00004058061LEVEL I NEEDLE BIOPSY/ ASPIRATION EXCEPT BONE MARROW
00005058061LEVEL II NEEDLE BIOPSY/ASPIRATION EXCEPT BONE MARROW
00006058061LEVEL I INCISION & DRAINAGE
00007058061LEVEL II INCISION & DRAINAGE
00008058061LEVEL III INCISION AND DRAINAGE
00012058061LEVEL I DEBRIDEMENT & DESTRUCTION
00015058061LEVEL II DEBRIDEMENT & DESTRUCTION
00016058061LEVEL III DEBRIDEMENT & DESTRUCTION
00017058061LEVEL IV DEBRIDEMENT & DESTRUCTION
00019058061LEVEL I EXCISION/ BIOPSY
00020058061LEVEL II EXCISION/ BIOPSY
00021058061LEVEL III EXCISION/ BIOPSY
00022058061LEVEL IV EXCISION/ BIOPSY
00028058061LEVEL I BREAST AND SKIN SURGERY
00029058061LEVEL II BREAST AND SKIN SURGERY
00030058061LEVEL III BREAST AND SKIN SURGERY
00031058061LEVEL I HEALTH AND BEHAVIOR SERVICES
00034058061MENTAL HEALTH SERVICES COMPOSITE
00039058061LEVEL III NEUROSTIMULATOR & RELATED PROCEDURES
00041058061LEVEL I ARTHROSCOPY
00042058061LEVEL II ARTHROSCOPY
00045058061BONE/JOINT MANIPULATION UNDER ANESTHESIA
00047058061ARTHROPLASTY
00049058061LEVEL I MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00050058061LEVEL II MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00051058061LEVEL III MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00052058061LEVEL IV MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00053058061LEVEL I HAND MUSCULOSKELETAL PROCEDURES
00054058061LEVEL II HAND MUSCULOSKELETAL PROCEDURES
00055058061LEVEL I FOOT MUSCULOSKELETAL PROCEDURES
00056058061LEVEL II FOOT MUSCULOSKELETAL PROCEDURES
00057058061BUNION PROCEDURES
00058058061LEVEL II STRAPPING AND CAST APPLICATION
00059058061LEVEL I STRAPPING AND CAST APPLICATION
00060058061MANIPULATION THERAPY
00061058061LEVEL II NEUROSTIMULATOR & RELATED PROCEDURES
00062058061LEVEL I TREATMENT FRACTURE/DISLOCATION
00063058061LEVEL II TREATMENT FRACTURE/DISLOCATION
00064058061LEVEL III TREATMENT FRACTURE/DISLOCATION
00066058061LEVEL V RADIATION THERAPY
00067058061SINGLE SESSION CRANIAL STEREOTACTIC RADIOSURGERY
00069058061THORACOSCOPY
00070058061THORACENTESIS/LAVAGE PROCEDURES
00071058061LEVEL I ENDOSCOPY UPPER AIRWAY
00072058061LEVEL II ENDOSCOPY UPPER AIRWAY
00073058061LEVEL III ENDOSCOPY UPPER AIRWAY
00074058061LEVEL IV ENDOSCOPY UPPER AIRWAY
00075058061LEVEL V ENDOSCOPY UPPER AIRWAY
00076058061LEVEL I ENDOSCOPY LOWER AIRWAY
00077058061PULMONARY TREATMENT
00079058061VENTILATION INITIATION AND MANAGEMENT
00080058061DIAGNOSTIC CARDIAC CATHETERIZATION
00083058061LEVEL I ENDOVASCULAR PROCEDURES
00084058061LEVEL I ELECTROPHYSIOLOGIC PROCEDURES
00085058061LEVEL II ELECTROPHYSIOLOGIC PROCEDURES
00086058061LEVEL III ELECTROPHYSIOLOGIC PROCEDURES
00088058061THROMBECTOMY
00089058061LEVEL III PACEMAKER AND SIMILAR PROCEDURES
00090058061LEVEL II PACEMAKER AND SIMILAR PROCEDURES
00093058061VASCULAR RECONSTRUCTION/FISTULA REPAIR
00094058061RESUSCITATION AND CARDIOVERSION
00095058061CARDIAC REHABILITATION
00096058061LEVEL II NONINVASIVE PHYSIOLOGIC STUDIES
00097058061LEVEL I NONINVASIVE PHYSIOLOGIC STUDIES
00099058061ELECTROCARDIOGRAMS/CARDIOGRAPHY
00100058061CARDIAC STRESS TESTS
00103058061MISCELLANEOUS VASCULAR PROCEDURES
00105058061LEVEL I PACEMAKER & SIMILAR PROCEDURES
00107058061LEVEL I ICD AND SIMILAR PROCEDURES
00108058061LEVEL II ICD AND SIMILAR PROCEDURES
00110058061TRANSFUSION
00111058061BLOOD PRODUCT EXCHANGE
00112058061APHERESIS AND STEM CELL PROCEDURES
00113058061EXCISION LYMPHATIC SYSTEM
00114058061THYROID/LYMPHADENECTOMY PROCEDURES
00121058061LEVEL I TUBE OR CATHETER CHANGES OR REPOSITIONING
00126058061LEVEL I URINARY AND ANAL PROCEDURES
00129058061LEVEL I CLOSED TREATMENT FRACTURE
00130058061LEVEL I LAPAROSCOPY
00131058061LEVEL II LAPAROSCOPY
00132058061LEVEL III LAPAROSCOPY
00138058061LEVEL II CLOSED TREATMENT FRACTURE
00139058061LEVEL III CLOSED TREATMENT FRACTURE
00141058061LEVEL I UPPER GI PROCEDURES
00142058061LEVEL I SMALL INTESTINE ENDOSCOPY
00143058061LOWER GI ENDOSCOPY
00146058061LEVEL I SIGMOIDOSCOPY AND ANOSCOPY
00147058061LEVEL II SIGMOIDOSCOPY AND ANOSCOPY
00148058061LEVEL I ANAL/RECTAL PROCEDURES
00149058061LEVEL III ANAL/RECTAL PROCEDURES
00150058061LEVEL IV ANAL/RECTAL PROCEDURES
00151058061ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP)
00152058061LEVEL I PERCUTANEOUS ABDOMINAL AND BILIARY PROCEDURES
00153058061PERITONEAL AND ABDOMINAL PROCEDURES
00154058061HERNIA/HYDROCELE PROCEDURES
00155058061LEVEL II ANAL/RECTAL PROCEDURES
00156058061LEVEL III URINARY AND ANAL PROCEDURES
00157058061COLORECTAL CANCER SCREENING: BARIUM ENEMA
00158058061COLORECTAL CANCER SCREENING: COLONOSCOPY
00159058061COLORECTAL CANCER SCREENING: FLEXIBLE SIGMOIDOSCOPY
00160058061LEVEL I CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00161058061LEVEL II CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00162058061LEVEL III CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00163058061LEVEL IV CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES
00164058061LEVEL II URINARY AND ANAL PROCEDURES
00165058061LEVEL IV URINARY AND ANAL PROCEDURES
00166058061LEVEL I URETHRAL PROCEDURES
00168058061LEVEL II URETHRAL PROCEDURES
00170058061DIALYSIS
00172058061LEVEL I PARTIAL HOSPITALIZATION (3 SERVICES) FOR CMHCS
00173058061LEVEL II PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR CMHCS
00174058061LEVEL IV LAPAROSCOPY
00175058061LEVEL I PARTIAL HOSPITALIZATION (3 SERVICES) FOR HOSPITAL-BASED PHPS
00176058061LEVEL II PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
00177058061LEVEL I ECHOCARDIOGRAM WITH CONTRAST
00178058061LEVEL II ECHOCARDIOGRAM WITH CONTRAST
00181058061LEVEL II MALE GENITAL PROCEDURES
00183058061LEVEL I MALE GENITAL PROCEDURES
00184058061PROSTATE BIOPSY
00188058061LEVEL I GYNECOLOGIC PROCEDURES
00189058061LEVEL II GYNECOLOGIC PROCEDURES
00192058061LEVEL III GYNECOLOGIC PROCEDURES
00193058061LEVEL IV GYNECOLOGIC PROCEDURES
00202058061LEVEL V GYNECOLOGIC PROCEDURES
00203058061LEVEL IV NERVE INJECTIONS
00204058061LEVEL I NERVE INJECTIONS
00205058061LEVEL III MALE GENITAL PROCEDURES
00206058061LEVEL II NERVE INJECTIONS
00207058061LEVEL III NERVE INJECTIONS
00208058061LAMINOTOMIES AND LAMINECTOMIES
00209058061LEVEL II EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00213058061LEVEL I EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00215058061LEVEL I NERVE AND MUSCLE SERVICES
00216058061LEVEL III NERVE AND MUSCLE SERVICES
00218058061LEVEL II NERVE AND MUSCLE SERVICES
00219058061VASCULAR LIGATION
00220058061LEVEL I NERVE PROCEDURES
00221058061LEVEL II NERVE PROCEDURES
00224058061IMPLANTATION OF CATHETER/RESERVOIR/SHUNT
00227058061IMPLANTATION OF DRUG INFUSION DEVICE
00229058061LEVEL II ENDOVASCULAR PROCEDURES
00230058061LEVEL I EYE TESTS & TREATMENTS
00231058061LEVEL III EYE TESTS & TREATMENTS
00233058061LEVEL II INTRAOCULAR PROCEDURES
00238058061LEVEL I EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00239058061LEVEL II EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00240058061LEVEL III EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00242058061LEVEL IV EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
00247058061LASER EYE PROCEDURES
00250058061LEVEL I ENT PROCEDURES
00251058061LEVEL II ENT PROCEDURES
00252058061LEVEL III ENT PROCEDURES
00253058061LEVEL IV ENT PROCEDURES
00254058061LEVEL V ENT PROCEDURES
00255058061LEVEL I INTRAOCULAR PROCEDURES
00256058061LEVEL VI ENT PROCEDURES
00259058061LEVEL VII ENT PROCEDURES
00260058061LEVEL I PLAIN FILM INCLUDING BONE DENSITY MEASUREMENT
00261058061LEVEL II PLAIN FILM INCLUDING BONE DENSITY MEASUREMENT
00263058061LEVEL I MISCELLANEOUS RADIOLOGY PROCEDURES
00265058061LEVEL I DIAGNOSTIC AND SCREENING ULTRASOUND
00266058061LEVEL II DIAGNOSTIC AND SCREENING ULTRASOUND
00267058061LEVEL III DIAGNOSTIC AND SCREENING ULTRASOUND
00269058061LEVEL I ECHOCARDIOGRAM WITHOUT CONTRAST
00270058061LEVEL II ECHOCARDIOGRAM WITHOUT CONTRAST
00272058061FLUOROSCOPY AND OTHER RADIOLOGY SERVICES
00274058061MYELOGRAPHY
00275058061ARTHROGRAPHY
00276058061LEVEL I DIGESTIVE RADIOLOGY
00277058061LEVEL II DIGESTIVE RADIOLOGY
00278058061DIAGNOSTIC UROGRAPHY
00279058061LEVEL II ANGIOGRAPHY AND VENOGRAPHY
00280058061LEVEL III ANGIOGRAPHY AND VENOGRAPHY
00283058061COMPUTED TOMOGRAPHY WITH CONTRAST
00284058061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST
00293058061LEVEL IV INTRAOCULAR PROCEDURES
00300058061LEVEL I RADIATION THERAPY
00301058061LEVEL II RADIATION THERAPY
00303058061TREATMENT DEVICE CONSTRUCTION
00304058061LEVEL I THERAPEUTIC RADIATION TREATMENT PREPARATION
00305058061LEVEL II THERAPEUTIC RADIATION TREATMENT PREPARATION
00308058061POSITRON EMISSION TOMOGRAPHY (PET) IMAGING
00310058061LEVEL III THERAPEUTIC RADIATION TREATMENT PREPARATION
00312058061RADIOELEMENT APPLICATIONS
00313058061BRACHYTHERAPY
00317058061LEVEL II MISCELLANEOUS RADIOLOGY PROCEDURES
00318058061LEVEL IV NEUROSTIMULATOR & RELATED PROCEDURES
00319058061LEVEL III ENDOVASCULAR PROCEDURES
00320058061ELECTROCONVULSIVE THERAPY
00322058061BRIEF INDIVIDUAL PSYCHOTHERAPY
00323058061EXTENDED INDIVIDUAL PSYCHOTHERAPY
00324058061FAMILY PSYCHOTHERAPY
00325058061GROUP PSYCHOTHERAPY
00326058061LEVEL I SKIN PROCEDURES
00327058061LEVEL II SKIN PROCEDURES
00328058061LEVEL III SKIN PROCEDURES
00329058061LEVEL IV SKIN PROCEDURES
00330058061DENTAL PROCEDURES
00331058061COMBINED ABDOMEN AND PELVIS CT WITHOUT CONTRAST
00332058061COMPUTED TOMOGRAPHY WITHOUT CONTRAST
00333058061COMPUTED TOMOGRAPHY WITHOUT CONTRAST FOLLOWED BY CONTRAST
00334058061COMBINED ABDOMEN AND PELVIS CT WITH CONTRAST
00336058061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST
00337058061MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY CONTRAST
00340058061LEVEL II MINOR PROCEDURES
00342058061LEVEL I PATHOLOGY
00345058061LEVEL I TRANSFUSION LABORATORY PROCEDURES
00346058061LEVEL II TRANSFUSION LABORATORY PROCEDURES
00351058061LEVEL V INTRAOCULAR PROCEDURES
00360058061LEVEL I ALIMENTARY TESTS
00361058061LEVEL II ALIMENTARY TESTS
00363058061OTORHINOLARYNGOLOGIC AND RELATED TESTS
00364058061LEVEL I AUDIOMETRY
00365058061LEVEL II AUDIOMETRY
00367058061LEVEL I PULMONARY TESTS
00369058061LEVEL II PULMONARY TESTS
00373058061NEUROPSYCHOLOGICAL TESTING
00375058061ANCILLARY OUTPATIENT SERVICES WHEN PATIENT EXPIRES
00377058061LEVEL II CARDIAC IMAGING
00378058061LEVEL II PULMONARY IMAGING
00383058061CARDIAC COMPUTED TOMOGRAPHIC IMAGING
00384058061GI PROCEDURES WITH STENTS
00385058061LEVEL I UROGENITAL PROCEDURES
00386058061LEVEL II UROGENITAL PROCEDURES
00388058061DISCOGRAPHY
