Addendum BB -- CN ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2022 (Including Ancillary Services for Which Payment is Packaged)							
"CPT codes and descriptions only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.  Dental codes (D codes) are copyright 2021 American Dental Association. All Rights Reserved. The existence or absence of a HCPCS code does not mean that an item or service is covered or non-covered. As a reminder, the fact that a drug, device, procedure, or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the program. Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure, or other service meets all program requirements for coverage. For example, MACs determine that it is reasonable and necessary to treat the beneficiarys condition and whether it is excluded from payment."							
							
HCPCS Code		Short Descriptor	CY 2022 Comment Indicator	Drug Pass-Through Expiration during Calendar Year	CN CY 2022 Payment Indicator	CN CY 2022 Payment Weight  	CN CY 2022 Payment Rate 
0331T		Heart symp image plnr			Z2	13.5496	$676.34
0332T		Heart symp image plnr spect			Z2	13.5496	$676.34
0394T		Hdr elctrnc skn surf brchytx			Z2	2.5064	$125.11
0395T		Hdr elctr ntrst/ntrcv brchtx			Z2	7.3555	$367.16
0422T		Tactile breast img uni/bi			Z2	0.8387	$41.86
0508T		Pls echo us b1 dns meas tib			Z2	1.1288	$56.35
0558T		Ct scan f/biomchn ct alys			Z2	0.8387	$41.86
0598T		Ncntc r-t fluor wnd img 1st			Z2	2.7441	$136.97
0599T		Ncntc r-t fluor wnd img ea			N1		
0609T		Mrs disc pain acquisj data			Z2	2.3858	$119.09
0611T		Mrs disc pain alg alys data			Z2	2.3858	$119.09
0633T		Ct breast w/3d uni c-			Z2	1.1288	$56.35
0634T		Ct breast w/3d uni c+			Z2	1.8521	$92.45
0635T		Ct breast w/3d uni c-/c+			Z2	1.8521	$92.45
0636T		Ct breast w/3d bi c-			Z2	2.3858	$119.09
0637T		Ct breast w/3d bi c+			Z2	3.8182	$190.59
0638T		Ct breast w/3d bi c-/c+			Z2	3.8182	$190.59
0648T		Quan mr tis wo mri 1orgn	NC		Z2	9.6499	$481.68
0689T		Quan us tis charac w/o dx us	NC		Z2	0.8387	$41.86
0697T		Quan mr tis wo mri mlt orgn	NC		Z2	2.3858	$119.09
70010		Contrast x-ray of brain			N1		
70015		Contrast x-ray of brain			N1		
70030		X-ray eye for foreign body			N1		
70100		X-ray exam of jaw <4views			N1		
70110		X-ray exam of jaw 4/> views			N1		
70120		X-ray exam of mastoids			N1		
70130		X-ray exam of mastoids			N1		
70134		X-ray exam of middle ear			N1		
70140		X-ray exam of facial bones			N1		
70150		X-ray exam of facial bones			N1		
70160		X-ray exam of nasal bones			N1		
70170		X-ray exam of tear duct			N1		
70190		X-ray exam of eye sockets			N1		
70200		X-ray exam of eye sockets			N1		
70210		X-ray exam of sinuses			N1		
70220		X-ray exam of sinuses			N1		
70240		X-ray exam pituitary saddle			N1		
70250		X-ray exam of skull			N1		
70260		X-ray exam of skull			N1		
70300		X-ray exam of teeth			N1		
70310		X-ray exam of teeth			N1		
70320		Full mouth x-ray of teeth			N1		
70328		X-ray exam of jaw joint			N1		
70330		X-ray exam of jaw joints			N1		
70332		X-ray exam of jaw joint			N1		
70336		Magnetic image jaw joint			Z2	2.3858	$119.09
70350		X-ray head for orthodontia			N1		
70355		Panoramic x-ray of jaws			N1		
70360		X-ray exam of neck			N1		
70370		Throat x-ray & fluoroscopy			N1		
70371		Speech evaluation complex			N1		
70380		X-ray exam of salivary gland			N1		
70390		X-ray exam of salivary duct			N1		
70450		Ct head/brain w/o dye			Z2	1.1288	$56.35
70460		Ct head/brain w/dye			Z2	1.8521	$92.45
70470		Ct head/brain w/o & w/dye			Z2	1.8521	$92.45
70480		Ct orbit/ear/fossa w/o dye			Z2	1.1288	$56.35
70481		Ct orbit/ear/fossa w/dye			Z2	1.8521	$92.45
70482		Ct orbit/ear/fossa w/o&w/dye			Z2	1.8521	$92.45
70486		Ct maxillofacial w/o dye			Z2	1.1288	$56.35
70487		Ct maxillofacial w/dye			Z2	1.8521	$92.45
70488		Ct maxillofacial w/o & w/dye			Z2	1.8521	$92.45
70490		Ct soft tissue neck w/o dye			Z2	1.1288	$56.35
70491		Ct soft tissue neck w/dye			Z2	1.8521	$92.45
70492		Ct sft tsue nck w/o & w/dye			Z2	1.8521	$92.45
70496		Ct angiography head			Z2	1.8521	$92.45
70498		Ct angiography neck			Z2	1.8521	$92.45
70540		Mri orbit/face/neck w/o dye			Z2	2.3858	$119.09
70542		Mri orbit/face/neck w/dye			Z2	3.8182	$190.59
70543		Mri orbt/fac/nck w/o &w/dye			Z2	3.8182	$190.59
70544		Mr angiography head w/o dye			Z2	2.3858	$119.09
70545		Mr angiography head w/dye	CH		Z3		$181.77
70546		Mr angiograph head w/o&w/dye			Z2	3.8182	$190.59
70547		Mr angiography neck w/o dye			Z2	2.3858	$119.09
70548		Mr angiography neck w/dye	CH		Z3		$187.14
70549		Mr angiograph neck w/o&w/dye			Z2	3.8182	$190.59
70551		Mri brain stem w/o dye			Z2	2.3858	$119.09
70552		Mri brain stem w/dye			Z2	3.8182	$190.59
70553		Mri brain stem w/o & w/dye			Z2	3.8182	$190.59
70554		Fmri brain by tech			Z2	2.3858	$119.09
70555		Fmri brain by phys/psych			Z2	2.3858	$119.09
70557		Mri brain w/o dye			Z2	5.0100	$250.08
70558		Mri brain w/dye			Z2	1.8521	$92.45
70559		Mri brain w/o & w/dye			Z2	1.8521	$92.45
71045		X-ray exam chest 1 view			Z3		$16.80
71046		X-ray exam chest 2 views			Z3		$22.85
71047		X-ray exam chest 3 views			N1		
71048		X-ray exam chest 4+ views			N1		
71100		X-ray exam ribs uni 2 views			N1		
71101		X-ray exam unilat ribs/chest			N1		
71110		X-ray exam ribs bil 3 views			N1		
71111		X-ray exam ribs/chest4/> vws			N1		
71120		X-ray exam breastbone 2/>vws			N1		
71130		X-ray strenoclavic jt 3/>vws			N1		
71250		Ct thorax dx c-			Z2	1.1288	$56.35
71260		Ct thorax dx c+			Z2	1.8521	$92.45
71270		Ct thorax dx c-/c+			Z2	1.8521	$92.45
71275		Ct angiography chest			Z2	1.8521	$92.45
71550		Mri chest w/o dye			Z2	2.3858	$119.09
71551		Mri chest w/dye			Z3		$317.17
71552		Mri chest w/o & w/dye			Z2	3.8182	$190.59
72040		X-ray exam neck spine 2-3 vw			N1		
72050		X-ray exam neck spine 4/5vws			N1		
72052		X-ray exam neck spine 6/>vws			N1		
72070		X-ray exam thorac spine 2vws			N1		
72072		X-ray exam thorac spine 3vws			N1		
72074		X-ray exam thorac spine4/>vw			N1		
72080		X-ray exam thoracolmb 2/> vw			N1		
72081		X-ray exam entire spi 1 vw			N1		
72082		X-ray exam entire spi 2/3 vw			N1		
72083		X-ray exam entire spi 4/5 vw			Z2	1.1288	$56.35
72084		X-ray exam entire spi 6/> vw			Z2	1.1288	$56.35
72100		X-ray exam l-s spine 2/3 vws			N1		
72110		X-ray exam l-2 spine 4/>vws			N1		
72114		X-ray exam l-s spine bending			N1		
72120		X-ray bend only l-s spine			N1		
72125		Ct neck spine w/o dye			Z2	1.1288	$56.35
72126		Ct neck spine w/dye			Z3		$118.27
72127		Ct neck spine w/o & w/dye			Z2	1.8521	$92.45
72128		Ct chest spine w/o dye			Z2	1.1288	$56.35
72129		Ct chest spine w/dye			Z2	1.8521	$92.45
72130		Ct chest spine w/o & w/dye			Z2	1.8521	$92.45
72131		Ct lumbar spine w/o dye			Z2	1.1288	$56.35
72132		Ct lumbar spine w/dye			Z3		$118.27
72133		Ct lumbar spine w/o & w/dye			Z2	1.8521	$92.45
72141		Mri neck spine w/o dye			Z2	2.3858	$119.09
72142		Mri neck spine w/dye			Z2	3.8182	$190.59
72146		Mri chest spine w/o dye			Z2	2.3858	$119.09
72147		Mri chest spine w/dye			Z2	3.8182	$190.59
72148		Mri lumbar spine w/o dye			Z2	2.3858	$119.09
72149		Mri lumbar spine w/dye			Z2	3.8182	$190.59
72156		Mri neck spine w/o & w/dye			Z2	3.8182	$190.59
72157		Mri chest spine w/o & w/dye			Z2	3.8182	$190.59
72158		Mri lumbar spine w/o & w/dye			Z2	3.8182	$190.59
72170		X-ray exam of pelvis			N1		
72190		X-ray exam of pelvis			N1		
72191		Ct angiograph pelv w/o&w/dye			Z2	1.8521	$92.45
72192		Ct pelvis w/o dye			Z2	1.1288	$56.35
72193		Ct pelvis w/dye			Z2	1.8521	$92.45
72194		Ct pelvis w/o & w/dye			Z2	1.8521	$92.45
72195		Mri pelvis w/o dye			Z2	2.3858	$119.09
72196		Mri pelvis w/dye			Z2	3.8182	$190.59
72197		Mri pelvis w/o & w/dye			Z2	3.8182	$190.59
72200		X-ray exam si joints			N1		
72202		X-ray exam si joints 3/> vws			N1		
72220		X-ray exam sacrum tailbone			N1		
72240		Myelography neck spine			N1		
72255		Myelography thoracic spine			N1		
72265		Myelography l-s spine			N1		
72270		Myelogphy 2/> spine regions			N1		
72275		Epidurography	CH		D5		
72285		Discography cerv/thor spine			N1		
72295		X-ray of lower spine disk			N1		
73000		X-ray exam of collar bone			N1		
73010		X-ray exam of shoulder blade			N1		
73020		X-ray exam of shoulder			N1		
73030		X-ray exam of shoulder			N1		
73040		Contrast x-ray of shoulder			N1		
73050		X-ray exam of shoulders			N1		
73060		X-ray exam of humerus			N1		
73070		X-ray exam of elbow			N1		
73080		X-ray exam of elbow			N1		
73085		Contrast x-ray of elbow			N1		
73090		X-ray exam of forearm			N1		
73092		X-ray exam of arm infant			N1		
73100		X-ray exam of wrist			N1		
73110		X-ray exam of wrist			N1		
73115		Contrast x-ray of wrist			N1		
73120		X-ray exam of hand			N1		
73130		X-ray exam of hand			N1		
73140		X-ray exam of finger(s)			N1		
73200		Ct upper extremity w/o dye			Z2	1.1288	$56.35
73201		Ct upper extremity w/dye			Z3		$156.57
73202		Ct uppr extremity w/o&w/dye			Z2	1.8521	$92.45
73206		Ct angio upr extrm w/o&w/dye			Z2	1.8521	$92.45
73218		Mri upper extremity w/o dye			Z2	2.3858	$119.09
73219		Mri upper extremity w/dye			Z2	3.8182	$190.59
73220		Mri uppr extremity w/o&w/dye			Z2	3.8182	$190.59
73221		Mri joint upr extrem w/o dye			Z2	2.3858	$119.09
73222		Mri joint upr extrem w/dye			Z3		$256.69
73223		Mri joint upr extr w/o&w/dye			Z2	3.8182	$190.59
73501		X-ray exam hip uni 1 view			N1		
73502		X-ray exam hip uni 2-3 views			N1		
73503		X-ray exam hip uni 4/> views			N1		
73521		X-ray exam hips bi 2 views			N1		
73522		X-ray exam hips bi 3-4 views			N1		
73523		X-ray exam hips bi 5/> views			N1		
73525		Contrast x-ray of hip			N1		
73551		X-ray exam of femur 1			N1		
73552		X-ray exam of femur 2/>			N1		
73560		X-ray exam of knee 1 or 2			N1		
73562		X-ray exam of knee 3			N1		
73564		X-ray exam knee 4 or more			N1		
73565		X-ray exam of knees			N1		
73580		Contrast x-ray of knee joint			N1		
73590		X-ray exam of lower leg			N1		
73592		X-ray exam of leg infant			N1		
73600		X-ray exam of ankle			N1		
73610		X-ray exam of ankle			N1		
73615		Contrast x-ray of ankle			N1		
73620		X-ray exam of foot			N1		
73630		X-ray exam of foot			N1		
73650		X-ray exam of heel			N1		
73660		X-ray exam of toe(s)			N1		
73700		Ct lower extremity w/o dye			Z2	1.1288	$56.35
73701		Ct lower extremity w/dye			Z2	1.8521	$92.45
73702		Ct lwr extremity w/o&w/dye			Z2	1.8521	$92.45
73706		Ct angio lwr extr w/o&w/dye			Z2	1.8521	$92.45
73718		Mri lower extremity w/o dye			Z2	2.3858	$119.09
73719		Mri lower extremity w/dye			Z2	3.8182	$190.59
73720		Mri lwr extremity w/o&w/dye			Z2	3.8182	$190.59
73721		Mri jnt of lwr extre w/o dye			Z2	2.3858	$119.09
73722		Mri joint of lwr extr w/dye			Z3		$257.36
73723		Mri joint lwr extr w/o&w/dye			Z2	3.8182	$190.59
74018		X-ray exam abdomen 1 view			N1		
74019		X-ray exam abdomen 2 views			N1		
74021		X-ray exam abdomen 3+ views			N1		
