Provider Type. Service Place

Transcription

1 34101 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION /1/1999 $ EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION /1/1999 $ EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION /1/1999 $ THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM INCISION /1/1999 $ THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM INCISION /1/1999 $ THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM INCISION THROMBECTOMY, DIRECT OR WITH CATHETER; AXILLARY AND SUBCLAVIAN VEIN, BY ARM INCISION /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; Page 1 of 34

2 35875 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT /1/1999 $ THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT /1/1999 $ INTRODUCTION OF NEEDLE OR INTRACATHETER; ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (CANNULA, FISTULA, OR GRAFT) /1/1999 $ INTRODUCTION OF NEEDLE OR INTRACATHETER; ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (CANNULA, FISTULA, OR GRAFT) /1/1999 $1, INTRODUCTION OF NEEDLE OR INTRACATHETER; ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (CANNULA, FISTULA, OR GRAFT) /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN)(E.G., FOR HEMODIALYSIS); PERCUTANEOUS, AGE 2 YEARS OR UNDER /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN)(E.G., FOR HEMODIALYSIS); PERCUTANEOUS, AGE 2 YEARS OR UNDER /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); PERCUTANEOUS, OVER AGE /1/1999 $88.00 Page 2 of 34

3 36489 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); PERCUTANEOUS, OVER AGE PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); PERCUTANEOUS, OVER AGE /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); CUTDOWN, AGE 2 YEARS OR UNDER /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); CUTDOWN, AGE 2 YEARS OR UNDER PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (E.G., FOR HEMODIALYSIS); CUTDOWN, AGE 2 YEARS OR UNDER /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN)(E.G., FOR HEMODIALYSIS); CUTDOWN, OVER AGE /1/1999 $ PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN)(E.G., FOR HEMODIALYSIS); CUTDOWN, OVER AGE /1/1999 $1, PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN)(E.G., FOR HEMODIALYSIS); CUTDOWN, OVER AGE /1/1999 $ REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE /1/1999 $ INSERTION OF IMPLANTABLE VENOUS ACCESS PORT, WITH/WITHOUT SUBCUTANEOUS RESERVOIR /1/1999 $ Page 3 of 34

4 36533 INSERTION OF IMPLANTABLE VENOUS ACCESS PORT, WITH/WITHOUT SUBCUTANEOUS RESERVOIR INSERTION OF IMPLANTABLE VENOUS ACCESS PORT, WITH/WITHOUT SUBCUTANEOUS RESERVOIR /1/1999 $ REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR /1/1999 $ REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR /1/1999 $ REMOVAL OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR /1/1999 $ REMOVAL OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR REMOVAL OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR /1/1999 $ ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS /1/1999 $ ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS /1/1999 $48.00 Page 4 of 34

5 36800 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN /1/1999 $ INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN /1/1999 $ INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE; (SEPARATE PROCEDURE); ARTERIOVENOUS EXTERNAL (SCRIBNER TYPE) /1/1999 $ INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE; (SEPARATE PROCEDURE); ARTERIOVENOUS EXTERNAL (SCRIBNER TYPE) INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE; (SEPARATE PROCEDURE); ARTERIOVENOUS EXTERNAL (SCRIBNER TYPE) /1/1999 $ INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE /1/1999 $ INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE /1/1999 $ ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (E.G..CIMINO TYPE) (SEPARATE PROCEDURE) /1/1999 $ Page 5 of 34

6 36821 ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (E.G..CIMINO TYPE) (SEPARATE PROCEDURE) ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (E.G..CIMINO TYPE) (SEPARATE PROCEDURE) /1/1999 $ CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT /1/1999 $ CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT /1/1999 $ CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT /1/1999 $ CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT /1/1999 $ CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT /1/1999 $ REVISION OF AN ARTERIOVENOUS FISTULA, WITH OR WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS GRAFT (SEPARATE PROCEDURE) /1/1999 $ Page 6 of 34

