Addendum BB -- ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2022 (Including Ancillary Services for Which Payment is Packaged)						
"CPT codes and descriptions only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.  Dental codes (D codes) are copyright 2021 American Dental Association. All Rights Reserved. The existence or absence of a HCPCS code does not mean that an item or service is covered or non-covered. As a reminder, the fact that a drug, device, procedure, or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the program. Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure, or other service meets all program requirements for coverage. For example, MACs determine that it is reasonable and necessary to treat the beneficiarys condition and whether it is excluded from payment."						
						
HCPCS Code		Short Descriptor	Drug Pass-Through Expiration during Calendar Year	July 2022 Payment Indicator	July 2022 Payment Weight  	July 2022 Payment Rate 
0331T		Heart symp image plnr		Z2	13.5464	$676.18
0332T		Heart symp image plnr spect		Z2	13.5464	$676.18
0394T		Hdr elctrnc skn surf brchytx		Z2	2.5058	$125.08
0395T		Hdr elctr ntrst/ntrcv brchtx		Z2	7.3537	$367.07
0422T		Tactile breast img uni/bi		Z2	0.8385	$41.85
0508T		Pls echo us b1 dns meas tib		Z2	1.1286	$56.34
0558T		Ct scan f/biomchn ct alys		Z2	0.8385	$41.85
0598T		Ncntc r-t fluor wnd img 1st		Z2	2.7435	$136.94
0599T		Ncntc r-t fluor wnd img ea		N1		
0609T		Mrs disc pain acquisj data		Z2	2.3852	$119.06
0611T		Mrs disc pain alg alys data		Z2	2.3852	$119.06
0633T		Ct breast w/3d uni c-		Z2	1.1286	$56.34
0634T		Ct breast w/3d uni c+		Z2	1.8517	$92.43
0635T		Ct breast w/3d uni c-/c+		Z2	1.8517	$92.43
0636T		Ct breast w/3d bi c-		Z2	2.3852	$119.06
0637T		Ct breast w/3d bi c+		Z2	3.8173	$190.54
0638T		Ct breast w/3d bi c-/c+		Z2	3.8173	$190.54
0648T		Quan mr tis wo mri 1orgn		Z2	9.6476	$481.57
0689T		Quan us tis charac w/o dx us		Z2	0.8385	$41.85
0697T		Quan mr tis wo mri mlt orgn		Z2	2.3852	$119.06
70010		Contrast x-ray of brain		N1		
70015		Contrast x-ray of brain		N1		
70030		X-ray eye for foreign body		N1		
70100		X-ray exam of jaw <4views		N1		
70110		X-ray exam of jaw 4/> views		N1		
70120		X-ray exam of mastoids		N1		
70130		X-ray exam of mastoids		N1		
70134		X-ray exam of middle ear		N1		
70140		X-ray exam of facial bones		N1		
70150		X-ray exam of facial bones		N1		
70160		X-ray exam of nasal bones		N1		
70170		X-ray exam of tear duct		N1		
70190		X-ray exam of eye sockets		N1		
70200		X-ray exam of eye sockets		N1		
70210		X-ray exam of sinuses		N1		
70220		X-ray exam of sinuses		N1		
70240		X-ray exam pituitary saddle		N1		
70250		X-ray exam of skull		N1		
70260		X-ray exam of skull		N1		
70300		X-ray exam of teeth		N1		
70310		X-ray exam of teeth		N1		
70320		Full mouth x-ray of teeth		N1		
70328		X-ray exam of jaw joint		N1		
70330		X-ray exam of jaw joints		N1		
70332		X-ray exam of jaw joint		N1		
70336		Magnetic image jaw joint		Z2	2.3852	$119.06
70350		X-ray head for orthodontia		N1		
70355		Panoramic x-ray of jaws		N1		
70360		X-ray exam of neck		N1		
70370		Throat x-ray & fluoroscopy		N1		
70371		Speech evaluation complex		N1		
70380		X-ray exam of salivary gland		N1		
70390		X-ray exam of salivary duct		N1		
70450		Ct head/brain w/o dye		Z2	1.1286	$56.34
70460		Ct head/brain w/dye		Z2	1.8517	$92.43
70470		Ct head/brain w/o & w/dye		Z2	1.8517	$92.43
70480		Ct orbit/ear/fossa w/o dye		Z2	1.1286	$56.34
70481		Ct orbit/ear/fossa w/dye		Z2	1.8517	$92.43
70482		Ct orbit/ear/fossa w/o&w/dye		Z2	1.8517	$92.43
70486		Ct maxillofacial w/o dye		Z2	1.1286	$56.34
70487		Ct maxillofacial w/dye		Z2	1.8517	$92.43
70488		Ct maxillofacial w/o & w/dye		Z2	1.8517	$92.43
70490		Ct soft tissue neck w/o dye		Z2	1.1286	$56.34
70491		Ct soft tissue neck w/dye		Z2	1.8517	$92.43
70492		Ct sft tsue nck w/o & w/dye		Z2	1.8517	$92.43
70496		Ct angiography head		Z2	1.8517	$92.43
70498		Ct angiography neck		Z2	1.8517	$92.43
70540		Mri orbit/face/neck w/o dye		Z2	2.3852	$119.06
70542		Mri orbit/face/neck w/dye		Z2	3.8173	$190.54
70543		Mri orbt/fac/nck w/o &w/dye		Z2	3.8173	$190.54
70544		Mr angiography head w/o dye		Z2	2.3852	$119.06
70545		Mr angiography head w/dye		Z3		$187.22
70546		Mr angiograph head w/o&w/dye		Z2	3.8173	$190.54
70547		Mr angiography neck w/o dye		Z2	2.3852	$119.06
70548		Mr angiography neck w/dye		Z2	3.8173	$190.54
70549		Mr angiograph neck w/o&w/dye		Z2	3.8173	$190.54
70551		Mri brain stem w/o dye		Z2	2.3852	$119.06
70552		Mri brain stem w/dye		Z2	3.8173	$190.54
70553		Mri brain stem w/o & w/dye		Z2	3.8173	$190.54
70554		Fmri brain by tech		Z2	2.3852	$119.06
70555		Fmri brain by phys/psych		Z2	2.3852	$119.06
70557		Mri brain w/o dye		Z2	5.0088	$250.02
70558		Mri brain w/dye		Z2	1.8517	$92.43
70559		Mri brain w/o & w/dye		Z2	1.8517	$92.43
71045		X-ray exam chest 1 view		Z3		$17.30
71046		X-ray exam chest 2 views		Z3		$23.53
71047		X-ray exam chest 3 views		N1		
71048		X-ray exam chest 4+ views		N1		
71100		X-ray exam ribs uni 2 views		N1		
71101		X-ray exam unilat ribs/chest		N1		
71110		X-ray exam ribs bil 3 views		N1		
71111		X-ray exam ribs/chest4/> vws		N1		
71120		X-ray exam breastbone 2/>vws		N1		
71130		X-ray strenoclavic jt 3/>vws		N1		
71250		Ct thorax dx c-		Z2	1.1286	$56.34
71260		Ct thorax dx c+		Z2	1.8517	$92.43
71270		Ct thorax dx c-/c+		Z2	1.8517	$92.43
71275		Ct angiography chest		Z2	1.8517	$92.43
71550		Mri chest w/o dye		Z2	2.3852	$119.06
71551		Mri chest w/dye		Z3		$326.68
71552		Mri chest w/o & w/dye		Z2	3.8173	$190.54
72020		X-ray exam of spine 1 view		N1		
72040		X-ray exam neck spine 2-3 vw		N1		
