00701063090SR89 STRONTIUM
00726063090DEXRAZOXANE HCL INJECTION
00731063090SARGRAMOSTIM INJECTION
00736063090AMPHOTERICIN B LIPOSOME INJ
00738063090RASBURICASE
00747063069CHLOROTHIAZIDE SODIUM INJ
00751063089MECHLORETHAMINE HCL INJ
00752063090DACTINOMYCIN INJECTION
00759063090NALTREXONE, DEPOT FORM
00800063090LEUPROLIDE ACETATE
00802063090ETOPOSIDE ORAL
00807063090ALDESLEUKIN INJECTION
00809063075BCG LIVE INTRAVESICAL VAC
00810063090GOSERELIN ACETATE IMPLANT
00812063090CARMUSTINE INJECTION
00820063090DAUNORUBICIN INJECTION
00821063069DAUNORUBICIN CITRATE INJ
00823063081DOCETAXEL INJECTION
00825063090NELARABINE INJECTION
00827063069FLOXURIDINE INJECTION
00831063069IFOSFAMIDE INJECTION
00832063073IDARUBICIN HCL INJECTION
00835063065COSYNTROPIN INJECTION NOS
00836063090INTERFERON ALFA-2B INJ
00838063071INTERFERON GAMMA 1-B INJ
00840063079INJ MELPHALAN HYDROCHL
00840080090INJ MELPHA HYDROCH NOS 50 MG
00843063090PEGASPARGASE INJECTION
00844063090PENTOSTATIN INJECTION
00849063073RITUXIMAB INJECTION
00850063090STREPTOZOCIN INJECTION
00851063090THIOTEPA INJECTION
00856063090PORFIMER SODIUM INJECTION
00858063090INJ CLADRIBINE
00864063090MITOXANTRONE HYDROCHL
00868063073ORAL APREPITANT
00873063069HYALGAN/SUPARTZ INJ PER DOSE
00873070077HYALGAN SUPARTZ VISCO-3 DOSE
00874063090SYNVISC OR SYNVISC-ONE
00875063090EUFLEXXA INJ PER DOSE
00877063090ORTHOVISC INJ PER DOSE
00887063090AZATHIOPRINE PARENTERAL
00890063090LYMPHOCYTE IMMUNE GLOBULIN
00901063090ALPHA 1 PROTEINASE INHIBITOR
00902063090INJECTION,ONABOTULINUMTOXINA
00903063090CYTOMEGALOVIRUS IMM IV /VIAL
00910063089INTERFERON BETA-1B / .25 MG
00913063069GANCICLOVIR LONG ACT IMPLANT
00925063090FACTOR VIII
00927063090FACTOR VIII RECOMBINANT
00928063090FACTOR IX COMPLEX
00929063090ANTI-INHIBITOR
00931063090FACTOR IX NON-RECOMBINANT
00932063090FACTOR IX RECOMBINANT NOS
00934063065CAPECITABINE, ORAL
00943063090OCTAGAM INJECTION
00944063090GAMMAGARD LIQUID INJECTION
00946063090HEPAGAM B IM INJECTION
00947063090FLEBOGAMMA INJECTION
00948063090GAMUNEX-C/GAMMAKED
00961063090ALBUMIN (HUMAN),5%, 50ML
00963063090ALBUMIN (HUMAN), 5%, 250 ML
00964063090ALBUMIN (HUMAN), 25%, 20 ML
00965063090ALBUMIN (HUMAN), 25%, 50ML
01015063090INJECTION GLATIRAMER ACETATE
01052063073INJECTION, VORICONAZOLE
01064063090I131 IODIDE CAP, RX
01083063090ADALIMUMAB INJECTION
01086063069TEMOZOLOMIDE
01138063090HEPAGAM B INTRAVENOUS, INJ
01139063090PROTEIN C CONCENTRATE
01142063089SUPPRELIN LA IMPLANT
01150063090I131 IODIDE SOL, RX
01166063081CYTARABINE LIPOSOME INJ
01168063090INJ, TEMSIROLIMUS
01178063090BUSULFAN INJECTION
01203063090VERTEPORFIN INJECTION
01207063090OCTREOTIDE INJECTION, DEPOT
01213063090ANTIHEMOPHILIC VIII/VWF COMP
01214063090INJ IVIG PRIVIGEN 500 MG
01232063090MITOMYCIN INJECTION
01235063090VALRUBICIN INJECTION
01236063076LEVOLEUCOVORIN INJECTION
01236077085INJ LEVOLEUCOVORIN NOS 0.5MG
01236090090INJ LEVOLEUCOVORIN NOS 0.5MG
01237063090INJ IRON DEXTRAN
01238063073TOPOTECAN ORAL
01253063077TRIAMCINOLONE A INJ PRS-FREE
01263063090ANTITHROMBIN III INJECTION
01268063090XYNTHA INJ
01272063065ACETYLCYSTEINE INJECTION
01274063090EDETATE CALCIUM DISODIUM INJ
01280063073CORTICOTROPIN INJECTION
01281063090BEVACIZUMAB INJECTION
01289063090ABOBOTULINUMTOXINA
01291063073RILONACEPT INJECTION
01295063090SM 153 LEXIDRONAM
01296063090DEGARELIX INJECTION
01297063090FERUMOXYTOL, NON-ESRD
01311063090CANAKINUMAB INJECTION
01312063090HIZENTRA INJECTION
01327063090IMIGLUCERASE INJECTION
01331063069OLANZAPINE LONG-ACTING INJ
01331082089OLANZAPINE LONG-ACTING INJ
01332063069ANTITHROMBIN RECOMBINANT
01338063069METHYL AMINOLEVULINATE, TOP
01340063090COLLAGENASE, CLOST HIST INJ
01341063090AMOBARBITAL 125 MG INJ
01352063090WILATE INJECTION
01353063090BELIMUMAB INJECTION
01354063067HYDROXYPROGESTERONE CAPROATE
01356063065ZOLEDRONIC ACID 1MG
01361063069ENFUVIRTIDE INJECTION
01408063090CYCLOPHOSPHAMIDE 100 MG INJ
01413063090LUMIZYME INJECTION
01415063090GLASSIA INJECTION
01416063089FACTOR XIII ANTI-HEM FACTOR
01417063090GEL-ONE
01420063090AFLIBERCEPT INJECTION
01421063071IMPORTED LIPODOX INJ
01421074090IMPORTED LIPODOX INJ
01424063069NABILONE ORAL
01426063090ERIBULIN MESYLATE INJECTION
01431063090CENTRUROIDES IMMUNE F(AB)
01433063090CALCITONIN SALMON INJECTION
01440063090INJ DESMOPRESSIN ACETATE
01442063090NON-HEU TC-99M ADD-ON/DOSE
01443063090ICATIBANT INJECTION
01446063090VISUALIZATION ADJUNCT
01457063069TOTAZOLINE HCL INJECTION
01458063090PHENTOLAINE MESYLATE INJ
01460063069INTERFERON ALFA-2A INJ
01464063069FACTOR VIII (PORCINE)
01465063065TACROL ASTAGRAF EX REL ORAL
01466063090INJ, VINCRISTINE SUL LIP 1MG
01467063090FACTOR IX RECOMBINAN RIXUBIS
01468063090INJ ARIPIPRAZOLE EXT REL 1MG
01469063090INJ FILGRASTIM EXCL BIOSIMIL
01471063090INJECTION, PERTUZUMAB, 1 MG
01472063090INJ BETA INTERFERON IM 1 MCG
01474063090CERTOLIZUMAB PEGOL INJ 1MG
01475063090GOLIMUMAB FOR IV USE 1MG
01476063090OBINUTUZUMAB INJ
01478063073HUMAN FIBRINOGEN CONC INJ
01478074090INJ HUMAN FIBRINOGEN CON NOS
01479063065THERASKIN
01480063090ELOSULFASE ALFA, INJECTION
01482063090DARBEPOETIN ALFA, ESRD USE
01484063073PENTAZOCINE INJECTION
01485063090FERUMOXYTOL, ESRD USE
01486063090FACTOR IX FC FUSION RECOMB
01487063065TESTOSTERONE UNDECANOATE 1MG
01488063090INJECTION, RAMUCIRUMAB
01489063090INJECTION, VEDOLIZUMAB
01490063090INJ PEMBROLIZUMAB
01491063077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01491078090NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01492063065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01492066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01492078090NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01493063065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01493066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01493078090NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01494063065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01494066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01494078090NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01495063065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01495066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01495078090NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01496063077NEW TECHNOLOGY  - LEVEL 1A ($0-$10)
01496078090NEW TECHNOLOGY - LEVEL 1A ($0-$10)
01497063065NEW TECHNOLOGY  - LEVEL 1B ($10-$20)
01497066077NEW TECHNOLOGY  - LEVEL 1B ($11-$20)
01497078090NEW TECHNOLOGY - LEVEL 1B ($11-$20)
01498063065NEW TECHNOLOGY  - LEVEL 1C ($20-$30)
01498066077NEW TECHNOLOGY  - LEVEL 1C ($21-$30)
01498078090NEW TECHNOLOGY - LEVEL 1C ($21-$30)
01499063065NEW TECHNOLOGY  - LEVEL 1D ($30-$40)
01499066077NEW TECHNOLOGY  - LEVEL 1D ($31-$40)
01499078090NEW TECHNOLOGY - LEVEL 1D ($31-$40)
01500063065NEW TECHNOLOGY  - LEVEL 1E ($40-$50)
01500066077NEW TECHNOLOGY  - LEVEL 1E ($41-$50)
01500078090NEW TECHNOLOGY - LEVEL 1E ($41-$50)