7 36832 REVISION OF AN ARTERIOVENOUS FISTULA, WITH OR WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS GRAFT (SEPARATE PROCEDURE) /1/1999 $ REVISION OF AN ARTERIOVENOUS FISTULA, WITH OR WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS GRAFT (SEPARATE PROCEDURE) REVISION OF AN ARTERIOVENOUS FISTULA, WITH OR WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS GRAFT (SEPARATE PROCEDURE) /1/1999 $ INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE) /1/1999 $ INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE) /1/1999 $ INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE) /1/1999 $ CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER /1/1999 $ CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER /1/1999 $ CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER /1/1999 $ CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER /1/1999 $ CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER /1/1999 $ Page 7 of 34

8 36861 CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER /1/1999 $ INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS, TEMPORARY /1/1999 $ INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS, TEMPORARY INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS, PERMANENT /1/1999 $ INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS, PERMANENT INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS, PERMANENT /1/1999 $ REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER /1/1999 $ REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE /1/1999 $ RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE /1/1999 $ RENAL BIOPSY; PERCUTANEOUS, BY SURGICAL EXPOSURE OF KIDNEY /1/1999 $62.50 Page 8 of 34

9 50205 RENAL BIOPSY; PERCUTANEOUS, BY SURGICAL EXPOSURE OF KIDNEY /1/1999 $ RENAL BIOPSY; PERCUTANEOUS, BY SURGICAL EXPOSURE OF KIDNEY RENAL BIOPSY; PERCUTANEOUS, BY SURGICAL EXPOSURE OF KIDNEY /1/1999 $ NEPHRECTOMY, PARTIAL /1/1999 $ NEPHRECTOMY, PARTIAL /1/1999 $ NEPHRECTOMY, PARTIAL /1/1999 $ RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE) /1/1999 $ RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE) /1/1999 $ RECIPIENT NEPHRECTOMY (SEPARATE PROCEDURE) /1/1999 $ RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; EXCLUDING DONOR AND RECIPIENT NEPHRECTOMY /1/1999 $ RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; EXCLUDING DONOR AND RECIPIENT NEPHRECTOMY /1/1999 $ RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; EXCLUDING DONOR AND RECIPIENT NEPHRECTOMY /1/1999 $ Page 9 of 34

10 50365 RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; W/RECIPIENT NEPHRECTOMY /1/1999 $ RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; W/RECIPIENT NEPHRECTOMY /1/1999 $1, RENAL ALLOTRANSPLANTATION, IMPLANTATION OF GRAFT; W/RECIPIENT NEPHRECTOMY /1/1999 $ REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT /1/1999 $ REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT /1/1999 $ REMOVAL OF TRANSPLANTED RENAL ALLOGRAFT /1/1999 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL /1/1999 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL /1/1995 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL /1/1999 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL /1/1995 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL RD 1/1/1999 $ RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL RD 1/1/1995 $11.50 Page 10 of 34

11 71015 RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL /1/1999 $ RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL /1/1995 $ RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL /1/1999 $ RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL /1/1995 $ RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL RD 1/1/1999 $ RADIOLOGIC EXAM,CHEST;STEREO,FRONTAL RD 1/1/1995 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL /1/1999 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL /1/1995 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL /1/1999 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL /1/1995 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL RD 1/1/1999 $ RADIOLOGIC EXAM, CHEST; 2 VIEWS, FRONTAL & LATERAL RD 1/1/1995 $15.00 Page 11 of 34

12 71021 RADIOLOGIC EXAMINATION, CHEST; TWO VIEWS, FRONTAL AND LATERAL WITH APICAL LORDOTIC PROCEDURE /1/1999 $ RADIOLOGIC EXAMINATION, CHEST; TWO VIEWS, FRONTAL AND LATERAL WITH APICAL LORDOTIC PROCEDURE /1/1999 $ RADIOLOGIC EXAMINATION, CHEST; TWO VIEWS, FRONTAL AND LATERAL WITH APICAL LORDOTIC PROCEDURE RD 1/1/1999 $ RADIOLOGIC EXAM, CHEST, COMPLETE, MIN 4VIEWS /1/1999 $ RADIOLOGIC EXAM, CHEST, COMPLETE, MIN 4VIEWS /1/1999 $ RADIOLOGIC EXAM, CHEST, COMPLETE, MIN 4VIEWS RD 1/1/1999 $ INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION RD 1/1/1999 $ ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $26.00 Page 12 of 34