72050		X-ray exam neck spine 4/5vws		N1		
72052		X-ray exam neck spine 6/>vws		N1		
72070		X-ray exam thorac spine 2vws		N1		
72072		X-ray exam thorac spine 3vws		N1		
72074		X-ray exam thorac spine4/>vw		N1		
72080		X-ray exam thoracolmb 2/> vw		N1		
72081		X-ray exam entire spi 1 vw		N1		
72082		X-ray exam entire spi 2/3 vw		N1		
72083		X-ray exam entire spi 4/5 vw		Z2	1.1286	$56.34
72084		X-ray exam entire spi 6/> vw		Z2	1.1286	$56.34
72100		X-ray exam l-s spine 2/3 vws		N1		
72110		X-ray exam l-2 spine 4/>vws		N1		
72114		X-ray exam l-s spine bending		N1		
72120		X-ray bend only l-s spine		N1		
72125		Ct neck spine w/o dye		Z2	1.1286	$56.34
72126		Ct neck spine w/dye		Z3		$121.81
72127		Ct neck spine w/o & w/dye		Z2	1.8517	$92.43
72128		Ct chest spine w/o dye		Z2	1.1286	$56.34
72129		Ct chest spine w/dye		Z2	1.8517	$92.43
72130		Ct chest spine w/o & w/dye		Z2	1.8517	$92.43
72131		Ct lumbar spine w/o dye		Z2	1.1286	$56.34
72132		Ct lumbar spine w/dye		Z3		$121.81
72133		Ct lumbar spine w/o & w/dye		Z2	1.8517	$92.43
72141		Mri neck spine w/o dye		Z2	2.3852	$119.06
72142		Mri neck spine w/dye		Z2	3.8173	$190.54
72146		Mri chest spine w/o dye		Z2	2.3852	$119.06
72147		Mri chest spine w/dye		Z2	3.8173	$190.54
72148		Mri lumbar spine w/o dye		Z2	2.3852	$119.06
72149		Mri lumbar spine w/dye		Z2	3.8173	$190.54
72156		Mri neck spine w/o & w/dye		Z2	3.8173	$190.54
72157		Mri chest spine w/o & w/dye		Z2	3.8173	$190.54
72158		Mri lumbar spine w/o & w/dye		Z2	3.8173	$190.54
72170		X-ray exam of pelvis		N1		
72190		X-ray exam of pelvis		N1		
72191		Ct angiograph pelv w/o&w/dye		Z2	1.8517	$92.43
72192		Ct pelvis w/o dye		Z2	1.1286	$56.34
72193		Ct pelvis w/dye		Z2	1.8517	$92.43
72194		Ct pelvis w/o & w/dye		Z2	1.8517	$92.43
72195		Mri pelvis w/o dye		Z2	2.3852	$119.06
72196		Mri pelvis w/dye		Z2	3.8173	$190.54
72197		Mri pelvis w/o & w/dye		Z2	3.8173	$190.54
72200		X-ray exam si joints		N1		
72202		X-ray exam si joints 3/> vws		N1		
72220		X-ray exam sacrum tailbone		N1		
72240		Myelography neck spine		N1		
72255		Myelography thoracic spine		N1		
72265		Myelography l-s spine		N1		
72270		Myelogphy 2/> spine regions		N1		
72285		Discography cerv/thor spine		N1		
72295		X-ray of lower spine disk		N1		
73000		X-ray exam of collar bone		N1		
73010		X-ray exam of shoulder blade		N1		
73020		X-ray exam of shoulder		N1		
73030		X-ray exam of shoulder		N1		
73040		Contrast x-ray of shoulder		N1		
73050		X-ray exam of shoulders		N1		
73060		X-ray exam of humerus		N1		
73070		X-ray exam of elbow		N1		
73080		X-ray exam of elbow		N1		
73085		Contrast x-ray of elbow		N1		
73090		X-ray exam of forearm		N1		
73092		X-ray exam of arm infant		N1		
73100		X-ray exam of wrist		N1		
73110		X-ray exam of wrist		N1		
73115		Contrast x-ray of wrist		N1		
73120		X-ray exam of hand		N1		
73130		X-ray exam of hand		N1		
73140		X-ray exam of finger(s)		N1		
73200		Ct upper extremity w/o dye		Z2	1.1286	$56.34
73201		Ct upper extremity w/dye		Z3		$161.26
73202		Ct uppr extremity w/o&w/dye		Z2	1.8517	$92.43
73206		Ct angio upr extrm w/o&w/dye		Z2	1.8517	$92.43
73218		Mri upper extremity w/o dye		Z2	2.3852	$119.06
73219		Mri upper extremity w/dye		Z2	3.8173	$190.54
73220		Mri uppr extremity w/o&w/dye		Z2	3.8173	$190.54
73221		Mri joint upr extrem w/o dye		Z2	2.3852	$119.06
73222		Mri joint upr extrem w/dye		Z3		$264.39
73223		Mri joint upr extr w/o&w/dye		Z2	3.8173	$190.54
73501		X-ray exam hip uni 1 view		N1		
73502		X-ray exam hip uni 2-3 views		N1		
73503		X-ray exam hip uni 4/> views		N1		
73521		X-ray exam hips bi 2 views		N1		
73522		X-ray exam hips bi 3-4 views		N1		
73523		X-ray exam hips bi 5/> views		N1		
73525		Contrast x-ray of hip		N1		
73551		X-ray exam of femur 1		N1		
73552		X-ray exam of femur 2/>		N1		
73560		X-ray exam of knee 1 or 2		N1		
73562		X-ray exam of knee 3		N1		
73564		X-ray exam knee 4 or more		N1		
73565		X-ray exam of knees		N1		
73580		Contrast x-ray of knee joint		N1		
73590		X-ray exam of lower leg		N1		
73592		X-ray exam of leg infant		N1		
73600		X-ray exam of ankle		N1		
73610		X-ray exam of ankle		N1		
73615		Contrast x-ray of ankle		N1		
73620		X-ray exam of foot		N1		
73630		X-ray exam of foot		N1		
73650		X-ray exam of heel		N1		
73660		X-ray exam of toe(s)		N1		
73700		Ct lower extremity w/o dye		Z2	1.1286	$56.34
73701		Ct lower extremity w/dye		Z2	1.8517	$92.43
73702		Ct lwr extremity w/o&w/dye		Z2	1.8517	$92.43
73706		Ct angio lwr extr w/o&w/dye		Z2	1.8517	$92.43
73718		Mri lower extremity w/o dye		Z2	2.3852	$119.06
73719		Mri lower extremity w/dye		Z2	3.8173	$190.54
73720		Mri lwr extremity w/o&w/dye		Z2	3.8173	$190.54
73721		Mri jnt of lwr extre w/o dye		Z2	2.3852	$119.06
73722		Mri joint of lwr extr w/dye		Z3		$265.08
73723		Mri joint lwr extr w/o&w/dye		Z2	3.8173	$190.54
74018		X-ray exam abdomen 1 view		N1		
74019		X-ray exam abdomen 2 views		N1		
74021		X-ray exam abdomen 3+ views		N1		
74022		X-ray exam complete abdomen		N1		
74150		Ct abdomen w/o dye		Z2	1.1286	$56.34
74160		Ct abdomen w/dye		Z2	1.8517	$92.43
74170		Ct abdomen w/o & w/dye		Z2	1.8517	$92.43
74174		Ct angio abd&pelv w/o&w/dye		Z2	3.8173	$190.54
74175		Ct angio abdom w/o & w/dye		Z2	1.8517	$92.43
74176		Ct abd & pelvis w/o contrast		Z3		$110.74
74177		Ct abd & pelv w/contrast		Z2	3.8173	$190.54
74178		Ct abd & pelv 1/> regns		Z2	3.8173	$190.54
74181		Mri abdomen w/o dye		Z2	2.3852	$119.06
74182		Mri abdomen w/dye		Z2	3.8173	$190.54
74183		Mri abdomen w/o & w/dye		Z2	3.8173	$190.54
74190		X-ray exam of peritoneum		N1		
74210		X-ray xm phrnx&/crv esoph c+		N1		
74220		X-ray xm esophagus 1cntrst		N1		
74230		X-ray xm swlng funcj c+		Z2	1.8517	$92.43