74022		X-ray exam complete abdomen			N1		
74150		Ct abdomen w/o dye			Z2	1.1288	$56.35
74160		Ct abdomen w/dye			Z2	1.8521	$92.45
74170		Ct abdomen w/o & w/dye			Z2	1.8521	$92.45
74174		Ct angio abd&pelv w/o&w/dye			Z2	3.8182	$190.59
74175		Ct angio abdom w/o & w/dye			Z2	1.8521	$92.45
74176		Ct abd & pelvis w/o contrast			Z3		$107.51
74177		Ct abd & pelv w/contrast			Z2	3.8182	$190.59
74178		Ct abd & pelv 1/> regns			Z2	3.8182	$190.59
74181		Mri abdomen w/o dye			Z2	2.3858	$119.09
74182		Mri abdomen w/dye			Z2	3.8182	$190.59
74183		Mri abdomen w/o & w/dye			Z2	3.8182	$190.59
74190		X-ray exam of peritoneum			N1		
74210		X-ray xm phrnx&/crv esoph c+			N1		
74220		X-ray xm esophagus 1cntrst			N1		
74230		X-ray xm swlng funcj c+			Z2	1.8521	$92.45
74235		Remove esophagus obstruction			N1		
74240		X-ray xm upr gi trc 1cntrst			Z3		$88.36
74246		X-ray xm upr gi trc 2cntrst			Z2	1.8521	$92.45
74250		X-ray xm sm int 1cntrst std			Z3		$87.69
74251		X-ray xm sm int 2cntrst std			Z2	1.8521	$92.45
74261		Ct colonography dx			Z2	1.1288	$56.35
74262		Ct colonography dx w/dye			Z2	1.8521	$92.45
74270		X-ray xm colon 1cntrst std			N1		
74280		X-ray xm colon 2cntrst std			N1		
74283		Ther nma rdctj intus/obstrcj			Z2	1.8521	$92.45
74290		Contrast x-ray gallbladder			N1		
74300		X-ray bile ducts/pancreas			N1		
74301		X-rays at surgery add-on			N1		
74328		X-ray bile duct endoscopy			N1		
74329		X-ray for pancreas endoscopy			N1		
74330		X-ray bile/panc endoscopy			N1		
74340		X-ray guide for gi tube			N1		
74355		X-ray guide intestinal tube			N1		
74360		X-ray guide gi dilation			N1		
74363		X-ray bile duct dilation			N1		
74400		Urography iv +-kub tomog			Z2	1.8521	$92.45
74410		Urography nfs drip&/bolus			Z2	1.8521	$92.45
74415		Urography nfs drip&/bls w/nf			Z2	1.8521	$92.45
74420		Urography rtrgr +-kub			Z2	3.8182	$190.59
74425		Urography antegrade rs&i			N1		
74430		Contrast x-ray bladder			N1		
74440		X-ray male genital tract			N1		
74445		X-ray exam of penis			N1		
74450		X-ray urethra/bladder			N1		
74455		X-ray urethra/bladder			N1		
74470		X-ray exam of kidney lesion			N1		
74485		Dilation urtr/urt rs&i			N1		
74710		X-ray measurement of pelvis			N1		
74712		Mri fetal sngl/1st gestation			Z2	2.3858	$119.09
74713		Mri fetal ea addl gestation			N1		
74740		X-ray female genital tract			N1		
74742		X-ray fallopian tube			N1		
74775		X-ray exam of perineum			Z2	2.3858	$119.09
75557		Cardiac mri for morph			Z2	2.3858	$119.09
75559		Cardiac mri w/stress img			Z2	5.0100	$250.08
75561		Cardiac mri for morph w/dye			Z2	3.8182	$190.59
75563		Card mri w/stress img & dye			Z3		$316.16
75565		Card mri veloc flow mapping			N1		
75571		Ct hrt w/o dye w/ca test			N1		
75572		Ct hrt w/3d image			Z2	1.8521	$92.45
75573		Ct hrt c+ strux cgen hrt ds			Z2	1.8521	$92.45
75574		Ct angio hrt w/3d image			Z2	1.8521	$92.45
75600		Contrast exam thoracic aorta			N1		
75605		Contrast exam thoracic aorta			N1		
75625		Contrast exam abdominl aorta			N1		
75630		X-ray aorta leg arteries			N1		
75635		Ct angio abdominal arteries			N1		
75705		Artery x-rays spine			N1		
75710		Artery x-rays arm/leg			N1		
75716		Artery x-rays arms/legs			N1		
75726		Artery x-rays abdomen			N1		
75731		Artery x-rays adrenal gland			Z3		$96.76
75733		Artery x-rays adrenals			N1		
75736		Artery x-rays pelvis			N1		
75741		Artery x-rays lung			N1		
75743		Artery x-rays lungs			N1		
75746		Artery x-rays lung			Z3		$80.64
75756		Artery x-rays chest			N1		
75774		Artery x-ray each vessel			N1		
75801		Lymph vessel x-ray arm/leg			N1		
75803		Lymph vessel x-ray arms/legs			Z2	11.1781	$557.97
75805		Lymph vessel x-ray trunk			Z2	28.0092	"$1,398.11"
75807		Lymph vessel x-ray trunk			N1		
75809		Nonvascular shunt x-ray			N1		
75810		Vein x-ray spleen/liver			Z2	28.0092	"$1,398.11"
75820		Vein x-ray arm/leg			N1		
75822		Vein x-ray arms/legs			Z3		$65.85
75825		Vein x-ray trunk			N1		
75827		Vein x-ray chest			N1		
75831		Vein x-ray kidney			N1		
75833		Vein x-ray kidneys			N1		
75840		Vein x-ray adrenal gland			N1		
75842		Vein x-ray adrenal glands			N1		
75860		Vein x-ray neck			N1		
75870		Vein x-ray skull			Z3		$102.81
75872		Vein x-ray skull epidural			N1		
75880		Vein x-ray eye socket			N1		
75885		Vein x-ray liver w/hemodynam			N1		
75887		Vein x-ray liver w/o hemodyn			Z3		$72.91
75889		Vein x-ray liver w/hemodynam			N1		
75891		Vein x-ray liver			N1		
75893		Venous sampling by catheter			N1		
75894		X-rays transcath therapy			N1		
75898		Follow-up angiography			Z2	28.0092	"$1,398.11"
75901		Remove cva device obstruct			N1		
75902		Remove cva lumen obstruct			N1		
75970		Vascular biopsy			N1		
75984		Xray control catheter change			N1		
75989		Abscess drainage under x-ray			N1		
76000		Fluoroscopy <1 hr phys/qhp			Z3		$27.55
76010		X-ray nose to rectum			N1		
76080		X-ray exam of fistula			N1		
76098		X-ray exam surgical specimen			N1		
76100		X-ray exam of body section			N1		
76101		Complex body section x-ray	CH		D5		
76102		Complex body section x-rays	CH		D5		
76120		Cine/video x-rays			N1		
76125		Cine/video x-rays add-on			N1		
76145		Med physic dos eval rad exps	CH 		Z2	3.5112	$175.27
76376		3d render w/intrp postproces			N1		
76377		3d render w/intrp postproces			N1		
76380		Cat scan follow-up study			N1		
76390		Mr spectroscopy			Z2	0.8387	$41.86
76391		Mr elastography			Z2	2.3858	$119.09
76496		Fluoroscopic procedure			N1		
76497		Ct procedure			N1		
76498		Mri procedure			Z2	0.8387	$41.86
76499		Radiographic procedure			N1		
76506		Echo exam of head			N1		
76510		Oph us dx b-scan&quan a-scan			N1		
76511		Oph us dx quan a-scan only			N1		
76512		Oph us dx b-scan			N1		
76513		Oph us dx ant sgm us uni/bi			N1		
76514		Echo exam of eye thickness			N1		
76516		Echo exam of eye			N1		
76519		Echo exam of eye			N1		
76529		Echo exam of eye			N1		
76536		Us exam of head and neck			N1		
76604		Us exam chest			N1		
76641		Ultrasound breast complete			N1		
76642		Ultrasound breast limited			N1		
76700		Us exam abdom complete			Z2	1.1288	$56.35
76705		Echo exam of abdomen			Z2	1.1288	$56.35
76770		Us exam abdo back wall comp			Z2	1.1288	$56.35
76775		Us exam abdo back wall lim			N1		
76776		Us exam k transpl w/doppler			Z2	1.1288	$56.35
76800		Us exam spinal canal			N1		
76801		Ob us < 14 wks single fetus			Z2	1.1288	$56.35
76802		Ob us < 14 wks addl fetus			N1		
76805		Ob us >= 14 wks sngl fetus			Z2	1.1288	$56.35
76810		Ob us >= 14 wks addl fetus			N1		
76811		Ob us detailed sngl fetus			Z3		$82.65
76812		Ob us detailed addl fetus			N1		
76813		Ob us nuchal meas 1 gest			N1		
76814		Ob us nuchal meas add-on			N1		
76815		Ob us limited fetus(s)			N1		
76816		Ob us follow-up per fetus			N1		
76817		Transvaginal us obstetric			N1		
76818		Fetal biophys profile w/nst			Z2	1.1288	$56.35
76819		Fetal biophys profil w/o nst			Z3		$46.70
76820		Umbilical artery echo			N1		
76821		Middle cerebral artery echo			N1		
76825		Echo exam of fetal heart			Z3		$186.13
76826		Echo exam of fetal heart			Z2	2.3858	$119.09
76827		Echo exam of fetal heart			N1		
76828		Echo exam of fetal heart			N1		
76830		Transvaginal us non-ob			Z2	1.1288	$56.35
76831		Echo exam uterus			Z3		$82.99
76856		Us exam pelvic complete			Z2	1.1288	$56.35
76857		Us exam pelvic limited			Z3		$24.19
76870		Us exam scrotum			N1		
76872		Us transrectal			Z2	1.1288	$56.35
76873		Echograp trans r pros study			Z2	1.1288	$56.35
76881		Us compl joint r-t w/img			Z3		$28.22
76882		Us lmtd jt/nonvasc xtr strux			N1		
76885		Us exam infant hips dynamic			N1		
76886		Us exam infant hips static			N1		
76932		Echo guide for heart biopsy			N1		
76936		Echo guide for artery repair			Z2	2.7441	$136.97
76937		Us guide vascular access			N1		
76940		Us guide tissue ablation			N1		
76941		Echo guide for transfusion			N1		
76942		Echo guide for biopsy			N1		
76945		Echo guide villus sampling			N1		
76946		Echo guide for amniocentesis			N1		
76948		Echo guide ova aspiration			N1		
76965		Echo guidance radiotherapy			N1		
76975		Gi endoscopic ultrasound			N1		
76977	**	Us bone density measure			Z3		$4.03
76978		Us trgt dyn mbubb 1st les			Z2	1.8521	$92.45
76979		Us trgt dyn mbubb ea addl			N1		
76981		Use parenchyma			Z2	1.1288	$56.35
76982		Use 1st target lesion			Z2	1.1288	$56.35
76983		Use ea addl target lesion			N1		
76998		Us guide intraop			N1		
76999		Echo examination procedure			N1		
77001		Fluoroguide for vein device			N1		
77002		Needle localization by xray			N1		
77003		Fluoroguide for spine inject			N1		
77011		Ct scan for localization			N1		
77012		Ct scan for needle biopsy			N1		
77013		Ct guide for tissue ablation			N1		
77014		Ct scan for therapy guide			N1		
77021		Mri guidance ndl plmt rs&i			N1		
77022		Mri gdn parnchyma tiss abltj			N1		
77046		Mri breast c- unilateral			Z2	2.3858	$119.09
77047		Mri breast c- bilateral			Z2	2.3858	$119.09
77053		X-ray of mammary duct			N1		
77054		X-ray of mammary ducts			N1		
77071		X-ray stress view			N1		
77072		X-rays for bone age			N1		
77073		X-rays bone length studies			N1		
77074		X-rays bone survey limited			N1		
77075		X-rays bone survey complete			N1		
77076		X-rays bone survey infant			N1		
77077		Joint survey single view			N1		
77078	**	Ct bone density axial			Z2	0.8387	$41.86
77080	**	Dxa bone density axial			Z3		$27.21
77081	**	Dxa bone density/peripheral			Z3		$20.83
77084		Magnetic image bone marrow			Z2	2.3858	$119.09
77085	**	Dxa bone density study			N1		
77086		Fracture assessment via dxa			N1		
77280		Set radiation therapy field			Z2	1.3157	$65.67
77285		Set radiation therapy field			Z2	3.5112	$175.27
77290		Set radiation therapy field			Z2	3.5112	$175.27
77293		Respirator motion mgmt simul			N1		
77295		3-d radiotherapy plan			Z3		$245.27
77299		Radiation therapy planning			Z2	1.3157	$65.67
77300		Radiation therapy dose plan			Z3		$31.92
77301		Radiotherapy dose plan imrt			Z2	13.0932	$653.56
77306		Telethx isodose plan simple			Z3		$71.23
77307		Telethx isodose plan cplx			Z3		$129.02
77316		Brachytx isodose plan simple			Z3		$165.64
77317		Brachytx isodose intermed			Z2	3.5112	$175.27
77318		Brachytx isodose complex			Z2	3.5112	$175.27
77321		Special teletx port plan			Z3		$42.67
77331		Special radiation dosimetry			Z3		$18.14
77332		Radiation treatment aid(s)			Z3		$14.11
77333		Radiation treatment aid(s)			Z2	1.3157	$65.67
77334		Radiation treatment aid(s)			Z3		$62.83
77336		Radiation physics consult			Z2	1.3157	$65.67
77338		Design mlc device for imrt			Z2	3.5112	$175.27
77370		Radiation physics consult			Z2	1.3157	$65.67
77385		Ntsty modul rad tx dlvr smpl			Z2	5.6257	$280.81
77386		Ntsty modul rad tx dlvr cplx			Z2	5.6257	$280.81
77387		Guidance for radj tx dlvr			N1		
77399		External radiation dosimetry			Z2	1.3157	$65.67
77401		Radiation treatment delivery			Z3		$40.65