01502063065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01502066090NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01503063065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01503066090NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01504063065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01504066090NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01505063065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01505066090NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01506063065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01506066090NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01507063065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01507066090NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01508063065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01508066090NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01509063065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01509066090NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01510063065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01510066090NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01511063065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01511066090NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01512063065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01512066090NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01513063065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01513066090NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01514063065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01514066090NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01515063065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01515066090NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01516063065NEW TECHNOLOGY - LEVEL 16  ($1400 - $1500)
01516066077NEW TECHNOLOGY - LEVEL 16  ($1401 - $1500)
01516078090NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01517063065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01517066090NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01518063065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01518066090NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01519063065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01519066090NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01520063065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01520066090NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01521063065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01521066090NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01522063065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01522066090NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01523063065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01523066090NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01524063065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01524066090NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01525063065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01525066090NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01526063065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01526066090NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01527063065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01527066090NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01528063065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01528066090NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01529063065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01529066090NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01530063065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01530066090NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01531063065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01531066090NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01532063065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01532066090NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01533063065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01533066090NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01534063065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01534066090NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01535063065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01535066090NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01536063065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01536066090NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01537063065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01537066090NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01539063065NEW TECHNOLOGY - LEVEL 2 ($50 - $100)
01539066090NEW TECHNOLOGY - LEVEL 2 ($51 - $100)
01540063065NEW TECHNOLOGY - LEVEL 3 ($100 - $200)
01540066090NEW TECHNOLOGY - LEVEL 3 ($101 - $200)
01541063065NEW TECHNOLOGY - LEVEL 4 ($200 - $300)
01541066090NEW TECHNOLOGY - LEVEL 4 ($201 - $300)
01542063065NEW TECHNOLOGY - LEVEL 5 ($300 - $400)
01542066090NEW TECHNOLOGY - LEVEL 5 ($301 - $400)
01543063065NEW TECHNOLOGY - LEVEL 6 ($400 - $500)
01543066090NEW TECHNOLOGY - LEVEL 6 ($401 - $500)
01544063065NEW TECHNOLOGY - LEVEL 7 ($500 - $600)
01544066090NEW TECHNOLOGY - LEVEL 7 ($501 - $600)
01545063065NEW TECHNOLOGY - LEVEL 8 ($600 - $700)
01545066090NEW TECHNOLOGY - LEVEL 8 ($601 - $700)
01546063065NEW TECHNOLOGY - LEVEL 9 ($700 - $800)
01546066090NEW TECHNOLOGY - LEVEL 9 ($701 - $800)
01547063065NEW TECHNOLOGY - LEVEL 10 ($800 - $900)
01547066090NEW TECHNOLOGY - LEVEL 10 ($801 - $900)
01548063065NEW TECHNOLOGY - LEVEL 11 ($900 - $1000)
01548066090NEW TECHNOLOGY - LEVEL 11 ($901 - $1000)
01549063065NEW TECHNOLOGY - LEVEL 12 ($1000 - $1100)
01549066090NEW TECHNOLOGY - LEVEL 12 ($1001 - $1100)
01550063065NEW TECHNOLOGY - LEVEL 13 ($1100 - $1200)
01550066090NEW TECHNOLOGY - LEVEL 13 ($1101 - $1200)
01551063065NEW TECHNOLOGY - LEVEL 14 ($1200- $1300)
01551066090NEW TECHNOLOGY - LEVEL 14 ($1201- $1300)
01552063065NEW TECHNOLOGY - LEVEL 15 ($1300 - $1400)
01552066090NEW TECHNOLOGY - LEVEL 15 ($1301 - $1400)
01553063065NEW TECHNOLOGY - LEVEL 16 ($1400 - $1500)
01553066090NEW TECHNOLOGY - LEVEL 16 ($1401 - $1500)
01554063065NEW TECHNOLOGY - LEVEL 17 ($1500-$1600)
01554066090NEW TECHNOLOGY - LEVEL 17 ($1501-$1600)
01555063065NEW TECHNOLOGY - LEVEL 18 ($1600-$1700)
01555066090NEW TECHNOLOGY - LEVEL 18 ($1601-$1700)
01556063065NEW TECHNOLOGY - LEVEL 19 ($1700-$1800)
01556066090NEW TECHNOLOGY - LEVEL 19 ($1701-$1800)
01557063065NEW TECHNOLOGY - LEVEL 20 ($1800-$1900)
01557066090NEW TECHNOLOGY - LEVEL 20 ($1801-$1900)
01558063065NEW TECHNOLOGY - LEVEL 21 ($1900-$2000)
01558066090NEW TECHNOLOGY - LEVEL 21 ($1901-$2000)
01559063065NEW TECHNOLOGY - LEVEL 22 ($2000-$2500)
01559066090NEW TECHNOLOGY - LEVEL 22 ($2001-$2500)
01560063065NEW TECHNOLOGY - LEVEL 23 ($2500-$3000)
01560066090NEW TECHNOLOGY - LEVEL 23 ($2501-$3000)
01561063065NEW TECHNOLOGY - LEVEL 24 ($3000-$3500)
01561066090NEW TECHNOLOGY - LEVEL 24 ($3001-$3500)
01562063065NEW TECHNOLOGY - LEVEL 25 ($3500-$4000)
01562066090NEW TECHNOLOGY - LEVEL 25 ($3501-$4000)
01563063065NEW TECHNOLOGY - LEVEL 26 ($4000-$4500)
01563066090NEW TECHNOLOGY - LEVEL 26 ($4001-$4500)
01564063065NEW TECHNOLOGY - LEVEL 27 ($4500-$5000)
01564066090NEW TECHNOLOGY - LEVEL 27 ($4501-$5000)
01565063065NEW TECHNOLOGY - LEVEL 28 ($5000-$5500)
01565066090NEW TECHNOLOGY - LEVEL 28 ($5001-$5500)
01566063065NEW TECHNOLOGY - LEVEL 29 ($5500-$6000)
01566066090NEW TECHNOLOGY - LEVEL 29 ($5501-$6000)
01567063065NEW TECHNOLOGY - LEVEL 30 ($6000-$6500)
01567066090NEW TECHNOLOGY - LEVEL 30 ($6001-$6500)
01568063065NEW TECHNOLOGY - LEVEL 31 ($6500-$7000)
01568066090NEW TECHNOLOGY - LEVEL 31 ($6501-$7000)
01569063065NEW TECHNOLOGY - LEVEL 32 ($7000-$7500)
01569066090NEW TECHNOLOGY - LEVEL 32 ($7001-$7500)
01570063065NEW TECHNOLOGY - LEVEL 33 ($7500-$8000)
01570066090NEW TECHNOLOGY - LEVEL 33 ($7501-$8000)
01571063065NEW TECHNOLOGY - LEVEL 34 ($8000-$8500)
01571066090NEW TECHNOLOGY - LEVEL 34 ($8001-$8500)
01572063065NEW TECHNOLOGY - LEVEL 35 ($8500-$9000)
01572066090NEW TECHNOLOGY - LEVEL 35 ($8501-$9000)
01573063065NEW TECHNOLOGY - LEVEL 36 ($9000-$9500)
01573066090NEW TECHNOLOGY - LEVEL 36 ($9001-$9500)
01574063065NEW TECHNOLOGY - LEVEL 37 ($9500-$10000)
01574066090NEW TECHNOLOGY - LEVEL 37 ($9501-$10000)