13 75658 ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION RD 1/1/1999 $ ANGIOGRAPHY, ARTERIOVENOUS SHUNT (E.G. DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ ANGIOGRAPHY, ARTERIOVENOUS SHUNT (E.G. DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ ANGIOGRAPHY, ARTERIOVENOUS SHUNT (E.G. DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION RD 1/1/1999 $ SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION RD 1/1/1999 $ VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION /1/1999 $ VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION RD 1/1/1999 $22.50 Page 13 of 34

14 75962 TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY /1/1999 $ TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY /1/1999 $ TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY RD 1/1/1999 $ ECHOGRAPHY, ABDOMINAL, B-SCAN &/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED ETC. (E.G. SINGLE ORGAN, QUADRANT, FOLLOW-UP) /1/1999 $ ECHOGRAPHY, ABDOMINAL, B-SCAN &/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED ETC. (E.G. SINGLE ORGAN, QUADRANT, FOLLOW-UP) /1/1999 $ ECHOGRAPHY, ABDOMINAL, B-SCAN &/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED ETC. (E.G. SINGLE ORGAN, QUADRANT, FOLLOW-UP) RD 1/1/1999 $ ECHOGRAPHY OF TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION WITH OR WITHOUT DUPLEX DOPPLER STUDIES /1/1999 $ ECHOGRAPHY OF TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION WITH OR WITHOUT DUPLEX DOPPLER STUDIES /1/1999 $ ECHOGRAPHY OF TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION WITH OR WITHOUT DUPLEX DOPPLER STUDIES RD 1/1/1999 $ ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDO-ANEURYSM OR ARTERIO-VENOUS FISTULAE(INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION & IMAGING) /1/1999 $ Page 14 of 34

15 76936 ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDO-ANEURYSM OR ARTERIO-VENOUS FISTULAE(INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION & IMAGING) /1/1999 $ ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDO-ANEURYSM OR ARTERIO-VENOUS FISTULAE(INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION & IMAGING) RD 1/1/1999 $ PERITONEAL-VENOUS SHUNT PATENCY TEST (E.G., FOR LAVEEN, DENVER SHUNT) /1/1999 $ PERITONEAL-VENOUS SHUNT PATENCY TEST (E.G., FOR LAVEEN, DENVER SHUNT) /1/1999 $ PERITONEAL-VENOUS SHUNT PATENCY TEST (E.G., FOR LAVEEN, DENVER SHUNT) RN 1/1/1999 $ KIDNEY IMAGING; STATIC ONLY /1/1999 $ KIDNEY IMAGING; STATIC ONLY /1/1999 $ KIDNEY IMAGING; STATIC ONLY RN 1/1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW /1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW /1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW RN 1/1/1999 $55.00 Page 15 of 34

16 78704 KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) /1/1999 $ KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) /1/1999 $ KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) RN 1/1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITHOUT PHARMACOLOGICAL INTERVENTION /1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITHOUT PHARMACOLOGICAL INTERVENTION /1/1999 $ KIDNEY IMAGING; WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITHOUT PHARMACOLOGICAL INTERVENTION RN 1/1/1999 $ KIDNEY IMAGING, TOMOGRAPHIC (SPECT) /1/1999 $ KIDNEY IMAGING, TOMOGRAPHIC (SPECT) /1/1999 $ KIDNEY IMAGING, TOMOGRAPHIC (SPECT) RN 1/1/1999 $ KIDNEY VASCULAR FLOW ONLY /1/1999 $ KIDNEY VASCULAR FLOW ONLY /1/1999 $ KIDNEY VASCULAR FLOW ONLY RN 1/1/1999 $29.00 Page 16 of 34