77402		Radiation treatment delivery			Z2	1.2421	$62.00
77407		Radiation treatment delivery			Z2	2.5064	$125.11
77412		Radiation treatment delivery			Z2	2.5064	$125.11
77417		Radiology port images(s)			N1		
77423		Neutron beam tx complex			Z3		$27.55
77424		Io rad tx delivery by x-ray			Z2	39.4514	"$1,969.26"
77425		Io rad tx deliver by elctrns			Z2	39.4514	"$1,969.26"
77435		Sbrt management			N1		
77470		Special radiation treatment			Z3		$28.22
77520		Proton trmt simple w/o comp			Z2	5.6257	$280.81
77522		Proton trmt simple w/comp			Z2	13.4126	$669.50
77523		Proton trmt intermediate			Z2	13.4126	$669.50
77525		Proton treatment complex			Z2	13.4126	$669.50
77600		Hyperthermia treatment			Z2	2.5064	$125.11
77605		Hyperthermia treatment			Z2	7.3555	$367.16
77610		Hyperthermia treatment			Z2	5.6257	$280.81
77615		Hyperthermia treatment			Z2	5.6257	$280.81
77620		Hyperthermia treatment			Z2	5.6257	$280.81
77750		Infuse radioactive materials	CH		Z3		$124.65
77761		Apply intrcav radiat simple			Z3		$206.63
77762		Apply intrcav radiat interm			Z3		$235.19
77763		Apply intrcav radiat compl			Z3		$303.39
77767		Hdr rdncl skn surf brachytx			Z2	2.5064	$125.11
77768		Hdr rdncl skn surf brachytx			Z2	2.5064	$125.11
77770		Hdr rdncl ntrstl/icav brchtx			Z3		$239.22
77771		Hdr rdncl ntrstl/icav brchtx			Z2	7.3555	$367.16
77772		Hdr rdncl ntrstl/icav brchtx			Z2	7.3555	$367.16
77778		Apply interstit radiat compl			Z2	7.3555	$367.16
77789		Apply surf ldr radionuclide			Z2	1.2421	$62.00
77790		Radiation handling			N1		
77799		Radium/radioisotope therapy			Z2	1.2421	$62.00
78012		Thyroid uptake measurement			Z2	3.9086	$195.10
78013		Thyroid imaging w/blood flow			Z2	3.9086	$195.10
78014		Thyroid imaging w/blood flow			Z2	3.9086	$195.10
78015		Thyroid met imaging			Z2	3.9086	$195.10
78016		Thyroid met imaging/studies			Z2	3.9086	$195.10
78018		Thyroid met imaging body			Z2	5.0739	$253.27
78020		Thyroid met uptake			N1		
78070		Parathyroid planar imaging			Z2	3.9086	$195.10
78071		Parathyrd planar w/wo subtrj			Z2	3.9086	$195.10
78072		Parathyrd planar w/spect&ct			Z2	5.0739	$253.27
78075		Adrenal cortex & medulla img			Z2	13.5496	$676.34
78099		Endocrine nuclear procedure			Z2	3.9086	$195.10
78102		Bone marrow imaging ltd			Z2	3.9086	$195.10
78103		Bone marrow imaging mult			Z2	3.9086	$195.10
78104		Bone marrow imaging body			Z2	3.9086	$195.10
78110		Plasma volume single			Z2	13.5496	$676.34
78111		Plasma volume multiple			Z2	13.5496	$676.34
78120		Red cell mass single			Z2	3.9086	$195.10
78121		Red cell mass multiple			Z2	5.0739	$253.27
78122		Blood volume			Z2	5.0739	$253.27
78130		Red cell survival study			Z2	3.9086	$195.10
78140		Red cell sequestration			Z2	3.9086	$195.10
78185		Spleen imaging			Z2	3.9086	$195.10
78191		Platelet survival			Z2	3.9086	$195.10
78195		Lymph system imaging			Z2	5.0739	$253.27
78199		Blood/lymph nuclear exam			Z2	3.9086	$195.10
78201		Liver imaging			Z2	5.0739	$253.27
78202		Liver imaging with flow			Z2	5.0739	$253.27
78215		Liver and spleen imaging			Z2	3.9086	$195.10
78216		Liver & spleen image/flow			Z2	3.9086	$195.10
78226		Hepatobiliary system imaging			Z2	3.9086	$195.10
78227		Hepatobil syst image w/drug			Z2	5.0739	$253.27
78230		Salivary gland imaging			Z2	3.9086	$195.10
78231		Serial salivary imaging			Z2	3.9086	$195.10
78232		Salivary gland function exam			Z2	3.9086	$195.10
78258		Esophageal motility study			Z2	3.9086	$195.10
78261		Gastric mucosa imaging			Z2	3.9086	$195.10
78262		Gastroesophageal reflux exam			Z2	3.9086	$195.10
78264		Gastric emptying imag study			Z2	3.9086	$195.10
78265		Gastric emptying imag study			Z2	3.9086	$195.10
78266		Gastric emptying imag study			Z2	5.0739	$253.27
78278		Acute gi blood loss imaging			Z2	3.9086	$195.10
78282		Gi protein loss exam			Z2	3.9086	$195.10
78290		Meckels divert exam			Z2	3.9086	$195.10
78291		Leveen/shunt patency exam			Z2	3.9086	$195.10
78299		Gi nuclear procedure			Z2	3.9086	$195.10
78300		Bone imaging limited area			Z2	3.9086	$195.10
78305		Bone imaging multiple areas			Z2	3.9086	$195.10
78306		Bone imaging whole body			Z2	3.9086	$195.10
78315		Bone imaging 3 phase			Z2	3.9086	$195.10
78399		Musculoskeletal nuclear exam			Z2	3.9086	$195.10
78414		Non-imaging heart function			Z2	5.0739	$253.27
78428		Cardiac shunt imaging			Z2	3.9086	$195.10
78429		Myocrd img pet 1 std w/ct			Z2	15.3460	$766.01
78430		Myocrd img pet rst/strs w/ct			Z2	15.3460	$766.01
78431		Myocrd img pet rst&strs ct			Z2	22.8480	"$1,140.48"
78432		Myocrd img pet 2rtracer			Z2	27.9242	"$1,393.86"
78433		Myocrd img pet 2rtracer ct			Z2	27.9242	"$1,393.86"
78434		Aqmbf pet rest & rx stress			N1		
78445		Vascular flow imaging			Z2	3.9086	$195.10
78451		Ht muscle image spect sing			Z2	13.5496	$676.34
78452		Ht muscle image spect mult			Z2	13.5496	$676.34
78453		Ht muscle image planar sing			Z2	13.5496	$676.34
78454		Ht musc image planar mult			Z2	13.5496	$676.34
78456		Acute venous thrombus image			Z2	13.5496	$676.34
78457		Venous thrombosis imaging			Z2	5.0739	$253.27
78458		Ven thrombosis images bilat			Z2	3.9086	$195.10
78459		Myocrd img pet single study			Z2	13.5496	$676.34
78466		Heart infarct image			Z2	3.9086	$195.10
78468		Heart infarct image (ef)			Z2	5.0739	$253.27
78469		Heart infarct image (3d)			Z2	5.0739	$253.27
78472		Gated heart planar single			Z2	3.9086	$195.10
78473		Gated heart multiple			Z2	3.9086	$195.10
78481		Heart first pass single			Z2	5.0739	$253.27
78483		Heart first pass multiple			Z2	5.0739	$253.27
78491		Myocrd img pet 1std rst/strs			Z2	15.3460	$766.01
78492		Myocrd img pet mlt rst&strs			Z2	15.3460	$766.01
78494		Heart image spect			Z2	3.9086	$195.10
78496		Heart first pass add-on			N1		
78499		Cardiovascular nuclear exam			Z2	3.9086	$195.10
78579		Lung ventilation imaging			Z2	3.9086	$195.10
78580		Lung perfusion imaging			Z2	3.9086	$195.10
78582		Lung ventilat&perfus imaging			Z2	5.0739	$253.27
78597		Lung perfusion differential			Z2	3.9086	$195.10
78598		Lung perf&ventilat diferentl			Z2	5.0739	$253.27
78599		Respiratory nuclear exam			Z2	3.9086	$195.10
78600		Brain image < 4 views			Z2	3.9086	$195.10
78601		Brain image w/flow < 4 views			Z2	3.9086	$195.10
78605		Brain image 4+ views			Z2	5.0739	$253.27
78606		Brain image w/flow 4 + views			Z2	5.0739	$253.27
78608		Brain imaging (pet)			Z2	15.3460	$766.01
78610		Brain flow imaging only			Z2	5.0739	$253.27
78630		Cerebrospinal fluid scan			Z2	5.0739	$253.27
78635		Csf ventriculography			Z2	5.0739	$253.27
78645		Csf shunt evaluation			Z2	5.0739	$253.27
78650		Csf leakage imaging			Z2	13.5496	$676.34
78660		Nuclear exam of tear flow			Z2	3.9086	$195.10
78699		Nervous system nuclear exam			Z2	3.9086	$195.10
78700		Kidney imaging morphol			Z2	3.9086	$195.10
78701		Kidney imaging with flow			Z2	3.9086	$195.10
78707		K flow/funct image w/o drug			Z2	5.0739	$253.27
78708		K flow/funct image w/drug			Z2	5.0739	$253.27
78709		K flow/funct image multiple			Z2	5.0739	$253.27
78725		Kidney function study			Z2	3.9086	$195.10
78730		Urinary bladder retention			N1		
78740		Ureteral reflux study			Z2	3.9086	$195.10
78761		Testicular imaging w/flow			Z2	3.9086	$195.10
78799		Genitourinary nuclear exam			Z2	3.9086	$195.10
78800		Rp loclzj tum 1 area 1 d img			Z2	3.9086	$195.10
78801		Rp loclzj tum 2+area 1+d img			Z2	3.9086	$195.10
78802		Rp loclzj tum whbdy 1 d img			Z2	13.5496	$676.34
78803		Rp loclzj tum spect 1 area			Z2	13.5496	$676.34
78804		Rp loclzj tum whbdy 2+d img			Z2	13.5496	$676.34
78808		Iv inj ra drug dx study			N1		
78811		Pet image ltd area			Z2	13.5496	$676.34
78812		Pet image skull-thigh			Z2	15.3460	$766.01
78813		Pet image full body			Z2	15.3460	$766.01
78814		Pet image w/ct lmtd			Z2	15.3460	$766.01
78815		Pet image w/ct skull-thigh			Z2	15.3460	$766.01
78816		Pet image w/ct full body			Z2	15.3460	$766.01
78830		Rp loclzj tum spect w/ct 1			Z2	13.5496	$676.34
78831		Rp loclzj tum spect 2 areas			Z2	13.5496	$676.34
78832		Rp loclzj tum spect w/ct 2			Z2	15.3460	$766.01
78999		Nuclear diagnostic exam			Z2	3.9086	$195.10
79005		Nuclear rx oral admin			Z3		$50.06
79101		Nuclear rx iv admin			Z3		$52.08
79200		Nuclear rx intracav admin			Z3		$53.09
79300		Nuclr rx interstit colloid			Z2	2.6236	$130.96
79403		Hematopoietic nuclear tx			Z3		$66.86
79440		Nuclear rx intra-articular			Z3		$39.98
79445		Nuclear rx intra-arterial			Z2	2.6236	$130.96
79999		Nuclear medicine therapy			Z2	2.6236	$130.96
90371		Hep b ig im			K2		$130.31
90375		Rabies ig im/sc			K2		$267.30
90376		Rabies ig heat treated			K2		$287.38
90377		Rabies ig ht&sol human im/sc			K5		
90378		Rsv mab im 50mg			K2		"$1,185.67"
90393		Vaccina ig im			K5		
90396		Varicella-zoster ig im			K2		"$1,965.97"
90476		Adenovirus vaccine type 4			N1		
90581		Anthrax vaccine sc or im			K5		
90630	**	Flu vacc iiv4 no preserv id			L1		
90632		Hepa vaccine adult im			N1		
90633		Hepa vacc ped/adol 2 dose im			N1		
90634		Hepa vacc ped/adol 3 dose			N1		
90636		Hep a/hep b vacc adult im			N1		
90647		Hib prp-omp vacc 3 dose im			N1		
90648		Hib prp-t vaccine 4 dose im			N1		
90653	**	Iiv adjuvant vaccine im			L1		
90654	**	Flu vacc iiv3 no preserv id			L1		
90655	**	Iiv3 vacc no prsv 0.25 ml im			L1		
90656	**	Iiv3 vacc no prsv 0.5 ml im			L1		
90657	**	Iiv3 vaccine splt 0.25 ml im			L1		
90660	**	Laiv3 vaccine intranasal			L1		
90661	**	Cciiv3 vac no prsv 0.5 ml im			L1		
90662	**	Iiv no prsv increased ag im			L1		
90670	**	Pcv13 vaccine im			L1		
90672	**	Laiv4 vaccine intranasal			L1		
90673	**	Riv3 vaccine no preserv im			L1		
90674	**	Cciiv4 vac no prsv 0.5 ml im			L1		
90675		Rabies vaccine im			K2		$327.53
90676		Rabies vaccine id			K2		$189.63
90680		Rv5 vacc 3 dose live oral			N1		
90682	**	Riv4 vacc recombinant dna im			L1		
90685	**	Iiv4 vacc no prsv 0.25 ml im			L1		
90686	**	Iiv4 vacc no prsv 0.5 ml im			L1		
90687	**	Iiv4 vaccine splt 0.25 ml im			L1		
90688	**	Iiv4 vaccine splt 0.5 ml im			L1		
90689	**	Vacc iiv4 no prsrv 0.25ml im			L1		
90690		Typhoid vaccine oral			N1		
90691		Typhoid vaccine im			N1		
90694		Vacc aiiv4 no prsrv 0.5ml im			L1		
90696		Dtap-ipv vaccine 4-6 yrs im			N1		
90698		Dtap-ipv/hib vaccine im			N1		
90717		Yellow fever vaccine subq			N1		
90732	**	Ppsv23 vacc 2 yrs+ subq/im			L1		
90740	**	Hepb vacc 3 dose immunsup im			F4		
90743	**	Hepb vacc 2 dose adolesc im			F4		
90744	**	Hepb vacc 3 dose ped/adol im			F4		
90746	**	Hepb vaccine 3 dose adult im			F4		
90747	**	Hepb vacc 4 dose immunsup im			F4		
90749		Vaccine toxoid			N1		
90756	**	Cciiv4 vacc abx free im			L1		
91035		G-esoph reflx tst w/electrod			Z2	5.0613	$252.64
91300		Sarscov2 vac 30mcg/0.3ml im			L1		
91301		Sarscov2 vac 100mcg/0.5ml im			L1		
91303		Sarscov2 vac ad26 .5ml im	NC		L1		
A9500		Tc99m sestamibi			N1		
A9501		Technetium tc-99m teboroxime			N1		
