00004060061LEVEL I NEEDLE BIOPSY/ ASPIRATION EXCEPT BONE MARROW
00005060061LEVEL II NEEDLE BIOPSY/ASPIRATION EXCEPT BONE MARROW
00006060061LEVEL I INCISION & DRAINAGE
00007060061LEVEL II INCISION & DRAINAGE
00008060061LEVEL III INCISION AND DRAINAGE
00012060061LEVEL I DEBRIDEMENT & DESTRUCTION
00015060061LEVEL II DEBRIDEMENT & DESTRUCTION
00016060061LEVEL III DEBRIDEMENT & DESTRUCTION
00017060061LEVEL IV DEBRIDEMENT & DESTRUCTION
00019060061LEVEL I EXCISION/ BIOPSY
00020060061LEVEL II EXCISION/ BIOPSY
00021060061LEVEL III EXCISION/ BIOPSY
00022060061LEVEL IV EXCISION/ BIOPSY
00028060061LEVEL I BREAST AND SKIN SURGERY
00029060061LEVEL II BREAST AND SKIN SURGERY
00030060061LEVEL III BREAST AND SKIN SURGERY
00031060061LEVEL I HEALTH AND BEHAVIOR SERVICES
00034060061MENTAL HEALTH SERVICES COMPOSITE
00039060061LEVEL III NEUROSTIMULATOR & RELATED PROCEDURES
00041060061LEVEL I ARTHROSCOPY
00042060061LEVEL II ARTHROSCOPY
00045060061BONE/JOINT MANIPULATION UNDER ANESTHESIA
00047060061ARTHROPLASTY
00049060061LEVEL I MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00050060061LEVEL II MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00051060061LEVEL III MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00052060061LEVEL IV MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00053060061LEVEL I HAND MUSCULOSKELETAL PROCEDURES
00054060061LEVEL II HAND MUSCULOSKELETAL PROCEDURES
00055060061LEVEL I FOOT MUSCULOSKELETAL PROCEDURES
00056060061LEVEL II FOOT MUSCULOSKELETAL PROCEDURES
00057060061BUNION PROCEDURES
00058060061LEVEL II STRAPPING AND CAST APPLICATION
00059060061LEVEL I STRAPPING AND CAST APPLICATION
00060060061MANIPULATION THERAPY
00061060061LEVEL II NEUROSTIMULATOR & RELATED PROCEDURES
00062060061LEVEL I TREATMENT FRACTURE/DISLOCATION
00063060061LEVEL II TREATMENT FRACTURE/DISLOCATION
00064060061LEVEL III TREATMENT FRACTURE/DISLOCATION
00066060061LEVEL V RADIATION THERAPY
00067060061SINGLE SESSION CRANIAL STEREOTACTIC RADIOSURGERY
00069060061THORACOSCOPY
00070060061THORACENTESIS/LAVAGE PROCEDURES
00071060061LEVEL I ENDOSCOPY UPPER AIRWAY
00072060061LEVEL II ENDOSCOPY UPPER AIRWAY
00073060061LEVEL III ENDOSCOPY UPPER AIRWAY
00074060061LEVEL IV ENDOSCOPY UPPER AIRWAY
00075060061LEVEL V ENDOSCOPY UPPER AIRWAY
00076060061LEVEL I ENDOSCOPY LOWER AIRWAY
00077060061PULMONARY TREATMENT
00079060061VENTILATION INITIATION AND MANAGEMENT
00080060061DIAGNOSTIC CARDIAC CATHETERIZATION
00083060061LEVEL I ENDOVASCULAR PROCEDURES
00084060061LEVEL I ELECTROPHYSIOLOGIC PROCEDURES
00085060061LEVEL II ELECTROPHYSIOLOGIC PROCEDURES
00086060061LEVEL III ELECTROPHYSIOLOGIC PROCEDURES
00088060061THROMBECTOMY
00089060061LEVEL III PACEMAKER AND SIMILAR PROCEDURES
00090060061LEVEL II PACEMAKER AND SIMILAR PROCEDURES
00093060061VASCULAR RECONSTRUCTION/FISTULA REPAIR
00094060061RESUSCITATION AND CARDIOVERSION
00095060061CARDIAC REHABILITATION
00096060061LEVEL II NONINVASIVE PHYSIOLOGIC STUDIES
00097060061LEVEL I NONINVASIVE PHYSIOLOGIC STUDIES
00099060061ELECTROCARDIOGRAMS/CARDIOGRAPHY
00100060061CARDIAC STRESS TESTS
00103060061MISCELLANEOUS VASCULAR PROCEDURES
00105060061LEVEL I PACEMAKER & SIMILAR PROCEDURES
00107060061LEVEL I ICD AND SIMILAR PROCEDURES
00108060061LEVEL II ICD AND SIMILAR PROCEDURES
00110060061TRANSFUSION
00111060061BLOOD PRODUCT EXCHANGE
00112060061APHERESIS AND STEM CELL PROCEDURES
00113060061EXCISION LYMPHATIC SYSTEM
00114060061THYROID/LYMPHADENECTOMY PROCEDURES
00121060061LEVEL I TUBE OR CATHETER CHANGES OR REPOSITIONING
00126060061LEVEL I URINARY AND ANAL PROCEDURES
00129060061LEVEL I CLOSED TREATMENT FRACTURE
00130060061LEVEL I LAPAROSCOPY
00131060061LEVEL II LAPAROSCOPY
00132060061LEVEL III LAPAROSCOPY
00138060061LEVEL II CLOSED TREATMENT FRACTURE
00139060061LEVEL III CLOSED TREATMENT FRACTURE
00141060061LEVEL I UPPER GI PROCEDURES
00142060061LEVEL I SMALL INTESTINE ENDOSCOPY
00143060061LOWER GI ENDOSCOPY
00146060061LEVEL I SIGMOIDOSCOPY AND ANOSCOPY
00147060061LEVEL II SIGMOIDOSCOPY AND ANOSCOPY
00148060061LEVEL I ANAL/RECTAL PROCEDURES
00149060061LEVEL III ANAL/RECTAL PROCEDURES
00150060061LEVEL IV ANAL/RECTAL PROCEDURES
00151060061ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP)
00152060061LEVEL I PERCUTANEOUS ABDOMINAL AND BILIARY PROCEDURES
00153060061PERITONEAL AND ABDOMINAL PROCEDURES
00154060061HERNIA/HYDROCELE PROCEDURES
00155060061LEVEL II ANAL/RECTAL PROCEDURES
00156060061LEVEL III URINARY AND ANAL PROCEDURES
00157060061COLORECTAL CANCER SCREENING: BARIUM ENEMA
00158060061COLORECTAL CANCER SCREENING: COLONOSCOPY
00159060061COLORECTAL CANCER SCREENING: FLEXIBLE SIGMOIDOSCOPY
00160060061LEVEL I CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00161060061LEVEL II CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00162060061LEVEL III CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00163060061LEVEL IV CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00164060061LEVEL II URINARY AND ANAL PROCEDURES
00165060061LEVEL IV URINARY AND ANAL PROCEDURES
00166060061LEVEL I URETHRAL PROCEDURES
00168060061LEVEL II URETHRAL PROCEDURES
00170060061DIALYSIS
00172060061LEVEL I PARTIAL HOSPITALIZATION (3 SERVICES) FOR CMHCS
00173060061LEVEL II PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR CMHCS
00174060061LEVEL IV LAPAROSCOPY
00175060061LEVEL I PARTIAL HOSPITALIZATION (3 SERVICES) FOR HOSPITAL-BASED PHPS
00176060061LEVEL II PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
00177060061LEVEL I ECHOCARDIOGRAM WITH CONTRAST
00178060061LEVEL II ECHOCARDIOGRAM WITH CONTRAST
00181060061LEVEL II MALE GENITAL PROCEDURES
00183060061LEVEL I MALE GENITAL PROCEDURES
00184060061PROSTATE BIOPSY
00188060061LEVEL I GYNECOLOGIC PROCEDURES
00189060061LEVEL II GYNECOLOGIC PROCEDURES
00192060061LEVEL III GYNECOLOGIC PROCEDURES
00193060061LEVEL IV GYNECOLOGIC PROCEDURES
00202060061LEVEL V GYNECOLOGIC PROCEDURES
00203060061LEVEL IV NERVE INJECTIONS
00204060061LEVEL I NERVE INJECTIONS
00205060061LEVEL III MALE GENITAL PROCEDURES
00206060061LEVEL II NERVE INJECTIONS
00207060061LEVEL III NERVE INJECTIONS
00208060061LAMINOTOMIES AND LAMINECTOMIES
00209060061LEVEL II EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00213060061LEVEL I EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00215060061LEVEL I NERVE AND MUSCLE SERVICES
00216060061LEVEL III NERVE AND MUSCLE SERVICES
00218060061LEVEL II NERVE AND MUSCLE SERVICES
00219060061VASCULAR LIGATION
00220060061LEVEL I NERVE PROCEDURES
00221060061LEVEL II NERVE PROCEDURES
00224060061IMPLANTATION OF CATHETER/RESERVOIR/SHUNT
00227060061IMPLANTATION OF DRUG INFUSION DEVICE
00229060061LEVEL II ENDOVASCULAR PROCEDURES
00230060061LEVEL I EYE TESTS & TREATMENTS
00231060061LEVEL III EYE TESTS & TREATMENTS
00233060061LEVEL II INTRAOCULAR PROCEDURES
00238060061LEVEL I EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00239060061LEVEL II EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00240060061LEVEL III EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00242060061LEVEL IV EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00247060061LASER EYE PROCEDURES
00250060061LEVEL I ENT PROCEDURES
00251060061LEVEL II ENT PROCEDURES
00252060061LEVEL III ENT PROCEDURES
00253060061LEVEL IV ENT PROCEDURES
00254060061LEVEL V ENT PROCEDURES
00255060061LEVEL I INTRAOCULAR PROCEDURES
00256060061LEVEL VI ENT PROCEDURES
00259060061LEVEL VII ENT PROCEDURES
00260060061LEVEL I PLAIN FILM INCLUDING BONE DENSITY MEASUREMENT
00261060061LEVEL II PLAIN FILM INCLUDING BONE DENSITY MEASUREMENT
00263060061LEVEL I MISCELLANEOUS RADIOLOGY PROCEDURES
00265060061LEVEL I DIAGNOSTIC AND SCREENING ULTRASOUND
00266060061LEVEL II DIAGNOSTIC AND SCREENING ULTRASOUND
00267060061LEVEL III DIAGNOSTIC AND SCREENING ULTRASOUND
00269060061LEVEL I ECHOCARDIOGRAM WITHOUT CONTRAST
00270060061LEVEL II ECHOCARDIOGRAM WITHOUT CONTRAST
00272060061FLUOROSCOPY AND OTHER RADIOLOGY SERVICES
00274060061MYELOGRAPHY
00275060061ARTHROGRAPHY
00276060061LEVEL I DIGESTIVE RADIOLOGY
00277060061LEVEL II DIGESTIVE RADIOLOGY
00278060061DIAGNOSTIC UROGRAPHY
00279060061LEVEL II ANGIOGRAPHY AND VENOGRAPHY
00280060061LEVEL III ANGIOGRAPHY AND VENOGRAPHY
00283060061COMPUTED TOMOGRAPHY WITH CONTRAST
00284060061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST
00293060061LEVEL IV INTRAOCULAR PROCEDURES
00300060061LEVEL I RADIATION THERAPY
00301060061LEVEL II RADIATION THERAPY
00303060061TREATMENT DEVICE CONSTRUCTION
00304060061LEVEL I THERAPEUTIC RADIATION TREATMENT PREPARATION
00305060061LEVEL II THERAPEUTIC RADIATION TREATMENT PREPARATION
00308060061POSITRON EMISSION TOMOGRAPHY (PET) IMAGING
00310060061LEVEL III THERAPEUTIC RADIATION TREATMENT PREPARATION
00312060061RADIOELEMENT APPLICATIONS
00313060061BRACHYTHERAPY
00317060061LEVEL II MISCELLANEOUS RADIOLOGY PROCEDURES
00318060061LEVEL IV NEUROSTIMULATOR & RELATED PROCEDURES
00319060061LEVEL III ENDOVASCULAR PROCEDURES
00320060061ELECTROCONVULSIVE THERAPY
00322060061BRIEF INDIVIDUAL PSYCHOTHERAPY
00323060061EXTENDED INDIVIDUAL PSYCHOTHERAPY
00324060061FAMILY PSYCHOTHERAPY
00325060061GROUP PSYCHOTHERAPY
00326060061LEVEL I SKIN PROCEDURES
00327060061LEVEL II SKIN PROCEDURES
00328060061LEVEL III SKIN PROCEDURES
00329060061LEVEL IV SKIN PROCEDURES
00330060061DENTAL PROCEDURES
00331060061COMBINED ABDOMEN AND PELVIS CT WITHOUT CONTRAST
00332060061COMPUTED TOMOGRAPHY WITHOUT CONTRAST
00333060061COMPUTED TOMOGRAPHY WITHOUT CONTRAST FOLLOWED BY CONTRAST
00334060061COMBINED ABDOMEN AND PELVIS CT WITH CONTRAST
00336060061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST
00337060061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY CONTRAST
00340060061LEVEL II MINOR PROCEDURES
00342060061LEVEL I PATHOLOGY
00345060061LEVEL I TRANSFUSION LABORATORY PROCEDURES
00346060061LEVEL II TRANSFUSION LABORATORY PROCEDURES
00351060061LEVEL V INTRAOCULAR PROCEDURES
00360060061LEVEL I ALIMENTARY TESTS
00361060061LEVEL II ALIMENTARY TESTS
00363060061OTORHINOLARYNGOLOGIC AND RELATED TESTS
00364060061LEVEL I AUDIOMETRY
00365060061LEVEL II AUDIOMETRY
00367060061LEVEL I PULMONARY TESTS
00369060061LEVEL II PULMONARY TESTS
00373060061NEUROPSYCHOLOGICAL TESTING
00375060061ANCILLARY OUTPATIENT SERVICES WHEN PATIENT EXPIRES
00377060061LEVEL II CARDIAC IMAGING
00378060061LEVEL II PULMONARY IMAGING
00383060061CARDIAC COMPUTED TOMOGRAPHIC IMAGING
00384060061GI PROCEDURES WITH STENTS
00385060061LEVEL I UROGENITAL PROCEDURES
00386060061LEVEL II UROGENITAL PROCEDURES
00388060061DISCOGRAPHY
00389060061LEVEL I NON-IMAGING NUCLEAR MEDICINE
00390060061LEVEL I ENDOCRINE IMAGING