74235		Remove esophagus obstruction		N1		
74240		X-ray xm upr gi trc 1cntrst		Z3		$91.01
74246		X-ray xm upr gi trc 2cntrst		Z2	1.8517	$92.43
74250		X-ray xm sm int 1cntrst std		Z3		$90.32
74251		X-ray xm sm int 2cntrst std		Z2	1.8517	$92.43
74261		Ct colonography dx		Z2	1.1286	$56.34
74262		Ct colonography dx w/dye		Z2	1.8517	$92.43
74270		X-ray xm colon 1cntrst std		N1		
74280		X-ray xm colon 2cntrst std		N1		
74283		Ther nma rdctj intus/obstrcj		Z2	1.8517	$92.43
74290		Contrast x-ray gallbladder		N1		
74300		X-ray bile ducts/pancreas		N1		
74301		X-rays at surgery add-on		N1		
74328		X-ray bile duct endoscopy		N1		
74329		X-ray for pancreas endoscopy		N1		
74330		X-ray bile/panc endoscopy		N1		
74340		X-ray guide for gi tube		N1		
74355		X-ray guide intestinal tube		N1		
74360		X-ray guide gi dilation		N1		
74363		X-ray bile duct dilation		N1		
74400		Urography iv +-kub tomog		Z2	1.8517	$92.43
74410		Urography nfs drip&/bolus		Z2	1.8517	$92.43
74415		Urography nfs drip&/bls w/nf		Z2	1.8517	$92.43
74420		Urography rtrgr +-kub		Z2	3.8173	$190.54
74425		Urography antegrade rs&i		N1		
74430		Contrast x-ray bladder		N1		
74440		X-ray male genital tract		N1		
74445		X-ray exam of penis		N1		
74450		X-ray urethra/bladder		N1		
74455		X-ray urethra/bladder		N1		
74470		X-ray exam of kidney lesion		N1		
74485		Dilation urtr/urt rs&i		N1		
74710		X-ray measurement of pelvis		N1		
74712		Mri fetal sngl/1st gestation		Z2	2.3852	$119.06
74713		Mri fetal ea addl gestation		N1		
74740		X-ray female genital tract		N1		
74742		X-ray fallopian tube		N1		
74775		X-ray exam of perineum		Z2	2.3852	$119.06
75557		Cardiac mri for morph		Z2	2.3852	$119.06
75559		Cardiac mri w/stress img		Z2	5.0088	$250.02
75561		Cardiac mri for morph w/dye		Z2	3.8173	$190.54
75563		Card mri w/stress img & dye		Z3		$325.64
75565		Card mri veloc flow mapping		N1		
75571		Ct hrt w/o dye w/ca test		N1		
75572		Ct hrt w/3d image		Z2	1.8517	$92.43
75573		Ct hrt c+ strux cgen hrt ds		Z2	1.8517	$92.43
75574		Ct angio hrt w/3d image		Z2	1.8517	$92.43
75600		Contrast exam thoracic aorta		N1		
75605		Contrast exam thoracic aorta		N1		
75625		Contrast exam abdominl aorta		N1		
75630		X-ray aorta leg arteries		N1		
75635		Ct angio abdominal arteries		N1		
75705		Artery x-rays spine		N1		
75710		Artery x-rays arm/leg		N1		
75716		Artery x-rays arms/legs		N1		
75726		Artery x-rays abdomen		N1		
75731		Artery x-rays adrenal gland		Z3		$99.67
75733		Artery x-rays adrenals		N1		
75736		Artery x-rays pelvis		N1		
75741		Artery x-rays lung		N1		
75743		Artery x-rays lungs		N1		
75746		Artery x-rays lung		Z3		$83.05
75756		Artery x-rays chest		N1		
75774		Artery x-ray each vessel		N1		
75801		Lymph vessel x-ray arm/leg		N1		
75803		Lymph vessel x-ray arms/legs		Z2	11.1755	$557.84
75805		Lymph vessel x-ray trunk		Z2	28.0026	"$1,397.78"
75807		Lymph vessel x-ray trunk		N1		
75809		Nonvascular shunt x-ray		N1		
75810		Vein x-ray spleen/liver		Z2	28.0026	"$1,397.78"
75820		Vein x-ray arm/leg		N1		
75822		Vein x-ray arms/legs		Z3		$67.83
75825		Vein x-ray trunk		N1		
75827		Vein x-ray chest		N1		
75831		Vein x-ray kidney		N1		
75833		Vein x-ray kidneys		N1		
75840		Vein x-ray adrenal gland		N1		
75842		Vein x-ray adrenal glands		N1		
75860		Vein x-ray neck		N1		
75870		Vein x-ray skull		Z3		$105.89
75872		Vein x-ray skull epidural		N1		
75880		Vein x-ray eye socket		N1		
75885		Vein x-ray liver w/hemodynam		N1		
75887		Vein x-ray liver w/o hemodyn		Z3		$75.10
75889		Vein x-ray liver w/hemodynam		N1		
75891		Vein x-ray liver		N1		
75893		Venous sampling by catheter		N1		
75894		X-rays transcath therapy		N1		
75898		Follow-up angiography		Z2	28.0026	"$1,397.78"
75901		Remove cva device obstruct		N1		
75902		Remove cva lumen obstruct		N1		
75970		Vascular biopsy		N1		
75984		Xray control catheter change		N1		
75989		Abscess drainage under x-ray		N1		
76000		Fluoroscopy <1 hr phys/qhp		Z3		$28.38
76010		X-ray nose to rectum		N1		
76080		X-ray exam of fistula		N1		
76098		X-ray exam surgical specimen		N1		
76100		X-ray exam of body section		N1		
76120		Cine/video x-rays		N1		
76125		Cine/video x-rays add-on		N1		
76145		Med physic dos eval rad exps		Z2	3.5104	$175.23
76376		3d render w/intrp postproces		N1		
76377		3d render w/intrp postproces		N1		
76380		Cat scan follow-up study		N1		
76390		Mr spectroscopy		Z2	0.8385	$41.85
76391		Mr elastography		Z2	2.3852	$119.06
76496		Fluoroscopic procedure		N1		
76497		Ct procedure		N1		
76498		Mri procedure		Z2	0.8385	$41.85
76499		Radiographic procedure		N1		
76506		Echo exam of head		N1		
76510		Oph us dx b-scan&quan a-scan		N1		
76511		Oph us dx quan a-scan only		N1		
76512		Oph us dx b-scan		N1		
76513		Oph us dx ant sgm us uni/bi		N1		
76514		Echo exam of eye thickness		N1		
76516		Echo exam of eye		N1		
76519		Echo exam of eye		N1		
76529		Echo exam of eye		N1		
76536		Us exam of head and neck		N1		
76604		Us exam chest		N1		
76641		Ultrasound breast complete		N1		
76642		Ultrasound breast limited		N1		
76700		Us exam abdom complete		Z2	1.1286	$56.34
76705		Echo exam of abdomen		Z2	1.1286	$56.34
76770		Us exam abdo back wall comp		Z2	1.1286	$56.34
76775		Us exam abdo back wall lim		N1		
76776		Us exam k transpl w/doppler		Z2	1.1286	$56.34
76800		Us exam spinal canal		N1		
76801		Ob us < 14 wks single fetus		Z2	1.1286	$56.34
76802		Ob us < 14 wks addl fetus		N1		
76805		Ob us >= 14 wks sngl fetus		Z2	1.1286	$56.34
76810		Ob us >= 14 wks addl fetus		N1		
76811		Ob us detailed sngl fetus		Z3		$85.13
76812		Ob us detailed addl fetus		N1		
76813		Ob us nuchal meas 1 gest		N1		
76814		Ob us nuchal meas add-on		N1		