01575063065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01575066090NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01576063065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01576066090NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01577063065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01577066090NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01578063065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01578066090NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01579063065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01579066090NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01580063065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01580066090NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01581063065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01581066090NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01582063065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01582066090NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01583063065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01583066090NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01584063065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01584066090NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01585063065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01585066090NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01589063065NEW TECHNOLOGY - LEVEL 38 ($10,000-$15,000)
01589066090NEW TECHNOLOGY - LEVEL 38 ($10,001-$15,000)
01590063065NEW TECHNOLOGY - LEVEL 39 ($15,000-$20,000)
01590066090NEW TECHNOLOGY - LEVEL 39 ($15,001-$20,000)
01591063065NEW TECHNOLOGY - LEVEL 40 ($20,000-$25,000)
01591066090NEW TECHNOLOGY - LEVEL 40 ($20,001-$25,000)
01592063065NEW TECHNOLOGY - LEVEL 41 ($25,000-$30,000)
01592066090NEW TECHNOLOGY - LEVEL 41 ($25,001-$30,000)
01593063065NEW TECHNOLOGY - LEVEL 42 ($30,000-$40,000)
01593066090NEW TECHNOLOGY - LEVEL 42 ($30,001-$40,000)
01594063065NEW TECHNOLOGY - LEVEL 43 ($40,000-$50,000)
01594066090NEW TECHNOLOGY - LEVEL 43 ($40,001-$50,000)
01595063065NEW TECHNOLOGY - LEVEL 44 ($50,000-$60,000)
01595066090NEW TECHNOLOGY - LEVEL 44 ($50,001-$60,000)
01596063065NEW TECHNOLOGY - LEVEL 45 ($60,000-$70,000)
01596066090NEW TECHNOLOGY - LEVEL 45 ($60,001-$70,000)
01597063065NEW TECHNOLOGY - LEVEL 46 ($70,000-$80,000)
01597066090NEW TECHNOLOGY - LEVEL 46 ($70,001-$80,000)
01598063065NEW TECHNOLOGY - LEVEL 47 ($80,000-$90,000)
01598066090NEW TECHNOLOGY - LEVEL 47 ($80,001-$90,000)
01599063065NEW TECHNOLOGY - LEVEL 48 ($90,000-$100,000)
01599066090NEW TECHNOLOGY - LEVEL 48 ($90,001-$100,000)
01605066069ABCIXIMAB INJECTION
01607063081EPTIFIBATIDE INJECTION
01608063090ETANERCEPT INJECTION
01609063090RHO(D) IMMUNE GLOBULIN H, SD
01612063069DACLIZUMAB, PARENTERAL
01613063081TRASTUZUMAB INJECTION
01613082085INJ TRASTUZUMAB EXCL BIOSIMI
01613086090TRASTUZUMAB INJECTION
01630063090HEP B IG, IM
01631063073BACLOFEN INTRATHECAL TRIAL
01633063069ALEFACEPT
01643063090Y90 IBRITUMOMAB, RX
01656063090FACTOR VIII FC FUSION RECOMB
01657063065PURAPLY, PURAPLY ANTIMIC
01657066069PURAPLY OR PURAPLY AM
01658063090INJECTION, BELINOSTAT, 10MG
01660063090INJECTION, ORITAVANCIN
01661063069GEN, NEURO, HF, RECHG BAT
01662063090INJ TEDIZOLID PHOSPHATE
01663063069INJ, PHENYLEPHRINE KETOROLAC
01664063069FLORBETAPIR F18
01665063065CAPSAICIN 8% PATCH
01666063069TETRACYCLIN INJECTION
01668063065CHORIONIC GONADOTROPIN/1000U
01669063077ERYTHRO LACTOBIONATE /500 MG
01669082085ERYTHRO LACTOBIONATE /500 MG
01669090090ERYTHRO LACTOBIONATE /500 MG
01670063090TETANUS IMMUNE GLOBULIN INJ
01675063090P32 NA PHOSPHATE
01676063069P32 CHROMIC PHOSPHATE
01683063090BASILIXIMAB
01684063089CORTICORELIN OVINE TRIFLUTAL
01685063090DARBEPOETIN ALFA, NON-ESRD
01686063090EPOETIN ALFA, NON-ESRD
01687063090DIGOXIN IMMUNE FAB (OVINE)
01688063090ETHANOLAMINE OLEATE
01689063090FOMEPIZOLE
01690063090HEMIN
01693063069LEPIRUDIN
01694063090ZICONOTIDE INJECTION
01695063080NESIRITIDE INJECTION
01696063090PALIFERMIN INJECTION
01697063073PEGAPTANIB SODIUM INJECTION
01700063090INJ SECRETIN SYNTHETIC HUMAN
01701063090TREPROSTINIL INJECTION
01704063090HUMATE-P, INJ
01705063081FACTOR VIIA
01705082090FACTOR VIIA RECOMB NOVOSEVEN
01709063089AZACITIDINE INJECTION
01710063090CLOFARABINE INJECTION
01711063090VANTAS IMPLANT
01712063090PACLITAXEL PROTEIN BOUND
01738063069OXALIPLATIN
01739063085PEGADEMASE BOVINE, 25 IU
01741063069UROFOLLITROPIN, 75 IU
01743063077NANDROLONE DECANOATE 50 MG
01745063090RADIUM RA223 DICHLORIDE THER
01746063089FACTOR XIII RECOMB A-SUBUNIT
01747063090MONOVISC INJ PER DOSE
01748063090INJ TBO FILGRASTIM 1 MICROG
01761064090ROLAPITANT, ORAL, 1MG
01807063065MENB PR W/OMV VACCINE IM
01808063065MENB RLP VACCINE IM
01809063090INJECTION, ALEMTUZUMAB
01822063070INJ FILGRASTIM GCSF BIOSIMIL
01822071089INJECTION, ZARXIO
01823063090INJECTION, DALBAVANCIN
01824063090CEFTAROLINE FOSAMIL INJ
01825063090CEFTAZIDIME AND AVIBACTAM
01826063090HYQVIA 100MG IMMUNEGLOBULIN
01827063090FACTOR VIII RECOMB OBIZUR
01828063065CARBIDOPA LEVODOPA ENTERAL
01828066073CARBIDOPA LEVODOPA ENT 100ML
01829063090PENICILLIN G BENZATHINE INJ
01831063065CHLORAMPHENICOL SODIUM INJEC
01832063090DIMETHYL SULFOXIDE 50% 50 ML
01833063065EPOETIN BETA ESRD USE
01834063065DIGOXIN INJECTION
01835063065ERGONOVINE MALEATE INJECTION
01836063069PENICILLIN G PROCAINE INJ
01836090090PENICILLIN G PROCAINE INJ
01837063065METHOCARBAMOL INJECTION
01838063069UROKINASE 250,000 IU INJ
01839063069ORAL BUSULFAN
01842063069LEUPROLIDE ACETATE IMPLANT
01843063065MENACWY VACCINE IM
01844063065ADYNOVATE FACTOR VIII RECOM
01844066090FACTOR VIII PEGYLATED RECOMB
01845063073TACROL ENVARSUS EX REL ORAL
01846063065NUWIQ FACTOR VIII RECOMB
01846066090FACTOR VIII NUWIQ RECOMB 1IU
01847063063INJ., INFLIXIMAB BIOSIMILAR
01847066070INJ., INFLIXIMAB BIOSIMILAR
01847071090INJECTION, INFLECTRA
01848066090ARTISS FIBRIN SEALANT
01849066090FOSCARNET SODIUM INJECTION
01850066090GAMMA GLOBULIN 1 CC INJ
01851066090GAMMA GLOBULIN > 10 CC INJ
01852066090INTERFERON BETA-1A INJ
01853066090MINOCYCLINE HYDROCHLORIDE
01854066085PENTOBARBITAL SODIUM INJ
01854090090PENTOBARBITAL SODIUM INJ
01855066069PRALIDOXIME CHLORIDE INJ
01856066090FACTOR VIII RECOMB NOVOEIGHT
01857066090INJ, FACTOR X, (HUMAN), 1IU
01858066073LEUPROLIDE ACETATE INJECITON
01859066090ARGATROBAN NONESRD USE 1MG
01860066073MONOCLONAL ANTIBODIES
01861066090INJ., BENDEKA 1 MG
01862067069GEL-SYN INJECTION 0.1 MG
01862070090GELSYN-3 INJECTION 0.1 MG
01863066073INJ DICLOFENAC SODIUM 0.5MG
01901066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01901070090NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01902066069NEW TECHNOLOGY - LEVEL 49 ($100,001-$120,000)
01902070090NEW TECHNOLOGY - LEVEL 49 ($100,001-$115,000)
01903066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01903070090NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01904066069NEW TECHNOLOGY - LEVEL 50 ($120,001-$140,000)
01904070090NEW TECHNOLOGY - LEVEL 50 ($115,001-$130,000)
01905066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01905070090NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01906066069NEW TECHNOLOGY - LEVEL 51 ($140,001-$160,000)
01906070090NEW TECHNOLOGY - LEVEL 51 ($130,001-$145,000)
01907070090NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
01908070090NEW TECHNOLOGY - LEVEL 52 ($145,001-$160,000)
02024078090GENERATOR, CCM, IMPLANT
02025078090CATH, PRESSURE,VALVE-OCCLU
02026078090ORTH/DEVIC/DRUG BN/BN,TIS/BN
02027078090PROBE, ROBOTIC, WATER-JET
02028078090IRIS PROSTHESIS
02029080080ENDOSCOPE, SINGLE, UGI
02029081081ENDOSCOPE, SINGLE, UGI
02029082090ENDOSCOPE, SINGLE, UGI
02030082090GEN, NEURO, CAROT SINUS BARO
02031082090HEMOSTATIC AGENT, GI, TOPIC
02032082090INTRAVERTEBRAL FX AUG IMPL
02033084090CATH, TRANS INTRA LITHO/CORO
02034085090PERSONALIZED INTERBODY CAGE
02035086090AUTO CELL PROCESS SYS
02036086090CARDIAC MONITOR SYS
02037089090PRESSURE SENSOR SYSTEM, IM
02038090090GEN, NEURO, CLO LOOP, RECHG