17 78725 KIDNEY FUNCTION STUDY WITHOUT PHARMACOLOGIC INTERVENTION /1/1999 $ KIDNEY FUNCTION STUDY WITHOUT PHARMACOLOGIC INTERVENTION /1/1999 $ KIDNEY FUNCTION STUDY WITHOUT PHARMACOLOGIC INTERVENTION RN 1/1/1999 $ AUTOMATED TEST;1 OR 2 CLINICAL CHEMISTRY TEST(S) /1/1995 $ AUTOMATED TEST;3 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;4 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;5 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;6 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;7 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;8 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;9 CLINICAL CHEMISTRY TEST(TESTS) /1/1995 $ AUTOMATED TEST;10 CLINICAL CHEMISTRY TESTS /1/1995 $8.00 Page 17 of 34

18 80011 AUTOMATED TEST;11 CLINICAL CHEMISTRY TESTS /1/1995 $ AUTOMATED TEST;12 CLINICAL CHEMISTRY TESTS /1/1995 $ AUTOMATED TEST;13-16 CLINICAL CHEMISTRY TESTS /1/1995 $ AUTOMATED MULTICHANNEL TEST;17-18 CLINICAL CHEMISTRY TESTS /1/1995 $ AUTOMATED TEST;19 OR MORE CLINICAL CHEMISTRY TESTS /1/1995 $ BASIC METABOLIC PANEL WHICH INCLUDES CARBON DIOXIDE (82374); CHLORIDE (82435); CREATININE (82565); GLUCOSE (82947); POTASSIUM (84132); SODIUM (84295); UREA NITROGEN (BUN) (84520) /1/1999 $ COMP METABOLIC PANEL (80054); HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT(CBC)(85022) OR HEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETE DIFFERENTIAL WBC COUNT(CBC)(85025); THYROID STIMULATING HORMONE(TSH)(84443) /1/1999 $ ELECTROLYTE PANEL WHICH INCLUDES CARBON DIOXIDE (82374); CHLORIDE (82435); POTASSIUM (84132); SODIUM (84295) /1/1999 $ COMP METABOLIC PANEL WHICH INCL ALBU(82040); BILIRU, TOTAL OR DIRECT(82250); CALC(82310); CHLOR(82435); CREAT(82565); GLUC(82947); PHOS, ALKALINE(84075); POTASS(84132); PROT, TOTAL(84155); SODIUM (84295); TRANSFERASE, ASPARTATE AMINO(AST)(SGOT)(84450); UREA NITRO (BUN)(84520) /1/1999 $8.00 Page 18 of 34

19 80091 THYROID PANEL;THYROXINE,TOTAL AND TRIODOTHYROINE (T-3),RESIN UPTAKE /1/1999 $ PER MONTH THYROID PANEL;THYROXINE,TOTAL AND TRIODOTHYROINE (T-3),RESIN UPTAKE /1/1995 $ PER MONTH THYROID PANEL;W/THYROID STIMULAT HORMONE /1/1999 $ PER MONTH THYROID PANEL;W/THYROID STIMULAT HORMONE /1/1995 $ PER MONTH ALBUMIN; SERUM /1/1999 $ BILIRUBIN; TOTAL OR DIRECT /1/1999 $ BILIRUBIN; TOTAL AND DIRECT /1/1999 $ CALCIUM: TOTAL /1/1999 $ CARBON DIOXIDE (BICARBONATE) /1/1999 $ CHLORIDE; BLOOD /1/1999 $ CREATININE;BLOOD /1/1999 $ PER MONTH CREATININE;BLOOD /1/1995 $ PER MONTH Page 19 of 34

20 82570 CREATININE;OTHER SOURCE /1/1995 $ CREATININE;CLEARANCE /1/1999 $ PER MONTH FOLIC ACID; SERUM /1/1999 $ GLUCOSE; QUANTITATIVE /1/1999 $ IRON BINDING CAPACITY /1/1999 $ LIPASE /1/1999 $ LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTROL (HDL CHOLESTEROL) /1/1999 $ LIPOPROTEIN, DIRECT MEASUREMENT VLDL CHOLESTEROL /1/1999 $ LIPOPROTEIN, DIRECT MEASUREMENT, LDL CHOLESTEROL /1/1999 $ PHOSPHATASE, ALKALINE /1/1999 $ POTASSIUM; SERUM /1/1999 $ PROTEIN; TOTAL, EXCEPT REFRACTOMETRY /1/1999 $5.05 Page 20 of 34