76815		Ob us limited fetus(s)		N1		
76816		Ob us follow-up per fetus		N1		
76817		Transvaginal us obstetric		N1		
76818		Fetal biophys profile w/nst		Z2	1.1286	$56.34
76819		Fetal biophys profil w/o nst		Z3		$48.10
76820		Umbilical artery echo		N1		
76821		Middle cerebral artery echo		N1		
76825		Echo exam of fetal heart		Z3		$191.72
76826		Echo exam of fetal heart		Z2	2.3852	$119.06
76827		Echo exam of fetal heart		N1		
76828		Echo exam of fetal heart		N1		
76830		Transvaginal us non-ob		Z2	1.1286	$56.34
76831		Echo exam uterus		Z3		$85.48
76856		Us exam pelvic complete		Z2	1.1286	$56.34
76857		Us exam pelvic limited		Z3		$24.92
76870		Us exam scrotum		N1		
76872		Us transrectal		Z2	1.1286	$56.34
76873		Echograp trans r pros study		Z2	1.1286	$56.34
76881		Us compl joint r-t w/img		Z3		$29.07
76882		Us lmtd jt/nonvasc xtr strux		N1		
76885		Us exam infant hips dynamic		N1		
76886		Us exam infant hips static		N1		
76932		Echo guide for heart biopsy		N1		
76936		Echo guide for artery repair		Z2	2.7435	$136.94
76937		Us guide vascular access		N1		
76940		Us guide tissue ablation		N1		
76941		Echo guide for transfusion		N1		
76942		Echo guide for biopsy		N1		
76945		Echo guide villus sampling		N1		
76946		Echo guide for amniocentesis		N1		
76948		Echo guide ova aspiration		N1		
76965		Echo guidance radiotherapy		N1		
76975		Gi endoscopic ultrasound		N1		
76977	**	Us bone density measure		Z3		$4.15
76978		Us trgt dyn mbubb 1st les		Z2	1.8517	$92.43
76979		Us trgt dyn mbubb ea addl		N1		
76981		Use parenchyma		Z2	1.1286	$56.34
76982		Use 1st target lesion		Z2	1.1286	$56.34
76983		Use ea addl target lesion		N1		
76998		Us guide intraop		N1		
76999		Echo examination procedure		N1		
77001		Fluoroguide for vein device		N1		
77002		Needle localization by xray		N1		
77003		Fluoroguide for spine inject		N1		
77011		Ct scan for localization		N1		
77012		Ct scan for needle biopsy		N1		
77013		Ct guide for tissue ablation		N1		
77014		Ct scan for therapy guide		N1		
77021		Mri guidance ndl plmt rs&i		N1		
77022		Mri gdn parnchyma tiss abltj		N1		
77046		Mri breast c- unilateral		Z2	2.3852	$119.06
77047		Mri breast c- bilateral		Z2	2.3852	$119.06
77053		X-ray of mammary duct		N1		
77054		X-ray of mammary ducts		N1		
77071		X-ray stress view		N1		
77072		X-rays for bone age		N1		
77073		X-rays bone length studies		N1		
77074		X-rays bone survey limited		N1		
77075		X-rays bone survey complete		N1		
77076		X-rays bone survey infant		N1		
77077		Joint survey single view		N1		
77078	**	Ct bone density axial		Z2	0.8385	$41.85
77080	**	Dxa bone density axial		Z3		$28.03
77081	**	Dxa bone density/peripheral		Z3		$21.46
77084		Magnetic image bone marrow		Z2	2.3852	$119.06
77085	**	Dxa bone density study		N1		
77086		Fracture assessment via dxa		N1		
77280		Set radiation therapy field		Z2	1.3153	$65.65
77285		Set radiation therapy field		Z2	3.5104	$175.23
77290		Set radiation therapy field		Z2	3.5104	$175.23
77293		Respirator motion mgmt simul		N1		
77295		3-d radiotherapy plan		Z3		$252.63
77299		Radiation therapy planning		Z2	1.3153	$65.65
77300		Radiation therapy dose plan		Z3		$32.88
77301		Radiotherapy dose plan imrt		Z2	13.0902	$653.41
77306		Telethx isodose plan simple		Z3		$73.37
77307		Telethx isodose plan cplx		Z3		$132.89
77316		Brachytx isodose plan simple		Z3		$170.61
77317		Brachytx isodose intermed		Z2	3.5104	$175.23
77318		Brachytx isodose complex		Z2	3.5104	$175.23
77321		Special teletx port plan		Z3		$43.95
77331		Special radiation dosimetry		Z3		$18.69
77332		Radiation treatment aid(s)		Z3		$14.53
77333		Radiation treatment aid(s)		Z2	1.3153	$65.65
77334		Radiation treatment aid(s)		Z3		$64.71
77336		Radiation physics consult		Z2	1.3153	$65.65
77338		Design mlc device for imrt		Z2	3.5104	$175.23
77370		Radiation physics consult		Z2	1.3153	$65.65
77385		Ntsty modul rad tx dlvr smpl		Z2	5.6243	$280.74
77386		Ntsty modul rad tx dlvr cplx		Z2	5.6243	$280.74
77387		Guidance for radj tx dlvr		N1		
77399		External radiation dosimetry		Z2	1.3153	$65.65
77401		Radiation treatment delivery		Z3		$41.87
77402		Radiation treatment delivery		Z2	1.2418	$61.99
77407		Radiation treatment delivery		Z2	2.5058	$125.08
77412		Radiation treatment delivery		Z2	2.5058	$125.08
77417		Radiology port images(s)		N1		
77423		Neutron beam tx complex		Z3		$28.38
77424		Io rad tx delivery by x-ray		Z2	39.4422	"$1,968.80"
77425		Io rad tx deliver by elctrns		Z2	39.4422	"$1,968.80"
77435		Sbrt management		N1		
77470		Special radiation treatment		Z3		$29.07
77520		Proton trmt simple w/o comp		Z2	5.6243	$280.74
77522		Proton trmt simple w/comp		Z2	13.4095	$669.35
77523		Proton trmt intermediate		Z2	13.4095	$669.35
77525		Proton treatment complex		Z2	13.4095	$669.35
77600		Hyperthermia treatment		Z2	2.5058	$125.08
77605		Hyperthermia treatment		Z2	7.3537	$367.07
77610		Hyperthermia treatment		Z2	5.6243	$280.74
77615		Hyperthermia treatment		Z2	5.6243	$280.74
77620		Hyperthermia treatment		Z2	5.6243	$280.74
77750		Infuse radioactive materials		Z2	2.5058	$125.08
77761		Apply intrcav radiat simple		Z3		$212.83
77762		Apply intrcav radiat interm		Z3		$242.24
77763		Apply intrcav radiat compl		Z3		$312.49
77767		Hdr rdncl skn surf brachytx		Z2	2.5058	$125.08
77768		Hdr rdncl skn surf brachytx		Z2	2.5058	$125.08
77770		Hdr rdncl ntrstl/icav brchtx		Z3		$246.40
77771		Hdr rdncl ntrstl/icav brchtx		Z2	7.3537	$367.07
77772		Hdr rdncl ntrstl/icav brchtx		Z2	7.3537	$367.07
77778		Apply interstit radiat compl		Z2	7.3537	$367.07
77789		Apply surf ldr radionuclide		Z2	1.2418	$61.99
77790		Radiation handling		N1		
77799		Radium/radioisotope therapy		Z2	1.2418	$61.99