02039090090GEN, NEURO, IMP LED, EX CNTR
02040090090ENDO, SINGLE, URINARY TRACT
02613063069LUNG BX PLUG W/DEL SYS
02616063090BRACHYTX, NON-STR,YTTRIUM-90
02623063069CATH, TRANSLUMIN, DRUG-COAT
02624063065WIRELESS PRESSURE SENSOR
02632063090IODINE I-125 SODIUM IODIDE
02634063090BRACHYTX, NON-STR, HA, I-125
02635063090BRACHYTX, NON-STR, HA, P-103
02636063090BRACHY LINEAR, NON-STR,P-103
02638063090BRACHYTX, STRANDED, I-125
02639063090BRACHYTX, NON-STRANDED,I-125
02640063090BRACHYTX, STRANDED, P-103
02641063090BRACHYTX, NON-STRANDED,P-103
02642063090BRACHYTX, STRANDED, C-131
02643063090BRACHYTX, NON-STRANDED,C-131
02644063065BRACHYTX CESIUM-131 CHLORIDE
02644070073BRACHYTX CESIUM-131 CHLORIDE
02645063090BRACHYTX, NON-STR, GOLD-198
02646063090BRACHYTX, NON-STR, HDR IR-192
02647063090BRACHYTX, NS, NON-HDRIR-192
02648063090BRACHYTX PLANAR, P-103
02698063090BRACHYTX, STRANDED, NOS
02699063090BRACHYTX, NON-STRANDED, NOS
02731063090IMMUNE GLOBULIN, POWDER
02770063090QUINUPRISTIN/DALFOPRISTIN
02993074089GEN, NEURO, TRANS SEN/STIM
03041066069BIVALIRUDIN
04001066090ECHO GUIDANCE RADIOTHERAPY
04002066090STEREOSCOPIC X-RAY GUIDANCE
04003066090RADIATION TREATMENT DELIVERY, MEV <= 5; SIMPLE
04004066090RADIATION TREATMENT DELIVERY, 6-10 MEV; SIMPLE
04005066090RADIATION TREATMENT DELIVERY, 11-19 MEV; SIMPLE
04006066090RADIATION TREATMENT DELIVERY, MEV>=20; SIMPLE
04007066090RADIATION TREATMENT DELIVERY, MEV<=5; INTERMEDIATE
04008066090RADIATION TREATMENT DELIVERY, 6-10 MEV; INTERMEDIATE
04009066090RADIATION TREATMENT DELIVERY, 11-19 MEV; INTERMEDIATE
04010066090RADIATION TREATMENT DELIVERY, MEV >=20; INTERMEDIATE
04011066090RADIATION TREATMENT DELIVERY, MEV<=5; COMPLEX
04012066090RADIATION TREATMENT DELIVERY, 6-10 MEV; COMPLEX
04013066090RADIATION TREATMENT DELIVERY, 11-19 MEV; COMPLEX
04014066090RADIATION TREATMENT DELIVERY, MEV >=20; COMPLEX
04015070090RADIATION TX DELIVERY IMRT
04016070090DELIVERY COMP IMRT
04017086090PAYER ONLY TESTING
04018086090PAYER ONLY TESTING
04019086090PAYER ONLY TESTING
04020086090PAYER ONLY TESTING
04021086090PAYER ONLY TESTING
04022086090PAYER ONLY TESTING
04023086090PAYER ONLY TESTING
04024086090PAYER ONLY TESTING
04025086090PAYER ONLY TESTING
04026086090PAYER ONLY TESTING
04027086090PAYER ONLY TESTING
04028086090PAYER ONLY TESTING
04029086090PAYER ONLY TESTING
04030086090PAYER ONLY TESTING
04031086090PAYER ONLY TESTING
05011063065LEVEL 1 EXAMINATIONS AND RELATED SERVICES
05012063065LEVEL 2 EXAMINATIONS AND RELATED SERVICES
05012066090CLINIC VISITS AND RELATED SERVICES
05013063065LEVEL 3 EXAMINATIONS AND RELATED SERVICES
05021063090LEVEL 1 TYPE A ED VISITS
05022063090LEVEL 2 TYPE A ED VISITS
05023063090LEVEL 3 TYPE A ED VISITS
05024063090LEVEL 4 TYPE A ED VISITS
05025063090LEVEL 5 TYPE A ED VISITS
05031063090LEVEL 1 TYPE B ED VISITS
05032063090LEVEL 2 TYPE B ED VISITS
05033063090LEVEL 3 TYPE B ED VISITS
05034063090LEVEL 4 TYPE B ED VISITS
05035063090LEVEL 5 TYPE B ED VISITS
05041063090CRITICAL CARE
05045063090TRAUMA RESPONSE WITH CRITICAL CARE
05051063090LEVEL 1 SKIN PROCEDURES
05052063090LEVEL 2 SKIN PROCEDURES
05053063090LEVEL 3 SKIN PROCEDURES
05054063090LEVEL 4 SKIN PROCEDURES
05055063090LEVEL 5 SKIN PROCEDURES
05061063090HYPERBARIC OXYGEN
05071063090LEVEL 1 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05072063090LEVEL 2 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05073063090LEVEL 3 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05074063065LEVEL 4 EXCISION/ BIOPSY/ INCISION AND DRAINAGE
05091063090LEVEL 1 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05092063090LEVEL 2 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05093063090LEVEL 3 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05094066090LEVEL 4 BREAST/LYMPHATIC SURGERY AND RELATED PROCEDURES
05101063090LEVEL 1 STRAPPING AND CAST APPLICATION
05102063090LEVEL 2 STRAPPING AND CAST APPLICATION
05111063065LEVEL 1 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05111066090LEVEL 1 MUSCULOSKELETAL PROCEDURES
05112063065LEVEL 2 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05112066090LEVEL 2 MUSCULOSKELETAL PROCEDURES
05113063065LEVEL 3 CLOSED TREATMENT FRACTURE AND RELATED SERVICES
05113066090LEVEL 3 MUSCULOSKELETAL PROCEDURES
05114066090LEVEL 4 MUSCULOSKELETAL PROCEDURES
05115066090LEVEL 5 MUSCULOSKELETAL PROCEDURES
05116066090LEVEL 6 MUSCULOSKELETAL PROCEDURES
05121063065LEVEL1 MUSCULOSKELETAL PROCEDURES
05122063065LEVEL 2 MUSCULOSKELETAL PROCEDURES
05123063065LEVEL 3 MUSCULOSKELETAL PROCEDURES
05124063065LEVEL 4 MUSCULOSKELETAL PROCEDURES
05125063065LEVEL 5 MUSCULOSKELETAL PROCEDURES
05141063065THORACOSCOPY
05151063090LEVEL 1 AIRWAY ENDOSCOPY
05152063090LEVEL 2 AIRWAY ENDOSCOPY
05153063090LEVEL 3 AIRWAY ENDOSCOPY
05154063090LEVEL 4 AIRWAY ENDOSCOPY
05155063090LEVEL 5 AIRWAY ENDOSCOPY
05161063090LEVEL 1 ENT PROCEDURES
05162063090LEVEL 2 ENT PROCEDURES
05163063090LEVEL 3 ENT PROCEDURES
05164063090LEVEL 4 ENT PROCEDURES
05165063090LEVEL 5 ENT PROCEDURES
05166063065LEVEL 6 ENT PROCEDURES
05166066090COCHLEAR IMPLANT PROCEDURE
05181063090LEVEL 1 VASCULAR PROCEDURES
05182063090LEVEL 2 VASCULAR PROCEDURES
05183063090LEVEL 3 VASCULAR PROCEDURES
05184070090LEVEL 4 VASCULAR PROCEDURES
05188063065DIAGNOSTIC CARDIAC CATHETERIZATION
05191063090LEVEL 1 ENDOVASCULAR PROCEDURES
05192063090LEVEL 2 ENDOVASCULAR PROCEDURES
05193063090LEVEL 3 ENDOVASCULAR PROCEDURES
05194066090LEVEL 4 ENDOVASCULAR PROCEDURES
05200066090IMPLANTATION WIRELESS PA PRESSURE MONITOR
05211063090LEVEL 1 ELECTROPHYSIOLOGIC PROCEDURES
05212063090LEVEL 2 ELECTROPHYSIOLOGIC PROCEDURES
05213063090LEVEL 3 ELECTROPHYSIOLOGIC PROCEDURES
05221063090LEVEL1 PACEMAKER AND SIMILAR PROCEDURES
05222063090LEVEL 2 PACEMAKER AND SIMILAR PROCEDURES
05223063090LEVEL 3 PACEMAKER AND SIMILAR PROCEDURES
05224063090LEVEL 4 PACEMAKER AND SIMILAR PROCEDURES
05231063090LEVEL 1 ICD AND SIMILAR PROCEDURES
05232063090LEVEL 2 ICD AND SIMILAR PROCEDURES
05241063065TRANSFUSION
05241066090LEVEL 1 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05242066090LEVEL 2 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05243066090LEVEL 3 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05244066090LEVEL 4 BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05271063065BLOOD PRODUCT EXCHANGE AND RELATED SERVICES
05281063065APHERESIS/STEM CELL AND RELATED SERVICES
05291063065THROMBOLYSIS AND OTHER DEVICE REVISIONS
05301063090LEVEL 1 UPPER GI PROCEDURES
05302063090LEVEL 2 UPPER GI PROCEDURES
05303063090LEVEL 3 UPPER GI PROCEDURES
05311063090LEVEL 1 LOWER GI PROCEDURES
05312063090LEVEL 2 LOWER GI PROCEDURES
05313063090LEVEL 3 LOWER GI PROCEDURES
05314063065LEVEL 4 LOWER GI PROCEDURES
05331063090COMPLEX GI PROCEDURES
05341063065PERITONEAL AND ABDOMINAL PROCEDURES
05341066090ABDOMINAL/PERITONEAL/BILIARY AND RELATED PROCEDURES
05351063065LEVEL 1 PERCUTANEOUS ABDOMINAL/BILIARY PROCEDURES AND RELATED PROCEDURES
05352063065LEVEL 2 PERCUTANEOUS ABDOMINAL/BILIARY PROCEDURES AND RELATED PROCEDURES
05361063065LEVEL 1 LAPAROSCOPY
05361066090LEVEL 1 LAPAROSCOPY AND RELATED SERVICES
05362063065LEVEL 2 LAPAROSCOPY
05362066090LEVEL 2 LAPAROSCOPY AND RELATED SERVICES
05371063090LEVEL 1 UROLOGY AND RELATED SERVICES
05372063090LEVEL 2 UROLOGY AND RELATED SERVICES
05373063090LEVEL 3 UROLOGY AND RELATED SERVICES
05374063090LEVEL 4 UROLOGY AND RELATED SERVICES
05375063090LEVEL 5 UROLOGY AND RELATED SERVICES
05376063090LEVEL 6 UROLOGY AND RELATED SERVICES
05377063090LEVEL 7 UROLOGY AND RELATED SERVICES
05378082090LEVEL 8 UROLOGY AND RELATED SERVICES
05391063065LEVEL 1 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05392063065LEVEL 2 TUBE/CATHETER CHANGES/THORACENTESIS/LAVAGE
05401063090DIALYSIS
05411063090LEVEL 1 GYNECOLOGIC PROCEDURES
05412063090LEVEL 2 GYNECOLOGIC PROCEDURES