00391060061LEVEL II ENDOCRINE IMAGING
00392060061LEVEL II NON-IMAGING NUCLEAR MEDICINE
00393060061HEMATOLOGIC PROCESSING & STUDIES
00394060061HEPATOBILIARY IMAGING
00395060061GI TRACT IMAGING
00396060061BONE IMAGING
00398060061LEVEL I CARDIAC IMAGING
00400060061HEMATOPOIETIC IMAGING
00401060061LEVEL I PULMONARY IMAGING
00402060061LEVEL II NERVOUS SYSTEM IMAGING
00403060061LEVEL I NERVOUS SYSTEM IMAGING
00404060061RENAL AND GENITOURINARY STUDIES
00406060061LEVEL I TUMOR/INFECTION IMAGING
00407060061RADIONUCLIDE THERAPY
00408060061LEVEL III TUMOR/INFECTION IMAGING
00412060061LEVEL III RADIATION THERAPY
00414060061LEVEL II TUMOR/INFECTION IMAGING
00415060061LEVEL II ENDOSCOPY LOWER AIRWAY
00419060061LEVEL II UPPER GI PROCEDURES
00420060061LEVEL III MINOR PROCEDURES
00422060061LEVEL III UPPER GI PROCEDURES
00423060061LEVEL II PERCUTANEOUS ABDOMINAL AND BILIARY PROCEDURES
00424060061LEVEL II SMALL INTESTINE ENDOSCOPY
00425060061LEVEL V MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00427060061LEVEL II TUBE OR CATHETER CHANGES OR REPOSITIONING
00428060061LEVEL III SIGMOIDOSCOPY AND ANOSCOPY
00431060061LEVEL IV CLOSED TREATMENT FRACTURE
00432060061LEVEL II HEALTH AND BEHAVIOR SERVICES
00433060061LEVEL II PATHOLOGY
00435060061LEVEL III EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00436060061LEVEL I DRUG ADMINISTRATION
00437060061LEVEL II DRUG ADMINISTRATION
00438060061LEVEL III DRUG ADMINISTRATION
00439060061LEVEL IV DRUG ADMINISTRATION
00440060061LEVEL V DRUG ADMINISTRATION
00442060061DOSIMETRIC DRUG ADMINISTRATION
00446060061LEVEL IV NERVE AND MUSCLE SERVICES
00450060061LEVEL I MINOR PROCEDURES
00609060061LEVEL 1 TYPE A EMERGENCY VISITS
00613060061LEVEL 2 TYPE A EMERGENCY VISITS
00614060061LEVEL 3 TYPE A EMERGENCY VISITS
00615060061LEVEL 4 TYPE A EMERGENCY VISITS
00616060061LEVEL 5 TYPE A EMERGENCY VISITS
00617060061CRITICAL CARE
00618060061TRAUMA RESPONSE WITH CRITICAL CARE
00621060061LEVEL I VASCULAR ACCESS PROCEDURES
00622060061LEVEL II VASCULAR ACCESS PROCEDURES
00624060061PHLEBOTOMY AND MINOR VASCULAR ACCESS DEVICE PROCEDURES
00626060061LEVEL 1 TYPE B EMERGENCY VISITS
00627060061LEVEL 2 TYPE B EMERGENCY VISITS
00628060061LEVEL 3 TYPE B EMERGENCY VISITS
00629060061LEVEL 4 TYPE B EMERGENCY VISITS
00630060061LEVEL 5 TYPE B EMERGENCY VISITS
00631060061LEVEL 1 EXAMINATIONS & RELATED SERVICES
00632060061LEVEL 2 EXAMINATIONS & RELATED SERVICES
00633060061LEVEL 3 EXAMINATIONS & RELATED SERVICES
00634060061HOSPITAL CLINIC VISITS
00648060061LEVEL IV BREAST AND SKIN SURGERY
00651060061COMPLEX INTERSTITIAL RADIATION SOURCE APPLICATION
00652060061INSERTION OF INTRAPERITONEAL AND PLEURAL CATHETERS
00655060061LEVEL IV PACEMAKER AND SIMILAR PROCEDURES
00659060061HYPERBARIC OXYGEN
00661060061LEVEL III PATHOLOGY
00662060061CT ANGIOGRAPHY
00667060061LEVEL IV RADIATION THERAPY
00668060061LEVEL I ANGIOGRAPHY AND VENOGRAPHY
00673060061LEVEL III INTRAOCULAR PROCEDURES
00676060061THROMBOLYSIS AND OTHER DEVICE REVISIONS
00688060061LEVEL I NEUROSTIMULATOR & RELATED PROCEDURES
00690060061LEVEL I ELECTRONIC ANALYSIS OF DEVICES
00691060061LEVEL III ELECTRONIC ANALYSIS OF DEVICES
00692060061LEVEL II ELECTRONIC ANALYSIS OF DEVICES
00698060061LEVEL II EYE TESTS & TREATMENTS
00701060087SR89 STRONTIUM
00726060087DEXRAZOXANE HCL INJECTION
00731060087SARGRAMOSTIM INJECTION
00736060087AMPHOTERICIN B LIPOSOME INJ
00738060087RASBURICASE
00747060069CHLOROTHIAZIDE SODIUM INJ
00751060087MECHLORETHAMINE HCL INJ
00752060087DACTINOMYCIN INJECTION
00759060087NALTREXONE, DEPOT FORM
00800060087LEUPROLIDE ACETATE
00802060087ETOPOSIDE ORAL
00807060087ALDESLEUKIN INJECTION
00809060075BCG LIVE INTRAVESICAL VAC
00810060087GOSERELIN ACETATE IMPLANT
00812060087CARMUSTINE INJECTION
00814060061ASPARAGINASE, NOS
00820060087DAUNORUBICIN INJECTION
00821060069DAUNORUBICIN CITRATE INJ
00823060081DOCETAXEL INJECTION
00825060087NELARABINE INJECTION
00827060069FLOXURIDINE INJECTION
00831060069IFOSFAMIDE INJECTION
00832060073IDARUBICIN HCL INJECTION
00835060065COSYNTROPIN INJECTION NOS
00836060087INTERFERON ALFA-2B INJ
00838060071INTERFERON GAMMA 1-B INJ
00840060079INJ MELPHALAN HYDROCHL
00840080087INJ MELPHA HYDROCH NOS 50 MG
00842060061FLUDARABINE PHOSPHATE INJ
00843060087PEGASPARGASE INJECTION
00844060087PENTOSTATIN INJECTION
00849060073RITUXIMAB INJECTION
00850060087STREPTOZOCIN INJECTION
00851060087THIOTEPA INJECTION
00856060087PORFIMER SODIUM INJECTION
00858060087INJ CLADRIBINE
00864060087MITOXANTRONE HYDROCHL
00868060073ORAL APREPITANT
00873060069HYALGAN/SUPARTZ INJ PER DOSE
00873070077HYALGAN SUPARTZ VISCO-3 DOSE
00874060087SYNVISC OR SYNVISC-ONE
00875060087EUFLEXXA INJ PER DOSE
00877060087ORTHOVISC INJ PER DOSE
00887060087AZATHIOPRINE PARENTERAL
00890060087LYMPHOCYTE IMMUNE GLOBULIN
00901060087ALPHA 1 PROTEINASE INHIBITOR
00902060087INJECTION,ONABOTULINUMTOXINA
00903060087CYTOMEGALOVIRUS IMM IV /VIAL
00910060087INTERFERON BETA-1B / .25 MG
00913060069GANCICLOVIR LONG ACT IMPLANT
00925060087FACTOR VIII
00927060087FACTOR VIII RECOMBINANT
00928060087FACTOR IX COMPLEX
00929060087ANTI-INHIBITOR
00931060087FACTOR IX NON-RECOMBINANT
00932060087FACTOR IX RECOMBINANT NOS
00934060065CAPECITABINE, ORAL
00943060087OCTAGAM INJECTION
00944060087GAMMAGARD LIQUID INJECTION
00945060061RHOPHYLAC INJECTION
00946060087HEPAGAM B IM INJECTION
00947060087FLEBOGAMMA INJECTION
00948060087GAMUNEX-C/GAMMAKED
00949060061FROZEN PLASMA, POOLED, SD
00950060061WHOLE BLOOD FOR TRANSFUSION
00952060061CRYOPRECIPITATE EACH UNIT
00954060061RBC LEUKOCYTES REDUCED
00955060061PLASMA, FRZ BETWEEN 8-24HOUR
00956060061PLASMA PROTEIN FRACT,5%,50ML
00957060061PLATELETS, EACH UNIT
00958060061PLAELET RICH PLASMA UNIT
00959060061RED BLOOD CELLS UNIT
00960060061WASHED RED BLOOD CELLS UNIT
00961060087ALBUMIN (HUMAN),5%, 50ML
00963060087ALBUMIN (HUMAN), 5%, 250 ML
00964060087ALBUMIN (HUMAN), 25%, 20 ML
00965060087ALBUMIN (HUMAN), 25%, 50ML
00966060061PLASMAPROTEIN FRACT,5%,250ML
00967060061BLOOD SPLIT UNIT
00968060061PLATELETS LEUKOREDUCED IRRAD
00969060061RBC LEUKOREDUCED IRRADIATED
01009060061CRYOPRECIPITATEREDUCEDPLASMA
01010060061BLOOD, L/R, CMV-NEG
01011060061PLATELETS, HLA-M, L/R, UNIT
01013060061PLATELETS LEUKOCYTES REDUCED
01015060087INJECTION GLATIRAMER ACETATE
01016060061BLOOD, L/R, FROZ/DEGLY/WASH
01017060061PLT, APH/PHER, L/R, CMV-NEG
01018060061BLOOD, L/R, IRRADIATED
01019060061PLATE PHERES LEUKOREDU IRRAD
01020060061PLT, PHER, L/R CMV-NEG, IRR
01021060061RBC, FRZ/DEG/WSH, L/R, IRRAD
01022060061RBC, L/R, CMV-NEG, IRRAD
01023060061PRALIDOXIME CHLORIDE INJ
01052060073INJECTION, VORICONAZOLE
01064060087I131 IODIDE CAP, RX
01083060087ADALIMUMAB INJECTION
01086060069TEMOZOLOMIDE
01138060087HEPAGAM B INTRAVENOUS, INJ
01139060087PROTEIN C CONCENTRATE
01142060087SUPPRELIN LA IMPLANT
01150060087I131 IODIDE SOL, RX
01166060081CYTARABINE LIPOSOME INJ
01168060087INJ, TEMSIROLIMUS
01178060087BUSULFAN INJECTION
01203060087VERTEPORFIN INJECTION
01207060087OCTREOTIDE INJECTION, DEPOT
01213060087ANTIHEMOPHILIC VIII/VWF COMP
01214060087INJ IVIG PRIVIGEN 500 MG
01232060087MITOMYCIN INJECTION
01235060087VALRUBICIN INJECTION
01236060076LEVOLEUCOVORIN INJECTION
01236077085INJ LEVOLEUCOVORIN NOS 0.5MG
01237060087INJ IRON DEXTRAN
01238060073TOPOTECAN ORAL
01253060077TRIAMCINOLONE A INJ PRS-FREE
01263060087ANTITHROMBIN III INJECTION
01268060087XYNTHA INJ
01272060065ACETYLCYSTEINE INJECTION
01274060087EDETATE CALCIUM DISODIUM INJ
01280060073CORTICOTROPIN INJECTION
01281060087BEVACIZUMAB INJECTION
01289060087ABOBOTULINUMTOXINA
01291060073RILONACEPT INJECTION
01295060087SM 153 LEXIDRONAM
01296060087DEGARELIX INJECTION
01297060087FERUMOXYTOL, NON-ESRD
01311060087CANAKINUMAB INJECTION
01312060087HIZENTRA INJECTION
01327060087IMIGLUCERASE INJECTION
01331060069OLANZAPINE LONG-ACTING INJ
01331082087OLANZAPINE LONG-ACTING INJ
01332060069ANTITHROMBIN RECOMBINANT
01338060069METHYL AMINOLEVULINATE, TOP
01340060087COLLAGENASE, CLOST HIST INJ
01341060087AMOBARBITAL 125 MG INJ
01350060061TOPOTECAN INJECTION
01352060087WILATE INJECTION
01353060087BELIMUMAB INJECTION
01354060067HYDROXYPROGESTERONE CAPROATE
01356060065ZOLEDRONIC ACID 1MG
01361060069ENFUVIRTIDE INJECTION
01408060087CYCLOPHOSPHAMIDE 100 MG INJ
01413060087LUMIZYME INJECTION
01415060087GLASSIA INJECTION
01416060087FACTOR XIII ANTI-HEM FACTOR
01417060087GEL-ONE
01419060061DERMACELL
01420060087AFLIBERCEPT INJECTION
01421060071IMPORTED LIPODOX INJ
01421074087IMPORTED LIPODOX INJ
01422060061ANTHRAX VACCINE SC OR IM
01424060069NABILONE ORAL
01426060087ERIBULIN MESYLATE INJECTION
01431060087CENTRUROIDES IMMUNE F(AB)
01433060087CALCITONIN SALMON INJECTION
01440060087INJ DESMOPRESSIN ACETATE
01442060087NON-HEU TC-99M ADD-ON/DOSE
01443060087ICATIBANT INJECTION
01446060087VISUALIZATION ADJUNCT
01448060061OPTHALMIC MITOMYCIN
01449060061TALYMED
01456060061PENTOBARBITAL SODIUM INJ
01457060069TOTAZOLINE HCL INJECTION
01458060087PHENTOLAINE MESYLATE INJ
01459060061UREA INJECTION
01460060069INTERFERON ALFA-2A INJ
01463060061TC99 TILMANOCEPT DIAG 0.5MCI
01464060069FACTOR VIII (PORCINE)
01465060061TACROLIMUS EX REL ORAL 0.1MG
01465062065TACROL ASTAGRAF EX REL ORAL
01466060087INJ, VINCRISTINE SUL LIP 1MG
01467060087FACTOR IX RECOMBINAN RIXUBIS
01468060087INJ ARIPIPRAZOLE EXT REL 1MG
01469060061INJ, FILGRASTIM G-CSF 1MCG
01469062087INJ FILGRASTIM EXCL BIOSIMIL
01471060087INJECTION, PERTUZUMAB, 1 MG
01472060087INJ BETA INTERFERON IM 1 MCG
01474060087CERTOLIZUMAB PEGOL INJ 1MG
01475060087GOLIMUMAB FOR IV USE 1MG
01476060087OBINUTUZUMAB INJ
01477060061INJ, TBO-FILGRASTIM, 5 MCG
01478060073HUMAN FIBRINOGEN CONC INJ
01478074087INJ HUMAN FIBRINOGEN CON NOS
01479060065THERASKIN
01480060087ELOSULFASE ALFA, INJECTION
01482060087DARBEPOETIN ALFA, ESRD USE
01484060073PENTAZOCINE INJECTION
01485060087FERUMOXYTOL, ESRD USE
01486060087FACTOR IX FC FUSION RECOMB
01487060065TESTOSTERONE UNDECANOATE 1MG
01488060087INJECTION, RAMUCIRUMAB
01489060087INJECTION, VEDOLIZUMAB
01490060061INJECTION, PEMBROLIZUMAB
01490062087INJ PEMBROLIZUMAB
01491060060NEW TECHNOLOGY - LEVEL IA ($0-$10)
01491061061NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01491062077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01491078087NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01492060060NEW TECHNOLOGY - LEVEL IB ($10-$20)
01492061061NEW TECHNOLOGY  - LEVEL IB ($10-$20)
01492062065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01492066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01492078087NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01493060060NEW TECHNOLOGY - LEVEL IC ($20-$30)