A9502		Tc99m tetrofosmin			N1		
A9503		Tc99m medronate			N1		
A9504		Tc99m apcitide			N1		
A9505		Tl201 thallium			N1		
A9507		In111 capromab			N1		
A9508		"I131 iodobenguate, dx"			N1		
A9509		Iodine i-123 sod iodide mil			N1		
A9510		Tc99m disofenin			N1		
A9512		Tc99m pertechnetate			N1		
A9515		Choline c-11			N1		
A9516		Iodine i-123 sod iodide mic			N1		
A9520		Tc99 tilmanocept diag 0.5mci			N1		
A9521		Tc99m exametazime			N1		
A9524		"I131 serum albumin, dx"			N1		
A9526		Nitrogen n-13 ammonia			N1		
A9527		Iodine i-125 sodium iodide			H2		$40.37
A9528		"Iodine i-131 iodide cap, dx"			N1		
A9529		"I131 iodide sol, dx"			N1		
A9531		I131 max 100uci			N1		
A9532		"I125 serum albumin, dx"			N1		
A9536		Tc99m depreotide			N1		
A9537		Tc99m mebrofenin			N1		
A9538		Tc99m pyrophosphate			N1		
A9539		Tc99m pentetate			N1		
A9540		Tc99m maa			N1		
A9541		Tc99m sulfur colloid			N1		
A9542		"In111 ibritumomab, dx"			N1		
A9546		Co57/58			N1		
A9547		In111 oxyquinoline			N1		
A9548		In111 pentetate			N1		
A9550		Tc99m gluceptate			N1		
A9551		Tc99m succimer			N1		
A9552		F18 fdg			N1		
A9553		Cr51 chromate			N1		
A9554		"I125 iothalamate, dx"			N1		
A9555		Rb82 rubidium			N1		
A9556		Ga67 gallium			N1		
A9557		Tc99m bicisate			N1		
A9558		Xe133 xenon 10mci			N1		
A9559		Co57 cyano			N1		
A9560		Tc99m labeled rbc			N1		
A9561		Tc99m oxidronate			N1		
A9562		Tc99m mertiatide			N1		
A9566		Tc99m fanolesomab			N1		
A9567		Technetium tc-99m aerosol			N1		
A9568		Technetium tc99m arcitumomab			N1		
A9569		Technetium tc-99m auto wbc			N1		
A9570		Indium in-111 auto wbc			N1		
A9571		Indium in-111 auto platelet			N1		
A9572		Indium in-111 pentetreotide			N1		
A9575		Inj gadoterate meglumi 0.1ml			N1		
A9576		Inj prohance multipack			N1		
A9577		Inj multihance			N1		
A9578		Inj multihance multipack			N1		
A9579		"Gad-base mr contrast nos,1ml"			N1		
A9580		Sodium fluoride f-18			N1		
A9581		Gadoxetate disodium inj			N1		
A9582		Iodine i-123 iobenguane			N1		
A9583		Gadofosveset trisodium inj			N1		
A9584		Iodine i-123 ioflupane			N1		
A9585		Gadobutrol injection			N1		
A9586		Florbetapir f18			N1		
A9587		Gallium ga-68			N1		
A9588		Fluciclovine f-18			N1		
A9590		Iodine i-131 iobenguane 1mci	CH 		K2		$320.12
A9591		Fluoroestradiol f 18			K2		$644.83
A9592		Copper cu 64 dotatate diag	NC		K2		$918.21
A9593		Gallium ga-68 psma-11 ucsf	NC		K2		$732.86
A9594		"Gallium ga-68 psma-11, ucla"	NC		K2		$717.55
A9595		"Piflu f-18, dia 1 millicurie"	NI 		K2		$526.44
A9597		"Pet, dx, for tumor id, noc"			N1		
A9598		"Pet dx for non-tumor id, noc"			N1		
A9698		Non-rad contrast materialnoc			N1		
A9700		Echocardiography contrast			N1		
C1052		"Hemostatic agent, gi, topic"			J7		
C1062		Intravertebral fx aug impl			J7		
C1713		"Anchor/screw bn/bn,tis/bn"			N1		
C1714		"Cath, trans atherectomy, dir"			N1		
C1715		Brachytherapy needle			N1		
C1716		"Brachytx, non-str, gold-198"			H2		$616.61
C1717		"Brachytx, non-str,hdr ir-192"			H2		$341.72
C1719		"Brachytx, ns, non-hdrir-192"			H2		$205.82
C1721		"Aicd, dual chamber"			N1		
C1722		"Aicd, single chamber"			N1		
C1724		"Cath, trans atherec,rotation"			N1		
C1725		"Cath, translumin non-laser"			N1		
C1726		"Cath, bal dil, non-vascular"			N1		
C1727		"Cath, bal tis dis, non-vas"			N1		
C1728		"Cath, brachytx seed adm"			N1		
C1729		"Cath, drainage"			N1		
C1730		"Cath, ep, 19 or few elect"			N1		
C1731		"Cath, ep, 20 or more elec"			N1		
C1732		"Cath, ep, diag/abl, 3d/vect"			N1		
C1733		"Cath, ep, othr than cool-tip"			N1		
C1734		"Orth/devic/drug bn/bn,tis/bn"			J7		
C1748		"Endoscope, single, ugi"			J7		
C1749		"Endo, colon, retro imaging"			N1		
C1750		"Cath, hemodialysis,long-term"			N1		
C1751		"Cath, inf, per/cent/midline"			N1		
C1752		"Cath,hemodialysis,short-term"			N1		
C1753		"Cath, intravas ultrasound"			N1		
C1754		"Catheter, intradiscal"			N1		
C1755		"Catheter, intraspinal"			N1		
C1756		"Cath, pacing, transesoph"			N1		
C1757		"Cath, thrombectomy/embolect"			N1		
C1758		"Catheter, ureteral"			N1		
C1759		"Cath, intra echocardiography"			N1		
C1760		"Closure dev, vasc"			N1		
C1761		"Cath, trans intra litho/coro"	NC		J7		
C1762		"Conn tiss, human(inc fascia)"			N1		
C1763		"Conn tiss, non-human"			N1		
C1764		"Event recorder, cardiac"			N1		
C1765		Adhesion barrier			N1		
C1766		"Intro/sheath,strble,non-peel"			N1		
C1767		"Generator, neuro non-recharg"			N1		
C1768		"Graft, vascular"			N1		
C1769		Guide wire			N1		
C1770		"Imaging coil, mr, insertable"			N1		
C1771		"Rep dev, urinary, w/sling"			N1		
C1772		"Infusion pump, programmable"			N1		
C1773		"Ret dev, insertable"			N1		
C1776		Joint device (implantable)			N1		
C1777		"Lead, aicd, endo single coil"			N1		
C1778		"Lead, neurostimulator"			N1		
C1779		"Lead, pmkr, transvenous vdd"			N1		
C1780		"Lens, intraocular (new tech)"			N1		
C1781		Mesh (implantable)			N1		
C1782		Morcellator			N1		
C1783		"Ocular imp, aqueous drain de"			N1		
C1784		"Ocular dev, intraop, det ret"			N1		
C1785		"Pmkr, dual, rate-resp"			N1		
C1786		"Pmkr, single, rate-resp"			N1		
C1787		"Patient progr, neurostim"			N1		
C1788		"Port, indwelling, imp"			N1		
C1789		"Prosthesis, breast, imp"			N1		
C1813		"Prosthesis, penile, inflatab"			N1		
C1814		"Retinal tamp, silicone oil"			N1		
C1815		"Pros, urinary sph, imp"			N1		
C1816		"Receiver/transmitter, neuro"			N1		
C1817		Septal defect imp sys			N1		
C1818		Integrated keratoprosthesis			N1		
C1819		Tissue localization-excision			N1		
C1820		Generator neuro rechg bat sy			N1		
C1821		Interspinous implant			N1		
C1822		"Gen, neuro, hf, rechg bat"			N1		
C1823		"Gen, neuro, trans sen/stim"			J7		
C1824		"Generator, ccm, implant"			J7		
C1825		"Gen, neuro, carot sinus baro"			J7		
C1830		Power bone marrow bx needle			N1		
C1831		Personalized interbody cage	NI		J7		
C1832		Auto cell process sys	NI		J7		
C1833		Cardiac monitor sys	NI		J7		
C1839		Iris prosthesis			J7		
C1840		Telescopic intraocular lens			N1		
C1841		Retinal prosth int/ext comp			J7		"$72,811.37"
C1842		"Retinal prosth, add-on"			J7		"$72,811.36"
C1849		"Skin substitute, synthetic"			N1		
C1874		"Stent, coated/cov w/del sys"			N1		
C1875		"Stent, coated/cov w/o del sy"			N1		
C1876		"Stent, non-coa/non-cov w/del"			N1		
C1877		"Stent, non-coat/cov w/o del"			N1		
C1878		Matrl for vocal cord			N1		
C1880		Vena cava filter			N1		
C1881		Dialysis access system			N1		
C1882		"Aicd, other than sing/dual"			N1		
C1883		"Adapt/ext, pacing/neuro lead"			N1		
C1884		Embolization protect syst			N1		
C1885		"Cath, translumin angio laser"			N1		
C1886		"Catheter, ablation"			N1		
C1887		"Catheter, guiding"			N1		
C1888		Endovas non-cardiac abl cath			N1		
C1889		"Implant/insert device, noc"			N1		
C1890		No device w/dev-intensive px			J7		
C1891		"Infusion pump,non-prog, perm"			N1		
C1892		"Intro/sheath,fixed,peel-away"			N1		
C1893		"Intro/sheath, fixed,non-peel"			N1		
C1894		"Intro/sheath, non-laser"			N1		
C1895		"Lead, aicd, endo dual coil"			N1		
C1896		"Lead, aicd, non sing/dual"			N1		
C1897		"Lead, neurostim test kit"			N1		
C1898		"Lead, pmkr, other than trans"			N1		
C1899		"Lead, pmkr/aicd combination"			N1		
C1900		"Lead, coronary venous"			N1		
C1982		"Cath, pressure,valve-occlu"			J7		
C2596		"Probe, robotic, water-jet"			J7		
C2613		Lung bx plug w/del sys			N1		
C2614		"Probe, perc lumb disc"			N1		
C2615		"Sealant, pulmonary, liquid"			N1		
C2616		"Brachytx, non-str,yttrium-90"			H2		"$17,763.21"
C2617		"Stent, non-cor, tem w/o del"			N1		
C2618		"Probe/needle, cryo"			N1		
C2619		"Pmkr, dual, non rate-resp"			N1		
C2620		"Pmkr, single, non rate-resp"			N1		
C2621		"Pmkr, other than sing/dual"			N1		
C2622		"Prosthesis, penile, non-inf"			N1		
C2623		"Cath, translumin, drug-coat"			N1		
C2624		Wireless pressure sensor			N1		
C2625		"Stent, non-cor, tem w/del sy"			N1		
C2626		"Infusion pump, non-prog,temp"			N1		
C2627		"Cath, suprapubic/cystoscopic"			N1		
C2628		"Catheter, occlusion"			N1		
C2629		"Intro/sheath, laser"			N1		
C2630		"Cath, ep, cool-tip"			N1		
C2631		"Rep dev, urinary, w/o sling"			N1		
C2634		"Brachytx, non-str, ha, i-125"			H2		$151.20
C2635		"Brachytx, non-str, ha, p-103"			H2		$45.62
C2636		"Brachy linear, non-str,p-103"			H2		$52.57
C2638		"Brachytx, stranded, i-125"			H2		$38.19
C2639		"Brachytx, non-stranded,i-125"			H2		$34.82
C2640		"Brachytx, stranded, p-103"			H2		$89.59
C2641		"Brachytx, non-stranded,p-103"			H2		$70.95
C2642		"Brachytx, stranded, c-131"			H2		$73.37
C2643		"Brachytx, non-stranded,c-131"			H2		$82.03
C2644		Brachytx cesium-131 chloride			K5		
C2645		"Brachytx planar, p-103"			H2		$4.69
C2698		"Brachytx, stranded, nos"			H2		$38.19
C2699		"Brachytx, non-stranded, nos"			H2		$34.82
C8900		"Mra w/cont, abd"			Z2	3.8182	$190.59
C8901		"Mra w/o cont, abd"			Z2	2.3858	$119.09
C8902		"Mra w/o fol w/cont, abd"			Z2	3.8182	$190.59
C8903		"Mri w/cont, breast,  uni"			Z2	1.8521	$92.45
C8905		"Mri w/o fol w/cont, brst, un"			Z2	3.8182	$190.59
C8906		"Mri w/cont, breast,  bi"			Z2	3.8182	$190.59
C8908		"Mri w/o fol w/cont, breast,"			Z2	3.8182	$190.59
C8909		"Mra w/cont, chest"			Z2	3.8182	$190.59
C8910		"Mra w/o cont, chest"			Z2	2.3858	$119.09
C8911		"Mra w/o fol w/cont, chest"			Z2	3.8182	$190.59
C8912		"Mra w/cont, lwr ext"			Z2	3.8182	$190.59
C8913		"Mra w/o cont, lwr ext"			Z2	2.3858	$119.09
C8914		"Mra w/o fol w/cont, lwr ext"			Z2	3.8182	$190.59
C8918		"Mra w/cont, pelvis"			Z2	3.8182	$190.59
C8919		"Mra w/o cont, pelvis"			Z2	2.3858	$119.09
C8920		"Mra w/o fol w/cont, pelvis"			Z2	3.8182	$190.59
C8931		"Mra, w/dye, spinal canal"			Z2	3.8182	$190.59
C8932		"Mra, w/o dye, spinal canal"			Z2	2.3858	$119.09
C8933		"Mra, w/o&w/dye, spinal canal"			Z2	3.8182	$190.59
C8934		"Mra, w/dye, upper extremity"			Z2	3.8182	$190.59
C8935		"Mra, w/o dye, upper extr"			Z2	2.3858	$119.09
C8936		"Mra, w/o&w/dye, upper extr"			Z2	3.8182	$190.59
C9046		Cocaine hcl nasal solution		*	K2		$1.33
C9047		"Injection, caplacizumab-yhdp"		*	K2		$691.29
C9065		Romidepsin non-lyophilized	CH		D5		
C9067		Gallium ga-68 dotatoc			K2		$8.64
C9068		"Copper cu-64, dotatate, dx"	CH		D5		
C9069		Belantamab mafodontin-blmf	CH		D5		
C9070		"Injection, tafasitamab-cxix"	CH		D5		
C9071		"Injection, viltolarsen"	CH		D5		
C9072		"Inj, imm glob asceniv"	CH		D5		
C9073		Brexucabtagene autoleucel ca	CH		D5		
C9084		"loncastuximab-lpyl, 0.1 mg"	NI 		K2		$242.05
C9085		Inj avalglucosid alfa-ngpt	NI 		K2		$70.65
C9086		"Inj, anifrolumab-fnia"	NI 		K2		$15.80
C9087		Inj cyclophosphamd auromedic	NI 		K2		$7.52
C9088		"Instill, bupivac and meloxic"	NI 		K2		$0.70
C9089		"Bupivacaine implant, 1 mg"	NI 		K2		$0.83
C9113		"Inj pantoprazole sodium, via"			N1		
C9122		Mometasone furoate (sinuva)	CH		D5		
C9132		"Kcentra, per i.u."	CH		D5		
C9248		"Inj, clevidipine butyrate"	CH		N1		