05413063090LEVEL 3 GYNECOLOGIC PROCEDURES
05414063090LEVEL 4 GYNECOLOGIC PROCEDURES
05415063090LEVEL 5 GYNECOLOGIC PROCEDURES
05416063090LEVEL 6 GYNECOLOGIC PROCEDURES
05431063090LEVEL 1 NERVE PROCEDURES
05432063090LEVEL 2 NERVE PROCEDURES
05441063090LEVEL 1 NERVE INJECTIONS
05442063090LEVEL 2 NERVE INJECTIONS
05443063090LEVEL 3 NERVE INJECTIONS
05461063090LEVEL 1 NEUROSTIMULATOR AND RELATED PROCEDURES
05462063090LEVEL 2 NEUROSTIMULATOR AND RELATED PROCEDURES
05463063090LEVEL 3 NEUROSTIMULATOR AND RELATED PROCEDURES
05464063090LEVEL 4 NEUROSTIMULATOR AND RELATED PROCEDURES
05465082090LEVEL 5 NEUROSTIMULATOR AND RELATED PROCEDURES
05471063090IMPLANTATION OF DRUG INFUSION DEVICE
05481063090LASER EYE PROCEDURES
05491063090LEVEL 1 INTRAOCULAR PROCEDURES
05492063090LEVEL 2 INTRAOCULAR PROCEDURES
05493063090LEVEL 3 INTRAOCULAR PROCEDURES
05494063090LEVEL 4 INTRAOCULAR PROCEDURES
05495066073LEVEL 5 INTRAOCULAR PROCEDURES
05495078090LEVEL 5 INTRAOCULAR PROCEDURES
05501063090LEVEL 1 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05502063090LEVEL 2 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05503063090LEVEL 3 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05504063090LEVEL 4 EXTRAOCULAR, REPAIR, AND PLASTIC EYE PROCEDURES
05521063065LEVEL 1 X-RAY AND RELATED SERVICES
05521066090LEVEL 1 IMAGING WITHOUT CONTRAST
05522063065LEVEL 2 X-RAY AND RELATED SERVICES
05522066090LEVEL 2 IMAGING WITHOUT CONTRAST
05523063065LEVEL 3 X-RAY AND RELATED SERVICES
05523066090LEVEL 3 IMAGING WITHOUT CONTRAST
05524063065LEVEL 4 X-RAY AND RELATED SERVICES
05524066090LEVEL 4 IMAGING WITHOUT CONTRAST
05525063065LEVEL 5 X-RAY AND RELATED SERVICES
05526063065LEVEL 6 X-RAY AND RELATED SERVICES
05531063065LEVEL 1 ULTRASOUND AND RELATED SERVICES
05532063065LEVEL 2 ULTRASOUND AND RELATED SERVICES
05533063065LEVEL 3 ULTRASOUND AND RELATED SERVICES
05534063065LEVEL 4 ULTRASOUND AND RELATED SERVICES
05561063065LEVEL 1 ECHOCARDIOGRAM WITH CONTRAST
05562063065LEVEL 2 ECHOCARDIOGRAM WITH CONTRAST
05570063065COMPUTED TOMOGRAPHY WITHOUT CONTRAST
05571063065LEVEL 1 COMPUTED TOMOGRAPHY WITH CONTRAST AND COMPUTED TOMOGRAPHY ANGIOGRAPHY
05571066090LEVEL 1 IMAGING WITH CONTRAST
05572063065LEVEL 2 COMPUTED TOMOGRAPHY WITH CONTRAST AND COMPUTED TOMOGRAPHY ANGIOGRAPHY
05572066090LEVEL 2 IMAGING WITH CONTRAST
05573066090LEVEL 3 IMAGING WITH CONTRAST
05581063065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST
05582063065MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST
05591063090LEVEL 1 NUCLEAR MEDICINE AND RELATED SERVICES
05592063090LEVEL 2 NUCLEAR MEDICINE AND RELATED SERVICES
05593063090LEVEL 3 NUCLEAR MEDICINE AND RELATED SERVICES
05594063090LEVEL 4 NUCLEAR MEDICINE AND RELATED SERVICES
05611063090LEVEL 1 THERAPEUTIC RADIATION TREATMENT PREPARATION
05612063090LEVEL 2 THERAPEUTIC RADIATION TREATMENT PREPARATION
05613063090LEVEL 3 THERAPEUTIC RADIATION TREATMENT PREPARATION
05614063065LEVEL 4 THERAPEUTIC RADIATION TREATMENT PREPARATION
05621063090LEVEL 1 RADIATION THERAPY
05622063090LEVEL 2 RADIATION THERAPY
05623063090LEVEL 3 RADIATION THERAPY
05624063090LEVEL 4 RADIATION THERAPY
05625063090LEVEL 5 RADIATION THERAPY
05626063090LEVEL 6 RADIATION THERAPY
05627063090LEVEL 7 RADIATION THERAPY
05661063090THERAPEUTIC NUCLEAR MEDICINE
05671063090LEVEL 1 PATHOLOGY
05672063090LEVEL 2 PATHOLOGY
05673063090LEVEL 3 PATHOLOGY
05674063090LEVEL 4 PATHOLOGY
05681063065TRANSFUSION LABORATORY PROCEDURES
05691063090LEVEL 1 DRUG ADMINISTRATION
05692063090LEVEL 2 DRUG ADMINISTRATION
05693063090LEVEL 3 DRUG ADMINISTRATION
05694063090LEVEL 4 DRUG ADMINISTRATION
05695063065LEVEL 5 DRUG ADMINISTRATION
05701063065DOSIMETRIC DRUG ADMINISTRATION
05721063079LEVEL1 DIAGNOSTIC TESTS AND RELATED SERVICES
05721080090LEVEL 1 DIAGNOSTIC TESTS AND RELATED SERVICES
05722063090LEVEL 2 DIAGNOSTIC TESTS AND RELATED SERVICES
05723063090LEVEL 3 DIAGNOSTIC TESTS AND RELATED SERVICES
05724063090LEVEL 4 DIAGNOSTIC TESTS AND RELATED SERVICES
05731063090LEVEL 1 MINOR PROCEDURES
05732063090LEVEL 2 MINOR PROCEDURES
05733063090LEVEL 3 MINOR PROCEDURES
05734063090LEVEL 4 MINOR PROCEDURES
05735066090LEVEL 5 MINOR PROCEDURES
05741063090LEVEL 1 ELECTRONIC ANALYSIS OF DEVICES
05742063090LEVEL 2 ELECTRONIC ANALYSIS OF DEVICES
05743063090LEVEL 3 ELECTRONIC ANALYSIS OF DEVICES
05771063090CARDIAC REHABILITATION
05781063090RESUSCITATION AND CARDIOVERSION
05791063090PULMONARY TREATMENT
05801063090VENTILATION INITIATION AND MANAGEMENT
05811063090MANIPULATION THERAPY
05821063090LEVEL 1 HEALTH AND BEHAVIOR SERVICES
05822063090LEVEL 2 HEALTH AND BEHAVIOR SERVICES
05823066090LEVEL 3 HEALTH AND BEHAVIOR SERVICES
05841063065PSYCHOTHERAPY
05851063065LEVEL 1 PARTIAL HOSPITALIZATION (3 SERVICES) FOR CMHCS
05852063065LEVEL 2 PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR CMHCS
05853066090PARTIAL HOSPITALIZATION (3 OR MORE SERVICES) FOR CMHCS
05861063065LEVEL 1 PARTIAL HOSPITALIZATION (3 SERVICES) FOR HOSPITAL-BASED PHPS
05862063065LEVEL 2 PARTIAL HOSPITALIZATION (4 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
05863066090PARTIAL HOSPITALIZATION (3 OR MORE SERVICES) FOR HOSPITAL-BASED PHPS
05871063090DENTAL PROCEDURES
05881063090ANCILLARY OUTPATIENT SERVICES WHEN PATIENT DIES
07000063089AMIFOSTINE
07011063081OPRELVEKIN INJECTION
07034063073SOMATROPIN INJECTION
07035063089TENIPOSIDE
07041063085TIROFIBAN HCL
07041086089TIROFIBAN HCL
07042063065CAPECITABINE, ORAL
07043063065INFLIXIMAB INJECTION
07043066090INFLIXIMAB NOT BIOSIMIL 10MG
07046063090DOXORUBICIN INJ 10MG
07048063090ALTEPLASE RECOMBINANT
07308063090AMINOLEVULINIC ACID HCL TOP
08001063069LDR PROSTATE BRACHYTHERAPY COMPOSITE
08004063090ULTRASOUND COMPOSITE
08005063090CT AND CTA WITHOUT CONTRAST COMPOSITE
08006063090CT AND CTA WITH CONTRAST COMPOSITE
08007063090MRI AND MRA WITHOUT CONTRAST COMPOSITE
08008063090MRI AND MRA WITH CONTRAST COMPOSITE
08010063090MENTAL HEALTH SERVICES COMPOSITE
08011063090COMPREHENSIVE OBSERVATION SERVICES
09001063065LINEZOLID INJECTION
09002063090TENECTEPLASE INJECTION
09003063090PALIVIZUMAB
09004088090INJECTION, INCLISIRAN, 1 MG
09005063077RETEPLASE INJECTION
09005082090RETEPLASE INJECTION
09006063090TACROLIMUS INJECTION
09007088090INJ CUTAQUIG 100 MG
09008088090INJ TEZEPELUMAB-EKKO, 1MG
09009088088INJECTION, CABOTEGRAVIR 1 MG
09009090090INJ, VUTRISIRAN, 1 MG
09010088090INJ EFGARTIGIMOD 2MG
09011090090MMRV VACCINE SC
09012063090ARSENIC TRIOXIDE INJECTION
09013090090INJ RISANKIZUMAB-RZAA 1 MG
09014070073INJECTION, CERLIPONASE ALFA
09014074081INJ., CERLIPONASE ALFA 1 MG
09015070073C-1 ESTERASE, HAEGARDA
09015074085INJ., HAEGARDA 10 UNITS
09016070073INJ, TRIPTORELIN EXT REL
09016074090INJ., TRIPTORELIN XR 3.75 MG
09017089090INJ. BYOOVIZ, 0.1 MG
09018063090INJ, RIMABOTULINUMTOXINB
09019063077CASPOFUNGIN ACETATE
09020090090ARGATROBAN NONESRD (ACCORD)
09021090090ARGATROBAN DIALYSIS (ACCORD)
09022090090ARGATROBAN NONESRD (AUROMED)
09023090090ARGATROBAN DIALYSIS, AUROMED
09024063090AMPHOTERICIN B LIPID COMPLEX
09025090090INJ GLUCAGON HCL, FRESENIUS
09026090090INJ, BORTEZOMIB, DR. REDDY'S
09027090090INJ, BORTEZOMIB FRESENIUSKAB
09028070073INJ. INOTUZUMAB OZOGAMICIN
09028074090INJ INOTUZUMAB OZOGAM 0.1 MG
09029070073INJECTION, GUSELKUMAB
09029074090INJ., GUSELKUMAB, 1 MG
09030072073INJ COPANLISIB
09030074090INJ., COPANLISIB, 1 MG
09031070081INJ, ETELCALCETIDE, 0.1 MG
09032063090BACLOFEN 10 MG INJECTION
09033063090CIDOFOVIR INJECTION
09034070090INJ CUVITRU, 100 MG
09035071090AXICABTAGENE CILOLEUCEL CAR+
09036071090INJECTION, RENFLEXIS
09037090090ARIPIPRAZOLE INJECTION
09038063090INJ ESTROGEN CONJUGATE
09039090090DIMECAPROL INJECTION
09040090090CORTICOTROPIN INJECTION
09041090090EPOETIN BETA ESRD USE
09042063090GLUCAGON HYDROCHLORIDE
09043066069AFSTYLA FACTOR VIII RECOMB
09043070090INJ, AFSTYLA, 1 I.U.