21 84295 SODIUM; SERUM /1/1999 $ THYROID STIMULATING HORMONE (TSH) /1/1999 $ TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) /1/1999 $ UREA NITROGEN; QUANTITATIVE /1/1999 $ BLOOD COUNT;SPUN MICROHEMATOCRIT /1/1999 $ BLOOD COUNT; OTHER THAN SPUN HEMATOCRIT /1/1999 $ BLOOD COUNT; HEMOGLOBIN /1/1999 $ HEMOGRAM, AUTOMATED AND MANUAL DIFFERENTIAL WBC COUNT (CBC) /1/1999 $ HEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETE DIFFERENTIAL WBC COUNT (CBC) /1/1999 $ END STAGE RENAL DISEASE (ESRD) RELATED SERVICES PER FULL MONTH; FOR PATIENTS UNDER 2 YRS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACYOF NUTRITION, ASSESSMENT OF GROWTH & DEVELOPMENT, & COUNSELING OF PARENTS /1/1999 $ PER MONTH Page 21 of 34

22 90919 ESRD RELATED SERVICES PER FULL MONTH; FOR PATIENTS BETWEEN 2 & 11 YRS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH & DEVELOPMENT, & COUNSELING OF PARENTS /1/1999 $ PER MONTH ESRD RELATED SERVICES PER FULL MONTH; FOR PATIENTS BETWEEN 12 & 19 YRS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH & DEVELOPMENT, & COUNSELING OF PARENTS /1/1999 $ PER MONTH ESRD RELATED SERVICES PER FULL MONTH; FOR PATIENTS 20 YRS OF AGE & OVER /1/1999 $ PER MONTH ESRD RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS UNDER 2 YRS OF AGE /1/1999 $ ESRD RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS BETWEEN 2 & 11 YRS OF AGE /1/1999 $ ESRD RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS BETWEEN 12 & 19 YRS OF AGE /1/1999 $ ESRD RELATED SERVICES (LESS THAN FULL MONTH), PER DAY; FOR PATIENTS 20 YRS OF AGE AND OVER /1/1999 $ HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION /1/1999 $ HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION AP 1/1/1999 $ PER MONTH HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION AP 1/1/1995 $ PER MONTH Page 22 of 34

23 90937 HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION /1/1999 $ PER MONTH HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION AP 1/1/1999 $ PER MONTH HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION AP 1/1/1995 $ PER MONTH DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL,HEMOFILTRATION), WITH SINGLE PHYSICIAN EVALUATION /1/1999 $ PER DAY DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL,HEMOFILTRATION), WITH SINGLE PHYSICIAN EVALUATION AP 1/1/1999 $ PER DAY DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL,HEMOFILTRATION), WITH SINGLE PHYSICIAN EVALUATION AP 1/1/1995 $ PER DAY DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION) REQUIRING REPEATED EVALUATIONS, WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION /1/1999 $ PER DAY DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION) REQUIRING REPEATED EVALUATIONS, WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION AP 1/1/1999 $ PER DAY DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION) REQUIRING REPEATED EVALUATIONS, WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION AP 1/1/1995 $ PER DAY Page 23 of 34

24 90989 DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COMPLETED COURSE /1/1999 $ PER PATIENT DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COMPLETED COURSE AP 1/1/1999 $ PER PATIENT DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COMPLETED COURSE AP 1/1/1995 $ PER PATIENT DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COURSE NOT COMPLETED, PER TRAINING SESSION /1/1999 $ DIALYSIS TRAINING, PATIENT, INCLUDING HELPER WHERE APPLICABLE, ANY MODE, COURSE NOT COMPLETED, PER TRAINING SESSION AP 1/1/1995 $ HEMOPERFUSION (E.G., WITH ACTIVATED CHARCOAL OR RESIN) AP 1/1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT /1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT /1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT /1/1995 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, W/O INTERPRETATION AND REPORT AZ 2/1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, W/O INTERPRETATION AND REPORT AZ 1/1/1999 $11.50 Page 24 of 34