00389058061LEVEL I NON-IMAGING NUCLEAR MEDICINE
00390058061LEVEL I ENDOCRINE IMAGING
00391058061LEVEL II ENDOCRINE IMAGING
00392058061LEVEL II NON-IMAGING NUCLEAR MEDICINE
00393058061HEMATOLOGIC PROCESSING & STUDIES
00394058061HEPATOBILIARY IMAGING
00395058061GI TRACT IMAGING
00396058061BONE IMAGING
00398058061LEVEL I CARDIAC IMAGING
00400058061HEMATOPOIETIC IMAGING
00401058061LEVEL I PULMONARY IMAGING
00402058061LEVEL II NERVOUS SYSTEM IMAGING
00403058061LEVEL I NERVOUS SYSTEM IMAGING
00404058061RENAL AND GENITOURINARY STUDIES
00406058061LEVEL I TUMOR/INFECTION IMAGING
00407058061RADIONUCLIDE THERAPY
00408058061LEVEL III TUMOR/INFECTION IMAGING
00412058061LEVEL III RADIATION THERAPY
00414058061LEVEL II TUMOR/INFECTION IMAGING
00415058061LEVEL II ENDOSCOPY LOWER AIRWAY
00419058061LEVEL II UPPER GI PROCEDURES
00420058061LEVEL III MINOR PROCEDURES
00422058061LEVEL III UPPER GI PROCEDURES
00423058061LEVEL II PERCUTANEOUS ABDOMINAL AND BILIARY PROCEDURES
00424058061LEVEL II SMALL INTESTINE ENDOSCOPY
00425058061LEVEL V MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT
00427058061LEVEL II TUBE OR CATHETER CHANGES OR REPOSITIONING
00428058061LEVEL III SIGMOIDOSCOPY AND ANOSCOPY
00431058061LEVEL IV CLOSED TREATMENT FRACTURE
00432058061LEVEL II HEALTH AND BEHAVIOR SERVICES
00433058061LEVEL II PATHOLOGY
00435058061LEVEL III EXTENDED EEG, SLEEP, AND CARDIOVASCULAR STUDIES
00436058061LEVEL I DRUG ADMINISTRATION
00437058061LEVEL II DRUG ADMINISTRATION
00438058061LEVEL III DRUG ADMINISTRATION
00439058061LEVEL IV DRUG ADMINISTRATION
00440058061LEVEL V DRUG ADMINISTRATION
00442058061DOSIMETRIC DRUG ADMINISTRATION
00446058061LEVEL IV NERVE AND MUSCLE SERVICES
00450058061LEVEL I MINOR PROCEDURES
00609058061LEVEL 1 TYPE A EMERGENCY VISITS
00613058061LEVEL 2 TYPE A EMERGENCY VISITS
00614058061LEVEL 3 TYPE A EMERGENCY VISITS
00615058061LEVEL 4 TYPE A EMERGENCY VISITS
00616058061LEVEL 5 TYPE A EMERGENCY VISITS
00617058061CRITICAL CARE
00618058061TRAUMA RESPONSE WITH CRITICAL CARE
00621058061LEVEL I VASCULAR ACCESS PROCEDURES
00622058061LEVEL II VASCULAR ACCESS PROCEDURES
00624058061PHLEBOTOMY AND MINOR VASCULAR ACCESS DEVICE PROCEDURES
00626058061LEVEL 1 TYPE B EMERGENCY VISITS
00627058061LEVEL 2 TYPE B EMERGENCY VISITS
00628058061LEVEL 3 TYPE B EMERGENCY VISITS
00629058061LEVEL 4 TYPE B EMERGENCY VISITS
00630058061LEVEL 5 TYPE B EMERGENCY VISITS
00631058061LEVEL 1 EXAMINATIONS & RELATED SERVICES
00632058061LEVEL 2 EXAMINATIONS & RELATED SERVICES
00633058061LEVEL 3 EXAMINATIONS & RELATED SERVICES
00634058061HOSPITAL CLINIC VISITS
00648058061LEVEL IV BREAST AND SKIN SURGERY
00651058061COMPLEX INTERSTITIAL RADIATION SOURCE APPLICATION
00652058061INSERTION OF INTRAPERITONEAL AND PLEURAL CATHETERS
00655058061LEVEL IV PACEMAKER AND SIMILAR PROCEDURES
00659058061HYPERBARIC OXYGEN
00661058061LEVEL III PATHOLOGY
00662058061CT ANGIOGRAPHY
00667058061LEVEL IV RADIATION THERAPY
00668058061LEVEL I ANGIOGRAPHY AND VENOGRAPHY
00673058061LEVEL III INTRAOCULAR PROCEDURES
00676058061THROMBOLYSIS AND OTHER DEVICE REVISIONS
00688058061LEVEL I NEUROSTIMULATOR & RELATED PROCEDURES
00690058061LEVEL I ELECTRONIC ANALYSIS OF DEVICES
00691058061LEVEL III ELECTRONIC ANALYSIS OF DEVICES
00692058061LEVEL II ELECTRONIC ANALYSIS OF DEVICES
00698058061LEVEL II EYE TESTS & TREATMENTS
00701058085SR89 STRONTIUM
00726058085DEXRAZOXANE HCL INJECTION
00731058085SARGRAMOSTIM INJECTION
00736058085AMPHOTERICIN B LIPOSOME INJ
00738058085RASBURICASE
00747058069CHLOROTHIAZIDE SODIUM INJ
00751058085MECHLORETHAMINE HCL INJ
00752058085DACTINOMYCIN INJECTION
00759058085NALTREXONE, DEPOT FORM
00800058085LEUPROLIDE ACETATE
00802058085ETOPOSIDE ORAL
00807058085ALDESLEUKIN INJECTION
00809058075BCG LIVE INTRAVESICAL VAC
00810058085GOSERELIN ACETATE IMPLANT
00812058085CARMUSTINE INJECTION
00814058061ASPARAGINASE, NOS
00820058085DAUNORUBICIN INJECTION
00821058069DAUNORUBICIN CITRATE INJ
00823058081DOCETAXEL INJECTION
00825058085NELARABINE INJECTION
00827058069FLOXURIDINE INJECTION
00831058069IFOSFAMIDE INJECTION
00832058073IDARUBICIN HCL INJECTION
00835058065COSYNTROPIN INJECTION NOS
00836058085INTERFERON ALFA-2B INJ
00838058071INTERFERON GAMMA 1-B INJ
00840058079INJ MELPHALAN HYDROCHL
00840080085INJ MELPHA HYDROCH NOS 50 MG
00842058061FLUDARABINE PHOSPHATE INJ
00843058085PEGASPARGASE INJECTION
00844058085PENTOSTATIN INJECTION
00849058073RITUXIMAB INJECTION
00850058085STREPTOZOCIN INJECTION
00851058085THIOTEPA INJECTION
00856058085PORFIMER SODIUM INJECTION
00858058085INJ CLADRIBINE
00864058085MITOXANTRONE HYDROCHL
00868058073ORAL APREPITANT
00873058069HYALGAN/SUPARTZ INJ PER DOSE
00873070077HYALGAN SUPARTZ VISCO-3 DOSE
00874058085SYNVISC OR SYNVISC-ONE
00875058085EUFLEXXA INJ PER DOSE
00877058085ORTHOVISC INJ PER DOSE
00887058085AZATHIOPRINE PARENTERAL
00890058085LYMPHOCYTE IMMUNE GLOBULIN
00901058085ALPHA 1 PROTEINASE INHIBITOR
00902058085INJECTION,ONABOTULINUMTOXINA
00903058085CYTOMEGALOVIRUS IMM IV /VIAL
00910058085INTERFERON BETA-1B / .25 MG
00913058069GANCICLOVIR LONG ACT IMPLANT
00925058085FACTOR VIII
00927058085FACTOR VIII RECOMBINANT
00928058085FACTOR IX COMPLEX
00929058085ANTI-INHIBITOR
00931058085FACTOR IX NON-RECOMBINANT
00932058085FACTOR IX RECOMBINANT NOS
00934058065CAPECITABINE, ORAL
00943058085OCTAGAM INJECTION
00944058085GAMMAGARD LIQUID INJECTION
00945058061RHOPHYLAC INJECTION
00946058085HEPAGAM B IM INJECTION
00947058085FLEBOGAMMA INJECTION
00948058085GAMUNEX-C/GAMMAKED
00949058061FROZEN PLASMA, POOLED, SD
00950058061WHOLE BLOOD FOR TRANSFUSION
00952058061CRYOPRECIPITATE EACH UNIT
00954058061RBC LEUKOCYTES REDUCED
00955058061PLASMA, FRZ BETWEEN 8-24HOUR
00956058061PLASMA PROTEIN FRACT,5%,50ML
00957058061PLATELETS, EACH UNIT
00958058061PLAELET RICH PLASMA UNIT
00959058061RED BLOOD CELLS UNIT
00960058061WASHED RED BLOOD CELLS UNIT
00961058085ALBUMIN (HUMAN),5%, 50ML
00963058085ALBUMIN (HUMAN), 5%, 250 ML
00964058085ALBUMIN (HUMAN), 25%, 20 ML
00965058085ALBUMIN (HUMAN), 25%, 50ML
00966058061PLASMAPROTEIN FRACT,5%,250ML
00967058061BLOOD SPLIT UNIT
00968058061PLATELETS LEUKOREDUCED IRRAD
00969058061RBC LEUKOREDUCED IRRADIATED
01009058061CRYOPRECIPITATEREDUCEDPLASMA
01010058061BLOOD, L/R, CMV-NEG
01011058061PLATELETS, HLA-M, L/R, UNIT
01013058061PLATELETS LEUKOCYTES REDUCED
01015058085INJECTION GLATIRAMER ACETATE
01016058061BLOOD, L/R, FROZ/DEGLY/WASH
01017058061PLT, APH/PHER, L/R, CMV-NEG
01018058061BLOOD, L/R, IRRADIATED
01019058061PLATE PHERES LEUKOREDU IRRAD
01020058061PLT, PHER, L/R CMV-NEG, IRR
01021058061RBC, FRZ/DEG/WSH, L/R, IRRAD
01022058061RBC, L/R, CMV-NEG, IRRAD
01023058061PRALIDOXIME CHLORIDE INJ
01052058073INJECTION, VORICONAZOLE
01064058085I131 IODIDE CAP, RX
01083058085ADALIMUMAB INJECTION
01086058069TEMOZOLOMIDE
01138058085HEPAGAM B INTRAVENOUS, INJ
01139058085PROTEIN C CONCENTRATE
01142058085SUPPRELIN LA IMPLANT
01150058085I131 IODIDE SOL, RX
01166058081CYTARABINE LIPOSOME INJ
01168058085INJ, TEMSIROLIMUS
01178058085BUSULFAN INJECTION
01203058085VERTEPORFIN INJECTION
01207058085OCTREOTIDE INJECTION, DEPOT
01213058085ANTIHEMOPHILIC VIII/VWF COMP
01214058085INJ IVIG PRIVIGEN 500 MG
01232058085MITOMYCIN INJECTION
01235058085VALRUBICIN INJECTION
01236058076LEVOLEUCOVORIN INJECTION
01236077085INJ LEVOLEUCOVORIN NOS 0.5MG
01237058085INJ IRON DEXTRAN
01238058073TOPOTECAN ORAL
01253058077TRIAMCINOLONE A INJ PRS-FREE
01263058085ANTITHROMBIN III INJECTION
01268058085XYNTHA INJ
01272058065ACETYLCYSTEINE INJECTION
01274058085EDETATE CALCIUM DISODIUM INJ
01280058073CORTICOTROPIN INJECTION
01281058085BEVACIZUMAB INJECTION
01289058085ABOBOTULINUMTOXINA
01291058073RILONACEPT INJECTION
01295058085SM 153 LEXIDRONAM
01296058085DEGARELIX INJECTION
01297058085FERUMOXYTOL, NON-ESRD
01311058085CANAKINUMAB INJECTION
01312058085HIZENTRA INJECTION
01327058085IMIGLUCERASE INJECTION
01331058069OLANZAPINE LONG-ACTING INJ
01331082085OLANZAPINE LONG-ACTING INJ
01332058069ANTITHROMBIN RECOMBINANT
01338058069METHYL AMINOLEVULINATE, TOP
01340058085COLLAGENASE, CLOST HIST INJ
01341058085AMOBARBITAL 125 MG INJ
01350058061TOPOTECAN INJECTION
01352058085WILATE INJECTION
01353058085BELIMUMAB INJECTION
01354058067HYDROXYPROGESTERONE CAPROATE
01356058065ZOLEDRONIC ACID 1MG
01361058069ENFUVIRTIDE INJECTION
01408058085CYCLOPHOSPHAMIDE 100 MG INJ
01413058085LUMIZYME INJECTION
01415058085GLASSIA INJECTION
01416058085FACTOR XIII ANTI-HEM FACTOR
01417058085GEL-ONE
01419058061DERMACELL
01420058085AFLIBERCEPT INJECTION
01421058071IMPORTED LIPODOX INJ
01421074085IMPORTED LIPODOX INJ
01422058061ANTHRAX VACCINE SC OR IM
01424058069NABILONE ORAL
01426058085ERIBULIN MESYLATE INJECTION
01431058085CENTRUROIDES IMMUNE F(AB)
01433058085CALCITONIN SALMON INJECTION
01439058058APROTONIN, 10,000 KIU
01440058085INJ DESMOPRESSIN ACETATE
01442058085NON-HEU TC-99M ADD-ON/DOSE
01443058085ICATIBANT INJECTION
01446058085VISUALIZATION ADJUNCT
01448058061OPTHALMIC MITOMYCIN
01449058061TALYMED
01456058061PENTOBARBITAL SODIUM INJ
01457058069TOTAZOLINE HCL INJECTION
01458058085PHENTOLAINE MESYLATE INJ
01459058061UREA INJECTION
01460058069INTERFERON ALFA-2A INJ
01463058061TC99 TILMANOCEPT DIAG 0.5MCI
01464058069FACTOR VIII (PORCINE)
01465058061TACROLIMUS EX REL ORAL 0.1MG
01465062065TACROL ASTAGRAF EX REL ORAL
01466058085INJ, VINCRISTINE SUL LIP 1MG
01467058085FACTOR IX RECOMBINAN RIXUBIS
01468058085INJ ARIPIPRAZOLE EXT REL 1MG
01469058061INJ, FILGRASTIM G-CSF 1MCG
01469062085INJ FILGRASTIM EXCL BIOSIMIL
01471058085INJECTION, PERTUZUMAB, 1 MG
01472058085INJ BETA INTERFERON IM 1 MCG
01474058085CERTOLIZUMAB PEGOL INJ 1MG
01475058085GOLIMUMAB FOR IV USE 1MG
01476058085OBINUTUZUMAB INJ
01477058061INJ, TBO-FILGRASTIM, 5 MCG
01478058073HUMAN FIBRINOGEN CONC INJ
01478074085INJ HUMAN FIBRINOGEN CON NOS
01479058065THERASKIN
01480058085ELOSULFASE ALFA, INJECTION
01482058085DARBEPOETIN ALFA, ESRD USE
01484058073PENTAZOCINE INJECTION
01485058085FERUMOXYTOL, ESRD USE
01486058085FACTOR IX FC FUSION RECOMB
01487058065TESTOSTERONE UNDECANOATE 1MG
01488058085INJECTION, RAMUCIRUMAB
01489058085INJECTION, VEDOLIZUMAB
01490058061INJECTION, PEMBROLIZUMAB
01490062085INJ PEMBROLIZUMAB
01491058059NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01491060060NEW TECHNOLOGY - LEVEL IA ($0-$10)
01491061061NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01491062077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01491078085NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01492058059NEW TECHNOLOGY  - LEVEL IB ($10-$20)
