.72
J9040	Bleomycin sulfate injection		N1		
J9041	Bortezomib injection		K2		$39.60
J9045	Carboplatin injection		N1		
J9050	Carmustine injection		K2		$172.56
J9055	Cetuximab injection		K2		$49.52
J9060	Cisplatin 10 MG injection		N1		
J9065	Inj cladribine per 1 MG		K2		$23.59
J9070	Cyclophosphamide 100 MG inj		N1		
J9098	Cytarabine liposome inj		K2		$479.02
J9100	Cytarabine hcl 100 MG inj		N1		
J9120	Dactinomycin injection		K2		$529.42
J9130	Dacarbazine 100 mg inj		N1		
J9150	Daunorubicin injection		K2		$13.16
J9151	Daunorubicin citrate inj		K2		$56.58
J9155	Degarelix injection		K2		$2.79
J9160	Denileukin diftitox inj		K2		"$1,559.54"
J9171	Docetaxel injection		K2		$20.84
J9175	Elliotts b solution per ml		N1		
J9178	"Inj, epirubicin hcl, 2 mg"		K2		$1.87
J9181	Etoposide injection		N1		
J9185	Fludarabine phosphate inj	CH	N1		
J9190	Fluorouracil injection		N1		
J9200	Floxuridine injection		K2		$36.60
J9201	Gemcitabine hcl injection		K2		$111.40
J9202	Goserelin acetate implant		K2		$195.16
J9206	Irinotecan injection	CH	N1		
J9207	Ixabepilone injection		K2		$62.53
J9208	Ifosfomide injection		K2		$31.21
J9209	Mesna injection		N1		
J9211	Idarubicin hcl injection		K2		$46.43
J9212	Interferon alfacon-1 inj	CH	N1		
J9214	Interferon alfa-2b inj		K2		$16.19
J9215	Interferon alfa-n3 inj		K2		$20.87
J9216	Interferon gamma 1-b inj		K2		$549.62
J9217	Leuprolide acetate suspnsion		K2		$210.96
J9218	Leuprolide acetate injeciton		K2		$4.88
J9219	Leuprolide acetate implant		K2		"$4,728.88"
J9225	Vantas implant		K2		"$3,223.57"
J9226	Supprelin LA implant		K2		"$15,184.53"
J9230	Mechlorethamine hcl inj		K2		$154.88
J9245	Inj melphalan hydrochl 50 MG		K2		"$1,272.01"
J9250	Methotrexate sodium inj		N1		
J9260	Methotrexate sodium inj		N1		
J9261	Nelarabine injection		K2		$110.19
J9263	Oxaliplatin		K2		$8.36
J9264	Paclitaxel protein bound		K2		$9.21
J9265	Paclitaxel injection	CH	N1		
J9266	Pegaspargase injection		K2		"$2,675.40"
J9268	Pentostatin injection		K2		"$1,068.16"
J9270	Plicamycin (mithramycin) inj		N1		
J9280	Mitomycin 5 MG inj		K2		$20.36
J9293	Mitoxantrone hydrochl / 5 MG		K2		$33.95
J9300	Gemtuzumab ozogamicin inj		K2		"$2,637.02"
J9302	Ofatumumab injection		K2		$45.41
J9303	Panitumumab injection		K2		$85.62
J9305	Pemetrexed injection		K2		$51.37
J9307	Pralatrexate injection		K2		$165.63
J9310	Rituximab injection		K2		$599.16
J9315	Romidepsin injection		K2		$219.30
J9320	Streptozocin injection		K2		$264.81
J9328	Temozolomide injection		K2		$4.86
J9330	Temsirolimus injection		K2		$49.87
J9340	Thiotepa injection		K2		$106.54
J9351	Topotecan injection		K2		$19.30
J9355	Trastuzumab injection		K2		$69.06
J9357	Valrubicin injection		K2		$946.64
J9360	Vinblastine sulfate inj		N1		
J9370	Vincristine sulfate 1 MG inj		N1		
J9390	Vinorelbine tartrate inj		N1		
J9395	"Injection, Fulvestrant"		K2		$81.81
J9600	Porfimer sodium injection		K2		"$3,017.82"
J9999	Chemotherapy drug		N1		
L8600	Implant breast silicone/eq		N1		
L8603	Collagen imp urinary 2.5 ml		N1		
L8604	Dextranomer/hyaluronic acid		N1		
L8606	Synthetic implnt urinary 1ml		N1		
L8609	Artificial cornea		N1		
L8610	Ocular implant		N1		
L8612	Aqueous shunt prosthesis		N1		
L8613	Ossicular implant		N1		
L8614	Cochlear device		N1		
L8630	Metacarpophalangeal implant		N1		
L8631	MCP joint repl 2 pc or more		N1		
L8641	Metatarsal joint implant		N1		
L8642	Hallux implant		N1		
L8658	Interphalangeal joint spacer		N1		
L8659	Interphalangeal joint repl		N1		