25 93005 ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, W/O INTERPRETATION AND REPORT AZ 1/1/1995 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY AY 2/1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY AY 1/1/1999 $ ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY AY 1/1/1995 $ DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) /1/1999 $ DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) /1/1999 $ DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) AY 2/1/1999 $ DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) AZ 1/1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $20.00 Page 25 of 34

26 99203 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT MAY NOT REQUIRE THE PRESENCE OF A PHYSICIAN. USUALLY, THE PRESENTING PROBLEM(S) ARE MINIMAL. TYPICALLY, 5 MINUTES ARE SPENT PERFORMING OR SUPERVISING THESE SERVICES /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION MAKING OF LOW COMPLEXITY /1/1999 $20.00 Page 26 of 34

27 99214 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $ INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE THREE KEY COMPONENTS: A DETAILED OR COMPREHENSIVE HISTORY; A DETAILED OR COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING THAT IS STRAIGHTFORWARD OR OF LOW COMPLEXITY /1/1999 $ INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $ SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED INTERVAL HISTORY; A PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION MAKING THAT IS STRAIGHTFORWARD OR OF LOW COMPLEXITY /1/1999 $17.00 Page 27 of 34

28 99232 SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED INTERVAL HISTORY: AN EXPANDED PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENTS: A DETAILED INTERVAL HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $ HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS /1/1999 $ HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES /1/1999 $ OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIES THESE THREE KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY /1/1999 $30.00 Page 28 of 34

29 99244 OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $ INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAKING /1/1999 $ INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY /1/1999 $ INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY /1/1999 $ INITIAL INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY /1/1999 $49.00 Page 29 of 34

30 E1520 HEPARIN INFUSION PUMP FOR DIALYSIS AP 1/1/1999 $67.50 E1590 HEMODIALYSIS MACHINE AP 1/1/1999 $ E1610 REVERSE OSMOSIS WATER PURIFICATION SYSTEM AP 1/1/1999 $ E1630 RECIPROCATING PERITONEAL DIALYSIS SYSTEM AP 1/1/1999 $ J0635 INJECTION, CALCITRIOL, 1 MCG AMP AE 1/1/1999 $12.56 J0635 INJECTION, CALCITRIOL, 1 MCG AMP AE 9/1/1998 $12.10 J0690 CEFAZOLIN SODIUM, UP TO 500 MG AE 2/1/2001 $2.06 J0690 CEFAZOLIN SODIUM, UP TO 500 MG AE 2/1/2001 $2.06 J0713 INJECTION, CEFTAZIDIME, PER 500 MG AE 1/1/1999 $6.75 J1580 INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG AE 1/1/1999 $2.19 J1580 INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG AE 9/1/1998 $2.19 J1750 INJECTION, INFED, 50 MG AE 7/1/2000 $17.90 Page 30 of 34

31 J1750 INJECTION, INFED, 50 MG AE 7/1/2000 $17.90 J1760 INJECTION, IRON DEXTRAN, 2 CC AE 1/1/1999 $35.81 J1760 INJECTION, IRON DEXTRAN, 2 CC AE 9/1/1998 $35.82 J1770 INJECTION, IRON DEXTRAN, 5 CC AE 1/1/1999 $89.53 J1770 INJECTION, IRON DEXTRAN, 5 CC AE 9/1/1998 $89.54 J1780 INJECTION, IRON DEXTRAN, 10 CC AE 1/1/1999 $ J1780 INJECTION, IRON DEXTRAN, 10 CC AE 9/1/1998 $ J3260 TOBRAMYCIN SULFATE, UP TO 80 MG AE 2/1/2001 $12.31 J3260 TOBRAMYCIN SULFATE, UP TO 80 MG AE 2/1/2001 $12.31 J3364 INJECTION, UROKINASE, 5000 IU VIAL AE 1/1/1999 $52.83 J3364 INJECTION, UROKINASE, 5000 IU VIAL AE 9/1/1998 $51.25 J3365 INJECTION, IV, UROKINASE, 250,000 I.U. VIAL AE 1/1/1999 $ Page 31 of 34