01493061061NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01493062065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01493066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01493078087NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01494060060NEW TECHNOLOGY - LEVEL ID ($30-$40)
01494061061NEW TECHNOLOGY  - LEVEL ID ($30-$40)
01494062065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01494066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01494078087NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01495060060NEW TECHNOLOGY - LEVEL IE ($40-$50)
01495061061NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01495062065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01495066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01495078087NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01496060060NEW TECHNOLOGY - LEVEL IA ($0-$10)
01496061061NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01496062077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01496078087NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01497060060NEW TECHNOLOGY - LEVEL IB ($10-$20)
01497061061NEW TECHNOLOGY  - LEVEL IB($10-$20)
01497062065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01497066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01497078087NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01498060060NEW TECHNOLOGY - LEVEL IC ($20-$30)
01498061061NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01498062065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01498066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01498078087NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01499060060NEW TECHNOLOGY - LEVEL ID ($30-$40)
01499061061NEW TECHNOLOGY  - LEVEL ID($30-$40)
01499062065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01499066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01499078087NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01500060060NEW TECHNOLOGY - LEVEL IE ($40-$50)
01500061061NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01500062065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01500066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01500078087NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01502060060NEW TECHNOLOGY - LEVEL II ($50 - $100)
01502061061NEW TECHNOLOGY - LEVEL II   ($50 - $100)
01502062065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01502066087NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01503060060NEW TECHNOLOGY - LEVEL III ($100 - $200)
01503061061NEW TECHNOLOGY - LEVEL III   ($100 - $200)
01503062065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01503066087NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01504060060NEW TECHNOLOGY - LEVEL IV ($200 - $300)
01504061061NEW TECHNOLOGY - LEVEL IV  ($200 - $300)
01504062065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01504066087NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01505060060NEW TECHNOLOGY - LEVEL V ($300 - $400)
01505061061NEW TECHNOLOGY - LEVEL V   ($300 - $400)
01505062065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01505066087NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01506060060NEW TECHNOLOGY - LEVEL VI ($400 - $500)
01506061061NEW TECHNOLOGY - LEVEL VI  ($400 - $500)
01506062065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01506066087NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01507060060NEW TECHNOLOGY - LEVEL VII ($500 - $600)
01507061061NEW TECHNOLOGY - LEVEL VII  ($500 - $600)
01507062065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01507066087NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01508060061NEW TECHNOLOGY - LEVEL VIII ($600 - $700)
01508062065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01508066087NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01509060061NEW TECHNOLOGY - LEVEL IX   ($700 - $800)
01509062065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01509066087NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01510060061NEW TECHNOLOGY - LEVEL X    ($800 - $900)
01510062065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01510066087NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01511060061NEW TECHNOLOGY - LEVEL XI   ($900 - $1000)
01511062065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01511066087NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01512060061NEW TECHNOLOGY - LEVEL XII  ($1000 - $1100)
01512062065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01512066087NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01513060061NEW TECHNOLOGY - LEVEL XIII  ($1100 - $1200)
01513062065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01513066087NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01514060061NEW TECHNOLOGY - LEVEL XIV ($1200- $1300)
01514062065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01514066087NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01515060061NEW TECHNOLOGY - LEVEL XV ($1300 - $1400)
01515062065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01515066087NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01516060061NEW TECHNOLOGY - LEVEL XVI  ($1400 - $1500)
01516062065NEW TECHNOLOGY - LEVEL 16  ($1400 - $1500)
01516066077NEW TECHNOLOGY - LEVEL 16  ($1401 - $1500)
01516078087NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01517060061NEW TECHNOLOGY - LEVEL XVII ($1500-$1600)
01517062065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01517066087NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01518060061NEW TECHNOLOGY - LEVEL XVIII ($1600-$1700)
01518062065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01518066087NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01519060061NEW TECHNOLOGY - LEVEL IXX ($1700-$1800)
01519062065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01519066087NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01520060061NEW TECHNOLOGY - LEVEL XX ($1800-$1900)
01520062065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01520066087NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01521060061NEW TECHNOLOGY - LEVEL XXI ($1900-$2000)
01521062065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01521066087NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01522060061NEW TECHNOLOGY - LEVEL XXII ($2000-$2500)
01522062065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01522066087NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01523060061NEW TECHNOLOGY - LEVEL XXIII ($2500-$3000)
01523062065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01523066087NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01524060061NEW TECHNOLOGY - LEVEL XXIV ($3000-$3500)
01524062065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01524066087NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01525060061NEW TECHNOLOGY - LEVEL XXV ($3500-$4000)
01525062065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01525066087NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01526060061NEW TECHNOLOGY - LEVEL XXVI ($4000-$4500)
01526062065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01526066087NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01527060061NEW TECHNOLOGY - LEVEL XXVII ($4500-$5000)
01527062065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01527066087NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01528060061NEW TECHNOLOGY - LEVEL XXVIII ($5000-$5500)
01528062065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01528066087NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01529060061NEW TECHNOLOGY - LEVEL XXIX ($5500-$6000)
01529062065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01529066087NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01530060061NEW TECHNOLOGY - LEVEL XXX ($6000-$6500)
01530062065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01530066087NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01531060061NEW TECHNOLOGY - LEVEL XXXI ($6500-$7000)
01531062065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01531066087NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01532060061NEW TECHNOLOGY - LEVEL XXXII ($7000-$7500)
01532062065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01532066087NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01533060061NEW TECHNOLOGY - LEVEL XXXIII ($7500-$8000)
01533062065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01533066087NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01534060061NEW TECHNOLOGY - LEVEL XXXIV ($8000-$8500)
01534062065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01534066087NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01535060061NEW TECHNOLOGY - LEVEL XXXV ($8500-$9000)
01535062065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01535066087NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01536060061NEW TECHNOLOGY - LEVEL XXXVI ($9000-$9500)
01536062065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01536066087NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01537060061NEW TECHNOLOGY - LEVEL XXXVII ($9500-$10000)
01537062065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01537066087NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01539060061NEW TECHNOLOGY - LEVEL II   ($50 - $100)
01539062065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01539066087NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01540060061NEW TECHNOLOGY - LEVEL III   ($100 - $200)
01540062065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01540066087NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01541060061NEW TECHNOLOGY - LEVEL IV  ($200 - $300)
01541062065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01541066087NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01542060061NEW TECHNOLOGY - LEVEL V   ($300 - $400)
01542062065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01542066087NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01543060061NEW TECHNOLOGY - LEVEL VI  ($400 - $500)
01543062065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01543066087NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01544060061NEW TECHNOLOGY - LEVEL VII  ($500 - $600)
01544062065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01544066087NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01545060061NEW TECHNOLOGY - LEVEL VIII ($600 - $700)
01545062065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01545066087NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01546060061NEW TECHNOLOGY - LEVEL IX   ($700 - $800)