78012		Thyroid uptake measurement		Z2	3.9077	$195.06
78013		Thyroid imaging w/blood flow		Z2	3.9077	$195.06
78014		Thyroid imaging w/blood flow		Z2	3.9077	$195.06
78015		Thyroid met imaging		Z2	3.9077	$195.06
78016		Thyroid met imaging/studies		Z2	3.9077	$195.06
78018		Thyroid met imaging body		Z2	5.0727	$253.21
78020		Thyroid met uptake		N1		
78070		Parathyroid planar imaging		Z2	3.9077	$195.06
78071		Parathyrd planar w/wo subtrj		Z2	3.9077	$195.06
78072		Parathyrd planar w/spect&ct		Z2	5.0727	$253.21
78075		Adrenal cortex & medulla img		Z2	13.5464	$676.18
78099		Endocrine nuclear procedure		Z2	3.9077	$195.06
78102		Bone marrow imaging ltd		Z2	3.9077	$195.06
78103		Bone marrow imaging mult		Z2	3.9077	$195.06
78104		Bone marrow imaging body		Z2	3.9077	$195.06
78110		Plasma volume single		Z2	13.5464	$676.18
78111		Plasma volume multiple		Z2	13.5464	$676.18
78120		Red cell mass single		Z2	3.9077	$195.06
78121		Red cell mass multiple		Z2	5.0727	$253.21
78122		Blood volume		Z2	5.0727	$253.21
78130		Red cell survival study		Z2	3.9077	$195.06
78140		Red cell sequestration		Z2	3.9077	$195.06
78185		Spleen imaging		Z2	3.9077	$195.06
78191		Platelet survival		Z2	3.9077	$195.06
78195		Lymph system imaging		Z2	5.0727	$253.21
78199		Blood/lymph nuclear exam		Z2	3.9077	$195.06
78201		Liver imaging		Z2	5.0727	$253.21
78202		Liver imaging with flow		Z2	5.0727	$253.21
78215		Liver and spleen imaging		Z2	3.9077	$195.06
78216		Liver & spleen image/flow		Z2	3.9077	$195.06
78226		Hepatobiliary system imaging		Z2	3.9077	$195.06
78227		Hepatobil syst image w/drug		Z2	5.0727	$253.21
78230		Salivary gland imaging		Z2	3.9077	$195.06
78231		Serial salivary imaging		Z2	3.9077	$195.06
78232		Salivary gland function exam		Z2	3.9077	$195.06
78258		Esophageal motility study		Z2	3.9077	$195.06
78261		Gastric mucosa imaging		Z2	3.9077	$195.06
78262		Gastroesophageal reflux exam		Z2	3.9077	$195.06
78264		Gastric emptying imag study		Z2	3.9077	$195.06
78265		Gastric emptying imag study		Z2	3.9077	$195.06
78266		Gastric emptying imag study		Z2	5.0727	$253.21
78278		Acute gi blood loss imaging		Z2	3.9077	$195.06
78282		Gi protein loss exam		Z2	3.9077	$195.06
78290		Meckels divert exam		Z2	3.9077	$195.06
78291		Leveen/shunt patency exam		Z2	3.9077	$195.06
78299		Gi nuclear procedure		Z2	3.9077	$195.06
78300		Bone imaging limited area		Z2	3.9077	$195.06
78305		Bone imaging multiple areas		Z2	3.9077	$195.06
78306		Bone imaging whole body		Z2	3.9077	$195.06
78315		Bone imaging 3 phase		Z2	3.9077	$195.06
78399		Musculoskeletal nuclear exam		Z2	3.9077	$195.06
78414		Non-imaging heart function		Z2	5.0727	$253.21
78428		Cardiac shunt imaging		Z2	3.9077	$195.06
78429		Myocrd img pet 1 std w/ct		Z2	15.3424	$765.83
78430		Myocrd img pet rst/strs w/ct		Z2	15.3424	$765.83
78431		Myocrd img pet rst&strs ct		Z2	22.8426	"$1,140.21"
78432		Myocrd img pet 2rtracer		Z2	27.9177	"$1,393.54"
78433		Myocrd img pet 2rtracer ct		Z2	27.9177	"$1,393.54"
78434		Aqmbf pet rest & rx stress		N1		
78445		Vascular flow imaging		Z2	3.9077	$195.06
78451		Ht muscle image spect sing		Z2	13.5464	$676.18
78452		Ht muscle image spect mult		Z2	13.5464	$676.18
78453		Ht muscle image planar sing		Z2	13.5464	$676.18
78454		Ht musc image planar mult		Z2	13.5464	$676.18
78456		Acute venous thrombus image		Z2	13.5464	$676.18
78457		Venous thrombosis imaging		Z2	5.0727	$253.21
78458		Ven thrombosis images bilat		Z2	3.9077	$195.06
78459		Myocrd img pet single study		Z2	13.5464	$676.18
78466		Heart infarct image		Z2	3.9077	$195.06
78468		Heart infarct image (ef)		Z2	5.0727	$253.21
78469		Heart infarct image (3d)		Z2	5.0727	$253.21
78472		Gated heart planar single		Z2	3.9077	$195.06
78473		Gated heart multiple		Z2	3.9077	$195.06
78481		Heart first pass single		Z2	5.0727	$253.21
78483		Heart first pass multiple		Z2	5.0727	$253.21
78491		Myocrd img pet 1std rst/strs		Z2	15.3424	$765.83
78492		Myocrd img pet mlt rst&strs		Z2	15.3424	$765.83
78494		Heart image spect		Z2	3.9077	$195.06
78496		Heart first pass add-on		N1		
78499		Cardiovascular nuclear exam		Z2	3.9077	$195.06
78579		Lung ventilation imaging		Z2	3.9077	$195.06
78580		Lung perfusion imaging		Z2	3.9077	$195.06
78582		Lung ventilat&perfus imaging		Z2	5.0727	$253.21
78597		Lung perfusion differential		Z2	3.9077	$195.06
78598		Lung perf&ventilat diferentl		Z2	5.0727	$253.21
78599		Respiratory nuclear exam		Z2	3.9077	$195.06
78600		Brain image < 4 views		Z2	3.9077	$195.06
78601		Brain image w/flow < 4 views		Z2	3.9077	$195.06
78605		Brain image 4+ views		Z2	5.0727	$253.21
78606		Brain image w/flow 4 + views		Z2	5.0727	$253.21
78608		Brain imaging (pet)		Z2	15.3424	$765.83
78610		Brain flow imaging only		Z2	5.0727	$253.21
78630		Cerebrospinal fluid scan		Z2	5.0727	$253.21
78635		Csf ventriculography		Z2	5.0727	$253.21
78645		Csf shunt evaluation		Z2	5.0727	$253.21
78650		Csf leakage imaging		Z2	13.5464	$676.18
78660		Nuclear exam of tear flow		Z2	3.9077	$195.06
78699		Nervous system nuclear exam		Z2	3.9077	$195.06
78700		Kidney imaging morphol		Z2	3.9077	$195.06
78701		Kidney imaging with flow		Z2	3.9077	$195.06
78707		K flow/funct image w/o drug		Z2	5.0727	$253.21
78708		K flow/funct image w/drug		Z2	5.0727	$253.21
78709		K flow/funct image multiple		Z2	5.0727	$253.21
78725		Kidney function study		Z2	3.9077	$195.06
78730		Urinary bladder retention		N1		
78740		Ureteral reflux study		Z2	3.9077	$195.06
78761		Testicular imaging w/flow		Z2	3.9077	$195.06
78799		Genitourinary nuclear exam		Z2	3.9077	$195.06
78800		Rp loclzj tum 1 area 1 d img		Z2	3.9077	$195.06
78801		Rp loclzj tum 2+area 1+d img		Z2	3.9077	$195.06