09044063090IBUTILIDE FUMARATE INJECTION
09045090090IDURSULFASE INJECTION
09046090090INJ., FIBRYGA, 1 MG
09047090090LEUPROLIDE ACETATE INJECITON
09048089090INJ, ALYMSYS, 10 MG
09049089090INJ, OLICERIDINE 0.1 MG
09050089090LEUPROLIDE INJ, CAMCEVI, 1MG
09051089090INJ, LANREOTIDE, (CIPLA) 1MG
09052066077FLUCICIOVINE F-18
09053089090FLUORODOPA F-18 DIAG PER MCI
09054089090LUTETIUM LU 177 VIPIVOTIDE
09055089090GALLIUM LOCAMETZ 1 MILLICURI
09056066077GALLIUM GA-68
09057089090INJ NIVOL RELATLIMAB 3MG/1MG
09058066090BUPRENORPHINE IMPLANT 74.2MG
09059066090VONVENDI INJ 1 IU VWF:RCO
09060066069DIAZOXIDE INJECTION
09061066069INJ MILRINONE LACTATE / 5 MG
09062066069TOPOTECAN INJECTION
09063082089RH IG MINIDOSE IM
09064070073ARIPIPRAZOLE INJECTION
09065070090ARGATROBAN ESRD DIALYSIS 1MG
09066070073INJ DIHYDROERGOTAMINE MESYLT
09067072073LUTETIUM LU 177 DOTATATE, TX
09067074090LUTETIUM LU 177 DOTATAT THER
09068088090SMALLPOX&MONKEYPOX VAC 0.5ML
09069082090PHENOBARBITAL SODIUM INJ
09070072072VORETIGNE NEPARVOVEC-RZYL
09070073073VORETIGENE NEPARVOVEC-RZYL
09070074090INJ LUXTURNA 1 BILLION VEC G
09071070090CAPSAICIN 8% PATCH
09072070073FOSPHENYTOIN INJ PE
09073072090BUPRENORPH XR 100 MG OR LESS
09074068069INJ, MAKENA
09074070090MAKENA, 10 MG
09075070077INJ, KOVALTRY, 1 I.U.
09075082090INJ, KOVALTRY, 1 I.U.
09076070073DIMECAPROL INJECTION
09077070073EPOETIN BETA NON ESRD
09077082089EPOETIN BETA NON ESRD
09078070090TESTOSTERONE UNDECANOATE 1MG
09079070090GENVISC 850, INJ, 1MG
09080070073FLUDARABINE PHOSPHATE INJ
09080090090FLUDARABINE 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
09087090090INJ, CLEVIDIPINE BUTYRATE
09088074090PENG BENZATHINE/PROCAINE INJ
09089074077ORAL FLUDARABINE PHOSPHATE
09090074077MELPHALAN ORAL 2 MG
09091074077DAUNORUBICIN CITRATE INJ
09092074081INTERFERON ALFA-2A INJ
09093074077PLICAMYCIN (MITHRAMYCIN) INJ
09093082089PLICAMYCIN (MITHRAMYCIN) INJ
09094074090RADIESSE INJECTION
09095074090INJ, SCULPTRA, 0.5MG
09096072073INJ RETACRIT ESRD ON DIALYSI
09096074084INJ RETACRIT ESRD ON DIALYSI
09097072073INJ RETACRIT NON-ESRD USE
09097074090INJ RETACRIT NON-ESRD USE
09098074077CHORIONIC GONADOTROPIN/1000U
09099073073INJ, AKYNZEO
09099074090INJ FOSNETUPITANT, PALONOSET
09100090090INJ, BORTEZOMIB, HOSPIRA
09101088090VACCINIA VRS VAC 0.3 ML PERQ
09102090090INJ, FULVESTRANT (TEVA)
09103090090INJ, FULVESTRANT (FRESENIUS)
09104063090ANTITHYMOCYTE GLOBULN RABBIT
09105090090INJ PEMETREXED (TEVA) 10MG
09108063090THYROTROPIN INJECTION
09119063085INJECTION, PEGFILGRASTIM 6MG
09120063090INJECTION, FULVESTRANT
09121063065INJECTION, ARGATROBAN
09122063090TRIPTORELIN PAMOATE
09124063081DAPTOMYCIN INJECTION
09125063076RISPERIDONE, LONG ACTING
09125077077INJ., RISPERDAL CONSTA, 0.5 MG
09125078081RISPERIDONE, LONG ACTING
09125082085INJ RISPERDAL CONSTA, 0.5 MG
09125086090RISPERIDONE, LONG ACTING
09126063090NATALIZUMAB INJECTION
09130063077INJ, IMM GLOB BIVIGAM, 500MG
09130082090INJ, IMM GLOB BIVIGAM, 500MG
09131063090INJ, ADO-TRASTUZUMAB EMT 1MG
09132063083KCENTRA, PER I.U.
09132084090PROTHROMBIN COMPLEX KCENTRA
09133063090RABIES IG, IM/SC
09134063090RABIES IG, HEAT TREATED
09135063090VARICELLA-ZOSTER IG, IM
09137063065BCG VACCINE, PERCUT
09139063090RABIES VACCINE, IM
09140063090RABIES VACCINE, ID
09143063065MENINGOCOCCAL VACCINE, SC
09171065065IDELVION, 1 I.U.
09171066090FACTOR IX IDELVION INJ
09172073089INJECTION, DEXAMETHASONE 9%
09173072090INJECTION, FULPHILA
09174074090INJ, DUROLANE 1 MG
09175074080PURAPLY 1 SQ CM
09176074080PURAPLY AM 1 SQ CM
09177074081ANTITHROMBIN RECOMBINANT
09178074090INJ., MEROPENEM, VABORBACTAM
09179074076INJECTION, ARISTADA INITIO
09179077077INJ., ARISTADA INITIO, 1 MG
09179078085INJECTION, ARISTADA INITIO
09179086090INJ., ARISTADA INITIO, 1 MG
09180074076INJECTION, PATISIRAN
09180077090INJ., PATISIRAN, 0.1 MG
09181074076INJECTION, RISPERIDONE
09181077090INJ., PERSERIS, 0.5 MG
09182074076INJ MOGAMULIZUMAB-KPKC
09182077077INJ, MOGAMULIZUMAB-KPKC, 1 MG
09182078090INJ MOGAMULIZUMAB-KPKC, 1 MG
09183074076INJECTION, PLAZOMICIN
09183077090INJ., PLAZOMICIN, 5 MG
09184074077IODINE I-131 IOBENGUANE, DX
09185074077IODINE I-131 IOBENGUANE, TX
09186074090INJ., RITUXIMAB, 10 MG
09187074090INJECTION, BUROSUMAB-TWZA 1M
09188074090INJ CROTALIDAE IM F(AB')2 EQ
09189074090INJ., IBALIZUMAB-UIYK, 10 MG
09190074081INJ., VESTRONIDASE ALFA-VJBK
09191074081INJ., FIBRYGA, 1 MG
09192074089INJ, BORTEZOMIB, NOS, 0.1 MG
09193073090NIVESTYM
09194074090TISAGENLECLEUCEL CAR-POS T
09195074090INJECTION, UDENYCA 0.5 MG
09196074090INJ, TRIVISC 1 MG
09197075076INJECTION, FREMANEZUMAB-VFRM
09197077090INJ., FREMANEZUMAB-VFRM 1 MG
09198075079INJ, COAGULATION FACTOR XA
09198080090INJ ANDEXXA, 10 MG
09199076090INJECTION, CAPLACIZUMAB-YHDP
09200085090INJ, REMDESIVIR, 1 MG
09201082090RABIES IG HT&SOL HUMAN IM/SC
09202087090DIFELIKEFALIN, ESRD ON DIALY
09203087090INJ CYCLOPHOSPHAMD AUROMEDIC
09204087090INJ TISOTU VEDOTIN-TFTV, 1MG
09205087090INJ LON TESIRIN-LPYL 0.075MG
09206087087PLASMINOGEN, HUMAN-TVMH 1 MG
09206088090INJ PLASMINOGEN TVMH 1MG
09207063073BORTEZOMIB INJECTION
09207074089INJ., VELCADE 0.1 MG
09207090090INJECTION, BORTEZOMIB, 0.1MG
09208063090AGALSIDASE BETA INJECTION
09209063090LARONIDASE INJECTION
09210063077PALONOSETRON HCL
09213063080PEMETREXED INJECTION
09213081090INJ. PEMETREXED NOS 10MG
09214063090BEVACIZUMAB INJECTION
09215063090CETUXIMAB INJECTION
09217063090LEUPROLIDE ACETATE SUSPNSION
09224063089GALSULFASE INJECTION
09225063076FLUOCINOLONE ACETONIDE IMPLT
09225077077INJ., RETISERT, 0.01 MG
09225078081FLUOCINOLONE ACETONIDE IMPLT
09225082085INJ., RETISERT, 0.01 MG
09225086090FLUOCINOLONE ACETONIDE IMPLT
09227082085MICAFUNGIN SODIUM INJECTION
09228063085TIGECYCLINE INJECTION
09229063085IBANDRONATE SODIUM INJECTION
09229090090IBANDRONATE SODIUM INJECTION
09230063090ABATACEPT INJECTION
09231063089DECITABINE INJECTION
09232063081IDURSULFASE INJECTION
09233063090RANIBIZUMAB INJECTION
09234063090ALGLUCOSIDASE ALFA INJECTION
09235063090PANITUMUMAB INJECTION
09236063090ECULIZUMAB INJECTION
09237063090INJ, LANREOTIDE ACETATE
09239072090BUPRENORPHINE XR OVER 100 MG
09240063090INJECTION, IXABEPILONE
09241087087SIROLIMUS, PROTEIN-BOUND,1MG
09241088090INJ SIROLIMUS PROT PART 1 MG
09242063085INJECTION, FOSAPREPITANT
09243063065BENDAMUSTINE INJECTION
09243066090INJ., TREANDA 1 MG
09245063090ROMIPLOSTIM INJECTION
09248063069INJ, CLEVIDIPINE BUTYRATE
09251063090C1 ESTERASE INHIBITOR INJ
09252063090PLERIXAFOR INJECTION
09253063090TEMOZOLOMIDE INJECTION
09255063090PALIPERIDONE PALMITATE INJ