32 J3365 INJECTION, IV, UROKINASE, 250,000 I.U. VIAL AE 9/1/1998 $ J3370 INJECTION, VANCOMYCIN HCL, UP TO 500 MG AE 1/1/1999 $7.41 J3370 INJECTION, VANCOMYCIN HCL, UP TO 500 MG AE 9/1/1998 $9.25 J7513 INJECTION, DACLIZUMAB, 5 MG/ML AE 1/1/1999 $79.46 J9696 CEFTRIAXONE SODIUM, PER 250 MG AE 2/1/2001 $13.35 J9696 CEFTRIAXONE SODIUM, PER 250 MG AE 2/1/2001 $13.35 P9010 BLOOD (WHOLE) FOR TRANSFUSION, PER UNIT B 1/1/1999 $ PINTS/CALENDAR YEAR & INCLUDES BLOOD PRODUCT, SUPPLIES, & BLOOD PROCESSING FEES P9010 BLOOD (WHOLE) FOR TRANSFUSION, PER UNIT B 1/1/1995 $ PINTS/CALENDAR YEAR & INCLUDES BLOOD PRODUCT, SUPPLIES, & BLOOD PROCESSING FEES P9021 RED BLOOD CELLS, EACH UNIT B 1/1/1999 $ PINTS/CALENDAR YEAR & INCLUDES BLOOD PRODUCT, SUPPLIES, & BLOOD PROCESSING FEES W0918 TRAINING FOR HOME DIALYSIS, COMPREHENSIVE SERVICE, PER DIALYSIS AP 1/1/1999 $ PER PATIENT W0919 BACK-UP DIALYSIS TREATMENT AP 1/1/1999 $ Page 32 of 34

33 W0920 INCENTER TREATMENT, PER DIALYSIS AP 1/1/1999 $ W0921 HOME TREATMENT FOR CAPD PER DAY AP 1/1/1999 $35.00 W0922 HOME TREATMENT FOR CCPD PER DAY AP 1/1/1999 $35.00 W0923 HOME TREATMENT HEMODIALYSIS, IPD PER DIALYSIS AP 1/1/1999 $35.00 W0924 KIDNEY MACHINE, INSTALLATION FEE AP 1/1/1999 $ PER PATIENT W0924 KIDNEY MACHINE, INSTALLATION FEE AP 1/1/1995 $ PER PATIENT W0925 KIDNEY MACHINE, MONTHLY RENTAL AP 1/1/1999 $ FEE PER MONTH W0925 KIDNEY MACHINE, MONTHLY RENTAL AP 1/1/1995 $ FEE PER MONTH W0926 WATER SOFTENER, INSTALLATION FEE, IN CONJUNCTION WITH REVERSE OSMOSIS SYSTEM ONLY AP 1/1/1999 $ PER PATIENT W0926 WATER SOFTENER, INSTALLATION FEE, IN CONJUNCTION WITH REVERSE OSMOSIS SYSTEM ONLY AP 1/1/1995 $ PER PATIENT W0927 WATER SOFTENER, MONTHLY RENTAL, IN CONJUNCTION WITH REVERSE OSMOSIS SYSTEM ONLY AP 1/1/1999 $6.00 FEE PER MONTH W0927 WATER SOFTENER, MONTHLY RENTAL, IN CONJUNCTION WITH REVERSE OSMOSIS SYSTEM ONLY AP 1/1/1995 $6.00 FEE PER MONTH Page 33 of 34

34 W0928 ANCILLARY DIALYSIS, NON-EXPENDABLE HOME EQUIPMENT (ONE TIME CHARGE) AP 1/1/1999 $ PER PATIENT W0928 ANCILLARY DIALYSIS, NON-EXPENDABLE HOME EQUIPMENT (ONE TIME CHARGE) AP 1/1/1995 $ PER PATIENT Page 34 of 34