78802		Rp loclzj tum whbdy 1 d img		Z2	13.5464	$676.18
78803		Rp loclzj tum spect 1 area		Z2	13.5464	$676.18
78804		Rp loclzj tum whbdy 2+d img		Z2	13.5464	$676.18
78808		Iv inj ra drug dx study		N1		
78811		Pet image ltd area		Z2	13.5464	$676.18
78812		Pet image skull-thigh		Z2	15.3424	$765.83
78813		Pet image full body		Z2	15.3424	$765.83
78814		Pet image w/ct lmtd		Z2	15.3424	$765.83
78815		Pet image w/ct skull-thigh		Z2	15.3424	$765.83
78816		Pet image w/ct full body		Z2	15.3424	$765.83
78830		Rp loclzj tum spect w/ct 1		Z2	13.5464	$676.18
78831		Rp loclzj tum spect 2 areas		Z2	13.5464	$676.18
78832		Rp loclzj tum spect w/ct 2		Z2	15.3424	$765.83
78999		Nuclear diagnostic exam		Z2	3.9077	$195.06
79005		Nuclear rx oral admin		Z3		$51.56
79101		Nuclear rx iv admin		Z3		$53.64
79200		Nuclear rx intracav admin		Z3		$54.68
79300		Nuclr rx interstit colloid		Z2	2.6230	$130.93
79403		Hematopoietic nuclear tx		Z3		$68.87
79440		Nuclear rx intra-articular		Z3		$41.18
79445		Nuclear rx intra-arterial		Z2	2.6230	$130.93
79999		Nuclear medicine therapy		Z2	2.6230	$130.93
90371		Hep b ig im		K2		$138.87
90375		Rabies ig im/sc		K2		$286.02
90376		Rabies ig heat treated		K2		$353.49
90377		Rabies ig ht&sol human im/sc		K2		$241.20
90378		Rsv mab im 50mg		K2		"$1,185.67"
90393		Vaccina ig im		K5		
90396		Varicella-zoster ig im		K2		"$2,073.13"
90476		Adenovirus vaccine type 4		N1		
90581		Anthrax vaccine sc or im		K5		
90630	**	Flu vacc iiv4 no preserv id		L1		
90632		Hepa vaccine adult im		N1		
90633		Hepa vacc ped/adol 2 dose im		N1		
90634		Hepa vacc ped/adol 3 dose		N1		
90636		Hep a/hep b vacc adult im		N1		
90647		Hib prp-omp vacc 3 dose im		N1		
90648		Hib prp-t vaccine 4 dose im		N1		
90653	**	Iiv adjuvant vaccine im		L1		
90654	**	Flu vacc iiv3 no preserv id		L1		
90655	**	Iiv3 vacc no prsv 0.25 ml im		L1		
90656	**	Iiv3 vacc no prsv 0.5 ml im		L1		
90657	**	Iiv3 vaccine splt 0.25 ml im		L1		
90660	**	Laiv3 vaccine intranasal		L1		
90661	**	Cciiv3 vac no prsv 0.5 ml im		L1		
90662	**	Iiv no prsv increased ag im		L1		
90670	**	Pcv13 vaccine im		L1		
90672	**	Laiv4 vaccine intranasal		L1		
90673	**	Riv3 vaccine no preserv im		L1		
90674	**	Cciiv4 vac no prsv 0.5 ml im		L1		
90675		Rabies vaccine im		K2		$291.79
90676		Rabies vaccine id		K2		$189.63
90680		Rv5 vacc 3 dose live oral		N1		
90682	**	Riv4 vacc recombinant dna im		L1		
90685	**	Iiv4 vacc no prsv 0.25 ml im		L1		
90686	**	Iiv4 vacc no prsv 0.5 ml im		L1		
90687	**	Iiv4 vaccine splt 0.25 ml im		L1		
90688	**	Iiv4 vaccine splt 0.5 ml im		L1		
90689	**	Vacc iiv4 no prsrv 0.25ml im		L1		
90690		Typhoid vaccine oral		N1		
90691		Typhoid vaccine im		N1		
90694		Vacc aiiv4 no prsrv 0.5ml im		L1		
90696		Dtap-ipv vaccine 4-6 yrs im		N1		
90698		Dtap-ipv/hib vaccine im		N1		
90717		Yellow fever vaccine subq		N1		
90732	**	Ppsv23 vacc 2 yrs+ subq/im		L1		
90739	**	Hepb vacc 2/4 dose adult im		F4		
90740	**	Hepb vacc 3 dose immunsup im		F4		
90743	**	Hepb vacc 2 dose adolesc im		F4		
90744	**	Hepb vacc 3 dose ped/adol im		F4		
90746	**	Hepb vaccine 3 dose adult im		F4		
90747	**	Hepb vacc 4 dose immunsup im		F4		
90749		Vaccine toxoid		N1		
90756	**	Cciiv4 vacc abx free im		L1		
90759		Hep b vac 3ag 10mcg 3 dos im		F4		
91035		G-esoph reflx tst w/electrod		Z2	5.0601	$252.58
91300		Sarscov2 vac 30mcg/0.3ml im		L1		
91301		Sarscov2 vac 100mcg/0.5ml im		L1		
91303		Sarscov2 vac ad26 .5ml im		L1		
A2001		"Innovamatrix ac, per sq cm"		N1		
A2001		"Innovamatrix ac, per sq cm"		N1		
A2002		Mirragen adv wnd mat per sq		N1		
A2004		"Xcellistem, per sq cm"		N1		
A2005		"Microlyte matrix, per sq cm"		N1		
A2006		Novosorb synpath per sq cm		N1		
A2007		"Restrata, per sq cm"		N1		
A2008		"Theragenesis, per sq cm"		N1		
A2009		"Symphony, per sq cm"		N1		
A2010		"Apis, per square centimeter"		N1		
A2011		"Supra sdrm, per sq cm"		N1		
A2012		"Suprathel, per sq cm"		N1		
A2013		"Innovamatrix fs, per sq cm"		N1		
A4100		Skin sub fda clrd as dev nos		N1		
A9500		Tc99m sestamibi		N1		
A9501		Technetium tc-99m teboroxime		N1		
A9502		Tc99m tetrofosmin		N1		
A9503		Tc99m medronate		N1		
A9504		Tc99m apcitide		N1		
A9505		Tl201 thallium		N1		
A9507		In111 capromab		N1		
A9508		"I131 iodobenguate, dx"		N1		
A9509		Iodine i-123 sod iodide mil		N1		
A9510		Tc99m disofenin		N1		
A9512		Tc99m pertechnetate		N1		
A9515		Choline c-11		N1		
A9516		Iodine i-123 sod iodide mic		N1		
A9520		Tc99 tilmanocept diag 0.5mci		N1		
A9521		Tc99m exametazime		N1		
A9524		"I131 serum albumin, dx"		N1		
A9526		Nitrogen n-13 ammonia		N1		
A9527		Iodine i-125 sodium iodide		H2		$40.37
A9528		"Iodine i-131 iodide cap, dx"		N1		
A9529		"I131 iodide sol, dx"		N1		
A9531		I131 max 100uci		N1		
A9532		"I125 serum albumin, dx"		N1		
A9536		Tc99m depreotide		N1		
A9537		Tc99m mebrofenin		N1		
A9538		Tc99m pyrophosphate		N1		
A9539		Tc99m pentetate		N1		
A9540		Tc99m maa		N1		
A9541		Tc99m sulfur colloid		N1		
A9542		"In111 ibritumomab, dx"		N1		
A9546		Co57/58		N1		
A9547		In111 oxyquinoline		N1		
A9548		In111 pentetate		N1		
A9550		Tc99m gluceptate		N1		
A9551		Tc99m succimer		N1		
A9552		F18 fdg		N1		
A9553		Cr51 chromate		N1		
A9554		"I125 iothalamate, dx"		N1		
A9555		Rb82 rubidium		N1		
A9556		Ga67 gallium		N1		
A9557		Tc99m bicisate		N1		
A9558		Xe133 xenon 10mci		N1		
A9559		Co57 cyano		N1		
A9560		Tc99m labeled rbc		N1		
A9561		Tc99m oxidronate		N1		
A9562		Tc99m mertiatide		N1		
A9566		Tc99m fanolesomab		N1		
A9567		Technetium tc-99m aerosol		N1		
A9568		Technetium tc99m arcitumomab		N1		
A9569		Technetium tc-99m auto wbc		N1		
A9570		Indium in-111 auto wbc		N1		
A9571		Indium in-111 auto platelet		N1		