01546062065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01546066087NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01547060061NEW TECHNOLOGY - LEVEL X    ($800 - $900)
01547062065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01547066087NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01548060061NEW TECHNOLOGY - LEVEL XI   ($900 - $1000)
01548062065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01548066087NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01549060061NEW TECHNOLOGY - LEVEL XII  ($1000 - $1100)
01549062065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01549066087NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01550060061NEW TECHNOLOGY - LEVEL XIII  ($1100 - $1200)
01550062065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01550066087NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01551060061NEW TECHNOLOGY - LEVEL XIV ($1200- $1300)
01551062065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01551066087NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01552060061NEW TECHNOLOGY - LEVEL XV ($1300 - $1400)
01552062065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01552066087NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01553060061NEW TECHNOLOGY - LEVEL XVI  ($1400 - $1500)
01553062065NEW TECHNOLOGY - LEVEL 16 ($1400 - $1500)
01553066087NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01554060061NEW TECHNOLOGY - LEVEL XVII ($1500-$1600)
01554062065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01554066087NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01555060061NEW TECHNOLOGY - LEVEL XVIII ($1600-$1700)
01555062065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01555066087NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01556060061NEW TECHNOLOGY - LEVEL XIX ($1700-$1800)
01556062065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01556066087NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01557060061NEW TECHNOLOGY - LEVEL XX ($1800-$1900)
01557062065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01557066087NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01558060061NEW TECHNOLOGY - LEVEL XXI ($1900-$2000)
01558062065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01558066087NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01559060061NEW TECHNOLOGY - LEVEL XXII ($2000-$2500)
01559062065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01559066087NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01560060061NEW TECHNOLOGY - LEVEL XXIII ($2500-$3000)
01560062065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01560066087NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01561060061NEW TECHNOLOGY - LEVEL XXIV ($3000-$3500)
01561062065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01561066087NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01562060061NEW TECHNOLOGY - LEVEL XXV ($3500-$4000)
01562062065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01562066087NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01563060061NEW TECHNOLOGY - LEVEL XXVI ($4000-$4500)
01563062065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01563066087NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01564060061NEW TECHNOLOGY - LEVEL XXVII ($4500-$5000)
01564062065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01564066087NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01565060061NEW TECHNOLOGY - LEVEL XXVIII ($5000-$5500)
01565062065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01565066087NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01566060061NEW TECHNOLOGY - LEVEL XXIX ($5500-$6000)
01566062065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01566066087NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01567060061NEW TECHNOLOGY - LEVEL XXX ($6000-$6500)
01567062065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01567066087NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01568060061NEW TECHNOLOGY - LEVEL XXXI ($6500-$7000)
01568062065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01568066087NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01569060061NEW TECHNOLOGY - LEVEL XXXII ($7000-$7500)
01569062065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01569066087NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01570060061NEW TECHNOLOGY - LEVEL XXXIII ($7500-$8000)
01570062065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01570066087NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01571060061NEW TECHNOLOGY - LEVEL XXXIV ($8000-$8500)
01571062065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01571066087NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01572060061NEW TECHNOLOGY - LEVEL XXXV ($8500-$9000)
01572062065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01572066087NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01573060061NEW TECHNOLOGY - LEVEL XXXVI ($9000-$9500)
01573062065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01573066087NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01574060061NEW TECHNOLOGY - LEVEL XXXVII ($9500-$10000)
01574062065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01574066087NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01575062065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01575066087NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01576062065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01576066087NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01577062065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01577066087NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01578062065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01578066087NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01579062065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01579066087NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01580062065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01580066087NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01581062065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01581066087NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01582062065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01582066087NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01583062065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01583066087NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01584062065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01584066087NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01585062065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01585066087NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01589062065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01589066087NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01590062065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01590066087NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01591062065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01591066087NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01592062065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01592066087NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01593062065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01593066087NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01594062065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01594066087NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01595062065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01595066087NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01596062065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01596066087NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01597062065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01597066087NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01598062065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01598066087NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01599062065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01599066087NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01605060061ABCIXIMAB INJECTION
01605066069ABCIXIMAB INJECTION
01607060081EPTIFIBATIDE INJECTION
01608060087ETANERCEPT INJECTION
01609060087RHO(D) IMMUNE GLOBULIN H, SD
01612060069DACLIZUMAB, PARENTERAL
01613060081TRASTUZUMAB INJECTION
01613082085INJ TRASTUZUMAB EXCL BIOSIMI
01613086087TRASTUZUMAB INJECTION
01630060087HEP B IG, IM
01631060073BACLOFEN INTRATHECAL TRIAL
01633060069ALEFACEPT
01643060087Y90 IBRITUMOMAB, RX
01656060061FACTOR VIII FC FUSION RECOMB
01656062087FACTOR VIII FC FUSION RECOMB
01657060061PURAPLY, PURAPLY ANTIMIC
01657062065PURAPLY, PURAPLY ANTIMIC
01657066069PURAPLY OR PURAPLY AM
01658060061INJECTION, BELINOSTAT
01658062087INJECTION, BELINOSTAT, 10MG
01659060061INJECTION, DALBAVANCIN
01660060087INJECTION, ORITAVANCIN
01661062069GEN, NEURO, HF, RECHG BAT
01662060061INJ, TEDIZOLID PHOSPHATE
01662062087INJ TEDIZOLID PHOSPHATE
01663060069INJ, PHENYLEPHRINE KETOROLAC
01664060069FLORBETAPIR F18
01665060065CAPSAICIN 8% PATCH
01666060069TETRACYCLIN INJECTION
01667060061ALATROFLOXACIN MESYLATE
01668060065CHORIONIC GONADOTROPIN/1000U
01669060077ERYTHRO LACTOBIONATE /500 MG
01669082085ERYTHRO LACTOBIONATE /500 MG
01670060087TETANUS IMMUNE GLOBULIN INJ
01675060087P32 NA PHOSPHATE
01676060069P32 CHROMIC PHOSPHATE
01683060087BASILIXIMAB
01684060087CORTICORELIN OVINE TRIFLUTAL
01685060087DARBEPOETIN ALFA, NON-ESRD
01686060087EPOETIN ALFA, NON-ESRD
01687060087DIGOXIN IMMUNE FAB (OVINE)
01688060087ETHANOLAMINE OLEATE
01689060087FOMEPIZOLE
01690060087HEMIN
01693060069LEPIRUDIN
01694060087ZICONOTIDE INJECTION
01695060080NESIRITIDE INJECTION
01696060087PALIFERMIN INJECTION
01697060073PEGAPTANIB SODIUM INJECTION
01700060087INJ SECRETIN SYNTHETIC HUMAN
01701060087TREPROSTINIL INJECTION
01704060087HUMATE-P, INJ
01705060081FACTOR VIIA
01705082087FACTOR VIIA RECOMB NOVOSEVEN
01709060087AZACITIDINE INJECTION
01710060087CLOFARABINE INJECTION
01711060087VANTAS IMPLANT
01712060087PACLITAXEL PROTEIN BOUND
01716060061BRACHYTX, NON-STR, GOLD-198
01717060061BRACHYTX, NON-STR, HDR IR-192
01719060061BRACHYTX, NS, NON-HDRIR-192
01738060069OXALIPLATIN
01739060085PEGADEMASE BOVINE, 25 IU
01741060069UROFOLLITROPIN, 75 IU
01742060061GOLD SODIUM THIOMALEATE INJ
01743060077NANDROLONE DECANOATE 50 MG
01744060061ZIDOVUDINE
01745060087RADIUM RA223 DICHLORIDE THER
01746060087FACTOR XIII RECOMB A-SUBUNIT
01747060087MONOVISC INJ PER DOSE
01748062087INJ TBO FILGRASTIM 1 MICROG
01761064087ROLAPITANT, ORAL, 1MG