09256063090DEXAMETHASONE INTRA IMPLANT
09257072073INJ. EMICIZUMAB-KXWH, 0.5 MG
09257074090INJ., EMICIZUMAB-KXWH 0.5 MG
09258063090TELAVANCIN INJECTION
09259063090PRALATREXATE INJECTION
09260063090OFATUMUMAB INJECTION
09261063065USTEKINUMAB INJECTION
09261066090USTEKINUMAB SUB CU INJ, 1 MG
09263063090ECALLANTIDE INJECTION
09264063090TOCILIZUMAB INJECTION
09265063084ROMIDEPSIN INJECTION
09269063090C-1 ESTERASE, BERINERT
09270063090GAMMAPLEX IVIG
09271063090VELAGLUCERASE ALFA
09272063090INJ, DENOSUMAB
09273063090SIPULEUCEL-T AUTO CD54+
09274063090CROTALIDAE POLY IMMUNE FAB
09276063090CABAZITAXEL INJECTION
09278063090INCOBOTULINUMTOXIN A
09281063090INJECTION, PEGLOTICASE
09284063090IPILIMUMAB INJECTION
09286063090BELATACEPT INJECTION
09287063090BRENTUXIMAB VEDOTIN INJ
09289063090ERWINAZE INJECTION
09293063077INJECTION, GLUCARPIDASE
09294063069INJ, TALIGLUCERACE ALFA 10 U
09294070090INJ, TALIGLUCERASE ALFA 10 U
09295063090INJECTION, CARFILZOMIB, 1 MG
09296063090INJ, ZIV-AFLIBERCEPT, 1MG
09297063090INJ, OMACETAXINE MEP, 0.01MG
09298063090INJ, OCRIPLASMIN, 0.125 MG
09299075075FACTOR VIII PEGYLATED-AUCL
09299076090INJ. JIVI 1 IU
09300063090OMALIZUMAB INJECTION
09301070090AMINOLEVULINIC ACID, 10% GEL
09302070073INJ, DAUNORUBICIN-CYTARABINE
09302074090INJ DAUNORUBICIN, CYTARABINE
09303075077INJECTION, LEVOLEUCOVORIN
09304075075INJECTION, CEMIPLIMAB
09304076076INJECTION, CEMIPLIMAB-RWLC
09304077090INJ., CEMIPLIMAB-RWLC, 1 MG
09305075076MOXETUMOMAB PASUDOTOX-TDFK
09305077090INJ., LUMOXITI, 0.01 MG
09306075090INJ., TILDRAKIZUMAB, 1 MG
09307075089COCAINE HCL NASAL SOLUTION
09308076076DEXAMETHASONE OPHTH INSERT
09308077089DEXAMETHA OPTH INSERT 0.1 MG
09309076076INJECTION, TAGRAXOFUSP-ERZS
09309077090INJ. TAGRAXOFUSP-ERZS 10 MCG
09310076076INJECTION, EMAPALUMAB-LZSG
09310077090INJ., EMAPALUMAB-LZSG, 1 MG
09311076076INJECTION, OMADACYCLINE
09311077090INJ., OMADACYCLINE, 1 MG
09312076076INJECTION, RAVULIZUMAB-CWV
09312077090INJ., RAVULIZUMAB-CWVZ 10 MG
09313075075INJ., BELRAPZO 1 MG
09313076090INJ. BELRAPZO/BENDAMUSTINE
09314076090INJ. HERCEPTIN HYLECTA, 10MG
09315078081DIPHTHERIA ANTITOXIN
09316078081CORTICOTROPIN INJECTION
09317078081DORIPENEM INJECTION
09318078090INJ HYDROXYPROGST CAPOAT NOS
09319078085SOMATROPIN INJECTION
09319090090SOMATROPIN INJECTION
09320078090CARBIDOPA LEVODOPA ENT 100ML
09321078081FOSPHENYTOIN INJ PE
09322076081BCG LIVE INTRAVESICAL 1MG
09323081090GALLIUM GA-68 DOTATOC
09324077080PHENYLEP KETOROLAC OPTH SOLN
09325077081INJ., ERAVACYCLINE, 1 MG
09326077081INJ., LANADELUMAB-FLYO, 1 MG
09327077090INJ. ROMOSOZUMAB-AQQG 1 MG
09328077090INJ., YUTIQ, 0.01 MG
09329076090INJ MVASI 10 MG
09330077090INJ., KANJINTI, 10 MG
09331078090INJ, POLATUZUMAB VEDOTIN 1MG
09332078079INJECTION, LEFAMULIN
09332080089INJ LEFAMULIN 1 MG
09333078080INJ, BREXANOLONE
09333081090INJ., BREXANOLONE, 1 MG
09334078089INJECTION, KHAPZORY, 0.5 MG
09335078081ORAL BUSULFAN
09336077090INJ TRUXIMA 10 MG
09337078090SYNOJOYNT, INJ., 1 MG
09338078081INJ., TRILURON, 1 MG
09339078090IODINE I-131 IOBENGUANE 1MCI
09340078090INJ, BROLUCIZUMAB-DBLL, 1 MG
09341077090INJ OGIVRI 10 MG
09342079079INJ, CRIZANLIZUMAB-TMCA
09343079079INJECTION, GIVOSIRAN
09343080090INJ GIVOSIRAN 0.5 MG
09344079079INJ CETIRIZINE HYDROCHLORIDE
09345077090INJ PEGFILGRASTIM-BMEZ 0.5MG
09346080082MOMETASONE FUROATE (SINUVA)
09346083090MOMETASONE SINUS SINUVA
09347080090INJ LUSPATERCEPT-AAMT 0.25MG
09348078090INJ., ZIRABEV, 10 MG
09349078090INJ HERZUMA 10 MG
09350078090INJ., TRAZIMERA, 10 MG
09351081081INJ BIMATOPROST ITC IMP 1MCG
09351082085INJ BIMATOPROST ITC IMP1MCG
09351086090INJ BIMATOPROST ITC IMP 1MCG
09352082090CHLOROQUINE INJECTION
09353080090INJ FAM-TRASTU DERU-NXKI 1MG
09354080090INJ RECOMBIN ESPEROCT PER IU
09355080080INJECTION, TEPROTUMUMAB-TRBW
09355081090INJ. TEPROTUMUMAB-TRBW 10 MG
09356080090INJ GOLODIRSEN 10 MG
09357080080INJECTION, EPTINEZUMAB-JJMR
09357081090INJ. EPTINEZUMAB-JJMR 1 MG
09358087087INJ., XIPERE, 1 MG
09358088090INJ XIPERE 1 MG
09359080090INJ CRIZANLIZUMAB-TMCA 5MG
09361080090INJ. CETIRIZINE HCL 0.5MG
09362080090INJ IMIP 4 CILAS 4 RELEB 2MG
09364080090INJ ENFORT VEDO-EJFV 0.25MG
09367078090INJ RUXIENCE, 10 MG
09370081081FLUOROESTRADIOL F18
09370082085FLUOROESTRADIOL F 18
09370086090FLUOROESTRADIOL F 18
09371080080INJECTION, MELOXICAM
09371081090INJ. MELOXICAM 1 MG
09372080090INJ. XEMBIFY, 100 MG
09373080083INJ ONASE ABEPAR-XIOI TREAT
09374081081MITOMYCIN PYELOCALYCEAL INST
09374082090MITOMYCIN INSTILLATION
09375080090INJ., EVOMELA, 1 MG
09376081090SACITUZUMAB GOVITECAN-HZIY
09377081090INJ. ISATUXIMAB-IRFC 10 MG
09378081081DARATUMUMAB HYALURONIDASE
09378082090DARATUMUMAB, HYALURONIDASE
09379081084ROMIDEPSIN NON-LYOPHILIZED
09380082084INJ., CEFIDEROCOL, 5 MG
09381080090INJ. AVSOLA, 10 MG
09382079090INJ ONTRUZANT 10 MG
09383082082COPPER CU-64, DOTATATE, DX
09383083090COPPER CU 64 DOTATATE DIAG
09384082082BELANTAMAB MAFODONTIN-BLMF
09384083086INJ BELANTAMAB MAFODONT BLMF
09384087090INJ BELANTAMAB MAFODOT BLMF
09385082082INJECTION, TAFASITAMAB-CXIX
09385083090INJ., TAFASITAMAB-CXIX
09386082082INJECTION, VILTOLARSEN
09386083090INJ. VILTOLARSEN
09387082090INJ. INFUGEM, 100 MG
09388081090INJ. FE DERISOMALTOSE 10 MG
09389082090INJ. LURBINECTEDIN, 0.1 MG
09390082090PERTUZU, TRASTUZU, 10 MG
09391082082BREXUCABTAGENE AUTOLEUCEL CA
09391083090BREXUCABTAGENE CAR POS T
09392082082INJ, IMM GLOB ASCENIV
09392083090INJ. ASCENIV
09393082090INJ CODEINE PHOSPHATE /30 MG
09394082090INJ. INEBILIZUMAB-CDON, 1 MG
09395082090FACTOR VIIA RECOMB SEVENFACT
09396082090AFAMELANOTIDE IMPLANT, 1 MG
09397083085COVID-19 VACCINE ADMINISTRATION DOSE 1 OF 2
09397086090COVID-19 VACCINE ADMIN DOSE 1 OF 2
09398083083COVID-19 VACCINE ADMINISTRATION DOSE 2 OF 2 OR SINGLE DOSE PRODUCT
09398084090COVID-19 VACCINE ADMIN DOSE 2 OF 2, SINGLE DOSE PRODUCT OR ADDITIONAL DOSE
09399090090COVID-19 VACCINE HOME ADMINISTRATION
09401089090BEBTELOVIMAB 175 MG
09406082090INJ, NYVEPRIA
09407083083INJECTION, LUMASIRAN
09407084090INJ. LUMASIRAN, 0.5 MG
09408084090INJ. NAXITAMAB-GQGK, 1 MG
09409084090GALLIUM GA-68 PSMA-11 UCSF
09410084090GALLIUM GA-68 PSMA-11, UCLA
09411084090INJ. RIABNI, 10 MG
09412084090INJECTION, CASIMERSEN, 10 MG
09413084085LISOCABTAGENE CAR POS T
09413086090LISOCABTAGENE CAR POS T
09414084084INJ CABOTEGRAVIR/RILPIVIRINE
09414085090INJ, CABOTE RILPIVIR 2MG 3MG
09415084084INJ, TRILACICLIB, 1 MG
09415085090INJECTION, TRILACICLIB, 1MG
09416084084INJ, EVINACUMAB-DGNB, 5 MG
09416085085INJ, EVINACUMAB-DGNB, 5MG
