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 $303.0970547 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 $245.4872156 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 $13.4273592 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 $63.0274410 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 N175833 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 $54.4076800 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 $42.9777076 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 $124.6177777 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 $139.4278399 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 $276.9878806 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 N190718 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 N1A9557 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" N1C1778 "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 $34.65C2640 "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 N1E0786 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 N1J0636 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 N1J1260 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 $58.90J1750 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 N1J3260 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 $2.79J9160 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 N1L8630 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" N1Q9962 "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."