01807060065MENB PR W/OMV VACCINE IM
01808060065MENB RLP VACCINE IM
01809061061INJECTION, ALEMTUZUMAB
01809062087INJECTION, ALEMTUZUMAB
01822060061INJ FILGRASTIM G-CSF BIOSIM
01822062070INJ FILGRASTIM GCSF BIOSIMIL
01822071087INJECTION, ZARXIO
01823062087INJECTION, DALBAVANCIN
01824062087CEFTAROLINE FOSAMIL INJ
01825062087CEFTAZIDIME AND AVIBACTAM
01826062087HYQVIA 100MG IMMUNEGLOBULIN
01827062087FACTOR VIII RECOMB OBIZUR
01828062065CARBIDOPA LEVODOPA ENTERAL
01828066073CARBIDOPA LEVODOPA ENT 100ML
01829062087PENICILLIN G BENZATHINE INJ
01831062065CHLORAMPHENICOL SODIUM INJEC
01832062087DIMETHYL SULFOXIDE 50% 50 ML
01833062065EPOETIN BETA ESRD USE
01834062065DIGOXIN INJECTION
01835062065ERGONOVINE MALEATE INJECTION
01836062069PENICILLIN G PROCAINE INJ
01837062065METHOCARBAMOL INJECTION
01838062069UROKINASE 250,000 IU INJ
01839062069ORAL BUSULFAN
01841060061RETINAL PROSTH INT/EXT COMP
01842062069LEUPROLIDE ACETATE IMPLANT
01843062065MENACWY VACCINE IM
01844063065ADYNOVATE FACTOR VIII RECOM
01844066087FACTOR VIII PEGYLATED RECOMB
01845063073TACROL ENVARSUS EX REL ORAL
01846063065NUWIQ FACTOR VIII RECOMB
01846066087FACTOR VIII NUWIQ RECOMB 1IU
01847063063INJ., INFLIXIMAB BIOSIMILAR
01847066070INJ., INFLIXIMAB BIOSIMILAR
01847071087INJECTION, INFLECTRA
01848066087ARTISS FIBRIN SEALANT
01849066087FOSCARNET SODIUM INJECTION
01850066087GAMMA GLOBULIN 1 CC INJ
01851066087GAMMA GLOBULIN > 10 CC INJ
01852066087INTERFERON BETA-1A INJ
01853066087MINOCYCLINE HYDROCHLORIDE
01854066085PENTOBARBITAL SODIUM INJ
01855066069PRALIDOXIME CHLORIDE INJ
01856066087FACTOR VIII RECOMB NOVOEIGHT
01857066087INJ, FACTOR X, (HUMAN), 1IU
01858066073LEUPROLIDE ACETATE INJECITON
01859066087ARGATROBAN NONESRD USE 1MG
01860066073MONOCLONAL ANTIBODIES
01861066087INJ., BENDEKA 1 MG
01862067069GEL-SYN INJECTION 0.1 MG
01862070087GELSYN-3 INJECTION 0.1 MG
01863066073INJ DICLOFENAC SODIUM 0.5MG
01901066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01901070087NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01902066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01902070087NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01903066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01903070087NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01904066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01904070087NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01905066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01905070087NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01906066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01906070087NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01907070087NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
01908070087NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
02024078087GENERATOR, CCM, IMPLANT
02025078087CATH, PRESSURE,VALVE-OCCLU
02026078087ORTH/DEVIC/DRUG BN/BN,TIS/BN
02027078087PROBE, ROBOTIC, WATER-JET
02028078087IRIS PROSTHESIS
02029080080ENDOSCOPE, SINGLE, UGI
02029081081ENDOSCOPE, SINGLE, UGI
02029082087ENDOSCOPE, SINGLE, UGI
02030082087GEN, NEURO, CAROT SINUS BARO
02031082087HEMOSTATIC AGENT, GI, TOPIC
02032082087INTRAVERTEBRAL FX AUG IMPL
02033084087CATH, TRANS INTRA LITHO/CORO
02034085087PERSONALIZED INTERBODY CAGE
02035086087AUTO CELL PROCESS SYS
02036086087CARDIAC MONITOR SYS
02613060069LUNG BX PLUG W/DEL SYS
02616060087BRACHYTX, NON-STR,YTTRIUM-90
02623060069CATH, TRANSLUMIN, DRUG-COAT
02624060065WIRELESS PRESSURE SENSOR
02632060087IODINE I-125 SODIUM IODIDE
02634060087BRACHYTX, NON-STR, HA, I-125
02635060087BRACHYTX, NON-STR, HA, P-103
02636060087BRACHY LINEAR, NON-STR,P-103
02638060087BRACHYTX, STRANDED, I-125
02639060087BRACHYTX, NON-STRANDED,I-125
02640060087BRACHYTX, STRANDED, P-103
02641060087BRACHYTX, NON-STRANDED,P-103
02642060087BRACHYTX, STRANDED, C-131
02643060087BRACHYTX, NON-STRANDED,C-131
02644060065BRACHYTX CESIUM-131 CHLORIDE
02644070073BRACHYTX CESIUM-131 CHLORIDE
02645062087BRACHYTX, NON-STR, GOLD-198
02646062087BRACHYTX, NON-STR, HDR IR-192
02647062087BRACHYTX, NS, NON-HDRIR-192
02648062087BRACHYTX PLANAR, P-103
02698060087BRACHYTX, STRANDED, NOS
02699060087BRACHYTX, NON-STRANDED, NOS
02731060087IMMUNE GLOBULIN, POWDER
02770060087QUINUPRISTIN/DALFOPRISTIN
02993074087GEN, NEURO, TRANS SEN/STIM
03041060061BIVALIRUDIN
03041066069BIVALIRUDIN
04001066087ECHO GUIDANCE RADIOTHERAPY
04002066087STEREOSCOPIC X-RAY GUIDANCE
04003066087RADIATION TREATMENT DELIVERY, MEV <= 5; SIMPLE
04004066087RADIATION TREATMENT DELIVERY, 6-10 MEV; SIMPLE
04005066087RADIATION TREATMENT DELIVERY, 11-19 MEV; SIMPLE
04006066087RADIATION TREATMENT DELIVERY, MEV>=20; SIMPLE
04007066087RADIATION TREATMENT DELIVERY, MEV<=5; INTERMEDIATE
04008066087RADIATION TREATMENT DELIVERY, 6-10 MEV; INTERMEDIATE
04009066087RADIATION TREATMENT DELIVERY, 11-19 MEV; INTERMEDIATE
04010066087RADIATION TREATMENT DELIVERY, MEV >=20; INTERMEDIATE
04011066087RADIATION TREATMENT DELIVERY, MEV<=5; COMPLEX
04012066087RADIATION TREATMENT DELIVERY, 6-10 MEV; COMPLEX
04013066087RADIATION TREATMENT DELIVERY, 11-19 MEV; COMPLEX
04014066087RADIATION TREATMENT DELIVERY, MEV >=20; COMPLEX
04015070087RADIATION TX DELIVERY IMRT
04016070087DELIVERY COMP IMRT
04017086087PAYER ONLY TESTING
04018086087PAYER ONLY TESTING
04019086087PAYER ONLY TESTING
04020086087PAYER ONLY TESTING
04021086087PAYER ONLY TESTING
04022086087PAYER ONLY TESTING
04023086087PAYER ONLY TESTING
04024086087PAYER ONLY TESTING
04025086087PAYER ONLY TESTING
04026086087PAYER ONLY TESTING
04027086087PAYER ONLY TESTING
04028086087PAYER ONLY TESTING
04029086087PAYER ONLY TESTING
04030086087PAYER ONLY TESTING
04031086087PAYER ONLY TESTING
05011062065LEVEL 1 EXAMINATIONS AND RELATED SERVICES
05012062065LEVEL 2 EXAMINATIONS AND RELATED SERVICES
05012066087CLINIC VISITS AND RELATED SERVICES
05013062065LEVEL 3 EXAMINATIONS AND RELATED SERVICES
05021062087LEVEL 1 TYPE A ED VISITS
05022062087LEVEL 2 TYPE A ED VISITS
05023062087LEVEL 3 TYPE A ED VISITS
05024062087LEVEL 4 TYPE A ED VISITS
05025062087LEVEL 5 TYPE A ED VISITS
05031062087LEVEL 1 TYPE B ED VISITS
05032062087LEVEL 2 TYPE B ED VISITS
05033062087LEVEL 3 TYPE B ED VISITS
05034062087LEVEL 4 TYPE B ED VISITS
05035062087LEVEL 5 TYPE B ED VISITS
05041062087CRITICAL CARE
05045062087TRAUMA RESPONSE WITH CRITICAL CARE
05051062087LEVEL 1 SKIN PROCEDURES
05052062087LEVEL 2 SKIN PROCEDURES
05053062087LEVEL 3 SKIN PROCEDURES
05054062087LEVEL 4 SKIN PROCEDURES
05055062087LEVEL 5 SKIN PROCEDURES
05061062087HYPERBARIC OXYGEN
05071062087LEVEL 1 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05072062087LEVEL 2 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05073062087LEVEL 3 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05074062065LEVEL 4 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05091062087LEVEL 1 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05092062087LEVEL 2 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05093062087LEVEL 3 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05094066087LEVEL 4 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05101062087LEVEL 1 STRAPPING AND CAST APPLICATION
05102062087LEVEL 2 STRAPPING AND CAST APPLICATION
05111062065LEVEL 1 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05111066087LEVEL 1 MUSCULOSKELETAL PROCEDURES
05112062065LEVEL 2 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05112066087LEVEL 2 MUSCULOSKELETAL PROCEDURES
05113062065LEVEL 3 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05113066087LEVEL 3 MUSCULOSKELETAL PROCEDURES
05114066087LEVEL 4 MUSCULOSKELETAL PROCEDURES
05115066087LEVEL 5 MUSCULOSKELETAL PROCEDURES
05116066087LEVEL 6 MUSCULOSKELETAL PROCEDURES
05121062065LEVEL1 MUSCULOSKELETAL PROCEDURES
05122062065LEVEL 2 MUSCULOSKELETAL PROCEDURES
05123062065LEVEL 3 MUSCULOSKELETAL PROCEDURES
05124062065LEVEL 4 MUSCULOSKELETAL PROCEDURES
05125062065LEVEL 5 MUSCULOSKELETAL PROCEDURES
05141062065THORACOSCOPY
05151062087LEVEL 1 AIRWAY ENDOSCOPY
05152062087LEVEL 2 AIRWAY ENDOSCOPY
05153062087LEVEL 3 AIRWAY ENDOSCOPY
05154062087LEVEL 4 AIRWAY ENDOSCOPY
05155062087LEVEL 5 AIRWAY ENDOSCOPY
05161062087LEVEL 1 ENT PROCEDURES
05162062087LEVEL 2 ENT PROCEDURES
05163062087LEVEL 3 ENT PROCEDURES
05164062087LEVEL 4 ENT PROCEDURES
05165062087LEVEL 5 ENT PROCEDURES
05166062065LEVEL 6 ENT PROCEDURES
05166066087COCHLEAR IMPLANT PROCEDURE
05181062087LEVEL 1 VASCULAR PROCEDURES
05182062087LEVEL 2 VASCULAR PROCEDURES
05183062087LEVEL 3 VASCULAR PROCEDURES
05184070087LEVEL 4 VASCULAR PROCEDURES
05188062065DIAGNOSTIC CARDIAC CATHETERIZATION
05191062087LEVEL 1 ENDOVASCULAR PROCEDURES
05192062087LEVEL 2 ENDOVASCULAR PROCEDURES
05193062087LEVEL 3 ENDOVASCULAR PROCEDURES
05194066087LEVEL 4 ENDOVASCULAR PROCEDURES
05200066087IMPLANTATION WIRELESS PA PRESSURE MONITOR
05211062087LEVEL 1 ELECTROPHYSIOLOGIC PROCEDURES
05212062087LEVEL 2 ELECTROPHYSIOLOGIC PROCEDURES
05213062087LEVEL 3 ELECTROPHYSIOLOGIC PROCEDURES
05221062087LEVEL1 PACEMAKER AND SIMILAR PROCEDURES
05222062087LEVEL 2 PACEMAKER AND SIMILAR PROCEDURES
05223062087LEVEL 3 PACEMAKER AND SIMILAR PROCEDURES
05224062087LEVEL 4 PACEMAKER AND SIMILAR PROCEDURES
05231062087LEVEL 1 ICD AND SIMILAR PROCEDURES
05232062087LEVEL 2 ICD AND SIMILAR PROCEDURES
05241062065TRANSFUSION
05241066087LEVEL 1 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05242066087LEVEL 2 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05243066087LEVEL 3 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05244066087LEVEL 4 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05271062065BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05281062065APHERESIS/STEM CELL AND RELATED SERVICES
05291062065THROMBOLYSIS AND OTHER DEVICE REVISIONS
05301062087LEVEL 1 UPPER GI PROCEDURES
05302062087LEVEL 2 UPPER GI PROCEDURES
05303062087LEVEL 3 UPPER GI PROCEDURES
05311062087LEVEL 1 LOWER GI PROCEDURES
05312062087LEVEL 2 LOWER GI PROCEDURES
05313062087LEVEL 3 LOWER GI PROCEDURES
05314062065LEVEL 4 LOWER GI PROCEDURES
05331062087COMPLEX GI PROCEDURES
05341062065PERITONEAL AND ABDOMINAL PROCEDURES
05341066087ABDOMINAL/PERITONEAL/BILIARY AND RELATED PROCEDURES
05351062065LEVEL 1 PERCUTANEOUS ABDOMINAL/BILIARY PROCEDURES AND RELATED PROCEDURES
05352062065LEVEL 2 PERCUTANEOUS ABDOMINAL/BILIARY PROCEDURES AND RELATED PROCEDURES
05361062065LEVEL 1 LAPAROSCOPY
05361066087LEVEL 1 LAPAROSCOPY AND RELATED SERVICES
05362062065LEVEL 2 LAPAROSCOPY
05362066087LEVEL 2 LAPAROSCOPY AND RELATED SERVICES
05371062087LEVEL 1 UROLOGY AND RELATED SERVICES
05372062087LEVEL 2 UROLOGY AND RELATED SERVICES