01492060060NEW TECHNOLOGY - LEVEL IB ($10-$20)
01492061061NEW TECHNOLOGY  - LEVEL IB ($10-$20)
01492062065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01492066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01492078085NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01493058059NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01493060060NEW TECHNOLOGY - LEVEL IC ($20-$30)
01493061061NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01493062065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01493066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01493078085NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01494058059NEW TECHNOLOGY  - LEVEL ID ($30-$40)
01494060060NEW TECHNOLOGY - LEVEL ID ($30-$40)
01494061061NEW TECHNOLOGY  - LEVEL ID ($30-$40)
01494062065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01494066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01494078085NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01495058059NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01495060060NEW TECHNOLOGY - LEVEL IE ($40-$50)
01495061061NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01495062065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01495066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01495078085NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01496058059NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01496060060NEW TECHNOLOGY - LEVEL IA ($0-$10)
01496061061NEW TECHNOLOGY  - LEVEL IA ($0-$10)
01496062077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01496078085NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01497058059NEW TECHNOLOGY  - LEVEL IB($10-$20)
01497060060NEW TECHNOLOGY - LEVEL IB ($10-$20)
01497061061NEW TECHNOLOGY  - LEVEL IB($10-$20)
01497062065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01497066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01497078085NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01498058059NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01498060060NEW TECHNOLOGY - LEVEL IC ($20-$30)
01498061061NEW TECHNOLOGY  - LEVEL IC ($20-$30)
01498062065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01498066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01498078085NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01499058059NEW TECHNOLOGY  - LEVEL ID($30-$40)
01499060060NEW TECHNOLOGY - LEVEL ID ($30-$40)
01499061061NEW TECHNOLOGY  - LEVEL ID($30-$40)
01499062065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01499066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01499078085NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01500058059NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01500060060NEW TECHNOLOGY - LEVEL IE ($40-$50)
01500061061NEW TECHNOLOGY  - LEVEL IE ($40-$50)
01500062065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01500066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01500078085NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01502058059NEW TECHNOLOGY - LEVEL II   ($50 - $100)
01502060060NEW TECHNOLOGY - LEVEL II ($50 - $100)
01502061061NEW TECHNOLOGY - LEVEL II   ($50 - $100)
01502062065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01502066085NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01503058059NEW TECHNOLOGY - LEVEL III   ($100 - $200)
01503060060NEW TECHNOLOGY - LEVEL III ($100 - $200)
01503061061NEW TECHNOLOGY - LEVEL III   ($100 - $200)
01503062065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01503066085NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01504058059NEW TECHNOLOGY - LEVEL IV  ($200 - $300)
01504060060NEW TECHNOLOGY - LEVEL IV ($200 - $300)
01504061061NEW TECHNOLOGY - LEVEL IV  ($200 - $300)
01504062065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01504066085NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01505058059NEW TECHNOLOGY - LEVEL V   ($300 - $400)
01505060060NEW TECHNOLOGY - LEVEL V ($300 - $400)
01505061061NEW TECHNOLOGY - LEVEL V   ($300 - $400)
01505062065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01505066085NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01506058059NEW TECHNOLOGY - LEVEL VI  ($400 - $500)
01506060060NEW TECHNOLOGY - LEVEL VI ($400 - $500)
01506061061NEW TECHNOLOGY - LEVEL VI  ($400 - $500)
01506062065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01506066085NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01507058059NEW TECHNOLOGY - LEVEL VII  ($500 - $600)
01507060060NEW TECHNOLOGY - LEVEL VII ($500 - $600)
01507061061NEW TECHNOLOGY - LEVEL VII  ($500 - $600)
01507062065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01507066085NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01508058061NEW TECHNOLOGY - LEVEL VIII ($600 - $700)
01508062065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01508066085NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01509058061NEW TECHNOLOGY - LEVEL IX   ($700 - $800)
01509062065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01509066085NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01510058061NEW TECHNOLOGY - LEVEL X    ($800 - $900)
01510062065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01510066085NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01511058061NEW TECHNOLOGY - LEVEL XI   ($900 - $1000)
01511062065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01511066085NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01512058061NEW TECHNOLOGY - LEVEL XII  ($1000 - $1100)
01512062065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01512066085NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01513058061NEW TECHNOLOGY - LEVEL XIII  ($1100 - $1200)
01513062065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01513066085NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01514058061NEW TECHNOLOGY - LEVEL XIV ($1200- $1300)
01514062065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01514066085NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01515058061NEW TECHNOLOGY - LEVEL XV ($1300 - $1400)
01515062065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01515066085NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01516058061NEW TECHNOLOGY - LEVEL XVI  ($1400 - $1500)
01516062065NEW TECHNOLOGY - LEVEL 16  ($1400 - $1500)
01516066077NEW TECHNOLOGY - LEVEL 16  ($1401 - $1500)
01516078085NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01517058061NEW TECHNOLOGY - LEVEL XVII ($1500-$1600)
01517062065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01517066085NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01518058061NEW TECHNOLOGY - LEVEL XVIII ($1600-$1700)
01518062065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01518066085NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01519058061NEW TECHNOLOGY - LEVEL IXX ($1700-$1800)
01519062065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01519066085NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01520058061NEW TECHNOLOGY - LEVEL XX ($1800-$1900)
01520062065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01520066085NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01521058061NEW TECHNOLOGY - LEVEL XXI ($1900-$2000)
01521062065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01521066085NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01522058061NEW TECHNOLOGY - LEVEL XXII ($2000-$2500)
01522062065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01522066085NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01523058061NEW TECHNOLOGY - LEVEL XXIII ($2500-$3000)
01523062065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01523066085NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01524058061NEW TECHNOLOGY - LEVEL XXIV ($3000-$3500)
01524062065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01524066085NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01525058061NEW TECHNOLOGY - LEVEL XXV ($3500-$4000)
01525062065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01525066085NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01526058061NEW TECHNOLOGY - LEVEL XXVI ($4000-$4500)
01526062065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01526066085NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01527058061NEW TECHNOLOGY - LEVEL XXVII ($4500-$5000)
01527062065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01527066085NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01528058061NEW TECHNOLOGY - LEVEL XXVIII ($5000-$5500)
01528062065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01528066085NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01529058061NEW TECHNOLOGY - LEVEL XXIX ($5500-$6000)
01529062065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01529066085NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01530058061NEW TECHNOLOGY - LEVEL XXX ($6000-$6500)
01530062065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01530066085NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01531058061NEW TECHNOLOGY - LEVEL XXXI ($6500-$7000)
01531062065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01531066085NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01532058061NEW TECHNOLOGY - LEVEL XXXII ($7000-$7500)
01532062065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01532066085NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01533058061NEW TECHNOLOGY - LEVEL XXXIII ($7500-$8000)
01533062065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01533066085NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01534058061NEW TECHNOLOGY - LEVEL XXXIV ($8000-$8500)
01534062065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01534066085NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01535058061NEW TECHNOLOGY - LEVEL XXXV ($8500-$9000)
01535062065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01535066085NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01536058061NEW TECHNOLOGY - LEVEL XXXVI ($9000-$9500)
01536062065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01536066085NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01537058061NEW TECHNOLOGY - LEVEL XXXVII ($9500-$10000)
01537062065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01537066085NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01539058061NEW TECHNOLOGY - LEVEL II   ($50 - $100)
01539062065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01539066085NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01540058061NEW TECHNOLOGY - LEVEL III   ($100 - $200)