A9572		Indium in-111 pentetreotide		N1		
A9575		Inj gadoterate meglumi 0.1ml		N1		
A9576		Inj prohance multipack		N1		
A9577		Inj multihance		N1		
A9578		Inj multihance multipack		N1		
A9579		"Gad-base mr contrast nos,1ml"		N1		
A9580		Sodium fluoride f-18		N1		
A9581		Gadoxetate disodium inj		N1		
A9582		Iodine i-123 iobenguane		N1		
A9583		Gadofosveset trisodium inj		N1		
A9584		Iodine i-123 ioflupane		N1		
A9585		Gadobutrol injection		N1		
A9586		Florbetapir f18		N1		
A9587		Gallium ga-68		N1		
A9588		Fluciclovine f-18		N1		
A9590		Iodine i-131 iobenguane 1mci		K2		$320.12
A9591		Fluoroestradiol f 18		K2		$677.08
A9592		Copper cu 64 dotatate diag		K2		$944.71
A9593		Gallium ga-68 psma-11 ucsf		K2		$732.86
A9594		"Gallium ga-68 psma-11, ucla"		K2		$717.55
A9595		"Piflu f-18, dia 1 millicurie"		K2		$558.03
A9596		Gallium illuccix 1 millicure		K2		$996.40
A9597		"Pet, dx, for tumor id, noc"		N1		
A9598		"Pet dx for non-tumor id, noc"		N1		
A9698		Non-rad contrast materialnoc		N1		
A9700		Echocardiography contrast		N1		
C1052		"Hemostatic agent, gi, topic"		J7		
C1062		Intravertebral fx aug impl		J7		
C1713		"Anchor/screw bn/bn,tis/bn"		N1		
C1714		"Cath, trans atherectomy, dir"		N1		
C1715		Brachytherapy needle		N1		
C1716		"Brachytx, non-str, gold-198"		H2		$616.61
C1717		"Brachytx, non-str,hdr ir-192"		H2		$341.72
C1719		"Brachytx, ns, non-hdrir-192"		H2		$205.82
C1721		"Aicd, dual chamber"		N1		
C1722		"Aicd, single chamber"		N1		
C1724		"Cath, trans atherec,rotation"		N1		
C1725		"Cath, translumin non-laser"		N1		
C1726		"Cath, bal dil, non-vascular"		N1		
C1727		"Cath, bal tis dis, non-vas"		N1		
C1728		"Cath, brachytx seed adm"		N1		
C1729		"Cath, drainage"		N1		
C1730		"Cath, ep, 19 or few elect"		N1		
C1731		"Cath, ep, 20 or more elec"		N1		
C1732		"Cath, ep, diag/abl, 3d/vect"		N1		
C1733		"Cath, ep, othr than cool-tip"		N1		
C1734		"Orth/devic/drug bn/bn,tis/bn"		J7		
C1748		"Endoscope, single, ugi"		J7		
C1749		"Endo, colon, retro imaging"		N1		
C1750		"Cath, hemodialysis,long-term"		N1		
C1751		"Cath, inf, per/cent/midline"		N1		
C1752		"Cath,hemodialysis,short-term"		N1		
C1753		"Cath, intravas ultrasound"		N1		
C1754		"Catheter, intradiscal"		N1		
C1755		"Catheter, intraspinal"		N1		
C1756		"Cath, pacing, transesoph"		N1		
C1757		"Cath, thrombectomy/embolect"		N1		
C1758		"Catheter, ureteral"		N1		
C1759		"Cath, intra echocardiography"		N1		
C1760		"Closure dev, vasc"		N1		
C1761		"Cath, trans intra litho/coro"		J7		
C1762		"Conn tiss, human(inc fascia)"		N1		
C1763		"Conn tiss, non-human"		N1		
C1764		"Event recorder, cardiac"		N1		
C1765		Adhesion barrier		N1		
C1766		"Intro/sheath,strble,non-peel"		N1		
C1767		"Generator, neuro non-recharg"		N1		
C1768		"Graft, vascular"		N1		
C1769		Guide wire		N1		
C1770		"Imaging coil, mr, insertable"		N1		
C1771		"Rep dev, urinary, w/sling"		N1		
C1772		"Infusion pump, programmable"		N1		
C1773		"Ret dev, insertable"		N1		
C1776		Joint device (implantable)		N1		
C1777		"Lead, aicd, endo single coil"		N1		
C1778		"Lead, neurostimulator"		N1		
C1779		"Lead, pmkr, transvenous vdd"		N1		
C1780		"Lens, intraocular (new tech)"		N1		
C1781		Mesh (implantable)		N1		
C1782		Morcellator		N1		
C1783		"Ocular imp, aqueous drain de"		N1		
C1784		"Ocular dev, intraop, det ret"		N1		
C1785		"Pmkr, dual, rate-resp"		N1		
C1786		"Pmkr, single, rate-resp"		N1		
C1787		"Patient progr, neurostim"		N1		
C1788		"Port, indwelling, imp"		N1		
C1789		"Prosthesis, breast, imp"		N1		
C1813		"Prosthesis, penile, inflatab"		N1		
C1814		"Retinal tamp, silicone oil"		N1		
C1815		"Pros, urinary sph, imp"		N1		
C1816		"Receiver/transmitter, neuro"		N1		
C1817		Septal defect imp sys		N1		
C1818		Integrated keratoprosthesis		N1		
C1819		Tissue localization-excision		N1		
C1820		Generator neuro rechg bat sy		N1		
C1821		Interspinous implant		N1		
C1822		"Gen, neuro, hf, rechg bat"		N1		
C1823		"Gen, neuro, trans sen/stim"		J7		
C1824		"Generator, ccm, implant"		J7		
C1825		"Gen, neuro, carot sinus baro"		J7		
C1830		Power bone marrow bx needle		N1		
C1831		Personalized interbody cage		J7		
C1832		Auto cell process sys		J7		
C1833		Cardiac monitor sys		J7		
C1839		Iris prosthesis		J7		
C1840		Telescopic intraocular lens		N1		
C1841		Retinal prosth int/ext comp		K5		
C1842		"Retinal prosth, add-on"		K5		
C1849		"Skin substitute, synthetic"		N1		
C1874		"Stent, coated/cov w/del sys"		N1		
C1875		"Stent, coated/cov w/o del sy"		N1		
C1876		"Stent, non-coa/non-cov w/del"		N1		
C1877		"Stent, non-coat/cov w/o del"		N1		
C1878		Matrl for vocal cord		N1		
C1880		Vena cava filter		N1		
C1881		Dialysis access system		N1		
C1882		"Aicd, other than sing/dual"		N1		
C1883		"Adapt/ext, pacing/neuro lead"		N1		
C1884		Embolization protect syst		N1		
C1885		"Cath, translumin angio laser"		N1		
C1886		"Catheter, ablation"		N1		
C1887		"Catheter, guiding"		N1		
C1888		Endovas non-cardiac abl cath		N1		
C1889		"Implant/insert device, noc"		N1		
C1890		No device w/dev-intensive px		J7		
C1891		"Infusion pump,non-prog, perm"		N1		
C1892		"Intro/sheath,fixed,peel-away"		N1		
C1893		"Intro/sheath, fixed,non-peel"		N1		
C1894		"Intro/sheath, non-laser"		N1		
C1895		"Lead, aicd, endo dual coil"		N1		
C1896		"Lead, aicd, non sing/dual"		N1		
C1897		"Lead, neurostim test kit"		N1		
C1898		"Lead, pmkr, other than trans"		N1		
C1899		"Lead, pmkr/aicd combination"		N1		
C1900		"Lead, coronary venous"		N1		
C1982		"Cath, pressure,valve-occlu"		J7		
C2596		"Probe, robotic, water-jet"		J7		
C2613		Lung bx plug w/del sys		N1		
C2614		"Probe, perc lumb disc"		N1		
C2615		"Sealant, pulmonary, liquid"		N1		