05373062087LEVEL 3 UROLOGY AND RELATED SERVICES
05374062087LEVEL 4 UROLOGY AND RELATED SERVICES
05375062087LEVEL 5 UROLOGY AND RELATED SERVICES
05376062087LEVEL 6 UROLOGY AND RELATED SERVICES
05377062087LEVEL 7 UROLOGY AND RELATED SERVICES
05378082087LEVEL 8 UROLOGY AND RELATED SERVICES
05391062065LEVEL 1 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05392062065LEVEL 2 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05401062087DIALYSIS
05411062087LEVEL 1 GYNECOLOGIC PROCEDURES
05412062087LEVEL 2 GYNECOLOGIC PROCEDURES
05413062087LEVEL 3 GYNECOLOGIC PROCEDURES
05414062087LEVEL 4 GYNECOLOGIC PROCEDURES
05415062087LEVEL 5 GYNECOLOGIC PROCEDURES
05416062087LEVEL 6 GYNECOLOGIC PROCEDURES
05431062087LEVEL 1 NERVE PROCEDURES
05432062087LEVEL 2 NERVE PROCEDURES
05441062087LEVEL 1 NERVE INJECTIONS
05442062087LEVEL 2 NERVE INJECTIONS
05443062087LEVEL 3 NERVE INJECTIONS
05461062087LEVEL 1 NEUROSTIMULATOR AND RELATED PROCEDURES
05462062087LEVEL 2 NEUROSTIMULATOR AND RELATED PROCEDURES
05463062087LEVEL 3 NEUROSTIMULATOR AND RELATED PROCEDURES
05464062087LEVEL 4 NEUROSTIMULATOR AND RELATED PROCEDURES
05465082087LEVEL 5 NEUROSTIMULATOR AND RELATED PROCEDURES
05471062087IMPLANTATION OF DRUG INFUSION DEVICE
05481062087LASER EYE PROCEDURES
05491062087LEVEL 1 INTRAOCULAR PROCEDURES
05492062087LEVEL 2 INTRAOCULAR PROCEDURES
05493062087LEVEL 3 INTRAOCULAR PROCEDURES
05494062087LEVEL 4 INTRAOCULAR PROCEDURES
05495066073LEVEL 5 INTRAOCULAR PROCEDURES
05495078087LEVEL 5 INTRAOCULAR PROCEDURES
05501062087LEVEL 1 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05502062087LEVEL 2 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05503062087LEVEL 3 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05504062087LEVEL 4 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05521062065LEVEL 1 X-RAY AND RELATED SERVICES
05521066087LEVEL 1 IMAGING WITHOUT CONTRAST
05522062065LEVEL 2 X-RAY AND RELATED SERVICES
05522066087LEVEL 2 IMAGING WITHOUT CONTRAST
05523062065LEVEL 3 X-RAY AND RELATED SERVICES
05523066087LEVEL 3 IMAGING WITHOUT CONTRAST
05524062065LEVEL 4 X-RAY AND RELATED SERVICES
05524066087LEVEL 4 IMAGING WITHOUT CONTRAST
05525062065LEVEL 5 X-RAY AND RELATED SERVICES
05526062065LEVEL 6 X-RAY AND RELATED SERVICES
05531062065LEVEL 1 ULTRASOUND AND RELATED SERVICES
05532062065LEVEL 2 ULTRASOUND AND RELATED SERVICES
05533062065LEVEL 3 ULTRASOUND AND RELATED SERVICES
05534062065LEVEL 4 ULTRASOUND AND RELATED SERVICES
05561062065LEVEL 1 ECHOCARDIOGRAM WITH CONTRAST
05562062065LEVEL 2 ECHOCARDIOGRAM WITH CONTRAST
05570062065COMPUTED TOMOGRAPHY WITHOUT CONTRAST
05571062065LEVEL 1 COMPUTED TOMOGRAPHY WITH CONTRAST AND COMPUTED TOMOGRAPHY ANGIOGRAPHY
05571066087LEVEL 1 IMAGING WITH CONTRAST
05572062065LEVEL 2 COMPUTED TOMOGRAPHY WITH CONTRAST AND COMPUTED TOMOGRAPHY ANGIOGRAPHY
05572066087LEVEL 2 IMAGING WITH CONTRAST
05573066087LEVEL 3 IMAGING WITH CONTRAST
05581062065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST
05582062065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST
05591062087LEVEL 1 NUCLEAR MEDICINE AND RELATED SERVICES
05592062087LEVEL 2 NUCLEAR MEDICINE AND RELATED SERVICES
05593062087LEVEL 3 NUCLEAR MEDICINE AND RELATED SERVICES
05594062087LEVEL 4 NUCLEAR MEDICINE AND RELATED SERVICES
05611062087LEVEL 1 THERAPEUTIC RADIATION TREATMENT PREPARATION
05612062087LEVEL 2 THERAPEUTIC RADIATION TREATMENT PREPARATION
05613062087LEVEL 3 THERAPEUTIC RADIATION TREATMENT PREPARATION
05614062065LEVEL 4 THERAPEUTIC RADIATION TREATMENT PREPARATION
05621062087LEVEL 1 RADIATION THERAPY
05622062087LEVEL 2 RADIATION THERAPY
05623062087LEVEL 3 RADIATION THERAPY
05624062087LEVEL 4 RADIATION THERAPY
05625062087LEVEL 5 RADIATION THERAPY
05626062087LEVEL 6 RADIATION THERAPY
05627062087LEVEL 7 RADIATION THERAPY
05661062087THERAPEUTIC NUCLEAR MEDICINE
05671062087LEVEL 1 PATHOLOGY
05672062087LEVEL 2 PATHOLOGY
05673062087LEVEL 3 PATHOLOGY
05674062087LEVEL 4 PATHOLOGY
05681062065TRANSFUSION LABORATORY PROCEDURES
05691062087LEVEL 1 DRUG ADMINISTRATION
05692062087LEVEL 2 DRUG ADMINISTRATION
05693062087LEVEL 3 DRUG ADMINISTRATION
05694062087LEVEL 4 DRUG ADMINISTRATION
05695062065LEVEL 5 DRUG ADMINISTRATION
05701062065DOSIMETRIC DRUG ADMINISTRATION
05721062079LEVEL1 DIAGNOSTIC TESTS AND RELATED SERVICES
05721080087LEVEL 1 DIAGNOSTIC TESTS AND RELATED SERVICES
05722062087LEVEL 2 DIAGNOSTIC TESTS AND RELATED SERVICES
05723062087LEVEL 3 DIAGNOSTIC TESTS AND RELATED SERVICES
05724062087LEVEL 4 DIAGNOSTIC TESTS AND RELATED SERVICES
05731062087LEVEL 1 MINOR PROCEDURES
05732062087LEVEL 2 MINOR PROCEDURES
05733062087LEVEL 3 MINOR PROCEDURES
05734062087LEVEL 4 MINOR PROCEDURES
05735066087LEVEL 5 MINOR PROCEDURES
05741062087LEVEL 1 ELECTRONIC ANALYSIS OF DEVICES
05742062087LEVEL 2 ELECTRONIC ANALYSIS OF DEVICES
05743062087LEVEL 3 ELECTRONIC ANALYSIS OF DEVICES
05771062087CARDIAC REHABILITATION
05781062087RESUSCITATION AND CARDIOVERSION
05791062087PULMONARY TREATMENT
05801062087VENTILATION INITIATION AND MANAGEMENT
05811062087MANIPULATION THERAPY
05821062087LEVEL 1 HEALTH AND BEHAVIOR SERVICES
05822062087LEVEL 2 HEALTH AND BEHAVIOR SERVICES
05823066087LEVEL 3 HEALTH AND BEHAVIOR SERVICES
05841062065PSYCHOTHERAPY
05851062065LEVEL 1 PARTIAL HOSPITALIZATION (3 SERVICES) FOR CMHCS
05852062065LEVEL 2 PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR CMHCS
05853066087PARTIAL HOSPITALIZATION (3 OR MORE SERVICES) FOR CMHCS
05861062065LEVEL 1 PARTIAL HOSPITALIZATION (3 SERVICES) FOR HOSPITAL-BASED PHPS
05862062065LEVEL 2 PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
05863066087PARTIAL HOSPITALIZATION (3 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
05871062087DENTAL PROCEDURES
05881062087ANCILLARY OUTPATIENT SERVICES WHEN PATIENT DIES
07000060087AMIFOSTINE
07011060081OPRELVEKIN INJECTION
07034060073SOMATROPIN INJECTION
07035060087TENIPOSIDE
07041060085TIROFIBAN HCL
07041086087TIROFIBAN HCL
07042060065CAPECITABINE, ORAL
07043060065INFLIXIMAB INJECTION
07043066087INFLIXIMAB NOT BIOSIMIL 10MG
07046060087DOXORUBICIN INJ 10MG
07048060087ALTEPLASE RECOMBINANT
07308060087AMINOLEVULINIC ACID HCL TOP
08001060069LDR PROSTATE BRACHYTHERAPY COMPOSITE
08004060087ULTRASOUND COMPOSITE
08005060087CT AND CTA WITHOUT CONTRAST COMPOSITE
08006060087CT AND CTA WITH CONTRAST COMPOSITE
08007060087MRI AND MRA WITHOUT CONTRAST COMPOSITE
08008060087MRI AND MRA WITH CONTRAST COMPOSITE
08009060061EXTENDED ASSESSMENT & MANAGEMENT COMPOSITE
08010062087MENTAL HEALTH SERVICES COMPOSITE
08011062087COMPREHENSIVE OBSERVATION SERVICES
09001060065LINEZOLID INJECTION
09002060087TENECTEPLASE INJECTION
09003060087PALIVIZUMAB
09005060077RETEPLASE INJECTION
09005082087RETEPLASE INJECTION
09006060087TACROLIMUS INJECTION
09012060087ARSENIC TRIOXIDE INJECTION
09014070073INJECTION, CERLIPONASE ALFA
09014074081INJ., CERLIPONASE ALFA 1 MG
09015070073C-1 ESTERASE, HAEGARDA
09015074085INJ., HAEGARDA 10 UNITS
09016070073INJ, TRIPTORELIN EXT REL
09016074087INJ., TRIPTORELIN XR 3.75 MG
09018060087INJ, RIMABOTULINUMTOXINB
09019060077CASPOFUNGIN ACETATE
09024060087AMPHOTERICIN B LIPID COMPLEX
09028070073INJ. INOTUZUMAB OZOGAMICIN
09028074087INJ INOTUZUMAB OZOGAM 0.1 MG
09029070073INJECTION, GUSELKUMAB
09029074087INJ., GUSELKUMAB, 1 MG
09030072073INJ COPANLISIB
09030074087INJ., COPANLISIB, 1 MG
09031070081INJ, ETELCALCETIDE, 0.1 MG
09032060087BACLOFEN 10 MG INJECTION
09033060087CIDOFOVIR INJECTION
09034070087INJ CUVITRU, 100 MG
09035071087AXICABTAGENE CILOLEUCEL CAR+
09036071087INJECTION, RENFLEXIS
09038060087INJ ESTROGEN CONJUGATE
09042060087GLUCAGON HYDROCHLORIDE
09043066069AFSTYLA FACTOR VIII RECOMB
09043070087INJ, AFSTYLA, 1 I.U.
09044060087IBUTILIDE FUMARATE INJECTION
09052066077FLUCICIOVINE F-18
09056066077GALLIUM GA-68
09058066087BUPRENORPHINE IMPLANT 74.2MG
09059066087VONVENDI INJ 1 IU VWF:RCO
09060066069DIAZOXIDE INJECTION
09061066069INJ MILRINONE LACTATE / 5 MG
09062066069TOPOTECAN INJECTION
09063082087RH IG MINIDOSE IM
09064070073ARIPIPRAZOLE INJECTION
09065070087ARGATROBAN ESRD DIALYSIS 1MG
09066070073INJ DIHYDROERGOTAMINE MESYLT
09067072073LUTETIUM LU 177 DOTATATE, TX
09067074087LUTETIUM LU 177 DOTATAT THER
09069082087PHENOBARBITAL SODIUM INJ
09070072072VORETIGNE NEPARVOVEC-RZYL
09070073073VORETIGENE NEPARVOVEC-RZYL
09070074087INJ LUXTURNA 1 BILLION VEC G
09071070087CAPSAICIN 8% PATCH
09072070073FOSPHENYTOIN INJ PE
09073072087BUPRENORPH XR 100 MG OR LESS
09074068069INJ, MAKENA
09074070087MAKENA, 10 MG
09075070077INJ, KOVALTRY, 1 I.U.
09075082087INJ, KOVALTRY, 1 I.U.
09076070073DIMECAPROL INJECTION
09077070073EPOETIN BETA NON ESRD
09077082087EPOETIN BETA NON ESRD
09078070087TESTOSTERONE UNDECANOATE 1MG
09079070087GENVISC 850, INJ, 1MG
09080070073FLUDARABINE PHOSPHATE INJ
09081070073TISAGENLECLEUCEL CAR-POS T
09082073073PURAPLY OR PURAPLY AM
09083073076INJ, PHENYLEPHRINE KETOROLAC
09084073080FLORBETAPIR F18
09085073080INJ SULF HEXA LIPID MICROSPH
09086074077HEPA VACC PED/ADOL 3 DOSE
09087074077INJ, CLEVIDIPINE BUTYRATE
09087082085INJ, CLEVIDIPINE BUTYRATE
09088074087PENG BENZATHINE/PROCAINE INJ
09089074077ORAL FLUDARABINE PHOSPHATE
09090074077MELPHALAN ORAL 2 MG
09091074077DAUNORUBICIN CITRATE INJ
09092074081INTERFERON ALFA-2A INJ
09093074077PLICAMYCIN (MITHRAMYCIN) INJ
09093082087PLICAMYCIN (MITHRAMYCIN) INJ
09094074087RADIESSE INJECTION
09095074087INJ, SCULPTRA, 0.5MG
09096072073INJ RETACRIT ESRD ON DIALYSI
09096074084INJ RETACRIT ESRD ON DIALYSI
09097072073INJ RETACRIT NON-ESRD USE
09097074087INJ RETACRIT NON-ESRD USE
09098074077CHORIONIC GONADOTROPIN/1000U
09099073073INJ, AKYNZEO
09099074087INJ FOSNETUPITANT, PALONOSET
09104060087ANTITHYMOCYTE GLOBULN RABBIT
09108060087THYROTROPIN INJECTION
09119060085INJECTION, PEGFILGRASTIM 6MG
09120060087INJECTION, FULVESTRANT
09121060065INJECTION, ARGATROBAN
09122060087TRIPTORELIN PAMOATE
09124060081DAPTOMYCIN INJECTION
09125060076RISPERIDONE, LONG ACTING
09125077077INJ., RISPERDAL CONSTA, 0.5 MG
09125078081RISPERIDONE, LONG ACTING
09125082085INJ RISPERDAL CONSTA, 0.5 MG
09125086087RISPERIDONE, LONG ACTING
09126060087NATALIZUMAB INJECTION
09130060077INJ, IMM GLOB BIVIGAM, 500MG
09130082087INJ, IMM GLOB BIVIGAM, 500MG
09131060087INJ, ADO-TRASTUZUMAB EMT 1MG
09132060083KCENTRA, PER I.U.
09132084087PROTHROMBIN COMPLEX KCENTRA
09133060087RABIES IG, IM/SC
09134060087RABIES IG, HEAT TREATED
09135060087VARICELLA-ZOSTER IG, IM
09137060065BCG VACCINE, PERCUT
09139060087RABIES VACCINE, IM
09140060087RABIES VACCINE, ID
09143060065MENINGOCOCCAL VACCINE, SC
09144060061ENCEPHALITIS VACCINE, SC
09171065065IDELVION, 1 I.U.