C9250		Artiss fibrin sealant			K2		$156.84
C9254		"Injection, lacosamide"			N1		
C9257		Bevacizumab injection			K2		$1.76
C9285		"Patch, lidocaine/tetracaine"			N1		
C9290		"Inj, bupivacaine liposome"			K2		$1.33
C9293		"Injection, glucarpidase"			K5		
C9352		"Neuragen nerve guide, per cm"			N1		
C9353		"Neurawrap nerve protector,cm"			N1		
C9354		"Veritas collagen matrix, cm2"			N1		
C9355		"Neuromatrix nerve cuff, cm"			N1		
C9356		"Tenoglide tendon prot, cm2"			N1		
C9358		"Surgimend, fetal"			N1		
C9359		"Implnt,bon void filler-putty"			N1		
C9360		"Surgimend, neonatal"			N1		
C9361		Neuromend nerve wrap			N1		
C9362		"Implnt,bon void filler-strip"			N1		
C9363		Integra meshed bil wound mat			N1		
C9364		"Porcine implant, permacol"			N1		
C9399		Unclassified drugs or biolog			K7		
C9460		"Injection, cangrelor"			K2		$16.32
C9462		"Injection, delafloxacin"	CH		N1		
C9482		Sotalol hydrochloride iv			K2		$17.58
C9488		Conivaptan hcl			K2		$43.94
C9738		Blue light cysto imag agent			N1		
C9762		Cardiac mri seg dys strain			Z2	5.0100	$250.08
C9763		Cardiac mri seg dys stress			Z2	5.0100	$250.08
G0130	**	Single energy x-ray study			Z3		$24.86
G0235		Pet not otherwise specified			Z2	3.9086	$195.10
J0120		Tetracyclin injection			N1		
J0121		"Inj., omadacycline, 1 mg"		*	K2		$3.30
J0122		"Inj., eravacycline, 1 mg"			N1		
J0129		Abatacept injection			K2		$45.27
J0130		Abciximab injection			N1		
J0131		Acetaminophen injection			N1		
J0132		Acetylcysteine injection			N1		
J0133		Acyclovir injection			N1		
J0135		Adalimumab injection			K2		"$1,581.57"
J0153		Adenosine inj 1mg			N1		
J0171		Adrenalin epinephrine inject			N1		
J0172		"Inj, aducanumab-avwa, 2 mg"	NI 		K2		$11.54
J0178		Aflibercept injection			K2		$917.94
J0179		"Inj, brolucizumab-dbll, 1 mg"			K2		$312.01
J0180		Agalsidase beta injection			K2		$198.14
J0185		"Inj., aprepitant, 1 mg"	CH		K2		$1.69
J0190		Inj biperiden lactate/5 mg			K5		
J0200		Alatrofloxacin mesylate			K5		
J0202		"Injection, alemtuzumab"			K2		"$2,086.32"
J0205		Alglucerase injection			K5		
J0207		Amifostine			K2		"$1,135.69"
J0210		Methyldopate hcl injection			K5		
J0215		Alefacept			K5		
J0220		Alglucosidase alfa injection			K2		$117.07
J0221		Lumizyme injection			K2		$180.35
J0222		"Inj., patisiran, 0.1 mg"	CH 		K2		$97.75
J0223		Inj givosiran 0.5 mg			K2		$106.76
J0223		Inj givosiran 0.5 mg			K2		$106.76
J0224		"Inj. lumasiran, 0.5 mg"	NC		K2		$302.30
J0256		Alpha 1 proteinase inhibitor			K2		$4.54
J0257		Glassia injection			K2		$4.95
J0278		Amikacin sulfate injection			N1		
J0280		Aminophyllin 250 mg inj			N1		
J0282		Amiodarone hcl			N1		
J0285		Amphotericin b			N1		
J0287		Amphotericin b lipid complex			K2		$9.50
J0288		Ampho b cholesteryl sulfate			K5		
J0289		Amphotericin b liposome inj			K2		$28.75
J0290		Ampicillin 500 mg inj			N1		
J0291		"Inj., plazomicin, 5 mg"	CH 		K2		$3.05
J0295		Ampicillin sulbactam 1.5 gm			N1		
J0300		Amobarbital 125 mg inj			K2		$125.22
J0330		Succinycholine chloride inj			N1		
J0348		Anidulafungin injection			N1		
J0350		Injection anistreplase 30 u			K5		
J0360		Hydralazine hcl injection			N1		
J0364		Apomorphine hydrochloride			K5		
J0365		"Aprotonin, 10,000 kiu"			K5		
J0380		Inj metaraminol bitartrate			K5		
J0390		Chloroquine injection			K2		$165.22
J0395		Arbutamine hcl injection			K5		
J0400		Aripiprazole injection			N1		
J0401		Inj aripiprazole ext rel 1mg			K2		$6.01
J0456		Azithromycin			N1		
J0461		Atropine sulfate injection			N1		
J0470		Dimecaprol injection			N1		
J0475		Baclofen 10 mg injection			K2		$177.43
J0476		Baclofen intrathecal trial			N1		
J0480		Basiliximab			K2		"$4,013.08"
J0485		Belatacept injection			K2		$3.80
J0490		Belimumab injection			K2		$47.57
J0500		Dicyclomine injection			N1		
J0515		Inj benztropine mesylate			N1		
J0517		"Inj., benralizumab, 1 mg"	CH 		K2		$170.80
J0520		Bethanechol chloride inject			K5		
J0558		Peng benzathine/procaine inj			K2		$11.79
J0561		Penicillin g benzathine inj			K2		$14.95
J0565		"Inj, bezlotoxumab, 10 mg"			K2		$39.77
J0567		"Inj., cerliponase alfa 1 mg"	CH		K5		
J0570		Buprenorphine implant 74.2mg			K2		"$1,311.75"
J0583		Bivalirudin			N1		
J0584		"Injection, burosumab-twza 1m"			K2		$369.11
J0585		"Injection,onabotulinumtoxina"			K2		$6.09
J0586		Abobotulinumtoxina			K2		$8.41
J0587		"Inj, rimabotulinumtoxinb"			K2		$12.05
J0588		Incobotulinumtoxin a			K2		$5.05
J0592		Buprenorphine hydrochloride			N1		
J0593		"Inj., lanadelumab-flyo, 1 mg"	CH		K5		
J0594		Busulfan injection			K2		$1.71
J0595		Butorphanol tartrate 1 mg			N1		
J0596		"Injection, ruconest"			K2		$29.97
J0597		"C-1 esterase, berinert"			K2		$57.39
J0598		"C-1 esterase, cinryze"			K2		$58.93
J0599		"Inj., haegarda 10 units"	CH		N1		
J0600		Edetate calcium disodium inj			K2		"$5,708.59"
J0606		"Inj, etelcalcetide, 0.1 mg"			N1		
J0610		Calcium gluconate injection			N1		
J0620		Calcium glycer & lact/10 ml			N1		
J0630		Calcitonin salmon injection			K2		"$3,100.79"
J0636		Inj calcitriol per 0.1 mcg			N1		
J0637		Caspofungin acetate			N1		
J0638		Canakinumab injection			K2		$115.61
J0640		Leucovorin calcium injection			N1		
J0641		Inj levoleucovorin nos 0.5mg	CH		N1		
J0642		"Injection, khapzory, 0.5 mg"		*	K2		$1.86
J0670		Inj mepivacaine hcl/10 ml			N1		
J0690		Cefazolin sodium injection			N1		
J0691		Inj lefamulin 1 mg			K2		$0.72
J0692		Cefepime hcl for injection			N1		
J0693		"Inj., cefiderocol, 5 mg"	CH		D5		
J0694		Cefoxitin sodium injection			N1		
J0695		Inj ceftolozane tazobactam			K2		$6.64
J0696		Ceftriaxone sodium injection			N1		
J0697		Sterile cefuroxime injection			N1		
J0698		Cefotaxime sodium injection			N1		
J0699		"Inj, cefiderocol, 10 mg"	NI 		K2		$2.01
J0702		Betamethasone acet&sod phosp			N1		
J0706		Caffeine citrate injection			N1		
J0710		Cephapirin sodium injection			K5		
J0712		Ceftaroline fosamil inj			K2		$3.51
J0713		Inj ceftazidime per 500 mg			N1		
J0714		Ceftazidime and avibactam			K2		$92.39
J0715		Ceftizoxime sodium / 500 mg			N1		
J0716		Centruroides immune f(ab)			K2		"$5,190.15"
J0717		Certolizumab pegol inj 1mg			K2		$6.27
J0720		Chloramphenicol sodium injec			N1		
J0725		Chorionic gonadotropin/1000u			N1		
J0735		Clonidine hydrochloride			N1		
J0740		Cidofovir injection			K2		$563.76
J0741		"Inj, cabote rilpivir 2mg 3mg"	NI 		K2		$20.56
J0742		Inj imip 4 cilas 4 releb 2mg			K2		$2.32
J0743		Cilastatin sodium injection			N1		
J0744		Ciprofloxacin iv			N1		
J0745		Inj codeine phosphate /30 mg			K2		$135.64
J0770		Colistimethate sodium inj			N1		
J0775		"Collagenase, clost hist inj"			K2		$56.66
J0780		Prochlorperazine injection			N1		
J0791		Inj crizanlizumab-tmca 5mg			K2		$123.29
J0791		Inj crizanlizumab-tmca 5mg			K2		$123.29
J0795		Corticorelin ovine triflutal			K2		$9.67
J0800		Corticotropin injection			N1		
J0834		"Inj., cosyntropin, 0.25 mg"			N1		
J0840		Crotalidae poly immune fab			K2		"$2,743.36"
J0841		Inj crotalidae im f(ab')2 eq			K2		"$1,189.81"
J0850		Cytomegalovirus imm iv /vial			K2		"$1,538.70"
J0875		"Injection, dalbavancin"			K2		$15.89
J0878		Daptomycin injection			N1		
J0881		"Darbepoetin alfa, non-esrd"			K2		$3.15
J0882		"Darbepoetin alfa, esrd use"			K2		$3.15
J0883		Argatroban nonesrd use 1mg			K2		$1.20
J0884		Argatroban esrd dialysis 1mg			K2		$1.20
J0885		"Epoetin alfa, non-esrd"			K2		$8.15
J0887		Epoetin beta esrd use			N1		
J0888		Epoetin beta non esrd			K2		$1.51
J0894		Decitabine injection			K2		$3.45
J0895		Deferoxamine mesylate inj			N1		
J0896		Inj luspatercept-aamt 0.25mg			K2		$36.85
J0897		Denosumab injection			K2		$21.19
J0945		Brompheniramine maleate inj			N1		
J1000		Depo-estradiol cypionate inj			N1		
J1020		Methylprednisolone 20 mg inj			N1		
J1030		Methylprednisolone 40 mg inj			N1		
J1040		Methylprednisolone 80 mg inj			N1		
J1050		Medroxyprogesterone acetate			N1		
J1071		Inj testosterone cypionate			N1		
J1094		Inj dexamethasone acetate			N1		
J1095		"Injection, dexamethasone 9%"		*	K2		$1.04
J1096		Dexametha opth insert 0.1 mg		*	K2		$133.30
J1097		Phenylep ketorolac opth soln			K2		$102.82
J1100		Dexamethasone sodium phos			N1		
J1110		Inj dihydroergotamine mesylt			N1		
J1120		Acetazolamid sodium injectio			N1		
J1130		Inj diclofenac sodium 0.5mg			N1		
J1160		Digoxin injection			N1		
J1162		Digoxin immune fab (ovine)			K2		"$4,128.19"
J1165		Phenytoin sodium injection			N1		
J1170		Hydromorphone injection			N1		
J1180		Dyphylline injection			K5		
J1190		Dexrazoxane hcl injection			K2		$192.33
J1200		Diphenhydramine hcl injectio			N1		
J1201		Inj. cetirizine hcl 0.5mg			K2		$15.38
J1201		Inj. cetirizine hcl 0.5mg			K2		$15.38
J1205		Chlorothiazide sodium inj			N1		
J1212		Dimethyl sulfoxide 50% 50 ml			K2		$637.11
J1230		Methadone injection			N1		
J1240		Dimenhydrinate injection			N1		
J1245		Dipyridamole injection			N1		
J1250		Inj dobutamine hcl/250 mg			N1		
J1260		Dolasetron mesylate			N1		
J1265		Dopamine injection			N1		
J1267		Doripenem injection			N1		
J1270		"Injection, doxercalciferol"			N1		
J1290		Ecallantide injection			K2		$503.88
J1300		Eculizumab injection			K2		$229.23
J1301		"Injection, edaravone, 1 mg"			K2		$20.51
J1303		"Inj., ravulizumab-cwvz 10 mg"		*	K2		$224.68
J1305		"Inj, evinacumab-dgnb, 5mg"	NI 		K2		$165.63
J1320		Amitriptyline injection			N1		
J1322		"Elosulfase alfa, injection"			K2		$250.33
J1324		Enfuvirtide injection			K5		
J1325		Epoprostenol injection			N1		
J1327		Eptifibatide injection	CH		K2		$1.99
J1330		Ergonovine maleate injection			K5		
J1335		Ertapenem injection			N1		
J1364		Erythro lactobionate /500 mg	CH		N1		
J1380		Estradiol valerate 10 mg inj			N1		
J1410		Inj estrogen conjugate 25 mg			K2		$341.46
J1426		"Injection, casimersen, 10 mg"	NI 		K2		$166.47
J1427		Inj. viltolarsen	NC		K2		$59.05
J1428		"Inj, eteplirsen, 10 mg"	CH		K5		
J1429		Inj golodirsen 10 mg			K2		$166.21
J1430		Ethanolamine oleate 100 mg			K2		$444.10
J1435		Injection estrone per 1 mg			K5		
J1438		Etanercept injection			K2		$790.78
J1439		Inj ferric carboxymaltos 1mg			K2		$1.12
J1442		Inj filgrastim excl biosimil			K2		$0.97
J1443		Inj ferric pyrophosphate cit			K5		
J1444		Fe pyro cit pow 0.1 mg iron			K5		
J1445		Inj triferic avnu 0.1mg iron	NI 		K5		
J1447		Inj tbo filgrastim 1 microg			K2		$0.46
J1448		"Injection, trilaciclib, 1mg"	NI 		K2		$4.97
J1450		Fluconazole			N1		
J1451		"Fomepizole, 15 mg"			K2		$5.98
J1452		Intraocular fomivirsen na			K5		
J1453		Fosaprepitant injection	CH		N1		
J1454		"Inj fosnetupitant, palonoset"	CH		K2		$571.22
J1455		Foscarnet sodium injection			K2		$72.86
J1457		Gallium nitrate injection			K5		
J1458		Galsulfase injection			K2		$411.92
J1459		Inj ivig privigen 500 mg			K2		$44.48
J1460		Gamma globulin 1 cc inj			K2		$44.13
J1554		Inj. asceniv	NC		K2		$481.77
J1555		"Inj cuvitru, 100 mg"			K2		$14.50