01540062065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01540066085NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01541058061NEW TECHNOLOGY - LEVEL IV  ($200 - $300)
01541062065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01541066085NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01542058061NEW TECHNOLOGY - LEVEL V   ($300 - $400)
01542062065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01542066085NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01543058061NEW TECHNOLOGY - LEVEL VI  ($400 - $500)
01543062065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01543066085NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01544058061NEW TECHNOLOGY - LEVEL VII  ($500 - $600)
01544062065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01544066085NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01545058061NEW TECHNOLOGY - LEVEL VIII ($600 - $700)
01545062065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01545066085NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01546058061NEW TECHNOLOGY - LEVEL IX   ($700 - $800)
01546062065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01546066085NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01547058061NEW TECHNOLOGY - LEVEL X    ($800 - $900)
01547062065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01547066085NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01548058061NEW TECHNOLOGY - LEVEL XI   ($900 - $1000)
01548062065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01548066085NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01549058061NEW TECHNOLOGY - LEVEL XII  ($1000 - $1100)
01549062065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01549066085NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01550058061NEW TECHNOLOGY - LEVEL XIII  ($1100 - $1200)
01550062065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01550066085NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01551058061NEW TECHNOLOGY - LEVEL XIV ($1200- $1300)
01551062065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01551066085NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01552058061NEW TECHNOLOGY - LEVEL XV ($1300 - $1400)
01552062065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01552066085NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01553058061NEW TECHNOLOGY - LEVEL XVI  ($1400 - $1500)
01553062065NEW TECHNOLOGY - LEVEL 16 ($1400 - $1500)
01553066085NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01554058061NEW TECHNOLOGY - LEVEL XVII ($1500-$1600)
01554062065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01554066085NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01555058061NEW TECHNOLOGY - LEVEL XVIII ($1600-$1700)
01555062065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01555066085NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01556058061NEW TECHNOLOGY - LEVEL XIX ($1700-$1800)
01556062065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01556066085NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01557058061NEW TECHNOLOGY - LEVEL XX ($1800-$1900)
01557062065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01557066085NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01558058061NEW TECHNOLOGY - LEVEL XXI ($1900-$2000)
01558062065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01558066085NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01559058061NEW TECHNOLOGY - LEVEL XXII ($2000-$2500)
01559062065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01559066085NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01560058061NEW TECHNOLOGY - LEVEL XXIII ($2500-$3000)
01560062065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01560066085NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01561058061NEW TECHNOLOGY - LEVEL XXIV ($3000-$3500)
01561062065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01561066085NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01562058061NEW TECHNOLOGY - LEVEL XXV ($3500-$4000)
01562062065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01562066085NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01563058061NEW TECHNOLOGY - LEVEL XXVI ($4000-$4500)
01563062065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01563066085NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01564058061NEW TECHNOLOGY - LEVEL XXVII ($4500-$5000)
01564062065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01564066085NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01565058061NEW TECHNOLOGY - LEVEL XXVIII ($5000-$5500)
01565062065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01565066085NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01566058061NEW TECHNOLOGY - LEVEL XXIX ($5500-$6000)
01566062065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01566066085NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01567058061NEW TECHNOLOGY - LEVEL XXX ($6000-$6500)
01567062065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01567066085NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01568058061NEW TECHNOLOGY - LEVEL XXXI ($6500-$7000)
01568062065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01568066085NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01569058061NEW TECHNOLOGY - LEVEL XXXII ($7000-$7500)
01569062065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01569066085NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01570058061NEW TECHNOLOGY - LEVEL XXXIII ($7500-$8000)
01570062065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01570066085NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01571058061NEW TECHNOLOGY - LEVEL XXXIV ($8000-$8500)
01571062065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01571066085NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01572058061NEW TECHNOLOGY - LEVEL XXXV ($8500-$9000)
01572062065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01572066085NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01573058061NEW TECHNOLOGY - LEVEL XXXVI ($9000-$9500)
01573062065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01573066085NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01574058061NEW TECHNOLOGY - LEVEL XXXVII ($9500-$10000)
01574062065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01574066085NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01575062065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01575066085NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01576062065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01576066085NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01577062065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01577066085NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01578062065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01578066085NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01579062065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01579066085NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01580062065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01580066085NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01581062065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01581066085NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01582062065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01582066085NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01583062065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01583066085NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01584062065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01584066085NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01585062065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01585066085NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01589062065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01589066085NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01590062065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01590066085NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01591062065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01591066085NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01592062065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01592066085NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01593062065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01593066085NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01594062065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01594066085NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01595062065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01595066085NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01596062065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01596066085NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01597062065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01597066085NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01598062065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01598066085NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01599062065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01599066085NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01605058061ABCIXIMAB INJECTION
01605066069ABCIXIMAB INJECTION
01607058081EPTIFIBATIDE INJECTION
01608058085ETANERCEPT INJECTION
01609058085RHO(D) IMMUNE GLOBULIN H, SD
01612058069DACLIZUMAB, PARENTERAL
01613058081TRASTUZUMAB INJECTION
01613082085INJ TRASTUZUMAB EXCL BIOSIMI
01630058085HEP B IG, IM
01631058073BACLOFEN INTRATHECAL TRIAL
01633058069ALEFACEPT
01643058085Y90 IBRITUMOMAB, RX
01656058058FACTOR VIII (ELOCTATE)
01656059061FACTOR VIII FC FUSION RECOMB
01656062085FACTOR VIII FC FUSION RECOMB
01657058058FORTADERM, FORTADERM ANTIMIC
01657059059FORTADERM, FORTADERM ANTIMIC
01657060061PURAPLY, PURAPLY ANTIMIC
01657062065PURAPLY, PURAPLY ANTIMIC
01657066069PURAPLY OR PURAPLY AM
01658058061INJECTION, BELINOSTAT
01658062085INJECTION, BELINOSTAT, 10MG
01659058061INJECTION, DALBAVANCIN
01660058085INJECTION, ORITAVANCIN
01661062069GEN, NEURO, HF, RECHG BAT
01662058061INJ, TEDIZOLID PHOSPHATE
01662062085INJ TEDIZOLID PHOSPHATE
01663058069INJ, PHENYLEPHRINE KETOROLAC
01664058069FLORBETAPIR F18
01665058065CAPSAICIN 8% PATCH
01666058069TETRACYCLIN INJECTION
01667058061ALATROFLOXACIN MESYLATE
01668058065CHORIONIC GONADOTROPIN/1000U
01669058077ERYTHRO LACTOBIONATE /500 MG