L8670	"Vascular graft, synthetic"		N1		
L8682	Implt neurostim radiofq rec		N1		
L8690	"Aud osseo dev, int/ext comp"		N1		
L8699	Prosthetic implant NOS		N1		
P9041	"Albumin (human),5%, 50ml"		K2		$20.37
P9045	"Albumin (human), 5%, 250 ml"		K2		$67.07
P9046	"Albumin (human), 25%, 20 ml"		K2		$29.16
P9047	"Albumin (human), 25%, 50ml"		K2		$70.39
Q0138	"Ferumoxytol, non-esrd"		K2		$0.69
Q0163	Diphenhydramine HCl 50mg		N1		
Q0164	Prochlorperazine maleate 5mg		N1		
Q0166	Granisetron hcl 1 mg oral		N1		
Q0167	Dronabinol 2.5mg oral		N1		
Q0169	Promethazine HCl 12.5mg oral		N1		
Q0171	Chlorpromazine HCl 10mg oral		N1		
Q0173	Trimethobenzamide HCl 250mg		N1		
Q0175	Perphenazine 4mg oral		N1		
Q0177	Hydroxyzine pamoate 25mg		N1		
Q0179	Ondansetron hcl 8 mg oral		N1		
Q0180	Dolasetron mesylate oral		N1		
Q0515	Sermorelin acetate injection		K2		$1.76
Q2004	Bladder calculi irrig sol		N1		
Q2009	Fosphenytoin inj PE		N1		
Q2017	"Teniposide, 50 mg"		K2		$316.52
Q2035**	"Afluria vacc, 3 yrs & >, im"		L1		
Q2036**	"Flulaval vacc, 3 yrs & >, im"		L1		
Q2037**	"Fluvirin vacc, 3 yrs & >, im"		L1		
Q2038**	"Fluzone vacc, 3 yrs & >, im"		L1		
Q2039**	"NOS flu vacc, 3 yrs & >, im"		L1		
Q2040	Incobotulinumtoxin A		K2		$5.57
Q3025	IM inj interferon beta 1-a		K2		$220.75
Q4100	"Skin substitute, NOS"		N1		
Q4101	Apligraf		K2		$34.06
Q4102	Oasis wound matrix		K2		$4.68
Q4103	Oasis burn matrix	CH	N1		
Q4104	Integra BMWD		K2		$15.45
Q4105	Integra DRT		K2		$10.95
Q4106	Dermagraft		K2		$39.39
Q4107	Graftjacket		K2		$92.79
Q4108	Integra matrix		K2		$20.95
Q4110	Primatrix		K2		$31.67
Q4111	Gammagraft		K2		$7.17
Q4112	Cymetra injectable		K2		$334.07
Q4113	Graftjacket xpress		K2		$334.07
Q4114	Integra flowable wound matri		K2		$972.75
Q4115	Alloskin		K2		$6.07
Q4116	Alloderm		K2		$31.11
Q4118	Matristem micromatrix		K2		$3.13
Q4119	Matristem wound matrix		K2		$6.04
Q4121	Theraskin		K2		$20.32
Q9951	"LOCM >= 400 mg/ml iodine,1ml"		N1		
Q9953	"Inj Fe-based MR contrast,1ml"		N1		
Q9954	"Oral MR contrast, 100 ml"		N1		
Q9955	"Inj perflexane lip micros,ml"		N1		
Q9956	"Inj octafluoropropane mic,ml"		N1		
Q9957	"Inj perflutren lip micros,ml"		N1		
Q9958	"HOCM <=149 mg/ml iodine, 1ml"		N1		
Q9959	"HOCM 150-199mg/ml iodine,1ml"		N1		
Q9960	"HOCM 200-249mg/ml iodine,1ml"		N1		
Q9961	"HOCM 250-299mg/ml iodine,1ml"		N1		
Q9962	"HOCM 300-349mg/ml iodine,1ml"		N1		
Q9963	"HOCM 350-399mg/ml iodine,1ml"		N1		
Q9964	"HOCM>= 400mg/ml iodine, 1ml"		N1		
Q9965	"LOCM 100-199mg/ml iodine,1ml"		N1		
Q9966	"LOCM 200-299mg/ml iodine,1ml"		N1		
Q9967	"LOCM 300-399mg/ml iodine,1ml"		N1		
Q9968	Visualization adjunct	CH	N1		
V2630	Anter chamber intraocul lens		N1		
V2631	Iris support intraoclr lens		N1		
V2632	Post chmbr intraocular lens		N1		
V2785	Corneal tissue processing		F4		
V2790	Amniotic membrane		N1		
					
					
NOTE 1:  The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount.  Sections 4104 and 10406 of the Affordable Care Act (ACA) waive coinsurance and the Part B deductible for most preventive services.  These preventive services are identified with a double asterisk (**).					
					
"NOTE 2:  In general, payment indicators for radiology services (Z2, Z3) are based on a comparison of the proposed rates according to the ASC standard ratesetting methodology and the MPFS proposed rates.  Under current law, the MPFS payment rates will have a negative update for CY 2012.  For a discussion of those rates, we refer readers to the CY 2012 MPFS proposed rule."