2006 Injection Pricing - Codes Priced by Carrier
HCPCS	Description	Payment Limit
Effective  For Services on or After 7/1/2006
*A4641	Supply radiopharmaceutical diagnostic imaging agent, not otherwise classified	$0.00
A9500	Supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m sestamibi, per unit dose	$121.70
A9502	Supply of radiopharmaceutical diagnostic imaging  agent, technetium tc 99m tetrofosmin, per unit dose	$121.05**
A9503	Supply of radiopharmaceutical diagnostic imaging agent, technetium tc 99m, medronate, up to 30 mci	$23.59
A9504	Supply of radiopharmaceutical diagnostic imaging  agent, technetium tc99m apcitide	$475.00
A9505	Supply of radiopharmaceutical diagnostic imaging agent, thallous chloride tl-201, per mci	$33.23
A9507	Supply of radiopharmaceutical diagnostic imaging agent, indium in 111 capromab pendetide, per dose	$2,949.41
A9508	Supply of radiopharmaceutical diagnostic imaging agent, iobenguane sulfate i-131, per 0.5 mci.	$576.20
A9510	Supply of radiopharmaceutical diagnostic imaging  agent, technetium tc99m disofenin, per vial.	$43.54
A9516	Supply Of Radiopharmaceutical Diagnostic Imaging Agent, I-123 Sodium Iodide capsule, per 100 uci	$88.57
A9517	Supply Of Radiopharmaceutical Therapeutic Imaging Agent, I-131 Sodium Iodide capsule, per mci	$199.86
A9521	Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries	$567.61
A9524	Supply Of Radiopharmaceutical Diagnostic Imaging Agent, Iodinated I-131 Serum albumin, 5 microcuries	$58.52
A9528	Supply of radiopharmaceutical diagnostic agent, i-131 sodium iodide capsule, per millicurie	$39.97
A9535	Injection, methylene blue, 1 ml	$0.52
A9536	Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries	$760.00
A9537	Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries	$59.54
A9538	Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 Millicuries	$24.70
A9539	Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries	$16.25
A9540	Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 Millicuries	$21.53
A9541	Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 Millicuries	$53.20
A9542	Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 Millicuries	$2,769.63
A9543	Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 Millicuries	$23,976.91
A9544	Iodine i-131 tositumomab, diagnostic, per study dose	$2,641.95
A9545	Iodine i-131 tositumomab, therapeutic, per treatment dose	$22,896.90
A9547	Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie	$291.61
A9548	Indium in-111 pentetate, diagnostic, per 0.5 millicurie	$272.21
A9549	Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 25 millicuries	$1,235.00
A9551	Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries	$126.63
A9552	Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries	$450.00
A9555	Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries	$500.00
A9556	Gallium ga-67 citrate, diagnostic, per millicurie	$31.95
A9557	Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries	$424.18
A9558	Xenon xe-133 gas, diagnostic, per 10 millicuries	$38.96
A9560	Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 Millicuries	$114.00
A9561	Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries	$32.83
A9562	Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries	$445.51
A9563	Sodium phosphate p-32, therapeutic, per millicurie	$143.15
A9564	Chromic phosphate p-32 suspension, therapeutic, per millicurie	$777.94
A9565	Indium in-111 pentetreotide, diagnostic, per millicurie	$744.80
A9600	Supply of therapeutic radiopharmaceutical, strontium-89 chloride, per mci	$882.79
A9605	Supply of therapeutic radiopharmaceutical, samarium sm 153 lexidronamm, 50 mci	$1,426.88
A9700	Supply of injectable contrast material for use in echocardiography, per study.	$160.06
J1675	Injection, histrelin acetate, 10 mg	$1,140.00
Q2004	Irrigation solution for treatment of bladder calculi, for example renacidin, Per 500 ml	$29.45
*	Code A4641 effective 12/1/03 will be priced on a claim to claim basis
	Non-par physicians get 95% of the fee schedule
	6/15/2006
	** Payment limit for A9502 corrected 7/20/2006