01669082085ERYTHRO LACTOBIONATE /500 MG
01670058085TETANUS IMMUNE GLOBULIN INJ
01675058085P32 NA PHOSPHATE
01676058069P32 CHROMIC PHOSPHATE
01683058085BASILIXIMAB
01684058085CORTICORELIN OVINE TRIFLUTAL
01685058085DARBEPOETIN ALFA, NON-ESRD
01686058085EPOETIN ALFA, NON-ESRD
01687058085DIGOXIN IMMUNE FAB (OVINE)
01688058085ETHANOLAMINE OLEATE
01689058085FOMEPIZOLE
01690058085HEMIN
01693058069LEPIRUDIN
01694058085ZICONOTIDE INJECTION
01695058080NESIRITIDE INJECTION
01696058085PALIFERMIN INJECTION
01697058073PEGAPTANIB SODIUM INJECTION
01700058085INJ SECRETIN SYNTHETIC HUMAN
01701058085TREPROSTINIL INJECTION
01704058085HUMATE-P, INJ
01705058081FACTOR VIIA
01705082085FACTOR VIIA RECOMB NOVOSEVEN
01709058085AZACITIDINE INJECTION
01710058085CLOFARABINE INJECTION
01711058085VANTAS IMPLANT
01712058085PACLITAXEL PROTEIN BOUND
01716058061BRACHYTX, NON-STR, GOLD-198
01717058061BRACHYTX, NON-STR, HDR IR-192
01719058061BRACHYTX, NS, NON-HDRIR-192
01738058069OXALIPLATIN
01739058085PEGADEMASE BOVINE, 25 IU
01741058069UROFOLLITROPIN, 75 IU
01742058061GOLD SODIUM THIOMALEATE INJ
01743058077NANDROLONE DECANOATE 50 MG
01744058061ZIDOVUDINE
01745058058RADIUM RA223 DICHLORIDE THER
01745059085RADIUM RA223 DICHLORIDE THER
01746058058FACTOR XIII RECOMB A-SUBUNIT
01746059085FACTOR XIII RECOMB A-SUBUNIT
01747058085MONOVISC INJ PER DOSE
01748062085INJ TBO FILGRASTIM 1 MICROG
01761064085ROLAPITANT, ORAL, 1MG
01807058065MENB PR W/OMV VACCINE IM
01808058065MENB RLP VACCINE IM
01809061061INJECTION, ALEMTUZUMAB
01809062085INJECTION, ALEMTUZUMAB
01822060061INJ FILGRASTIM G-CSF BIOSIM
01822062070INJ FILGRASTIM GCSF BIOSIMIL
01822071085INJECTION, ZARXIO
01823062085INJECTION, DALBAVANCIN
01824062085CEFTAROLINE FOSAMIL INJ
01825062085CEFTAZIDIME AND AVIBACTAM
01826062085HYQVIA 100MG IMMUNEGLOBULIN
01827062085FACTOR VIII RECOMB OBIZUR
01828062065CARBIDOPA LEVODOPA ENTERAL
01828066073CARBIDOPA LEVODOPA ENT 100ML
01829062085PENICILLIN G BENZATHINE INJ
01831062065CHLORAMPHENICOL SODIUM INJEC
01832062085DIMETHYL 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
01841058061RETINAL PROSTH INT/EXT COMP
01842062069LEUPROLIDE ACETATE IMPLANT
01843062065MENACWY VACCINE IM
01844063065ADYNOVATE FACTOR VIII RECOM
01844066085FACTOR VIII PEGYLATED RECOMB
01845063073TACROL ENVARSUS EX REL ORAL
01846063065NUWIQ FACTOR VIII RECOMB
01846066085FACTOR VIII NUWIQ RECOMB 1IU
01847063063INJ., INFLIXIMAB BIOSIMILAR
01847066070INJ., INFLIXIMAB BIOSIMILAR
01847071085INJECTION, INFLECTRA
01848066085ARTISS FIBRIN SEALANT
01849066085FOSCARNET SODIUM INJECTION
01850066085GAMMA GLOBULIN 1 CC INJ
01851066085GAMMA GLOBULIN > 10 CC INJ
01852066085INTERFERON BETA-1A INJ
01853066085MINOCYCLINE HYDROCHLORIDE
01854066085PENTOBARBITAL SODIUM INJ
01855066069PRALIDOXIME CHLORIDE INJ
01856066085FACTOR VIII RECOMB NOVOEIGHT
01857066085INJ, FACTOR X, (HUMAN), 1IU
01858066073LEUPROLIDE ACETATE INJECITON
01859066085ARGATROBAN NONESRD USE 1MG
01860066073MONOCLONAL ANTIBODIES
01861066085INJ., BENDEKA 1 MG
01862067069GEL-SYN INJECTION 0.1 MG
01862070085GELSYN-3 INJECTION 0.1 MG
01863066073INJ DICLOFENAC SODIUM 0.5MG
01901066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01901070085NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01902066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01902070085NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01903066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01903070085NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01904066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01904070085NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01905066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01905070085NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01906066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01906070085NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01907070085NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
01908070085NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
02024078085GENERATOR, CCM, IMPLANT
02025078085CATH, PRESSURE,VALVE-OCCLU
02026078085ORTH/DEVIC/DRUG BN/BN,TIS/BN
02027078085PROBE, ROBOTIC, WATER-JET
02028078085IRIS PROSTHESIS
02029080080ENDOSCOPE, SINGLE, UGI
02029081081ENDOSCOPE, SINGLE, UGI
02029082085ENDOSCOPE, SINGLE, UGI
02030082085GEN, NEURO, CAROT SINUS BARO
02031082085HEMOSTATIC AGENT, GI, TOPIC
02032082085INTRAVERTEBRAL FX AUG IMPL
02033084085CATH, TRANS INTRA LITHO/CORO
02034085085PERSONALIZED INTERBODY CAGE
02613060069LUNG BX PLUG W/DEL SYS
02616058085BRACHYTX, NON-STR,YTTRIUM-90
02623059069CATH, TRANSLUMIN, DRUG-COAT
02624058065WIRELESS PRESSURE SENSOR
02632058085IODINE I-125 SODIUM IODIDE
02634058085BRACHYTX, NON-STR, HA, I-125
02635058085BRACHYTX, NON-STR, HA, P-103
02636058085BRACHY LINEAR, NON-STR,P-103
02638058085BRACHYTX, STRANDED, I-125
02639058085BRACHYTX, NON-STRANDED,I-125
02640058085BRACHYTX, STRANDED, P-103
02641058085BRACHYTX, NON-STRANDED,P-103
02642058085BRACHYTX, STRANDED, C-131
02643058085BRACHYTX, NON-STRANDED,C-131
02644058065BRACHYTX CESIUM-131 CHLORIDE
02644070073BRACHYTX CESIUM-131 CHLORIDE
02645062085BRACHYTX, NON-STR, GOLD-198
02646062085BRACHYTX, NON-STR, HDR IR-192
02647062085BRACHYTX, NS, NON-HDRIR-192
02648062085BRACHYTX PLANAR, P-103
02698058085BRACHYTX, STRANDED, NOS
02699058085BRACHYTX, NON-STRANDED, NOS
02731058085IMMUNE GLOBULIN, POWDER
02770058085QUINUPRISTIN/DALFOPRISTIN
02993074085GEN, NEURO, TRANS SEN/STIM
03041058061BIVALIRUDIN
03041066069BIVALIRUDIN
04001066085ECHO GUIDANCE RADIOTHERAPY
04002066085STEREOSCOPIC X-RAY GUIDANCE
04003066085RADIATION TREATMENT DELIVERY, MEV <= 5; SIMPLE
04004066085RADIATION TREATMENT DELIVERY, 6-10 MEV; SIMPLE
04005066085RADIATION TREATMENT DELIVERY, 11-19 MEV; SIMPLE
04006066085RADIATION TREATMENT DELIVERY, MEV>=20; SIMPLE
04007066085RADIATION TREATMENT DELIVERY, MEV<=5; INTERMEDIATE
04008066085RADIATION TREATMENT DELIVERY, 6-10 MEV; INTERMEDIATE
04009066085RADIATION TREATMENT DELIVERY, 11-19 MEV; INTERMEDIATE
04010066085RADIATION TREATMENT DELIVERY, MEV >=20; INTERMEDIATE
04011066085RADIATION TREATMENT DELIVERY, MEV<=5; COMPLEX
04012066085RADIATION TREATMENT DELIVERY, 6-10 MEV; COMPLEX
04013066085RADIATION TREATMENT DELIVERY, 11-19 MEV; COMPLEX
04014066085RADIATION TREATMENT DELIVERY, MEV >=20; COMPLEX
04015070085RADIATION TX DELIVERY IMRT
04016070085DELIVERY COMP IMRT
05011062065LEVEL 1 EXAMINATIONS AND RELATED SERVICES
05012062065LEVEL 2 EXAMINATIONS AND RELATED SERVICES
05012066085CLINIC VISITS AND RELATED SERVICES
05013062065LEVEL 3 EXAMINATIONS AND RELATED SERVICES
05021062085LEVEL 1 TYPE A ED VISITS
05022062085LEVEL 2 TYPE A ED VISITS
05023062085LEVEL 3 TYPE A ED VISITS
05024062085LEVEL 4 TYPE A ED VISITS
05025062085LEVEL 5 TYPE A ED VISITS
05031062085LEVEL 1 TYPE B ED VISITS
05032062085LEVEL 2 TYPE B ED VISITS
05033062085LEVEL 3 TYPE B ED VISITS
05034062085LEVEL 4 TYPE B ED VISITS
05035062085LEVEL 5 TYPE B ED VISITS
05041062085CRITICAL CARE
05045062085TRAUMA RESPONSE WITH CRITICAL CARE
05051062085LEVEL 1 SKIN PROCEDURES
05052062085LEVEL 2 SKIN PROCEDURES
05053062085LEVEL 3 SKIN PROCEDURES
05054062085LEVEL 4 SKIN PROCEDURES
05055062085LEVEL 5 SKIN PROCEDURES
05061062085HYPERBARIC OXYGEN
05071062085LEVEL 1 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05072062085LEVEL 2 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05073062085LEVEL 3 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05074062065LEVEL 4 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05091062085LEVEL 1 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05092062085LEVEL 2 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05093062085LEVEL 3 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05094066085LEVEL 4 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05101062085LEVEL 1 STRAPPING AND CAST APPLICATION
05102062085LEVEL 2 STRAPPING AND CAST APPLICATION
05111062065LEVEL 1 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05111066085LEVEL 1 MUSCULOSKELETAL PROCEDURES
05112062065LEVEL 2 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05112066085LEVEL 2 MUSCULOSKELETAL PROCEDURES
05113062065LEVEL 3 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05113066085LEVEL 3 MUSCULOSKELETAL PROCEDURES
05114066085LEVEL 4 MUSCULOSKELETAL PROCEDURES
05115066085LEVEL 5 MUSCULOSKELETAL PROCEDURES
05116066085LEVEL 6 MUSCULOSKELETAL PROCEDURES
05121062065LEVEL1 MUSCULOSKELETAL PROCEDURES
05122062065LEVEL 2 MUSCULOSKELETAL PROCEDURES
05123062065LEVEL 3 MUSCULOSKELETAL PROCEDURES
05124062065LEVEL 4 MUSCULOSKELETAL PROCEDURES
05125062065LEVEL 5 MUSCULOSKELETAL PROCEDURES
05141062065THORACOSCOPY
05151062085LEVEL 1 AIRWAY ENDOSCOPY
05152062085LEVEL 2 AIRWAY ENDOSCOPY
05153062085LEVEL 3 AIRWAY ENDOSCOPY
05154062085LEVEL 4 AIRWAY ENDOSCOPY
05155062085LEVEL 5 AIRWAY ENDOSCOPY
05161062085LEVEL 1 ENT PROCEDURES
05162062085LEVEL 2 ENT PROCEDURES
05163062085LEVEL 3 ENT PROCEDURES
05164062085LEVEL 4 ENT PROCEDURES
05165062085LEVEL 5 ENT PROCEDURES
05166062065LEVEL 6 ENT PROCEDURES
05166066085COCHLEAR IMPLANT PROCEDURE
05181062085LEVEL 1 VASCULAR PROCEDURES
05182062085LEVEL 2 VASCULAR PROCEDURES
05183062085LEVEL 3 VASCULAR PROCEDURES
05184070085LEVEL 4 VASCULAR PROCEDURES
05188062065DIAGNOSTIC CARDIAC CATHETERIZATION
05191062085LEVEL 1 ENDOVASCULAR PROCEDURES
05192062085LEVEL 2 ENDOVASCULAR PROCEDURES
05193062085LEVEL 3 ENDOVASCULAR PROCEDURES
05194066085LEVEL 4 ENDOVASCULAR PROCEDURES
05200066085IMPLANTATION WIRELESS PA PRESSURE MONITOR
05211062085LEVEL 1 ELECTROPHYSIOLOGIC PROCEDURES
05212062085LEVEL 2 ELECTROPHYSIOLOGIC PROCEDURES
05213062085LEVEL 3 ELECTROPHYSIOLOGIC PROCEDURES
05221062085LEVEL1 PACEMAKER AND SIMILAR PROCEDURES
05222062085LEVEL 2 PACEMAKER AND SIMILAR PROCEDURES
05223062085LEVEL 3 PACEMAKER AND SIMILAR PROCEDURES
05224062085LEVEL 4 PACEMAKER AND SIMILAR PROCEDURES
05231062085LEVEL 1 ICD AND SIMILAR PROCEDURES
05232062085LEVEL 2 ICD AND SIMILAR PROCEDURES
05241062065TRANSFUSION
05241066085LEVEL 1 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05242066085LEVEL 2 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05243066085LEVEL 3 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05244066085LEVEL 4 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05271062065BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05281062065APHERESIS/STEM CELL AND RELATED SERVICES
05291062065THROMBOLYSIS AND OTHER DEVICE REVISIONS
05301062085LEVEL 1 UPPER GI PROCEDURES
05302062085LEVEL 2 UPPER GI PROCEDURES