09171066087FACTOR IX IDELVION INJ
09172073087INJECTION, DEXAMETHASONE 9%
09173072087INJECTION, FULPHILA
09174074087INJ, DUROLANE 1 MG
09175074080PURAPLY 1 SQ CM
09176074080PURAPLY AM 1 SQ CM
09177074081ANTITHROMBIN RECOMBINANT
09178074087INJ., MEROPENEM, VABORBACTAM
09179074076INJECTION, ARISTADA INITIO
09179077077INJ., ARISTADA INITIO, 1 MG
09179078085INJECTION, ARISTADA INITIO
09179086087INJ., ARISTADA INITIO, 1 MG
09180074076INJECTION, PATISIRAN
09180077087INJ., PATISIRAN, 0.1 MG
09181074076INJECTION, RISPERIDONE
09181077087INJ., PERSERIS, 0.5 MG
09182074076INJ MOGAMULIZUMAB-KPKC
09182077077INJ, MOGAMULIZUMAB-KPKC, 1 MG
09182078087INJ MOGAMULIZUMAB-KPKC, 1 MG
09183074076INJECTION, PLAZOMICIN
09183077087INJ., PLAZOMICIN, 5 MG
09184074077IODINE I-131 IOBENGUANE, DX
09185074077IODINE I-131 IOBENGUANE, TX
09186074087INJ., RITUXIMAB, 10 MG
09187074087INJECTION, BUROSUMAB-TWZA 1M
09188074087INJ CROTALIDAE IM F(AB')2 EQ
09189074087INJ., IBALIZUMAB-UIYK, 10 MG
09190074081INJ., VESTRONIDASE ALFA-VJBK
09191074081INJ., FIBRYGA, 1 MG
09192074087INJ, BORTEZOMIB, NOS, 0.1 MG
09193073087NIVESTYM
09194074087TISAGENLECLEUCEL CAR-POS T
09195074087INJECTION, UDENYCA 0.5 MG
09196074087INJ, TRIVISC 1 MG
09197075076INJECTION, FREMANEZUMAB-VFRM
09197077087INJ., FREMANEZUMAB-VFRM 1 MG
09198075079INJ, COAGULATION FACTOR XA
09198080087INJ ANDEXXA, 10 MG
09199076087INJECTION, CAPLACIZUMAB-YHDP
09200085087INJ, REMDESIVIR, 1 MG
09201082087RABIES IG HT&SOL HUMAN IM/SC
09202087087DIFELIKEFALIN, ESRD ON DIALY
09203087087INJ CYCLOPHOSPHAMD AUROMEDIC
09204087087INJ TISOTU VEDOTIN-TFTV, 1MG
09205087087INJ LON TESIRIN-LPYL 0.075MG
09206087087PLASMINOGEN, HUMAN-TVMH 1 MG
09207060073BORTEZOMIB INJECTION
09207074087INJ., VELCADE 0.1 MG
09208060087AGALSIDASE BETA INJECTION
09209060087LARONIDASE INJECTION
09210060077PALONOSETRON HCL
09213060080PEMETREXED INJECTION
09213081087INJ. PEMETREXED NOS 10MG
09214060087BEVACIZUMAB INJECTION
09215060087CETUXIMAB INJECTION
09217060087LEUPROLIDE ACETATE SUSPNSION
09224060087GALSULFASE INJECTION
09225060076FLUOCINOLONE ACETONIDE IMPLT
09225077077INJ., RETISERT, 0.01 MG
09225078081FLUOCINOLONE ACETONIDE IMPLT
09225082085INJ., RETISERT, 0.01 MG
09225086087FLUOCINOLONE ACETONIDE IMPLT
09227060061MICAFUNGIN SODIUM INJECTION
09227082085MICAFUNGIN SODIUM INJECTION
09228060085TIGECYCLINE INJECTION
09229060085IBANDRONATE SODIUM INJECTION
09230060087ABATACEPT INJECTION
09231060087DECITABINE INJECTION
09232060081IDURSULFASE INJECTION
09233060087RANIBIZUMAB INJECTION
09234060087ALGLUCOSIDASE ALFA INJECTION
09235060087PANITUMUMAB INJECTION
09236060087ECULIZUMAB INJECTION
09237060087INJ, LANREOTIDE ACETATE
09239072087BUPRENORPHINE XR OVER 100 MG
09240060087INJECTION, IXABEPILONE
09241087087SIROLIMUS, PROTEIN-BOUND,1MG
09242060085INJECTION, FOSAPREPITANT
09243060065BENDAMUSTINE INJECTION
09243066087INJ., TREANDA 1 MG
09245060087ROMIPLOSTIM INJECTION
09248060069INJ, CLEVIDIPINE BUTYRATE
09251060087C1 ESTERASE INHIBITOR INJ
09252060087PLERIXAFOR INJECTION
09253060087TEMOZOLOMIDE INJECTION
09255060087PALIPERIDONE PALMITATE INJ
09256060087DEXAMETHASONE INTRA IMPLANT
09257072073INJ. EMICIZUMAB-KXWH, 0.5 MG
09257074087INJ., EMICIZUMAB-KXWH 0.5 MG
09258060087TELAVANCIN INJECTION
09259060087PRALATREXATE INJECTION
09260060087OFATUMUMAB INJECTION
09261060065USTEKINUMAB INJECTION
09261066087USTEKINUMAB SUB CU INJ, 1 MG
09263060087ECALLANTIDE INJECTION
09264060087TOCILIZUMAB INJECTION
09265060084ROMIDEPSIN INJECTION
09269060087C-1 ESTERASE, BERINERT
09270060087GAMMAPLEX IVIG
09271060087VELAGLUCERASE ALFA
09272060087INJ, DENOSUMAB
09273060087SIPULEUCEL-T AUTO CD54+
09274060087CROTALIDAE POLY IMMUNE FAB
09276060087CABAZITAXEL INJECTION
09278060087INCOBOTULINUMTOXIN A
09281060087INJECTION, PEGLOTICASE
09284060087IPILIMUMAB INJECTION
09286060087BELATACEPT INJECTION
09287060087BRENTUXIMAB VEDOTIN INJ
09289060087ERWINAZE INJECTION
09293060077INJECTION, GLUCARPIDASE
09294060069INJ, TALIGLUCERACE ALFA 10 U
09294070087INJ, TALIGLUCERASE ALFA 10 U
09295060087INJECTION, CARFILZOMIB, 1 MG
09296060087INJ, ZIV-AFLIBERCEPT, 1MG
09297060087INJ, OMACETAXINE MEP, 0.01MG
09298060087INJ, OCRIPLASMIN, 0.125 MG
09299075075FACTOR VIII PEGYLATED-AUCL
09299076087INJ. JIVI 1 IU
09300060087OMALIZUMAB INJECTION
09301070087AMINOLEVULINIC ACID, 10% GEL
09302070073INJ, DAUNORUBICIN-CYTARABINE
09302074087INJ DAUNORUBICIN, CYTARABINE
09303075077INJECTION, LEVOLEUCOVORIN
09304075075INJECTION, CEMIPLIMAB
09304076076INJECTION, CEMIPLIMAB-RWLC
09304077087INJ., CEMIPLIMAB-RWLC, 1 MG
09305075076MOXETUMOMAB PASUDOTOX-TDFK
09305077087INJ., LUMOXITI, 0.01 MG
09306075087INJ., TILDRAKIZUMAB, 1 MG
09307075087COCAINE HCL NASAL SOLUTION
09308076076DEXAMETHASONE OPHTH INSERT
09308077087DEXAMETHA OPTH INSERT 0.1 MG
09309076076INJECTION, TAGRAXOFUSP-ERZS
09309077087INJ. TAGRAXOFUSP-ERZS 10 MCG
09310076076INJECTION, EMAPALUMAB-LZSG
09310077087INJ., EMAPALUMAB-LZSG, 1 MG
09311076076INJECTION, OMADACYCLINE
09311077087INJ., OMADACYCLINE, 1 MG
09312076076INJECTION, RAVULIZUMAB-CWV
09312077087INJ., RAVULIZUMAB-CWVZ 10 MG
09313075075INJ., BELRAPZO 1 MG
09313076087INJ. BELRAPZO/BENDAMUSTINE
09314076087INJ. HERCEPTIN HYLECTA, 10MG
09315078081DIPHTHERIA ANTITOXIN
09316078081CORTICOTROPIN INJECTION
09317078081DORIPENEM INJECTION
09318078087INJ HYDROXYPROGST CAPOAT NOS
09319078085SOMATROPIN INJECTION
09320078087CARBIDOPA LEVODOPA ENT 100ML
09321078081FOSPHENYTOIN INJ PE
09322076081BCG LIVE INTRAVESICAL 1MG
09323081087GALLIUM GA-68 DOTATOC
09324077080PHENYLEP KETOROLAC OPTH SOLN
09325077081INJ., ERAVACYCLINE, 1 MG
09326077081INJ., LANADELUMAB-FLYO, 1 MG
09327077087INJ. ROMOSOZUMAB-AQQG 1 MG
09328077087INJ., YUTIQ, 0.01 MG
09329076087INJ MVASI 10 MG
09330077087INJ., KANJINTI, 10 MG
09331078087INJ, POLATUZUMAB VEDOTIN 1MG
09332078079INJECTION, LEFAMULIN
09332080087INJ LEFAMULIN 1 MG
09333078080INJ, BREXANOLONE
09333081087INJ., BREXANOLONE, 1 MG
09334078087INJECTION, KHAPZORY, 0.5 MG
09335078081ORAL BUSULFAN
09336077087INJ TRUXIMA 10 MG
09337078087SYNOJOYNT, INJ., 1 MG
09338078081INJ., TRILURON, 1 MG
09339078087IODINE I-131 IOBENGUANE 1MCI
09340078087INJ, BROLUCIZUMAB-DBLL, 1 MG
09341077087INJ OGIVRI 10 MG
09342079079INJ, CRIZANLIZUMAB-TMCA
09343079079INJECTION, GIVOSIRAN
09343080087INJ GIVOSIRAN 0.5 MG
09344079079INJ CETIRIZINE HYDROCHLORIDE
09345077087INJ PEGFILGRASTIM-BMEZ 0.5MG
09346080082MOMETASONE FUROATE (SINUVA)
09346083087MOMETASONE SINUS SINUVA
09347080087INJ LUSPATERCEPT-AAMT 0.25MG
09348078087INJ., ZIRABEV, 10 MG
09349078087INJ HERZUMA 10 MG
09350078087INJ., TRAZIMERA, 10 MG
09351081081INJ BIMATOPROST ITC IMP 1MCG
09351082085INJ BIMATOPROST ITC IMP1MCG
09351086087INJ BIMATOPROST ITC IMP 1MCG
09352082087CHLOROQUINE INJECTION
09353080087INJ FAM-TRASTU DERU-NXKI 1MG
09354080087INJ RECOMBIN ESPEROCT PER IU
09355080080INJECTION, TEPROTUMUMAB-TRBW
09355081087INJ. TEPROTUMUMAB-TRBW 10 MG
09356080087INJ GOLODIRSEN 10 MG
09357080080INJECTION, EPTINEZUMAB-JJMR
09357081087INJ. EPTINEZUMAB-JJMR 1 MG
09358087087INJ., XIPERE, 1 MG
09359080087INJ CRIZANLIZUMAB-TMCA 5MG
09361080087INJ. CETIRIZINE HCL 0.5MG
09362080087INJ IMIP 4 CILAS 4 RELEB 2MG
09364080087INJ ENFORT VEDO-EJFV 0.25MG
09367078087INJ RUXIENCE, 10 MG
09370081081FLUOROESTRADIOL F18
09370082085FLUOROESTRADIOL F 18
09370086087FLUOROESTRADIOL F 18
09371080080INJECTION, MELOXICAM
09371081087INJ. MELOXICAM 1 MG
09372080087INJ. XEMBIFY, 100 MG
09373080083INJ ONASE ABEPAR-XIOI TREAT
09374081081MITOMYCIN PYELOCALYCEAL INST
09374082087MITOMYCIN INSTILLATION
09375080087INJ., EVOMELA, 1 MG
09376081087SACITUZUMAB GOVITECAN-HZIY
09377081087INJ. ISATUXIMAB-IRFC 10 MG
09378081081DARATUMUMAB HYALURONIDASE
09378082087DARATUMUMAB, HYALURONIDASE
09379081084ROMIDEPSIN NON-LYOPHILIZED
09380082084INJ., CEFIDEROCOL, 5 MG
09381080087INJ. AVSOLA, 10 MG
09382079087INJ ONTRUZANT 10 MG
09383082082COPPER CU-64, DOTATATE, DX
09383083087COPPER CU 64 DOTATATE DIAG