09416086090INJ, EVINACUMAB-DGNB, 5 MG
09417084084INJ, MELPHALAN FLUFEN, 1 MG
09417085090INJ, MELPHALAN FLUFENAMI 1MG
09418084090INJ. MARGETUXIMAB-CMKB, 5 MG
09419084090INJ FENSOLVI 0.25 MG
09420086089EPTIFIBATIDE INJECTION
09421086090INJ, GRANISETRON, XR, 0.1 MG
09422085085IDECABTAGENE CAR POS T
09422086090IDECABTAGENE VICLEUCEL CAR
09423085085INJ DOSTARLIMAB-GXLY, 100 MG
09424085085INJ, AMIVANTAMAB-VMJW, 10 MG
09425085086LONCASTUXIMAB-LPYL, 0.1 MG
09426085090INJ, CEFIDEROCOL, 10 MG
09427085090INJECTION, ORITAVANCIN 10 MG
09428085090INJ ROMIDEPSIN NON-LYO 0.1MG
09429085090INJ ROMIDEPSIN LYOPHIL 0.1MG
09430086090PIFLU F-18, DIA 1 MILLICURIE
09431086090INJ, DOSTARLIMAB-GXLY, 10 MG
09432086090INJ, AMIVANTAMAB-VMJW
09433086086INJ AVALGLUCOSID ALFA-NGPT
09433087090INJ AVAL ALFA-NQPT 4MG
09434086086INJ, ANIFROLUMAB-FNIA
09434087090INJ ANIFROLUMAB-FNIA 1MG
09435086086INJ CYCLOPHOSPHAMD AUROMEDIC
09436086090INJ PEGFILGRAST EX BIO 0.5MG
09437086090INJ, ASPARA, RYLAZE, 0.1 MG
09438086090INJECTION, ADUCANUMAB-AVWA, 2 MG
09439087087INJ., SUSVIMO, 0.1 MG
09439088090INJ, SUSVIMO 0.1 MG
09440087090INSTILL, BUPIVAC AND MELOXIC
09441063090INJ FERRIC CARBOXYMALTOS 1MG
09442087090INJ. PEMETREXED, 10 MG
09443088090GALLIUM ILLUCCIX 1 MILLICURE
09444088090INJ, SUTIMLIMAB-JOME, 10 MG
09445063090INJECTION, RUCONEST
09446088090INJ, TEBENTAFUSP-TEBN, 1 MCG
09447088088INJ, RELEUKO, 1 MCG
09447089090INJ, RELEUKO 1 MCG
09448063073NETUPITANT PALONOSETRON ORAL
09448074090ORAL NETUPITANT, PALONOSETRO
09449063090INJECTION, BLINATUMOMAB
09450063076FLUOCINOL ACET INTRAVIT IMP
09450077077INJ., ILUVIEN, 0.01 MG
09450078081FLUOCINOL ACET INTRAVIT IMP
09450082085INJ., ILUVIEN, 0.01 MG
09450086090FLUOCINOL ACET INTRAVIT IMP
09451063090INJECTION, PERAMIVIR
09452063090INJ CEFTOLOZANE TAZOBACTAM
09453063090INJECTION, NIVOLUMAB
09454063090INJ, PASIREOTIDE LONG ACTING
09455063090INJECTION, SILTUXIMAB
09456063090INJECTION, ISAVUCONAZONIUM
09457063069INJ SULF HEXA LIPID MICROSPH
09458063063FLORBETABEN F18
09458064073FLORBETABEN F18 DIAGNOSTIC
09458078080FLORBETABEN F18 DIAGNOSTIC
09459063063FLUTEMETAMOL F18
09459064073FLUTEMETAMOL F18 DIAGNOSTIC
09459078080FLUTEMETAMOL F18 DIAGNOSTIC
09460063090INJECTION, CANGRELOR
09461063065CHOLINE C 11, DIAGNOSTIC
09461066073CHOLINE C-11, DIAGNOSTIC, PER STUDY DOSE UP TO 20 MILLICURIES
09462071085INJECTION, DELAFLOXACIN
09463071073INJECTION, APREPITANT
09463074090INJ., APREPITANT, 1 MG
09464071073INJECTION, ROLAPITANT
09464074080INJ., ROLAPITANT, 0.5 MG
09465071073INJECTION, DUROLANE
09466071073INJECTION, BENRALIZUMAB
09466074090INJ., BENRALIZUMAB, 1 MG
09467071073INJ RITUXIMAB HYALURONIDASE
09467074090INJ RITUXIMAB, HYALURONIDASE
09468071073INJ, FACTOR IX, REBINYN
09468074090FACTOR IX RECOMB GLY REBINYN
09469071071INJ TRIAMCINOLONE ACETONIDE
09469072073INJ., TRIAMCINOLONE EXT REL
09469074090INJ TRIAMCINOLONE ACE XR 1MG
09470063065ARIPIPRAZOLE LAUROXIL IM
09470066076ARIPIPRAZOLE LAUROXIL 1MG
09470077090ARIPIRAZOLE LAUROXIL 1 MG
09471063065HYMOVIS, 1 MG
09471066090HYMOVIS INJECTION 1 MG
09472063090INJ TALIMOGENE LAHERPAREPVEC
09473063065INJECTION, MEPOLIZUMAB
09473066090INJECTION, MEPOLIZUMAB, 1MG
09474063065INJ, IRINOTECAN LIPOSOME
09474066090INJ IRINOTECAN LIPOSOME 1 MG
09475063065INJECTION, NECITUMUMAB
09475066090INJECTION, NECITUMUMAB, 1 MG
09476064065INJECTION, DARATUMUMAB
09476066090INJECTION, DARATUMUMAB 10 MG
09477064065INJECTION, ELOTUZUMAB
09477066090INJECTION, ELOTUZUMAB, 1MG
09478064065INJECTION, SEBELIPASE ALFA
09478066090INJ SEBELIPASE ALFA 1 MG
09479064090INSTILL, CIPROFLOXACIN OTIC
09480064065INJECTION, TRABECTEDIN
09480066090INJECTION TRABECTEDIN 0.1MG
09481065090INJECTION, RESLIZUMAB
09482065090SOTALOL HYDROCHLORIDE IV
09483065069INJECTION, ATEZOLIZUMAB
09483070090INJ, ATEZOLIZUMAB,10 MG
09484067069INJECTION, ETEPLIRSEN
09484070081INJ, ETEPLIRSEN, 10 MG
09485067069INJECTION, OLARATUMAB
09485070089INJ, OLARATUMAB, 10 MG
09486067069INJ, GRANISETRON EXT
09486070078INJ, GRANISETRON, XR, 0.1 MG
09487067067USTEKINUMAB IV INJ, 1 MG
09487068069USTEKINUMAB IV INJ, 1 MG
09487070090USTEKINUMAB, IV INJECT,1 MG
09488067069CONIVAPTAN HCL
09488070090CONIVAPTAN HCL
09489068069INJECTION, NUSINERSEN
09489070090INJ, NUSINERSEN, 0.1MG
09490068069INJECTION, BEZLOTOXUMAB
09490070090INJ, BEZLOTOXUMAB, 10 MG
09491069069INJECTION, AVELUMAB
09491070090INJECTION, AVELUMAB, 10 MG
09492069073INJECTION, DURVALUMAB
09492074090INJ., DURVALUMAB, 10 MG
09493069073INJECTION, EDARAVONE
09493074090INJECTION, EDARAVONE, 1 MG
09494069090INJECTION, OCRELIZUMAB
09495070090GEMTUZUMAB OZOGAMICIN INJ
09496088088INJ, FARICIMAB-SVOA, 0.1 MG
09496089090INJ, FARICIMAB-SVOA, 0.1MG
09497063073LOXAPINE, INHALATION POWDER
09497074077LOXAPINE FOR INHALATION 1 MG
09498088088CILTACABTAGENE CAR POS T
09498089090CILTACABTAGENE CAR-POS T
09499090090ADENOVIRUS VACCINE TYPE 4
09500063090PLATELETS, IRRADIATED
09501063090PLATELET PHERES LEUKOREDUCED
09502063090PLATELET PHERESIS IRRADIATED
09503063090FR FRZ PLASMA DONOR RETESTED
09504063090RBC DEGLYCEROLIZED
09505063090RBC IRRADIATED
09506063065GRANULOCYTES, PHERESIS UNIT
09507063090PLATELETS, PHERESIS
09508063090PLASMA 1 DONOR FRZ W/IN 8 HR
09509063090FROZEN PLASMA, POOLED, SD
09510063090WHOLE BLOOD FOR TRANSFUSION
09511063090CRYOPRECIPITATE EACH UNIT
09512063090RBC LEUKOCYTES REDUCED
09513063090PLASMA, FRZ BETWEEN 8-24HOUR
09514063090PLASMA PROTEIN FRACT,5%,50ML
09515063090PLATELETS, EACH UNIT
09516063090PLAELET RICH PLASMA UNIT
09517063090RED BLOOD CELLS UNIT
09518063090WASHED RED BLOOD CELLS UNIT
09519063090PLASMAPROTEIN FRACT,5%,250ML
09520063090BLOOD SPLIT UNIT
09521063090PLATELETS LEUKOREDUCED IRRAD
09522063090RBC LEUKOREDUCED IRRADIATED
09523063090CRYOPRECIPITATEREDUCEDPLASMA
09524063090BLOOD, L/R, CMV-NEG
09525063090PLATELETS, HLA-M, L/R, UNIT
09526063090PLATELETS LEUKOCYTES REDUCED
09527063090BLOOD, L/R, FROZ/DEGLY/WASH
09528063090PLT, APH/PHER, L/R, CMV-NEG
09529063090BLOOD, L/R, IRRADIATED
09530063090PLATE PHERES LEUKOREDU IRRAD
09531063090PLT, PHER, L/R CMV-NEG, IRR
09532063090RBC, FRZ/DEG/WSH, L/R, IRRAD
09533063090RBC, L/R, CMV-NEG, IRRAD
09534063090PATHOGEN REDUCED PLASMA POOL
09535063090PATHOGEN REDUCED PLASMA SING
09536063067PATHOGEN REDUCED PLATELETS
09536068069PLATELETS PHERESIS PATH REDUC
09536070073PLATELETS, PATHOGEN REDUCED
09536074090PLATELETS PHERESIS PATH REDU
09537082090BLOOD COMPONENT/PRODUCT NOC
09538085090PLASMA CRYO REDU PATH EACH
09539085090CRYO FIB COMP PATH REDU EACH
09540087089COVID-19 CONVALESCENT PLASMA
09540090090COVID-19 CONVALESCENT PLASMA