05303062085LEVEL 3 UPPER GI PROCEDURES
05311062085LEVEL 1 LOWER GI PROCEDURES
05312062085LEVEL 2 LOWER GI PROCEDURES
05313062085LEVEL 3 LOWER GI PROCEDURES
05314062065LEVEL 4 LOWER GI PROCEDURES
05331062085COMPLEX GI PROCEDURES
05341062065PERITONEAL AND ABDOMINAL PROCEDURES
05341066085ABDOMINAL/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
05361066085LEVEL 1 LAPAROSCOPY AND RELATED SERVICES
05362062065LEVEL 2 LAPAROSCOPY
05362066085LEVEL 2 LAPAROSCOPY AND RELATED SERVICES
05371062085LEVEL 1 UROLOGY AND RELATED SERVICES
05372062085LEVEL 2 UROLOGY AND RELATED SERVICES
05373062085LEVEL 3 UROLOGY AND RELATED SERVICES
05374062085LEVEL 4 UROLOGY AND RELATED SERVICES
05375062085LEVEL 5 UROLOGY AND RELATED SERVICES
05376062085LEVEL 6 UROLOGY AND RELATED SERVICES
05377062085LEVEL 7 UROLOGY AND RELATED SERVICES
05378082085LEVEL 8 UROLOGY AND RELATED SERVICES
05391062065LEVEL 1 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05392062065LEVEL 2 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05401062085DIALYSIS
05411062085LEVEL 1 GYNECOLOGIC PROCEDURES
05412062085LEVEL 2 GYNECOLOGIC PROCEDURES
05413062085LEVEL 3 GYNECOLOGIC PROCEDURES
05414062085LEVEL 4 GYNECOLOGIC PROCEDURES
05415062085LEVEL 5 GYNECOLOGIC PROCEDURES
05416062085LEVEL 6 GYNECOLOGIC PROCEDURES
05431062085LEVEL 1 NERVE PROCEDURES
05432062085LEVEL 2 NERVE PROCEDURES
05441062085LEVEL 1 NERVE INJECTIONS
05442062085LEVEL 2 NERVE INJECTIONS
05443062085LEVEL 3 NERVE INJECTIONS
05461062085LEVEL 1 NEUROSTIMULATOR AND RELATED PROCEDURES
05462062085LEVEL 2 NEUROSTIMULATOR AND RELATED PROCEDURES
05463062085LEVEL 3 NEUROSTIMULATOR AND RELATED PROCEDURES
05464062085LEVEL 4 NEUROSTIMULATOR AND RELATED PROCEDURES
05465082085LEVEL 5 NEUROSTIMULATOR AND RELATED PROCEDURES
05471062085IMPLANTATION OF DRUG INFUSION DEVICE
05481062085LASER EYE PROCEDURES
05491062085LEVEL 1 INTRAOCULAR PROCEDURES
05492062085LEVEL 2 INTRAOCULAR PROCEDURES
05493062085LEVEL 3 INTRAOCULAR PROCEDURES
05494062085LEVEL 4 INTRAOCULAR PROCEDURES
05495066073LEVEL 5 INTRAOCULAR PROCEDURES
05495078085LEVEL 5 INTRAOCULAR PROCEDURES
05501062085LEVEL 1 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05502062085LEVEL 2 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05503062085LEVEL 3 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05504062085LEVEL 4 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05521062065LEVEL 1 X-RAY AND RELATED SERVICES
05521066085LEVEL 1 IMAGING WITHOUT CONTRAST
05522062065LEVEL 2 X-RAY AND RELATED SERVICES
05522066085LEVEL 2 IMAGING WITHOUT CONTRAST
05523062065LEVEL 3 X-RAY AND RELATED SERVICES
05523066085LEVEL 3 IMAGING WITHOUT CONTRAST
05524062065LEVEL 4 X-RAY AND RELATED SERVICES
05524066085LEVEL 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
05571066085LEVEL 1 IMAGING WITH CONTRAST
05572062065LEVEL 2 COMPUTED TOMOGRAPHY WITH CONTRAST AND COMPUTED TOMOGRAPHY ANGIOGRAPHY
05572066085LEVEL 2 IMAGING WITH CONTRAST
05573066085LEVEL 3 IMAGING WITH CONTRAST
05581062065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST
05582062065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST
05591062085LEVEL 1 NUCLEAR MEDICINE AND RELATED SERVICES
05592062085LEVEL 2 NUCLEAR MEDICINE AND RELATED SERVICES
05593062085LEVEL 3 NUCLEAR MEDICINE AND RELATED SERVICES
05594062085LEVEL 4 NUCLEAR MEDICINE AND RELATED SERVICES
05611062085LEVEL 1 THERAPEUTIC RADIATION TREATMENT PREPARATION
05612062085LEVEL 2 THERAPEUTIC RADIATION TREATMENT PREPARATION
05613062085LEVEL 3 THERAPEUTIC RADIATION TREATMENT PREPARATION
05614062065LEVEL 4 THERAPEUTIC RADIATION TREATMENT PREPARATION
05621062085LEVEL 1 RADIATION THERAPY
05622062085LEVEL 2 RADIATION THERAPY
05623062085LEVEL 3 RADIATION THERAPY
05624062085LEVEL 4 RADIATION THERAPY
05625062085LEVEL 5 RADIATION THERAPY
05626062085LEVEL 6 RADIATION THERAPY
05627062085LEVEL 7 RADIATION THERAPY
05661062085THERAPEUTIC NUCLEAR MEDICINE
05671062085LEVEL 1 PATHOLOGY
05672062085LEVEL 2 PATHOLOGY
05673062085LEVEL 3 PATHOLOGY
05674062085LEVEL 4 PATHOLOGY
05681062065TRANSFUSION LABORATORY PROCEDURES
05691062085LEVEL 1 DRUG ADMINISTRATION
05692062085LEVEL 2 DRUG ADMINISTRATION
05693062085LEVEL 3 DRUG ADMINISTRATION
05694062085LEVEL 4 DRUG ADMINISTRATION
05695062065LEVEL 5 DRUG ADMINISTRATION
05701062065DOSIMETRIC DRUG ADMINISTRATION
05721062079LEVEL1 DIAGNOSTIC TESTS AND RELATED SERVICES
05721080085LEVEL 1 DIAGNOSTIC TESTS AND RELATED SERVICES
05722062085LEVEL 2 DIAGNOSTIC TESTS AND RELATED SERVICES
05723062085LEVEL 3 DIAGNOSTIC TESTS AND RELATED SERVICES
05724062085LEVEL 4 DIAGNOSTIC TESTS AND RELATED SERVICES
05731062085LEVEL 1 MINOR PROCEDURES
05732062085LEVEL 2 MINOR PROCEDURES
05733062085LEVEL 3 MINOR PROCEDURES
05734062085LEVEL 4 MINOR PROCEDURES
05735066085LEVEL 5 MINOR PROCEDURES
05741062085LEVEL 1 ELECTRONIC ANALYSIS OF DEVICES
05742062085LEVEL 2 ELECTRONIC ANALYSIS OF DEVICES
05743062085LEVEL 3 ELECTRONIC ANALYSIS OF DEVICES
05771062085CARDIAC REHABILITATION
05781062085RESUSCITATION AND CARDIOVERSION
05791062085PULMONARY TREATMENT
05801062085VENTILATION INITIATION AND MANAGEMENT
05811062085MANIPULATION THERAPY
05821062085LEVEL 1 HEALTH AND BEHAVIOR SERVICES
05822062085LEVEL 2 HEALTH AND BEHAVIOR SERVICES
05823066085LEVEL 3 HEALTH AND BEHAVIOR SERVICES
05841062065PSYCHOTHERAPY
05851062065LEVEL 1 PARTIAL HOSPITALIZATION (3 SERVICES) FOR CMHCS
05852062065LEVEL 2 PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR CMHCS
05853066085PARTIAL 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
05863066085PARTIAL HOSPITALIZATION (3 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
05871062085DENTAL PROCEDURES
05881062085ANCILLARY OUTPATIENT SERVICES WHEN PATIENT DIES
06073080085PAYER ONLY APC FOR TESTING
06075080085PAYER ONLY APC FOR TESTING
06077080085PAYER ONLY APC FOR TESTING
06079080085PAYER ONLY APC FOR TESTING
06081080085PAYER ONLY APC FOR TESTING
06083080085PAYER ONLY APC FOR TESTING
06085080085PAYER ONLY APC FOR TESTING
06087080085PAYER ONLY APC FOR TESTING
06089080085PAYER ONLY APC FOR TESTING
06091080085PAYER ONLY APC FOR TESTING
06093080085PAYER ONLY APC FOR TESTING
06095080085PAYER ONLY APC FOR TESTING
06097080085PAYER ONLY APC FOR TESTING
06099080085PAYER ONLY APC FOR TESTING
06101080085PAYER ONLY APC FOR TESTING
06103080085PAYER ONLY APC FOR TESTING
06105080085PAYER ONLY APC FOR TESTING
07000058085AMIFOSTINE
07011058081OPRELVEKIN INJECTION
07034058073SOMATROPIN INJECTION
07035058085TENIPOSIDE
07041058085TIROFIBAN HCL
07042058065CAPECITABINE, ORAL
07043058065INFLIXIMAB INJECTION
07043066085INFLIXIMAB NOT BIOSIMIL 10MG
07046058085DOXORUBICIN INJ 10MG
07048058085ALTEPLASE RECOMBINANT
07308058085AMINOLEVULINIC ACID HCL TOP
08001058069LDR PROSTATE BRACHYTHERAPY COMPOSITE
08004058085ULTRASOUND COMPOSITE
08005058085CT AND CTA WITHOUT CONTRAST COMPOSITE
08006058085CT AND CTA WITH CONTRAST COMPOSITE
08007058085MRI AND MRA WITHOUT CONTRAST COMPOSITE
08008058085MRI AND MRA WITH CONTRAST COMPOSITE
08009058061EXTENDED ASSESSMENT & MANAGEMENT COMPOSITE
08010062085MENTAL HEALTH SERVICES COMPOSITE
08011062085COMPREHENSIVE OBSERVATION SERVICES
09001058065LINEZOLID INJECTION
09002058085TENECTEPLASE INJECTION
09003058085PALIVIZUMAB
09005058077RETEPLASE INJECTION
09005082085RETEPLASE INJECTION
09006058085TACROLIMUS INJECTION
09012058085ARSENIC TRIOXIDE INJECTION
09014070073INJECTION, CERLIPONASE ALFA
09014074081INJ., CERLIPONASE ALFA 1 MG
09015070073C-1 ESTERASE, HAEGARDA
09015074085INJ., HAEGARDA 10 UNITS
09016070073INJ, TRIPTORELIN EXT REL
09016074085INJ., TRIPTORELIN XR 3.75 MG
09018058085INJ, RIMABOTULINUMTOXINB
09019058077CASPOFUNGIN ACETATE
09024058085AMPHOTERICIN B LIPID COMPLEX
09028070073INJ. INOTUZUMAB OZOGAMICIN
09028074085INJ INOTUZUMAB OZOGAM 0.1 MG
09029070073INJECTION, GUSELKUMAB
09029074085INJ., GUSELKUMAB, 1 MG
09030072073INJ COPANLISIB
09030074085INJ., COPANLISIB, 1 MG
09031070081INJ, ETELCALCETIDE, 0.1 MG
09032058085BACLOFEN 10 MG INJECTION
09033058085CIDOFOVIR INJECTION
09034070085INJ CUVITRU, 100 MG
09035071085AXICABTAGENE CILOLEUCEL CAR+
09036071085INJECTION, RENFLEXIS
09038058085INJ ESTROGEN CONJUGATE
09042058085GLUCAGON HYDROCHLORIDE
09043066069AFSTYLA FACTOR VIII RECOMB
09043070085INJ, AFSTYLA, 1 I.U.
09044058085IBUTILIDE FUMARATE INJECTION
09052066077FLUCICIOVINE F-18
09056066077GALLIUM GA-68
09058066085BUPRENORPHINE IMPLANT 74.2MG
09059066085VONVENDI INJ 1 IU VWF:RCO
09060066069DIAZOXIDE INJECTION
09061066069INJ MILRINONE LACTATE / 5 MG
09062066069TOPOTECAN INJECTION
09063082085RH IG MINIDOSE IM
09064070073ARIPIPRAZOLE INJECTION
09065070085ARGATROBAN ESRD DIALYSIS 1MG
09066070073INJ DIHYDROERGOTAMINE MESYLT
09067072073LUTETIUM LU 177 DOTATATE, TX
09067074085LUTETIUM LU 177 DOTATAT THER
09069082085PHENOBARBITAL SODIUM INJ
09070072072VORETIGNE NEPARVOVEC-RZYL
09070073073VORETIGENE NEPARVOVEC-RZYL
09070074085INJ LUXTURNA 1 BILLION VEC G
09071070085CAPSAICIN 8% PATCH
09072070073FOSPHENYTOIN INJ PE
09073072085BUPRENORPH XR 100 MG OR LESS
09074068069INJ, MAKENA
09074070085MAKENA, 10 MG
09075070077INJ, KOVALTRY, 1 I.U.
09075082085INJ, KOVALTRY, 1 I.U.
09076070073DIMECAPROL INJECTION
09077070073EPOETIN BETA NON ESRD
09077082085EPOETIN BETA NON ESRD
09078070085TESTOSTERONE UNDECANOATE 1MG
09079070085GENVISC 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
09088074085PENG BENZATHINE/PROCAINE INJ
09089074077ORAL FLUDARABINE PHOSPHATE
09090074077MELPHALAN ORAL 2 MG
09091074077DAUNORUBICIN CITRATE INJ
09092074081INTERFERON ALFA-2A INJ
09093074077PLICAMYCIN (MITHRAMYCIN) INJ
09093082085PLICAMYCIN (MITHRAMYCIN) INJ
09094074085RADIESSE INJECTION
09095074085INJ, SCULPTRA, 0.5MG
09096072073INJ RETACRIT ESRD ON DIALYSI
09096074084INJ RETACRIT ESRD ON DIALYSI
09097072073INJ RETACRIT NON-ESRD USE
09097074085INJ RETACRIT NON-ESRD USE
09098074077CHORIONIC GONADOTROPIN/1000U
09099073073INJ, AKYNZEO
09099074085INJ FOSNETUPITANT, PALONOSET
09104058085ANTITHYMOCYTE GLOBULN RABBIT
09108058085THYROTROPIN INJECTION
09119058085INJECTION, PEGFILGRASTIM 6MG
09120058085INJECTION, FULVESTRANT
09121058065INJECTION, ARGATROBAN
09122058085TRIPTORELIN PAMOATE
09124058081DAPTOMYCIN INJECTION
09125058076RISPERIDONE, LONG ACTING
09125077077INJ., RISPERDAL CONSTA, 0.5 MG
09125078081RISPERIDONE, LONG ACTING
09125082085INJ RISPERDAL CONSTA, 0.5 MG
09126058085NATALIZUMAB INJECTION
09130058077INJ, IMM GLOB BIVIGAM, 500MG
09130082085INJ, IMM GLOB BIVIGAM, 500MG
09131058085INJ, ADO-TRASTUZUMAB EMT 1MG
09132058083KCENTRA, PER I.U.