09384082082BELANTAMAB MAFODONTIN-BLMF
09384083086INJ BELANTAMAB MAFODONT BLMF
09384087087INJ BELANTAMAB MAFODOT BLMF
09385082082INJECTION, TAFASITAMAB-CXIX
09385083087INJ., TAFASITAMAB-CXIX
09386082082INJECTION, VILTOLARSEN
09386083087INJ. VILTOLARSEN
09387082087INJ. INFUGEM, 100 MG
09388081087INJ. FE DERISOMALTOSE 10 MG
09389082087INJ. LURBINECTEDIN, 0.1 MG
09390082087PERTUZU, TRASTUZU, 10 MG
09391082082BREXUCABTAGENE AUTOLEUCEL CA
09391083087BREXUCABTAGENE CAR POS T
09392082082INJ, IMM GLOB ASCENIV
09392083087INJ. ASCENIV
09393082087INJ CODEINE PHOSPHATE /30 MG
09394082087INJ. INEBILIZUMAB-CDON, 1 MG
09395082087FACTOR VIIA RECOMB SEVENFACT
09396082087AFAMELANOTIDE IMPLANT, 1 MG
09397083085COVID-19 VACCINE ADMINISTRATION DOSE 1 OF 2
09397086087COVID-19 VACCINE ADMIN DOSE 1 OF 2
09398083083COVID-19 VACCINE ADMINISTRATION DOSE 2 OF 2 OR SINGLE DOSE PRODUCT
09398084087COVID-19 VACCINE ADMIN DOSE 2 OF 2, SINGLE DOSE PRODUCT OR ADDITIONAL DOSE
09406082087INJ, NYVEPRIA
09407083083INJECTION, LUMASIRAN
09407084087INJ. LUMASIRAN, 0.5 MG
09408084087INJ. NAXITAMAB-GQGK, 1 MG
09409084087GALLIUM GA-68 PSMA-11 UCSF
09410084087GALLIUM GA-68 PSMA-11, UCLA
09411084087INJ. RIABNI, 10 MG
09412084087INJECTION, CASIMERSEN, 10 MG
09413084085LISOCABTAGENE CAR POS T
09413086087LISOCABTAGENE CAR POS T
09414084084INJ CABOTEGRAVIR/RILPIVIRINE
09414085087INJ, CABOTE RILPIVIR 2MG 3MG
09415084084INJ, TRILACICLIB, 1 MG
09415085087INJECTION, TRILACICLIB, 1MG
09416084084INJ, EVINACUMAB-DGNB, 5 MG
09416085085INJ, EVINACUMAB-DGNB, 5MG
09416086087INJ, EVINACUMAB-DGNB, 5 MG
09417084084INJ, MELPHALAN FLUFEN, 1 MG
09417085087INJ, MELPHALAN FLUFENAMI 1MG
09418084087INJ. MARGETUXIMAB-CMKB, 5 MG
09419084087INJ FENSOLVI 0.25 MG
09420086087EPTIFIBATIDE INJECTION
09421086087INJ, GRANISETRON, XR, 0.1 MG
09422085085IDECABTAGENE CAR POS T
09422086087IDECABTAGENE VICLEUCEL CAR
09423085085INJ DOSTARLIMAB-GXLY, 100 MG
09424085085INJ, AMIVANTAMAB-VMJW, 10 MG
09425085086LONCASTUXIMAB-LPYL, 0.1 MG
09426085087INJ, CEFIDEROCOL, 10 MG
09427085087INJECTION, ORITAVANCIN 10 MG
09428085087INJ ROMIDEPSIN NON-LYO 0.1MG
09429085087INJ ROMIDEPSIN LYOPHIL 0.1MG
09430086087PIFLU F-18, DIA 1 MILLICURIE
09431086087INJ, DOSTARLIMAB-GXLY, 10 MG
09432086087INJ, AMIVANTAMAB-VMJW
09433086086INJ AVALGLUCOSID ALFA-NGPT
09433087087INJ AVAL ALFA-NQPT 4MG
09434086086INJ, ANIFROLUMAB-FNIA
09434087087INJ ANIFROLUMAB-FNIA 1MG
09435086086INJ CYCLOPHOSPHAMD AUROMEDIC
09436086087INJ PEGFILGRAST EX BIO 0.5MG
09437086087INJ, ASPARA, RYLAZE, 0.1 MG
09438086087INJECTION, ADUCANUMAB-AVWA, 2 MG
09439087087INJ., SUSVIMO, 0.1 MG
09440087087INSTILL, BUPIVAC AND MELOXIC
09441060087INJ FERRIC CARBOXYMALTOS 1MG
09442087087INJ. PEMETREXED, 10 MG
09445060061C-1 ESTERASE, RUCONEST
09445062087INJECTION, RUCONEST
09448060061NETUPITANT PALONOSETRON ORAL
09448062073NETUPITANT PALONOSETRON ORAL
09448074087ORAL NETUPITANT, PALONOSETRO
09449060061INJ, BLINATUMOMAB
09449062087INJECTION, BLINATUMOMAB
09450060061FLUOCINOLONE ACETONIDE IMPLT
09450062076FLUOCINOL ACET INTRAVIT IMP
09450077077INJ., ILUVIEN, 0.01 MG
09450078081FLUOCINOL ACET INTRAVIT IMP
09450082085INJ., ILUVIEN, 0.01 MG
09450086087FLUOCINOL ACET INTRAVIT IMP
09451060087INJECTION, PERAMIVIR
09452060061INJ, CEFTOLOZANE/TAZOBACTAM
09452062087INJ CEFTOLOZANE TAZOBACTAM
09453060087INJECTION, NIVOLUMAB
09454060087INJ, PASIREOTIDE LONG ACTING
09455060087INJECTION, SILTUXIMAB
09456061061INJ, ISAVUCONAZONIUM SULFATE
09456062087INJECTION, ISAVUCONAZONIUM
09457061061LUMASON CONTRAST AGENT
09457062069INJ SULF HEXA LIPID MICROSPH
09458062063FLORBETABEN F18
09458064073FLORBETABEN F18 DIAGNOSTIC
09458078080FLORBETABEN F18 DIAGNOSTIC
09459062063FLUTEMETAMOL F18
09459064073FLUTEMETAMOL F18 DIAGNOSTIC
09459078080FLUTEMETAMOL F18 DIAGNOSTIC
09460062087INJECTION, CANGRELOR
09461063065CHOLINE C 11, DIAGNOSTIC
09461066073CHOLINE C-11, DIAGNOSTIC, PER STUDY DOSE UP TO 20 MILLICURIES
09462071085INJECTION, DELAFLOXACIN
09463071073INJECTION, APREPITANT
09463074087INJ., APREPITANT, 1 MG
09464071073INJECTION, ROLAPITANT
09464074080INJ., ROLAPITANT, 0.5 MG
09465071073INJECTION, DUROLANE
09466071073INJECTION, BENRALIZUMAB
09466074087INJ., BENRALIZUMAB, 1 MG
09467071073INJ RITUXIMAB HYALURONIDASE
09467074087INJ RITUXIMAB, HYALURONIDASE
09468071073INJ, FACTOR IX, REBINYN
09468074087FACTOR IX RECOMB GLY REBINYN
09469071071INJ TRIAMCINOLONE ACETONIDE
09469072073INJ., TRIAMCINOLONE EXT REL
09469074087INJ TRIAMCINOLONE ACE XR 1MG
09470063065ARIPIPRAZOLE LAUROXIL IM
09470066076ARIPIPRAZOLE LAUROXIL 1MG
09470077087ARIPIRAZOLE LAUROXIL 1 MG
09471063065HYMOVIS, 1 MG
09471066087HYMOVIS INJECTION 1 MG
09472063087INJ TALIMOGENE LAHERPAREPVEC
09473063065INJECTION, MEPOLIZUMAB
09473066087INJECTION, MEPOLIZUMAB, 1MG
09474063065INJ, IRINOTECAN LIPOSOME
09474066087INJ IRINOTECAN LIPOSOME 1 MG
09475063065INJECTION, NECITUMUMAB
09475066087INJECTION, NECITUMUMAB, 1 MG
09476064065INJECTION, DARATUMUMAB
09476066087INJECTION, DARATUMUMAB 10 MG
09477064065INJECTION, ELOTUZUMAB
09477066087INJECTION, ELOTUZUMAB, 1MG
09478064065INJECTION, SEBELIPASE ALFA
09478066087INJ SEBELIPASE ALFA 1 MG
09479064087INSTILL, CIPROFLOXACIN OTIC
09480064065INJECTION, TRABECTEDIN
09480066087INJECTION TRABECTEDIN 0.1MG
09481065087INJECTION, RESLIZUMAB
09482065087SOTALOL HYDROCHLORIDE IV
09483065069INJECTION, ATEZOLIZUMAB
09483070087INJ, ATEZOLIZUMAB,10 MG
09484067069INJECTION, ETEPLIRSEN
09484070081INJ, ETEPLIRSEN, 10 MG
09485067069INJECTION, OLARATUMAB
09485070087INJ, OLARATUMAB, 10 MG
09486067069INJ, GRANISETRON EXT
09486070078INJ, GRANISETRON, XR, 0.1 MG
09487067067USTEKINUMAB IV INJ, 1 MG
09487068069USTEKINUMAB IV INJ, 1 MG
09487070087USTEKINUMAB, IV INJECT,1 MG
09488067069CONIVAPTAN HCL
09488070087CONIVAPTAN HCL
09489068069INJECTION, NUSINERSEN
09489070087INJ, NUSINERSEN, 0.1MG
09490068069INJECTION, BEZLOTOXUMAB
09490070087INJ, BEZLOTOXUMAB, 10 MG
09491069069INJECTION, AVELUMAB
09491070087INJECTION, AVELUMAB, 10 MG
09492069073INJECTION, DURVALUMAB
09492074087INJ., DURVALUMAB, 10 MG
09493069073INJECTION, EDARAVONE
09493074087INJECTION, EDARAVONE, 1 MG
09494069087INJECTION, OCRELIZUMAB
09495070087GEMTUZUMAB OZOGAMICIN INJ
09497060073LOXAPINE, INHALATION POWDER
09497074077LOXAPINE FOR INHALATION 1 MG
09500060087PLATELETS, IRRADIATED
09501060087PLATELET PHERES LEUKOREDUCED
09502060087PLATELET PHERESIS IRRADIATED
09503060087FR FRZ PLASMA DONOR RETESTED
09504060087RBC DEGLYCEROLIZED
09505060087RBC IRRADIATED
09506060065GRANULOCYTES, PHERESIS UNIT
09507060087PLATELETS, PHERESIS
09508060087PLASMA 1 DONOR FRZ W/IN 8 HR
09509062087FROZEN PLASMA, POOLED, SD
09510062087WHOLE BLOOD FOR TRANSFUSION
09511062087CRYOPRECIPITATE EACH UNIT
09512062087RBC LEUKOCYTES REDUCED
09513062087PLASMA, FRZ BETWEEN 8-24HOUR
09514062087PLASMA PROTEIN FRACT,5%,50ML
09515062087PLATELETS, EACH UNIT
09516062087PLAELET RICH PLASMA UNIT
09517062087RED BLOOD CELLS UNIT
09518062087WASHED RED BLOOD CELLS UNIT
09519062087PLASMAPROTEIN FRACT,5%,250ML
09520062087BLOOD SPLIT UNIT
09521062087PLATELETS LEUKOREDUCED IRRAD
09522062087RBC LEUKOREDUCED IRRADIATED
09523062087CRYOPRECIPITATEREDUCEDPLASMA
09524062087BLOOD, L/R, CMV-NEG
09525062087PLATELETS, HLA-M, L/R, UNIT
09526062087PLATELETS LEUKOCYTES REDUCED
09527062087BLOOD, L/R, FROZ/DEGLY/WASH
09528062087PLT, APH/PHER, L/R, CMV-NEG
09529062087BLOOD, L/R, IRRADIATED
09530062087PLATE PHERES LEUKOREDU IRRAD
09531062087PLT, PHER, L/R CMV-NEG, IRR
09532062087RBC, FRZ/DEG/WSH, L/R, IRRAD
09533062087RBC, L/R, CMV-NEG, IRRAD
09534062087PATHOGEN REDUCED PLASMA POOL
09535062087PATHOGEN REDUCED PLASMA SING
09536062067PATHOGEN REDUCED PLATELETS
09536068069PLATELETS PHERESIS PATH REDUC
09536070073PLATELETS, PATHOGEN REDUCED
09536074087PLATELETS PHERESIS PATH REDU
09537082087BLOOD COMPONENT/PRODUCT NOC
09538085087PLASMA CRYO REDU PATH EACH
09539085087CRYO FIB COMP PATH REDU EACH
09540087087COVID-19 CONVALESCENT PLASMA