J1556		"Inj, imm glob bivigam, 500mg"			K2		$70.49
J1557		Gammaplex injection			K2		$48.53
J1558		"Inj. xembify, 100 mg"			K2		$13.61
J1559		Hizentra injection			K2		$11.58
J1560		Gamma globulin > 10 cc inj			K2		$441.31
J1561		Gamunex-c/gammaked			K2		$48.22
J1562		"Vivaglobin, inj"			K5		
J1566		"Immune globulin, powder"			K2		$65.49
J1568		Octagam injection			K2		$41.63
J1569		Gammagard liquid injection			K2		$44.49
J1570		Ganciclovir sodium injection			N1		
J1571		Hepagam b im injection			K2		$70.94
J1572		Flebogamma injection			K2		$36.80
J1573		"Hepagam b intravenous, inj"			K2		$71.24
J1575		Hyqvia 100mg immuneglobulin			K2		$15.16
J1580		Garamycin gentamicin inj			N1		
J1595		Injection glatiramer acetate			K2		$141.29
J1599		"Ivig non-lyophilized, nos"			N1		
J1600		Gold sodium thiomaleate inj			K5		
J1602		Golimumab for iv use 1mg			K2		$16.82
J1610		Glucagon hydrochloride/1 mg			K2		$171.74
J1620		Gonadorelin hydroch/ 100 mcg			K5		
J1626		Granisetron hcl injection			N1		
J1627		"Inj, granisetron, xr, 0.1 mg"	CH		K2		$6.94
J1628		"Inj., guselkumab, 1 mg"			K2		$82.56
J1630		Haloperidol injection			N1		
J1631		Haloperidol decanoate inj			N1		
J1632		"Inj., brexanolone, 1 mg"			K2		$74.65
J1640		"Hemin, 1 mg"			K2		$26.64
J1642		Inj heparin sodium per 10 u			N1		
J1644		Inj heparin sodium per 1000u			N1		
J1645		Dalteparin sodium			N1		
J1650		Inj enoxaparin sodium			N1		
J1652		Fondaparinux sodium			N1		
J1655		Tinzaparin sodium injection			N1		
J1670		Tetanus immune globulin inj			K2		$441.70
J1700		Hydrocortisone acetate inj			N1		
J1710		Hydrocortisone sodium ph inj			N1		
J1720		Hydrocortisone sodium succ i			N1		
J1726		"Makena, 10 mg"			K2		$16.82
J1729		Inj hydroxyprogst capoat nos			K2		$21.54
J1730		Diazoxide injection			K5		
J1738		Inj. meloxicam 1 mg			K2		$3.18
J1740		Ibandronate sodium injection	CH		N1		
J1741		Ibuprofen injection			N1		
J1742		Ibutilide fumarate injection			K2		$205.06
J1743		Idursulfase injection			N1		
J1744		Icatibant injection			K2		$204.96
J1745		Infliximab not biosimil 10mg			K2		$39.53
J1746		"Inj., ibalizumab-uiyk, 10 mg"			K2		$66.39
J1750		Inj iron dextran			K2		$15.84
J1756		Iron sucrose injection			N1		
J1786		Imuglucerase injection			K2		$44.05
J1790		Droperidol injection			N1		
J1800		Propranolol injection			N1		
J1815		Insulin injection			N1		
J1817		Insulin for insulin pump use			N1		
J1823		"Inj. inebilizumab-cdon, 1 mg"	CH 		K2		$458.21
J1826		Interferon beta-1a inj			K2		"$2,293.85"
J1830		Interferon beta-1b / .25 mg			K2		$406.24
J1833		"Injection, isavuconazonium"			K2		$0.83
J1835		Itraconazole injection			K5		
J1840		Kanamycin sulfate 500 mg inj			N1		
J1850		Kanamycin sulfate 75 mg inj			K5		
J1885		Ketorolac tromethamine inj			N1		
J1890		Cephalothin sodium injection			N1		
J1930		Lanreotide injection			K2		$67.64
J1931		Laronidase injection			K2		$34.75
J1940		Furosemide injection			N1		
J1943		"Inj., aristada initio, 1 mg"	CH 		K2		$3.05
J1944		Aripirazole lauroxil 1 mg			K2		$2.99
J1945		Lepirudin			K5		
J1950		Leuprolide acetate /3.75 mg			K2		"$1,406.37"
J1951		Inj fensolvi 0.25 mg	NC		K2		$126.28
J1952		"Leuprolide inj, camcevi, 1mg"	NI 		K5		
J1953		Levetiracetam injection			N1		
J1956		Levofloxacin injection			N1		
J1960		Levorphanol tartrate inj			N1		
J1980		Hyoscyamine sulfate inj			N1		
J1990		Chlordiazepoxide injection			N1		
J2001		Lidocaine injection			N1		
J2010		Lincomycin injection			N1		
J2060		Lorazepam injection			N1		
J2062		Loxapine for inhalation 1 mg			K5		
J2150		Mannitol injection			N1		
J2170		Mecasermin injection			N1		
J2175		Meperidine hydrochl /100 mg			N1		
J2180		Meperidine/promethazine inj			N1		
J2182		"Injection, mepolizumab, 1mg"			K2		$28.29
J2185		Meropenem			N1		
J2186		"Inj., meropenem, vaborbactam"			K2		$1.76
J2210		Methylergonovin maleate inj			N1		
J2212		Methylnaltrexone injection			N1		
J2248		Micafungin sodium injection	CH		N1		
J2250		Inj midazolam hydrochloride			N1		
J2260		Inj milrinone lactate / 5 mg			N1		
J2265		Minocycline hydrochloride			K2		$2.00
J2270		Morphine sulfate injection			N1		
J2274		Inj morphine pf epid ithc			N1		
J2278		Ziconotide injection			K2		$8.69
J2280		"Inj, moxifloxacin 100 mg"			N1		
J2300		Inj nalbuphine hydrochloride			N1		
J2310		Inj naloxone hydrochloride			N1		
J2315		"Naltrexone, depot form"			K2		$3.53
J2320		Nandrolone decanoate 50 mg			N1		
J2323		Natalizumab injection			K2		$23.24
J2326		"Inj, nusinersen, 0.1mg"			K2		"$1,122.13"
J2350		"Injection, ocrelizumab, 1 mg"			K2		$58.29
J2353		"Octreotide injection, depot"			K2		$205.37
J2354		"Octreotide inj, non-depot"			N1		
J2355		Oprelvekin injection	CH		K5		
J2357		Omalizumab injection			K2		$37.67
J2358		Olanzapine long-acting inj			K2		$2.91
J2360		Orphenadrine injection			N1		
J2370		Phenylephrine hcl injection			N1		
J2400		Chloroprocaine hcl injection			N1		
J2405		Ondansetron hcl injection			N1		
J2406		"Injection, oritavancin 10 mg"	NI 		K2		$41.92
J2407		"Injection, oritavancin"			K2		$23.63
J2410		Oxymorphone hcl injection			N1		
J2425		Palifermin injection			K2		$23.93
J2426		Paliperidone palmitate inj			K2		$12.66
J2430		Pamidronate disodium /30 mg			N1		
J2440		Papaverin hcl injection			N1		
J2460		Oxytetracycline injection			K5		
J2469		Palonosetron hcl			N1		
J2501		Paricalcitol			N1		
J2502		"Inj, pasireotide long acting"			K2		$359.03
J2503		Pegaptanib sodium injection	CH 		N1		
J2504		"Pegademase bovine, 25 iu"	CH		N1		
J2505		"Injection, pegfilgrastim 6mg"	CH		D5		
J2506		Inj pegfilgrast ex bio 0.5mg	NI 		K2		$185.14
J2507		Pegloticase injection			K2		"$2,960.91"
J2510		Penicillin g procaine inj			N1		
J2513		Pentastarch 10% solution			K5		
J2515		Pentobarbital sodium inj	CH		N1		
J2540		Penicillin g potassium inj			N1		
J2543		Piperacillin/tazobactam			N1		
J2547		"Injection, peramivir"			K2		$1.68
J2550		Promethazine hcl injection			N1		
J2560		Phenobarbital sodium inj			K2		$40.22
J2562		Plerixafor injection			K2		$382.85
J2590		Oxytocin injection			N1		
J2597		Inj desmopressin acetate			K2		$9.40
J2650		Prednisolone acetate inj			N1		
J2670		Totazoline hcl injection			K5		
J2675		Inj progesterone per 50 mg			N1		
J2680		Fluphenazine decanoate 25 mg			N1		
J2690		Procainamide hcl injection			N1		
J2700		Oxacillin sodium injeciton			N1		
J2704		"Inj, propofol, 10 mg"			N1		
J2710		Neostigmine methylslfte inj			N1		
J2720		Inj protamine sulfate/10 mg			N1		
J2724		Protein c concentrate			K2		$15.13
J2725		Inj protirelin per 250 mcg			K5		
J2730		Pralidoxime chloride inj			N1		
J2760		Phentolaine mesylate inj			K2		$416.00
J2765		Metoclopramide hcl injection			N1		
J2770		Quinupristin/dalfopristin			K2		$444.67
J2778		Ranibizumab injection			K2		$318.47
J2780		Ranitidine hydrochloride inj			N1		
J2783		Rasburicase			K2		$315.06
J2785		Regadenoson injection			N1		
J2786		"Injection, reslizumab, 1mg"			K2		$10.11
J2788		Rho d immune globulin 50 mcg			N1		
J2790		Rho d immune globulin inj			N1		
J2791		Rhophylac injection			N1		
J2792		"Rho(d) immune globulin h, sd"			K2		$31.42
J2793		Rilonacept injection			K5		
J2794		"Inj risperdal consta, 0.5 mg"			K2		$11.04
J2795		Ropivacaine hcl injection			N1		
J2796		Romiplostim injection			K2		$83.47
J2798		"Inj., perseris, 0.5 mg"			K2		$10.68
J2800		Methocarbamol injection			N1		
J2805		Sincalide injection			N1		
J2810		Inj theophylline per 40 mg			N1		
J2820		Sargramostim injection			K2		$51.55
J2840		Inj sebelipase alfa 1 mg			K2		$539.91
J2850		Inj secretin synthetic human			K2		$34.78
J2860		"Injection, siltuximab"			K2		$124.09
J2910		Aurothioglucose injeciton			K5		
J2916		Na ferric gluconate complex			N1		
J2920		Methylprednisolone injection			N1		
J2930		Methylprednisolone injection			N1		
J2940		Somatrem injection			K5		
J2941		Somatropin injection	CH		N1		
J2950		Promazine hcl injection			N1		
J2993		Reteplase injection			K2		"$2,506.51"
J2995		Inj streptokinase /250000 iu			K5		
J2997		Alteplase recombinant			K2		$87.75
J3000		Streptomycin injection			N1		
J3010		Fentanyl citrate injection			N1		
J3030		Sumatriptan succinate / 6 mg			N1		
J3031		"Inj., fremanezumab-vfrm 1 mg"		*	K2		$2.34
J3032		Inj. eptinezumab-jjmr 1 mg			K2		$15.64
J3060		"Inj, taliglucerase alfa 10 u"			K2		$41.32
J3070		Pentazocine injection			N1		
J3090		Inj tedizolid phosphate			K2		$1.60
J3095		Telavancin injection			K2		$6.16
J3101		Tenecteplase injection			K2		$134.74
J3105		Terbutaline sulfate inj			N1		
J3111		Inj. romosozumab-aqqg 1 mg		*	K2		$9.34
J3121		Inj testostero enanthate 1mg			N1		
J3145		Testosterone undecanoate 1mg			K2		$1.63
J3230		Chlorpromazine hcl injection			N1		
J3240		Thyrotropin injection			K2		"$1,837.25"
J3241		Inj. teprotumumab-trbw 10 mg			K2		$315.88
J3243		Tigecycline injection	CH		N1		
J3245		"Inj., tildrakizumab, 1 mg"		*	K2		$134.08
J3246		Tirofiban hcl			K2		$3.83
J3250		Trimethobenzamide hcl inj			N1		
J3260		Tobramycin sulfate injection			N1		
J3262		Tocilizumab injection			K2		$5.55
J3265		Injection torsemide 10 mg/ml			N1		
J3280		Thiethylperazine maleate inj			K5		
J3285		Treprostinil injection			K2		$59.68
J3300		Triamcinolone a inj prs-free			N1		
J3301		Triamcinolone acet inj nos			N1		
J3302		Triamcinolone diacetate inj			N1		
J3303		Triamcinolone hexacetonl inj			N1		
J3304		Inj triamcinolone ace xr 1mg	CH		K2		$17.75
J3305		Inj trimetrexate glucoronate			K5		
J3310		Perphenazine injeciton			N1		
J3315		Triptorelin pamoate			K2		$379.90
J3316		"Inj., triptorelin xr 3.75 mg"			K2		"$3,120.11"
J3320		Spectinomycn di-hcl inj			K5		
J3350		Urea injection			K5		
J3355		"Urofollitropin, 75 iu"			K5		
J3357		"Ustekinumab sub cu inj, 1 mg"			K2		$176.65
J3358		"Ustekinumab, iv inject, 1 mg"			K2		$11.68
J3360		Diazepam injection			N1		
J3364		Urokinase 5000 iu injection			N1		
J3365		"Urokinase 250,000 iu inj"			K5		
J3370		Vancomycin hcl injection			N1		
J3380		"Injection, vedolizumab"			K2		$21.28
J3385		Velaglucerase alfa			K2		$359.29
J3396		Verteporfin injection			K2		$11.25
J3397		"Inj., vestronidase alfa-vjbk"	CH		K5		
J3398		Inj luxturna 1 billion vec g	CH		K2		"$2,953.71"
J3400		Triflupromazine hcl inj			K5		
J3410		Hydroxyzine hcl injection			N1		
J3411		Thiamine hcl 100 mg			N1		
J3415		Pyridoxine hcl 100 mg			N1		
J3420		Vitamin b12 injection			N1		
J3430		Vitamin k phytonadione inj			N1		
J3465		"Injection, voriconazole"			N1		
J3470		Hyaluronidase injection			N1		
J3471		"Ovine, up to 999 usp units"			N1		
J3472		"Ovine, 1000 usp units"			N1		
J3473		Hyaluronidase recombinant			N1		
J3475		Inj magnesium sulfate			N1		
J3480		Inj potassium chloride			N1		
J3485		Zidovudine			N1		
J3486		Ziprasidone mesylate			N1		
J3489		Zoledronic acid 1mg			N1		
J3490		Drugs unclassified injection			N1		
J3530		Nasal vaccine inhalation			N1		