09132084085PROTHROMBIN COMPLEX KCENTRA
09133058085RABIES IG, IM/SC
09134058085RABIES IG, HEAT TREATED
09135058085VARICELLA-ZOSTER IG, IM
09137058065BCG VACCINE, PERCUT
09139058085RABIES VACCINE, IM
09140058085RABIES VACCINE, ID
09143058065MENINGOCOCCAL VACCINE, SC
09144058061ENCEPHALITIS VACCINE, SC
09171065065IDELVION, 1 I.U.
09171066085FACTOR IX IDELVION INJ
09172073085INJECTION, DEXAMETHASONE 9%
09173072085INJECTION, FULPHILA
09174074085INJ, DUROLANE 1 MG
09175074080PURAPLY 1 SQ CM
09176074080PURAPLY AM 1 SQ CM
09177074081ANTITHROMBIN RECOMBINANT
09178074085INJ., MEROPENEM, VABORBACTAM
09179074076INJECTION, ARISTADA INITIO
09179077077INJ., ARISTADA INITIO, 1 MG
09179078085INJECTION, ARISTADA INITIO
09180074076INJECTION, PATISIRAN
09180077085INJ., PATISIRAN, 0.1 MG
09181074076INJECTION, RISPERIDONE
09181077085INJ., PERSERIS, 0.5 MG
09182074076INJ MOGAMULIZUMAB-KPKC
09182077077INJ, MOGAMULIZUMAB-KPKC, 1 MG
09182078085INJ MOGAMULIZUMAB-KPKC, 1 MG
09183074076INJECTION, PLAZOMICIN
09183077085INJ., PLAZOMICIN, 5 MG
09184074077IODINE I-131 IOBENGUANE, DX
09185074077IODINE I-131 IOBENGUANE, TX
09186074085INJ., RITUXIMAB, 10 MG
09187074085INJECTION, BUROSUMAB-TWZA 1M
09188074085INJ CROTALIDAE IM F(AB')2 EQ
09189074085INJ., IBALIZUMAB-UIYK, 10 MG
09190074081INJ., VESTRONIDASE ALFA-VJBK
09191074081INJ., FIBRYGA, 1 MG
09192074085INJ, BORTEZOMIB, NOS, 0.1 MG
09193073085NIVESTYM
09194074085TISAGENLECLEUCEL CAR-POS T
09195074085INJECTION, UDENYCA 0.5 MG
09196074085INJ, TRIVISC 1 MG
09197075076INJECTION, FREMANEZUMAB-VFRM
09197077085INJ., FREMANEZUMAB-VFRM 1 MG
09198075079INJ, COAGULATION FACTOR XA
09198080085INJ ANDEXXA, 10 MG
09199076085INJECTION, CAPLACIZUMAB-YHDP
09207058073BORTEZOMIB INJECTION
09207074085INJ., VELCADE 0.1 MG
09208058085AGALSIDASE BETA INJECTION
09209058085LARONIDASE INJECTION
09210058077PALONOSETRON HCL
09213058080PEMETREXED INJECTION
09213081085INJ. PEMETREXED NOS 10MG
09214058085BEVACIZUMAB INJECTION
09215058085CETUXIMAB INJECTION
09217058085LEUPROLIDE ACETATE SUSPNSION
09224058085GALSULFASE INJECTION
09225058076FLUOCINOLONE ACETONIDE IMPLT
09225077077INJ., RETISERT, 0.01 MG
09225078081FLUOCINOLONE ACETONIDE IMPLT
09225082085INJ., RETISERT, 0.01 MG
09227058061MICAFUNGIN SODIUM INJECTION
09227082085MICAFUNGIN SODIUM INJECTION
09228058085TIGECYCLINE INJECTION
09229058085IBANDRONATE SODIUM INJECTION
09230058085ABATACEPT INJECTION
09231058085DECITABINE INJECTION
09232058081IDURSULFASE INJECTION
09233058085RANIBIZUMAB INJECTION
09234058085ALGLUCOSIDASE ALFA INJECTION
09235058085PANITUMUMAB INJECTION
09236058085ECULIZUMAB INJECTION
09237058085INJ, LANREOTIDE ACETATE
09239072085BUPRENORPHINE XR OVER 100 MG
09240058085INJECTION, IXABEPILONE
09242058085INJECTION, FOSAPREPITANT
09243058065BENDAMUSTINE INJECTION
09243066085INJ., TREANDA 1 MG
09245058085ROMIPLOSTIM INJECTION
09248058069INJ, CLEVIDIPINE BUTYRATE
09251058085C1 ESTERASE INHIBITOR INJ
09252058085PLERIXAFOR INJECTION
09253058085TEMOZOLOMIDE INJECTION
09255058085PALIPERIDONE PALMITATE INJ
09256058085DEXAMETHASONE INTRA IMPLANT
09257072073INJ. EMICIZUMAB-KXWH, 0.5 MG
09257074085INJ., EMICIZUMAB-KXWH 0.5 MG
09258058085TELAVANCIN INJECTION
09259058085PRALATREXATE INJECTION
09260058085OFATUMUMAB INJECTION
09261058065USTEKINUMAB INJECTION
09261066085USTEKINUMAB SUB CU INJ, 1 MG
09263058085ECALLANTIDE INJECTION
09264058085TOCILIZUMAB INJECTION
09265058084ROMIDEPSIN INJECTION
09269058085C-1 ESTERASE, BERINERT
09270058085GAMMAPLEX IVIG
09271058085VELAGLUCERASE ALFA
09272058085INJ, DENOSUMAB
09273058085SIPULEUCEL-T AUTO CD54+
09274058085CROTALIDAE POLY IMMUNE FAB
09276058085CABAZITAXEL INJECTION
09278058085INCOBOTULINUMTOXIN A
09281058085INJECTION, PEGLOTICASE
09284058085IPILIMUMAB INJECTION
09286058085BELATACEPT INJECTION
09287058085BRENTUXIMAB VEDOTIN INJ
09289058085ERWINAZE INJECTION
09293058077INJECTION, GLUCARPIDASE
09294058069INJ, TALIGLUCERACE ALFA 10 U
09294070085INJ, TALIGLUCERASE ALFA 10 U
09295058085INJECTION, CARFILZOMIB, 1 MG
09296058085INJ, ZIV-AFLIBERCEPT, 1MG
09297058085INJ, OMACETAXINE MEP, 0.01MG
09298058085INJ, OCRIPLASMIN, 0.125 MG
09299075075FACTOR VIII PEGYLATED-AUCL
09299076085INJ. JIVI 1 IU
09300058085OMALIZUMAB INJECTION
09301070085AMINOLEVULINIC ACID, 10% GEL
09302070073INJ, DAUNORUBICIN-CYTARABINE
09302074085INJ DAUNORUBICIN, CYTARABINE
09303075077INJECTION, LEVOLEUCOVORIN
09304075075INJECTION, CEMIPLIMAB
09304076076INJECTION, CEMIPLIMAB-RWLC
09304077085INJ., CEMIPLIMAB-RWLC, 1 MG
09305075076MOXETUMOMAB PASUDOTOX-TDFK
09305077085INJ., LUMOXITI, 0.01 MG
09306075085INJ., TILDRAKIZUMAB, 1 MG
09307075085COCAINE HCL NASAL SOLUTION
09308076076DEXAMETHASONE OPHTH INSERT
09308077085DEXAMETHA OPTH INSERT 0.1 MG
09309076076INJECTION, TAGRAXOFUSP-ERZS
09309077085INJ. TAGRAXOFUSP-ERZS 10 MCG
09310076076INJECTION, EMAPALUMAB-LZSG
09310077085INJ., EMAPALUMAB-LZSG, 1 MG
09311076076INJECTION, OMADACYCLINE
09311077085INJ., OMADACYCLINE, 1 MG
09312076076INJECTION, RAVULIZUMAB-CWV
09312077085INJ., RAVULIZUMAB-CWVZ 10 MG
09313075075INJ., BELRAPZO 1 MG
09313076085INJ. BELRAPZO/BENDAMUSTINE
09314076085INJ. HERCEPTIN HYLECTA, 10MG
09315078081DIPHTHERIA ANTITOXIN
09316078081CORTICOTROPIN INJECTION
09317078081DORIPENEM INJECTION
09318078085INJ HYDROXYPROGST CAPOAT NOS
09319078085SOMATROPIN INJECTION
09320078085CARBIDOPA LEVODOPA ENT 100ML
09321078081FOSPHENYTOIN INJ PE
09322076081BCG LIVE INTRAVESICAL 1MG
09323081085GALLIUM GA-68 DOTATOC
09324077080PHENYLEP KETOROLAC OPTH SOLN
09325077081INJ., ERAVACYCLINE, 1 MG
09326077081INJ., LANADELUMAB-FLYO, 1 MG
09327077085INJ. ROMOSOZUMAB-AQQG 1 MG
09328077085INJ., YUTIQ, 0.01 MG
09329076085INJ MVASI 10 MG
09330077085INJ., KANJINTI, 10 MG
09331078085INJ, POLATUZUMAB VEDOTIN 1MG
09332078079INJECTION, LEFAMULIN
09332080085INJ LEFAMULIN 1 MG
09333078080INJ, BREXANOLONE
09333081085INJ., BREXANOLONE, 1 MG
09334078085INJECTION, KHAPZORY, 0.5 MG
09335078081ORAL BUSULFAN
09336077085INJ TRUXIMA 10 MG
09337078085SYNOJOYNT, INJ., 1 MG
09338078081INJ., TRILURON, 1 MG
09339078085IODINE I-131 IOBENGUANE 1MCI
09340078085INJ, BROLUCIZUMAB-DBLL, 1 MG
09341077085INJ OGIVRI 10 MG
09342079079INJ, CRIZANLIZUMAB-TMCA
09343079079INJECTION, GIVOSIRAN
09343080085INJ GIVOSIRAN 0.5 MG
09344079079INJ CETIRIZINE HYDROCHLORIDE
09345077085INJ PEGFILGRASTIM-BMEZ 0.5MG
09346080082MOMETASONE FUROATE (SINUVA)
09346083085MOMETASONE SINUS SINUVA
09347080085INJ LUSPATERCEPT-AAMT 0.25MG
09348078085INJ., ZIRABEV, 10 MG
09349078085INJ HERZUMA 10 MG
09350078085INJ., TRAZIMERA, 10 MG
09351081081INJ BIMATOPROST ITC IMP 1MCG
09351082085INJ BIMATOPROST ITC IMP1MCG
09352082085CHLOROQUINE INJECTION
09353080085INJ FAM-TRASTU DERU-NXKI 1MG
09354080085INJ RECOMBIN ESPEROCT PER IU
09355080080INJECTION, TEPROTUMUMAB-TRBW
09355081085INJ. TEPROTUMUMAB-TRBW 10 MG
09356080085INJ GOLODIRSEN 10 MG
09357080080INJECTION, EPTINEZUMAB-JJMR
09357081085INJ. EPTINEZUMAB-JJMR 1 MG
09359080085INJ CRIZANLIZUMAB-TMCA 5MG
09361080085INJ. CETIRIZINE HCL 0.5MG
09362080085INJ IMIP 4 CILAS 4 RELEB 2MG
09364080085INJ ENFORT VEDO-EJFV 0.25MG
09367078085INJ RUXIENCE, 10 MG
09370081081FLUOROESTRADIOL F18
09370082085FLUOROESTRADIOL F 18
09371080080INJECTION, MELOXICAM
09371081085INJ. MELOXICAM 1 MG
09372080085INJ. XEMBIFY, 100 MG
09373080083INJ ONASE ABEPAR-XIOI TREAT
09374081081MITOMYCIN PYELOCALYCEAL INST
09374082085MITOMYCIN INSTILLATION
09375080085INJ., EVOMELA, 1 MG
09376081085SACITUZUMAB GOVITECAN-HZIY
09377081085INJ. ISATUXIMAB-IRFC 10 MG
09378081081DARATUMUMAB HYALURONIDASE
09378082085DARATUMUMAB, HYALURONIDASE
09379081084ROMIDEPSIN NON-LYOPHILIZED
09380082084INJ., CEFIDEROCOL, 5 MG
09381080085INJ. AVSOLA, 10 MG
09382079085INJ ONTRUZANT 10 MG
09383082082COPPER CU-64, DOTATATE, DX
09383083085COPPER CU 64 DOTATATE DIAG
09384082082BELANTAMAB MAFODONTIN-BLMF
09384083085INJ BELANTAMAB MAFODONT BLMF
09385082082INJECTION, TAFASITAMAB-CXIX
09385083085INJ., TAFASITAMAB-CXIX
09386082082INJECTION, VILTOLARSEN
09386083085INJ. VILTOLARSEN
09387082085INJ. INFUGEM, 100 MG
09388081085INJ. FE DERISOMALTOSE 10 MG
09389082085INJ. LURBINECTEDIN, 0.1 MG
09390082085PERTUZU, TRASTUZU, 10 MG
09391082082BREXUCABTAGENE AUTOLEUCEL CA
09391083085BREXUCABTAGENE CAR POS T
09392082082INJ, IMM GLOB ASCENIV
09392083085INJ. ASCENIV
09393082085INJ CODEINE PHOSPHATE /30 MG
09394082085INJ. INEBILIZUMAB-CDON, 1 MG
09395082085FACTOR VIIA RECOMB SEVENFACT
09396082085AFAMELANOTIDE IMPLANT, 1 MG
09397083085COVID-19 VACCINE ADMINISTRATION DOSE 1 OF 2
09398083083COVID-19 VACCINE ADMINISTRATION DOSE 2 OF 2 OR SINGLE DOSE PRODUCT
09398084085COVID-19 VACCINE ADMIN DOSE 2 OF 2, SINGLE DOSE PRODUCT OR ADDITIONAL DOSE
09406082085INJ, NYVEPRIA
09407083083INJECTION, LUMASIRAN
09407084085INJ. LUMASIRAN, 0.5 MG
09408084085INJ. NAXITAMAB-GQGK, 1 MG
09409084085GALLIUM GA-68 PSMA-11 UCSF
09410084085GALLIUM GA-68 PSMA-11, UCLA
09411084085INJ. RIABNI, 10 MG
09412084085INJECTION, CASIMERSEN, 10 MG
09413084085LISOCABTAGENE CAR POS T
09414084084INJ CABOTEGRAVIR/RILPIVIRINE
09414085085INJ, CABOTE RILPIVIR 2MG 3MG
09415084084INJ, TRILACICLIB, 1 MG
09415085085INJECTION, TRILACICLIB, 1MG
09416084084INJ, EVINACUMAB-DGNB, 5 MG
09416085085INJ, EVINACUMAB-DGNB, 5MG
09417084084INJ, MELPHALAN FLUFEN, 1 MG
09417085085INJ, MELPHALAN FLUFENAMI 1MG
09418084085INJ. MARGETUXIMAB-CMKB, 5 MG
09419084085INJ FENSOLVI 0.25 MG
09422085085IDECABTAGENE CAR POS T
09423085085INJ DOSTARLIMAB-GXLY, 100 MG
09424085085INJ, AMIVANTAMAB-VMJW, 10 MG
09425085085LONCASTUXIMAB-LPYL, 0.1 MG
09426085085INJ, CEFIDEROCOL, 10 MG
09427085085INJECTION, ORITAVANCIN 10 MG
09428085085INJ ROMIDEPSIN NON-LYO 0.1MG
09429085085INJ ROMIDEPSIN LYOPHIL 0.1MG
09441058085INJ FERRIC CARBOXYMALTOS 1MG
09445059061C-1 ESTERASE, RUCONEST
09445062085INJECTION, RUCONEST
09448059059ORAL NETUPITANT PALONOSETRON
09448060061NETUPITANT PALONOSETRON ORAL
09448062073NETUPITANT PALONOSETRON ORAL
09448074085ORAL NETUPITANT, PALONOSETRO
09449059061INJ, BLINATUMOMAB
09449062085INJECTION, BLINATUMOMAB
09450059061FLUOCINOLONE ACETONIDE IMPLT
09450062076FLUOCINOL ACET INTRAVIT IMP
09450077077INJ., ILUVIEN, 0.01 MG
09450078081FLUOCINOL ACET INTRAVIT IMP
09450082085INJ., ILUVIEN, 0.01 MG
09451059085INJECTION, PERAMIVIR
09452059061INJ, CEFTOLOZANE/TAZOBACTAM
09452062085INJ CEFTOLOZANE TAZOBACTAM
09453060085INJECTION, NIVOLUMAB
09454060085INJ, PASIREOTIDE LONG ACTING
09455060085INJECTION, SILTUXIMAB
09456061061INJ, ISAVUCONAZONIUM SULFATE
09456062085INJECTION, 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
09460062085INJECTION, CANGRELOR
09461063065CHOLINE C 11, DIAGNOSTIC
09461066073CHOLINE C-11, DIAGNOSTIC, PER STUDY DOSE UP TO 20 MILLICURIES
09462071085INJECTION, DELAFLOXACIN
09463071073INJECTION, APREPITANT
09463074085INJ., APREPITANT, 1 MG
09464071073INJECTION, ROLAPITANT
09464074080INJ., ROLAPITANT, 0.5 MG
09465071073INJECTION, DUROLANE
09466071073INJECTION, BENRALIZUMAB
09466074085INJ., BENRALIZUMAB, 1 MG
09467071073INJ RITUXIMAB HYALURONIDASE
09467074085INJ RITUXIMAB, HYALURONIDASE
09468071073INJ, FACTOR IX, REBINYN
09468074085FACTOR IX RECOMB GLY REBINYN
09469071071INJ TRIAMCINOLONE ACETONIDE
09469072073INJ., TRIAMCINOLONE EXT REL
09469074085INJ TRIAMCINOLONE ACE XR 1MG
09470063065ARIPIPRAZOLE LAUROXIL IM
09470066076ARIPIPRAZOLE LAUROXIL 1MG
09470077085ARIPIRAZOLE LAUROXIL 1 MG
09471063065HYMOVIS, 1 MG
09471066085HYMOVIS INJECTION 1 MG
09472063085INJ TALIMOGENE LAHERPAREPVEC
09473063065INJECTION, MEPOLIZUMAB
09473066085INJECTION, MEPOLIZUMAB, 1MG
09474063065INJ, IRINOTECAN LIPOSOME
09474066085INJ IRINOTECAN LIPOSOME 1 MG
09475063065INJECTION, NECITUMUMAB
09475066085INJECTION, NECITUMUMAB, 1 MG
09476064065INJECTION, DARATUMUMAB
09476066085INJECTION, DARATUMUMAB 10 MG
09477064065INJECTION, ELOTUZUMAB
09477066085INJECTION, ELOTUZUMAB, 1MG
09478064065INJECTION, SEBELIPASE ALFA
09478066085INJ SEBELIPASE ALFA 1 MG
09479064085INSTILL, CIPROFLOXACIN OTIC
09480064065INJECTION, TRABECTEDIN
09480066085INJECTION TRABECTEDIN 0.1MG
09481065085INJECTION, RESLIZUMAB
09482065085SOTALOL HYDROCHLORIDE IV
09483065069INJECTION, ATEZOLIZUMAB
09483070085INJ, ATEZOLIZUMAB,10 MG
09484067069INJECTION, ETEPLIRSEN
09484070081INJ, ETEPLIRSEN, 10 MG
09485067069INJECTION, OLARATUMAB
09485070085INJ, OLARATUMAB, 10 MG
09486067069INJ, GRANISETRON EXT
09486070078INJ, GRANISETRON, XR, 0.1 MG
09487067067USTEKINUMAB IV INJ, 1 MG
09487068069USTEKINUMAB IV INJ, 1 MG
09487070085USTEKINUMAB, IV INJECT,1 MG
09488067069CONIVAPTAN HCL
09488070085CONIVAPTAN HCL
09489068069INJECTION, NUSINERSEN
09489070085INJ, NUSINERSEN, 0.1MG
09490068069INJECTION, BEZLOTOXUMAB
09490070085INJ, BEZLOTOXUMAB, 10 MG
09491069069INJECTION, AVELUMAB
09491070085INJECTION, AVELUMAB, 10 MG
09492069073INJECTION, DURVALUMAB
09492074085INJ., DURVALUMAB, 10 MG
09493069073INJECTION, EDARAVONE
09493074085INJECTION, EDARAVONE, 1 MG
09494069085INJECTION, OCRELIZUMAB
09495070085GEMTUZUMAB OZOGAMICIN INJ
09497058073LOXAPINE, INHALATION POWDER
09497074077LOXAPINE FOR INHALATION 1 MG
09500058085PLATELETS, IRRADIATED
09501058085PLATELET PHERES LEUKOREDUCED
09502058085PLATELET PHERESIS IRRADIATED
09503058085FR FRZ PLASMA DONOR RETESTED
09504058085RBC DEGLYCEROLIZED
09505058085RBC IRRADIATED
09506058065GRANULOCYTES, PHERESIS UNIT
09507058085PLATELETS, PHERESIS
09508058085PLASMA 1 DONOR FRZ W/IN 8 HR
09509062085FROZEN PLASMA, POOLED, SD
09510062085WHOLE BLOOD FOR TRANSFUSION
09511062085CRYOPRECIPITATE EACH UNIT
09512062085RBC LEUKOCYTES REDUCED
09513062085PLASMA, FRZ BETWEEN 8-24HOUR
09514062085PLASMA PROTEIN FRACT,5%,50ML
09515062085PLATELETS, EACH UNIT
09516062085PLAELET RICH PLASMA UNIT
09517062085RED BLOOD CELLS UNIT
09518062085WASHED RED BLOOD CELLS UNIT
09519062085PLASMAPROTEIN FRACT,5%,250ML
09520062085BLOOD SPLIT UNIT
09521062085PLATELETS LEUKOREDUCED IRRAD
09522062085RBC LEUKOREDUCED IRRADIATED
09523062085CRYOPRECIPITATEREDUCEDPLASMA
09524062085BLOOD, L/R, CMV-NEG
09525062085PLATELETS, HLA-M, L/R, UNIT
09526062085PLATELETS LEUKOCYTES REDUCED
09527062085BLOOD, L/R, FROZ/DEGLY/WASH
09528062085PLT, APH/PHER, L/R, CMV-NEG
09529062085BLOOD, L/R, IRRADIATED
09530062085PLATE PHERES LEUKOREDU IRRAD
09531062085PLT, PHER, L/R CMV-NEG, IRR
09532062085RBC, FRZ/DEG/WSH, L/R, IRRAD
09533062085RBC, L/R, CMV-NEG, IRRAD
09534062085PATHOGEN REDUCED PLASMA POOL
09535062085PATHOGEN REDUCED PLASMA SING
09536062067PATHOGEN REDUCED PLATELETS
09536068069PLATELETS PHERESIS PATH REDUC
09536070073PLATELETS, PATHOGEN REDUCED
09536074085PLATELETS PHERESIS PATH REDU
09537082085BLOOD COMPONENT/PRODUCT NOC
09538085085PLASMA CRYO REDU PATH EACH
09539085085CRYO FIB COMP PATH REDU EACH