J3590		Unclassified biologics			N1		
J7030		Normal saline solution infus			N1		
J7040		Normal saline solution infus			N1		
J7042		5% dextrose/normal saline			N1		
J7050		Normal saline solution infus			N1		
J7060		5% dextrose/water			N1		
J7070		D5w infusion			N1		
J7100		Dextran 40 infusion			N1		
J7110		Dextran 75 infusion			N1		
J7120		Ringers lactate infusion			N1		
J7121		5% dextrose in lac ringers			N1		
J7131		Hypertonic saline sol			N1		
J7168		Prothrombin complex kcentra	NC		K2		$1.99
J7169		"Inj andexxa, 10 mg"		*	K2		$289.93
J7170		"Inj., emicizumab-kxwh 0.5 mg"	CH		K2		$48.88
J7175		"Inj, factor x, (human), 1iu"			K2		$8.20
J7177		"Inj., fibryga, 1 mg"			N1		
J7178		Inj human fibrinogen con nos			K2		$1.30
J7179		Vonvendi inj 1 iu vwf:rco			K2		$1.85
J7180		Factor xiii anti-hem factor			K2		$9.14
J7181		Factor xiii recomb a-subunit			K2		$15.87
J7182		Factor viii recomb novoeight			K2		$1.51
J7183		Wilate injection			K2		$1.16
J7185		Xyntha inj			K2		$1.33
J7186		Antihemophilic viii/vwf comp			K2		$1.14
J7187		"Humate-p, inj"			K2		$1.26
J7188		Factor viii recomb obizur			K2		$3.19
J7189		Factor viia recomb novoseven			K2		$2.33
J7190		Factor viii			K2		$1.12
J7191		Factor viii (porcine)			K5		
J7192		Factor viii recombinant nos			K2		$1.43
J7193		Factor ix non-recombinant			K2		$1.17
J7194		Factor ix complex			K2		$1.54
J7195		Factor ix recombinant nos			K2		$1.61
J7196		Antithrombin recombinant			N1		
J7197		Antithrombin iii injection			K2		$3.20
J7198		Anti-inhibitor			K2		$2.21
J7200		Factor ix recombinan rixubis			K2		$1.54
J7201		Factor ix alprolix recomb			K2		$3.28
J7202		Factor ix idelvion inj			K2		$4.59
J7203		Factor ix recomb gly rebinyn	CH 		K2		$4.23
J7204		Inj recombin esperoct per iu			K2		$2.23
J7205		Factor viii fc fusion recomb			K2		$2.15
J7207		Factor viii pegylated recomb			K2		$1.92
J7208		Inj. jivi 1 iu		*	K2		$2.10
J7209		Factor viii nuwiq recomb 1iu			K2		$1.24
J7210		"Inj, afstyla, 1 i.u."			K2		$1.36
J7211		"Inj, kovaltry, 1 i.u."			K2		$1.24
J7212		Factor viia recomb sevenfact	CH 		K2		$2.27
J7308		Aminolevulinic acid hcl top			K2		$392.48
J7309		"Methyl aminolevulinate, top"			K5		
J7310		Ganciclovir long act implant			K5		
J7311		"Inj., retisert, 0.01 mg"			K2		$339.00
J7312		Dexamethasone intra implant			K2		$199.69
J7313		"Inj., iluvien, 0.01 mg"			K2		$490.95
J7314		"Inj., yutiq, 0.01 mg"			K2		$513.16
J7315		Ophthalmic mitomycin			N1		
J7316		"Inj, ocriplasmin, 0.125 mg"			K2		"$1,046.93"
J7318		"Inj, durolane 1 mg"	CH 		K2		$17.23
J7320		"Genvisc 850, inj, 1mg"			K2		$16.92
J7321		Hyalgan or supartz inj dose			N1		
J7322		Hymovis injection 1 mg			K2		$31.67
J7323		Euflexxa inj per dose			K2		$138.82
J7324		Orthovisc inj per dose			K2		$148.74
J7325		Synvisc or synvisc-one			K2		$11.24
J7326		Gel-one			K2		"$1,219.00"
J7327		Monovisc inj per dose			K2		$762.80
J7328		Gelsyn-3 injection 0.1 mg			K2		$2.18
J7329		"Inj, trivisc 1 mg"			K2		$19.12
J7331		"Synojoynt, inj., 1 mg"			K2		$18.02
J7332		"Inj., triluron, 1 mg"	CH		K5		
J7333		Visco-3 inj dose	CH		D5		
J7336		Capsaicin 8% patch			K2		$3.23
J7340		Carbidopa levodopa ent 100ml			K2		$211.70
J7342		Ciprofloxacin otic susp 6 mg			K2		$29.98
J7345		"Aminolevulinic acid, 10% gel"			K2		$1.59
J7351		Inj bimatoprost itc imp1mcg			K2		$205.63
J7352		"Afamelanotide implant, 1 mg"			K2		"$3,218.90"
J7402		Mometasone sinus sinuva	NC		K2		$10.56
J7500		Azathioprine oral 50mg			N1		
J7501		Azathioprine parenteral			K2		$245.02
J7502		Cyclosporine oral 100 mg			N1		
J7503		Tacrol envarsus ex rel oral			N1		
J7504		Lymphocyte immune globulin			K2		"$2,355.53"
J7505		Monoclonal antibodies			N1		
J7507		Tacrolimus imme rel oral 1mg			N1		
J7508		Tacrol astagraf ex rel oral			N1		
J7509		Methylprednisolone oral			N1		
J7510		Prednisolone oral per 5 mg			N1		
J7511		Antithymocyte globuln rabbit			K2		$837.42
J7512		Prednisone ir or dr oral 1mg			N1		
J7513		"Daclizumab, parenteral"			K5		
J7515		Cyclosporine oral 25 mg			N1		
J7516		Cyclosporin parenteral 250mg			N1		
J7517		Mycophenolate mofetil oral			N1		
J7518		Mycophenolic acid			N1		
J7520		"Sirolimus, oral"			N1		
J7525		Tacrolimus injection			K2		$219.33
J7527		Oral everolimus			N1		
J7599		Immunosuppressive drug noc			N1		
J7665		Mannitol for inhaler			N1		
J7674		"Methacholine chloride, neb"			N1		
J7799		Non-inhalation drug for dme			N1		
J7999		"Compounded drug, noc"			N1		
J8501		Oral aprepitant			N1		
J8510		Oral busulfan			N1		
J8520		"Capecitabine, oral, 150 mg"			N1		
J8521		"Capecitabine, oral, 500 mg"			N1		
J8530		Cyclophosphamide oral 25 mg			N1		
J8540		Oral dexamethasone			N1		
J8560		Etoposide oral 50 mg			K2		$75.63
J8562		Oral fludarabine phosphate			K5		
J8565		Gefitinib oral			K5		
J8597		Antiemetic drug oral nos			N1		
J8600		Melphalan oral 2 mg			N1		
J8610		Methotrexate oral 2.5 mg			N1		
J8650		Nabilone oral			K5		
J8655		"Oral netupitant, palonosetro"			K2		$315.59
J8670		"Rolapitant, oral, 1mg"			K2		$1.75
J8700		Temozolomide			N1		
J8705		Topotecan oral			N1		
J9000		Doxorubicin hcl injection			N1		
J9015		Aldesleukin injection			K2		"$3,795.26"
J9017		Arsenic trioxide injection			K2		$13.11
J9019		Erwinaze injection			K2		$427.27
J9020		"Asparaginase, nos"			K5		
J9021		"Inj, aspara, rylaze, 0.1 mg"	NI 		K2		$45.22
J9022		"Inj, atezolizumab,10 mg"			K2		$79.75
J9023		"Injection, avelumab, 10 mg"			K2		$86.19
J9025		Azacitidine injection			K2		$0.93
J9027		Clofarabine injection			K2		$53.15
J9030		Bcg live intravesical 1mg			N1		
J9032		"Injection, belinostat, 10mg"			K2		$42.77
J9033		"Inj., treanda 1 mg"			K2		$22.01
J9034		"Inj., bendeka 1 mg"			K2		$19.65
J9034		"Inj., bendeka 1 mg"			K2		$19.65
J9035		Bevacizumab injection			K2		$70.41
J9036		Inj. belrapzo/bendamustine		*	K2		$21.47
J9037		Inj belantamab mafodont blmf	NC		K2		$42.78
J9039		"Injection, blinatumomab"			K2		$123.88
J9040		Bleomycin sulfate injection			N1		
J9041		"Inj., velcade 0.1 mg"			K2		$45.16
J9042		Brentuximab vedotin inj			K2		$189.34
J9043		Cabazitaxel injection			K2		$189.00
J9044		"Inj, bortezomib, nos, 0.1 mg"			K2		$18.31
J9045		Carboplatin injection			N1		
J9047		"Injection, carfilzomib, 1 mg"			K2		$41.10
J9050		Carmustine injection			K2		"$1,234.46"
J9055		Cetuximab injection			K2		$66.71
J9057		"Inj., copanlisib, 1 mg"	CH		K2		$80.96
J9060		Cisplatin 10 mg injection			N1		
J9061		"Inj, amivantamab-vmjw"	NI 		K2		$17.58
J9065		Inj cladribine per 1 mg			K2		$18.02
J9070		Cyclophosphamide 100 mg inj			K2		$29.15
J9098		Cytarabine liposome inj	CH		K5		
J9100		Cytarabine hcl 100 mg inj			N1		
J9118		Inj. calaspargase pegol-mknl			K5		
J9119		"Inj., cemiplimab-rwlc, 1 mg"		*	K2		$27.54
J9120		Dactinomycin injection			K2		$890.64
J9130		Dacarbazine 100 mg inj			N1		
J9144		"Daratumumab, hyaluronidase"			K2		$45.10
J9145		"Injection, daratumumab 10 mg"			K2		$57.55
J9150		Daunorubicin injection			K2		$40.36
J9151		Daunorubicin citrate inj			K5		
J9153		"Inj daunorubicin, cytarabine"			K2		$202.60
J9155		Degarelix injection			K2		$4.12
J9160		Denileukin diftitox inj			K5		
J9165		Diethylstilbestrol injection			K5		
J9171		Docetaxel injection			N1		
J9173		"Inj., durvalumab, 10 mg"			K2		$76.86
J9175		Elliotts b solution per ml			N1		
J9176		"Injection, elotuzumab, 1mg"			K2		$6.77
J9177		Inj enfort vedo-ejfv 0.25mg			K2		$30.17
J9178		"Inj, epirubicin hcl, 2 mg"			N1		
J9179		Eribulin mesylate injection			K2		$123.93
J9181		Etoposide injection			N1		
J9185		Fludarabine phosphate inj			N1		
J9190		Fluorouracil injection			N1		
J9198		"Inj. infugem, 100 mg"			K2		$34.00
J9200		Floxuridine injection			N1		
J9201		In gemcitabine hcl nos 200mg			N1		
J9202		Goserelin acetate implant			K2		$525.21
J9203		Gemtuzumab ozogamicin 0.1 mg			K2		$207.99
J9204		"Inj mogamulizumab-kpkc, 1 mg"	CH 		K2		$210.05
J9205		Inj irinotecan liposome 1 mg			K2		$57.20
J9206		Irinotecan injection			N1		
J9207		Ixabepilone injection			K2		$112.12
J9208		Ifosfamide injection			N1		
J9209		Mesna injection			N1		
J9210		"Inj., emapalumab-lzsg, 1 mg"		*	K2		$376.03
J9211		Idarubicin hcl injection			N1		
J9212		Interferon alfacon-1 inj			K5		
J9213		Interferon alfa-2a inj	CH		K5		
J9214		Interferon alfa-2b inj			K2		$33.24
J9215		Interferon alfa-n3 inj			K5		
J9216		Interferon gamma 1-b inj			K5		
J9217		Leuprolide acetate suspnsion			K2		$139.09
J9218		Leuprolide acetate injeciton			N1		
J9219		Leuprolide acetate implant			K5		
J9223		"Inj. lurbinectedin, 0.1 mg"			K2		$174.03
J9225		Vantas implant			K2		"$5,166.29"
J9226		Supprelin la implant			K2		"$43,467.03"
J9227		Inj. isatuximab-irfc 10 mg			K2		$67.60
J9228		Ipilimumab injection			K2		$158.65
J9229		Inj inotuzumab ozogam 0.1 mg			K2		"$2,371.62"
J9230		Mechlorethamine hcl inj			K2		$11.74
J9245		Inj melpha hydroch nos 50 mg			K2		$208.41
J9246		"Inj., evomela, 1 mg"			K2		$18.20
J9247		"Inj, melphalan flufenami 1mg"	NI 		K2		$499.86
J9250		Methotrexate sodium inj			N1		
J9260		Methotrexate sodium inj			N1		
J9261		Nelarabine injection			K2		$155.90
J9262		"Inj, omacetaxine mep, 0.01mg"			K2		$3.30
J9263		Oxaliplatin			N1		
J9264		Paclitaxel protein bound			K2		$14.08
J9266		Pegaspargase injection			K2		"$21,561.05"
J9267		Paclitaxel injection			N1		
J9268		Pentostatin injection			K2		"$1,880.67"
J9269		Inj. tagraxofusp-erzs 10 mcg		*	K2		$290.37
J9270		Plicamycin (mithramycin) inj			K2		$115.40
J9271		Inj pembrolizumab			K2		$52.75
J9272		"Inj, dostarlimab-gxly, 10 mg"	NI 		K2		$213.61
J9280		Mitomycin injection			K2		$38.63
J9281		Mitomycin instillation			K2		$281.88
J9285		"Inj, olaratumab, 10 mg"			K2		$52.07
J9293		Mitoxantrone hydrochl / 5 mg			K2		$26.29
J9295		"Injection, necitumumab, 1 mg"			K2		$5.74
J9299		"Injection, nivolumab"			K2		$28.86
J9301		Obinutuzumab inj			K2		$64.54
J9302		Ofatumumab injection			K2		$63.96
J9303		Panitumumab injection			K2		$130.38
J9304		"Inj. pemetrexed, 10 mg"			K5		
J9305		Inj. pemetrexed nos 10mg			K2		$74.93
J9306		"Injection, pertuzumab, 1 mg"			K2		$13.56
J9307		Pralatrexate injection			K2		$314.84
J9308		"Injection, ramucirumab"			K2		$62.69
J9309		"Inj, polatuzumab vedotin 1mg"			K2		$113.57
J9311		"Inj rituximab, hyaluronidase"	CH		K2		$37.94
J9312		"Inj., rituximab, 10 mg"			K2		$86.94
J9313		"Inj., lumoxiti, 0.01 mg"		*	K2		$23.39
J9315		Romidepsin injection	CH		D5		
J9316		"Pertuzu, trastuzu, 10 mg"			K2		$72.15
J9317		Sacituzumab govitecan-hziy			K2		$30.35
J9318		Inj romidepsin non-lyo 0.1mg	NI 		K2		$33.91
J9319		Inj romidepsin lyophil 0.1mg	NI 		K2		$33.68
J9320		Streptozocin injection			K2		$348.51
J9325		Inj talimogene laherparepvec			K2		$57.26
J9328		Temozolomide injection			K2		$10.41
J9330		Temsirolimus injection			K2		$38.25
J9340		Thiotepa injection			K2		$305.84
J9348		"Inj. naxitamab-gqgk, 1 mg"	NC		K2		$539.07
J9349		"Inj., tafasitamab-cxix"			K2		$12.62
J9351		Topotecan injection			N1		
J9352		Injection trabectedin 0.1mg			K2		$325.03
J9353		"Inj. margetuximab-cmkb, 5 mg"	NC		K2		$42.99
J9354		"Inj, ado-trastuzumab emt 1mg"			K2		$34.18
J9355		Inj trastuzumab excl biosimi			K2		$89.81
J9356		"Inj. herceptin hylecta, 10mg"		*	K2		$71.85
J9357		Valrubicin injection			K2		"$1,425.37"
J9358		Inj fam-trastu deru-nxki 1mg			K2		$24.27
J9360		Vinblastine sulfate inj			N1		
J9370		Vincristine sulfate 1 mg inj			N1		
J9371		"Inj, vincristine sul lip 1mg"			K2		"$3,370.23"
J9390		Vinorelbine tartrate inj			N1		
J9395		"Injection, fulvestrant"			K2		$15.98
J9400		"Inj, ziv-aflibercept, 1mg"			K2		$8.42
J9600		Porfimer sodium injection			K2		"$21,856.35"
J9999		Chemotherapy drug			N1		
L8600		Implant breast silicone/eq			N1		
L8603		Collagen imp urinary 2.5 ml			N1		
L8604		Dextranomer/hyaluronic acid			N1		
L8605		Inj bulking agent anal canal			N1		
L8606		Synthetic implnt urinary 1ml			N1		
L8607		Inj vocal cord bulking agent			N1		
L8609		Artificial cornea			N1		
L8610		Ocular implant			N1		
L8612		Aqueous shunt prosthesis			N1		
L8613		Ossicular implant			N1		
L8614		Cochlear device			N1		
L8630		Metacarpophalangeal implant			N1		
L8631		Mcp joint repl 2 pc or more			N1		
L8641		Metatarsal joint implant			N1		
L8642		Hallux implant			N1		
L8658		Interphalangeal joint spacer			N1		
L8659		Interphalangeal joint repl			N1		
L8670		"Vascular graft, synthetic"			N1		
L8679		Imp neurosti pls gn any type			N1		
L8682		Implt neurostim radiofq rec			N1		
L8690		"Aud osseo dev, int/ext comp"			N1		
L8699		Prosthetic implant nos			N1		
L9900		O&p supply/accessory/service			N1		
P9041		"Albumin (human),5%, 50ml"			K2		$10.49
P9045		"Albumin (human), 5%, 250 ml"			K2		$52.45
P9046		"Albumin (human), 25%, 20 ml"			K2		$20.98
P9047		"Albumin (human), 25%, 50ml"			K2		$52.45
P9050		"Granulocytes, pheresis unit"			K5		
Q0138		"Ferumoxytol, non-esrd"			K2		$1.00
Q0139		"Ferumoxytol, esrd use"			K2		$1.00
Q0161		Chlorpromazine hcl 5mg oral			N1		
Q0162		Ondansetron oral			N1		
Q0163		Diphenhydramine hcl 50mg			N1		
Q0164		Prochlorperazine maleate 5mg			N1		
Q0166		Granisetron hcl 1 mg oral			N1		
Q0167		Dronabinol 2.5mg oral			N1		
Q0169		Promethazine hcl 12.5mg oral			N1		
Q0173		Trimethobenzamide hcl 250mg			N1		
Q0174		Thiethylperazine maleate10mg			K5		
Q0175		Perphenazine 4mg oral			N1		
Q0177		Hydroxyzine pamoate 25mg			N1		
Q0180		Dolasetron mesylate oral			N1		
Q0181		Unspecified oral anti-emetic			N1		
Q0239		Bamlanivimab-xxxx	CH		D5		
Q0240		Casirivi and imdevi 600 mg	NI 		L1		
Q0243		Casirivimab and imdevimab			L1		
Q0244		Casirivi and imdevi 1200 mg	NI 		L1		
Q0245		Bamlanivimab and etesevima	NC		L1		
Q0247		Sotrovimab	NI 		L1		
Q0249		Tocilizumab for covid-19	NI 		L1		
Q0515		Sermorelin acetate injection			K5		
Q2004		Bladder calculi irrig sol			N1		
Q2009		Fosphenytoin inj pe			N1		
Q2017		"Teniposide, 50 mg"			K2		"$2,645.71"
Q2026		Radiesse injection			K2		$257.37
Q2028		"Inj, sculptra, 0.5mg"			K2		$2.49
Q2034	**	Agriflu vaccine			L1		
Q2035	**	"Afluria vacc, 3 yrs & >, im"			L1		
Q2036	**	"Flulaval vacc, 3 yrs & >, im"			L1		
Q2037	**	"Fluvirin vacc, 3 yrs & >, im"			L1		
Q2038	**	"Fluzone vacc, 3 yrs & >, im"			L1		
Q2039	**	"Influenza virus vaccine, nos"			L1		
Q2043		Sipuleucel-t auto cd54+			K2		"$53,017.58"
Q2049		Imported lipodox inj			K2		$311.04
Q2050		Doxorubicin inj 10mg			K2		$234.03
Q3027		Inj beta interferon im 1 mcg			K2		$55.29
Q3031		Collagen skin test			N1		
Q4100		"Skin substitute, nos"			N1		
Q4101		Apligraf			N1		
Q4102		Oasis wound matrix			N1		
Q4103		Oasis burn matrix			N1		
Q4104		Integra bmwd			N1		
Q4105		Integra drt or omnigraft			N1		
Q4106		Dermagraft			N1		
Q4107		Graftjacket			N1		
Q4108		Integra matrix			N1		
Q4110		Primatrix			N1		
Q4111		Gammagraft			N1		
Q4112		Cymetra injectable			N1		
Q4113		Graftjacket xpress			N1		
Q4114		Integra flowable wound matri			N1		
Q4115		Alloskin			N1		
Q4116		Alloderm			N1		
Q4117		Hyalomatrix			N1		
Q4118		Matristem micromatrix			N1		
Q4121		Theraskin			N1		
Q4122		"Dermacell, awm, porous sq cm"			N1		
Q4123		Alloskin			N1		
Q4124		Oasis tri-layer wound matrix			N1		
Q4125		Arthroflex			N1		
Q4126		Memoderm/derma/tranz/integup			N1		
Q4127		Talymed			N1		
Q4128		Flexhd/allopatchhd/matrixhd			N1		
Q4130		Strattice tm			N1		
Q4132		"Grafix core, grafixpl core"			N1		
Q4133		Grafix stravix prime pl sqcm			N1		
Q4134		Hmatrix			N1		
Q4135		Mediskin			N1		
Q4136		Ezderm			N1		
Q4137		Amnioexcel biodexcel 1sq cm			N1		
Q4138		"Biodfence dryflex, 1cm"			N1		
Q4139		"Amnio or biodmatrix, inj 1cc"			N1		
Q4140		Biodfence 1cm			N1		
Q4141		"Alloskin ac, 1 cm"			N1		
Q4142		Xcm biologic tiss matrix 1cm			N1		
Q4143		"Repriza, 1cm"			N1		
Q4145		"Epifix, inj, 1mg"			N1		
Q4146		"Tensix, 1cm"			N1		
Q4147		Architect ecm px fx 1 sq cm			N1		
Q4148		Neox neox rt or clarix cord			N1		
Q4149		"Excellagen, 0.1 cc"			N1		
Q4150		Allowrap ds or dry 1 sq cm			N1		
Q4151		"Amnioband, guardian 1 sq cm"			N1		
Q4152		Dermapure 1 square cm			N1		
Q4153		"Dermavest, plurivest sq cm"			N1		
Q4154		Biovance 1 square cm			N1		
Q4155		Neoxflo or clarixflo 1 mg			N1		
Q4156		Neox 100 or clarix 100			N1		
Q4157		Revitalon 1 square cm			N1		
Q4158		"Kerecis omega3, per sq cm"			N1		
Q4159		Affinity1 square cm			N1		
Q4160		Nushield 1 square cm			N1		
Q4161		Bio-connekt per square cm			N1		
Q4162		"Wndex flw, bioskn flw, 0.5cc"			N1		
Q4163		"Woundex, bioskin, per sq cm"			N1		
Q4164		"Helicoll, per square cm"			N1		
Q4165		"Keramatrix, kerasorb sq cm"			N1		
Q4166		"Cytal, per square centimeter"			N1		
Q4167		"Truskin, per sq centimeter"			N1		
Q4168		"Amnioband, 1 mg"			N1		
Q4169		"Artacent wound, per sq cm"			N1		
Q4170		"Cygnus, per sq cm"			N1		
Q4171		"Interfyl, 1 mg"			N1		
Q4173		Palingen or palingen xplus			N1		
Q4174		Palingen or promatrx			N1		
Q4175		Miroderm			N1		
Q4176		"Neopatch or therion, 1 sq cm"			N1		
Q4177		"Floweramnioflo, 0.1 cc"			N1		
Q4178		"Floweramniopatch, per sq cm"			N1		
Q4179		"Flowerderm, per sq cm"			N1		
Q4180		"Revita, per sq cm"			N1		
Q4181		"Amnio wound, per square cm"			N1		
Q4182		"Transcyte, per sq centimeter"			N1		
Q4183		"Surgigraft, 1 sq cm"			N1		
Q4184		Cellesta or duo per sq cm			N1		
Q4185		Cellesta flowab amnion 0.5cc			N1		
Q4186		Epifix 1 sq cm			N1		
Q4187		Epicord 1 sq cm			N1		
Q4188		Amnioarmor 1 sq cm			N1		
Q4189		"Artacent ac, 1 mg"			N1		
Q4190		Artacent ac 1 sq cm			N1		
Q4191		Restorigin 1 sq cm			N1		
Q4192		"Restorigin, 1 cc"			N1		
Q4193		Coll-e-derm 1 sq cm			N1		
Q4194		Novachor 1 sq cm			N1		
Q4195		Puraply 1 sq cm			N1		
Q4196		Puraply am 1 sq cm			N1		
Q4197		Puraply xt 1 sq cm			N1		
Q4198		Genesis amnio membrane 1sqcm			N1		
Q4200		Skin te 1 sq cm			N1		
Q4201		Matrion 1 sq cm			N1		
Q4202		"Keroxx (2.5g/cc), 1cc"			N1		
Q4203		"Derma-gide, 1 sq cm"			N1		
Q4204		Xwrap 1 sq cm			N1		
Q4227		Amniocore per sq cm			N1		
Q4228		"Bionextpatch, per sq cm"	CH		D5		
Q4229		Cogenex amnio memb per sq cm			N1		
Q4230		Cogenex flow amnion 0.5 cc			N1		
Q4231		"Corplex p, per cc"			N1		
Q4232		"Corplex, per sq cm"			N1		
Q4233		Surfactor /nudyn per 0.5 cc			N1		
Q4234		"Xcellerate, per sq cm"			N1		
Q4235		Amniorepair or altiply sq cm			N1		
Q4236		Carepatch per sq cm	CH 		D5		
Q4237		"Cryo-cord, per sq cm"			N1		
Q4238		"Derm-maxx, per sq cm"			N1		
Q4239		Amnio-maxx or lite per sq cm			N1		
Q4240		Corecyte topical only 0.5 cc			N1		
Q4241		"Polycyte, topical only 0.5cc"			N1		
Q4242		"Amniocyte plus, per 0.5 cc"			N1		
Q4244		"Procenta, per 200 mg"			N1		
Q4245		"Amniotext, per cc"			N1		
Q4246		"Coretext or protext, per cc"			N1		
Q4247		"Amniotext patch, per sq cm"			N1		
Q4248		Dermacyte amn mem allo sq cm			N1		
Q5101		"Injection, zarxio"			K2		$0.32
Q5103		"Injection, inflectra"			K2		$41.19
Q5104		"Injection, renflexis"	CH 		K2		$38.79
Q5105		Inj retacrit esrd on dialysi	CH 		N1		
Q5106		Inj retacrit non-esrd use	CH 		K2		$8.66
Q5107		Inj mvasi 10 mg			K2		$44.56
Q5108		"Injection, fulphila"		*	K2		$211.19
Q5109		"Injection, ixifi, 10 mg"			K5		
Q5110		Nivestym		*	K2		$0.33
Q5111		"Injection, udenyca 0.5 mg"		*	K2		$222.38
Q5112		Inj ontruzant 10 mg			K2		$66.55
Q5113		Inj herzuma 10 mg			K2		$57.30
Q5114		Inj ogivri 10 mg			K2		$59.91
Q5115		Inj truxima 10 mg			K2		$60.58
Q5116		"Inj., trazimera, 10 mg"			K2		$59.93
Q5117		"Inj., kanjinti, 10 mg"			K2		$53.18
Q5118		"Inj., zirabev, 10 mg"			K2		$52.37
Q5119		"Inj ruxience, 10 mg"			K2		$58.80
Q5120		Inj pegfilgrastim-bmez 0.5mg			K2		$245.43
Q5120		Inj pegfilgrastim-bmez 0.5mg			K2		$245.43
Q5121		"Inj. avsola, 10 mg"			K2		$47.12
Q5122		"Inj, nyvepria"	CH 		K2		$284.69
Q5123		"Inj. riabni, 10 mg"	NC		K2		$72.23
Q9950		Inj sulf hexa lipid microsph			N1		
Q9951		"Locm >= 400 mg/ml iodine,1ml"			N1		
Q9953		"Inj fe-based mr contrast,1ml"			N1		
Q9954		"Oral mr contrast, 100 ml"			N1		
Q9955		"Inj perflexane lip micros,ml"			N1		
Q9956		"Inj octafluoropropane mic,ml"			N1		
Q9957		"Inj perflutren lip micros,ml"			N1		
Q9958		"Hocm <=149 mg/ml iodine, 1ml"			N1		
Q9959		"Hocm 150-199mg/ml iodine,1ml"			N1		
Q9960		"Hocm 200-249mg/ml iodine,1ml"			N1		
Q9961		"Hocm 250-299mg/ml iodine,1ml"			N1		
Q9962		"Hocm 300-349mg/ml iodine,1ml"			N1		
Q9963		"Hocm 350-399mg/ml iodine,1ml"			N1		
Q9964		"Hocm>= 400mg/ml iodine, 1ml"			N1		
Q9965		"Locm 100-199mg/ml iodine,1ml"			N1		
Q9966		"Locm 200-299mg/ml iodine,1ml"			N1		
Q9967		"Locm 300-399mg/ml iodine,1ml"			N1		
Q9968		Visualization adjunct			K2		$6.73
Q9982		Flutemetamol f18 diagnostic			N1		
Q9983		Florbetaben f18 diagnostic			N1		
Q9991		Buprenorph xr 100 mg or less	CH  		K2		"$1,796.80"
Q9992		Buprenorphine xr over 100 mg	CH  		K2		"$1,796.80"
V2630		Anter chamber intraocul lens			N1		
V2631		Iris support intraoclr lens			N1		
V2632		Post chmbr intraocular lens			N1		
V2785		Corneal tissue processing			F4		
V2790		Amniotic membrane			N1		
							
							
NOTE 1:  The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount except for most preventive services.  Sections 4104 and 10406 of the Affordable Care Act (ACA) waive coinsurance and the Part B deductible for most preventive services.  These preventive services are identified with a double asterisk (**).							
							
							
"NOTE 2:  In general, payment indicators Z2 and Z3 (certain radiology or diagnostic services) are based on a comparison of the proposed rates according to the ASC standard ratesetting methodology and the MPFS final rates effective January 1, 2022. MPFS final rates do not include changes to the MPFS as enacted by Public Law 117-71 on December 10, 2021. For a discussion of the MPFS rates, we refer readers to the CY 2022 MPFS final rule."							
							