C2616		"Brachytx, non-str,yttrium-90"		H2		"$17,763.21"
C2617		"Stent, non-cor, tem w/o del"		N1		
C2618		"Probe/needle, cryo"		N1		
C2619		"Pmkr, dual, non rate-resp"		N1		
C2620		"Pmkr, single, non rate-resp"		N1		
C2621		"Pmkr, other than sing/dual"		N1		
C2622		"Prosthesis, penile, non-inf"		N1		
C2623		"Cath, translumin, drug-coat"		N1		
C2624		Wireless pressure sensor		N1		
C2625		"Stent, non-cor, tem w/del sy"		N1		
C2626		"Infusion pump, non-prog,temp"		N1		
C2627		"Cath, suprapubic/cystoscopic"		N1		
C2628		"Catheter, occlusion"		N1		
C2629		"Intro/sheath, laser"		N1		
C2630		"Cath, ep, cool-tip"		N1		
C2631		"Rep dev, urinary, w/o sling"		N1		
C2634		"Brachytx, non-str, ha, i-125"		H2		$151.20
C2635		"Brachytx, non-str, ha, p-103"		H2		$45.62
C2636		"Brachy linear, non-str,p-103"		H2		$52.57
C2638		"Brachytx, stranded, i-125"		H2		$38.19
C2639		"Brachytx, non-stranded,i-125"		H2		$34.82
C2640		"Brachytx, stranded, p-103"		H2		$89.59
C2641		"Brachytx, non-stranded,p-103"		H2		$70.95
C2642		"Brachytx, stranded, c-131"		H2		$73.37
C2643		"Brachytx, non-stranded,c-131"		H2		$82.03
C2644		Brachytx cesium-131 chloride		K5		
C2645		"Brachytx planar, p-103"		H2		$4.69
C2698		"Brachytx, stranded, nos"		H2		$38.19
C2699		"Brachytx, non-stranded, nos"		H2		$34.82
C8900		"Mra w/cont, abd"		Z2	3.8173	$190.54
C8901		"Mra w/o cont, abd"		Z2	2.3852	$119.06
C8902		"Mra w/o fol w/cont, abd"		Z2	3.8173	$190.54
C8903		"Mri w/cont, breast,  uni"		Z2	1.8517	$92.43
C8905		"Mri w/o fol w/cont, brst, un"		Z2	3.8173	$190.54
C8906		"Mri w/cont, breast,  bi"		Z2	3.8173	$190.54
C8908		"Mri w/o fol w/cont, breast,"		Z2	3.8173	$190.54
C8909		"Mra w/cont, chest"		Z2	3.8173	$190.54
C8910		"Mra w/o cont, chest"		Z2	2.3852	$119.06
C8911		"Mra w/o fol w/cont, chest"		Z2	3.8173	$190.54
C8912		"Mra w/cont, lwr ext"		Z2	3.8173	$190.54
C8913		"Mra w/o cont, lwr ext"		Z2	2.3852	$119.06
C8914		"Mra w/o fol w/cont, lwr ext"		Z2	3.8173	$190.54
C8918		"Mra w/cont, pelvis"		Z2	3.8173	$190.54
C8919		"Mra w/o cont, pelvis"		Z2	2.3852	$119.06
C8920		"Mra w/o fol w/cont, pelvis"		Z2	3.8173	$190.54
C8931		"Mra, w/dye, spinal canal"		Z2	3.8173	$190.54
C8932		"Mra, w/o dye, spinal canal"		Z2	2.3852	$119.06
C8933		"Mra, w/o&w/dye, spinal canal"		Z2	3.8173	$190.54
C8934		"Mra, w/dye, upper extremity"		Z2	3.8173	$190.54
C8935		"Mra, w/o dye, upper extr"		Z2	2.3852	$119.06
C8936		"Mra, w/o&w/dye, upper extr"		Z2	3.8173	$190.54
C9046		Cocaine hcl nasal solution	*	K2		$1.23
C9047		"Injection, caplacizumab-yhdp"	*	K2		$717.21
C9067		Gallium ga-68 dotatoc		K2		$8.64
C9084		"loncastuximab-lpyl, 0.1 mg"		D5		
C9085		Inj avalglucosid alfa-ngpt		D5		
C9086		"Inj, anifrolumab-fnia"		D5		
C9087		Inj cyclophosphamd auromedic		D5		
C9088		"Instill, bupivac and meloxic"		K2		$0.70
C9089		"Bupivacaine implant, 1 mg"		K2		$0.81
C9090		"Plasminogen, human-tvmh 1 mg"		D5		
C9091		"Sirolimus, protein-bound,1mg"		D5		
C9092		"Inj., xipere, 1 mg"		D5		
C9093		"Inj., susvimo, 0.1 mg"		D5		
C9094		"Inj, sutimlimab-jome, 10 mg"		K2		$16.86
C9095		"Inj, tebentafusp-tebn, 1 mcg"		K2		$193.23
C9096		"Inj, releuko, 1 mcg"		K2		$0.78
C9097		"Inj, faricimab-svoa, 0.1 mg"		K2		$37.60
C9113		"Inj pantoprazole sodium, via"		N1		
C9248		"Inj, clevidipine butyrate"		N1		
C9250		Artiss fibrin sealant		K2		$193.87
C9254		"Injection, lacosamide"		N1		
C9257		Bevacizumab injection		K2		$1.73
C9285		"Patch, lidocaine/tetracaine"		N1		
C9290		"Inj, bupivacaine liposome"		K2		$1.38
C9293		"Injection, glucarpidase"		K5		
C9352		"Neuragen nerve guide, per cm"		N1		
C9353		"Neurawrap nerve protector,cm"		N1		
C9354		"Veritas collagen matrix, cm2"		N1		
C9355		"Neuromatrix nerve cuff, cm"		N1		
C9356		"Tenoglide tendon prot, cm2"		N1		
C9358		"Surgimend, fetal"		N1		
C9359		"Implnt,bon void filler-putty"		N1		
C9360		"Surgimend, neonatal"		N1		
C9361		Neuromend nerve wrap		N1		
C9362		"Implnt,bon void filler-strip"		N1		
C9363		Integra meshed bil wound mat		N1		
C9364		"Porcine implant, permacol"		N1		
C9399		Unclassified drugs or biolog		K7		
C9460		"Injection, cangrelor"		K2		$17.39
C9462		"Injection, delafloxacin"		N1		
C9482		Sotalol hydrochloride iv		K2		$19.32
C9488		Conivaptan hcl		K2		$43.10
C9738		Blue light cysto imag agent		N1		
C9762		Cardiac mri seg dys strain		Z2	5.0088	$250.02
C9763		Cardiac mri seg dys stress		Z2	5.0088	$250.02
C9776		Fluo bile duct imaging w/icg		N1		
C9803		Hopd covid-19 spec collect		N1		
G0130	**	Single energy x-ray study		Z3		$25.61
G0235		Pet not otherwise specified		Z2	3.9077	$195.06
J0120		Tetracyclin injection		N1		
J0121		"Inj., omadacycline, 1 mg"	*	K2		$3.47
J0122		"Inj., eravacycline, 1 mg"		N1		
J0129		Abatacept injection		K2		$44.22
J0130		Abciximab injection		N1		
J0131		Acetaminophen injection		N1		
J0132		Acetylcysteine injection		N1		
J0133		Acyclovir injection		N1		
J0135		Adalimumab injection		K2		"$1,698.61"
J0153		Adenosine inj 1mg		N1		
J0171		Adrenalin epinephrine inject		N1		
J0172		"Inj, aducanumab-avwa, 2 mg"		K2		$5.98
J0178		Aflibercept injection		K2		$912.89
J0179		"Inj, brolucizumab-dbll, 1 mg"		K2		$311.96
J0180		Agalsidase beta injection		K2		$205.92
J0185		"Inj., aprepitant, 1 mg"		K2		$1.72
J0190		Inj biperiden lactate/5 mg		K5		
J0200		Alatrofloxacin mesylate		K5		
J0202		"Injection, alemtuzumab"		K2		"$2,194.49"
J0205		Alglucerase injection		K5		
J0207		Amifostine		K2		"$1,135.69"
J0210		Methyldopate hcl injection		K5		
J0215		Alefacept		K5		
J0219		Inj aval alfa-nqpt 4mg		K2		$72.68
J0220		Alglucosidase alfa injection		K2		$117.07
J0221		Lumizyme injection		K2		$186.41
J0222		"Inj., patisiran, 0.1 mg"		K2		$98.97
J0223		Inj givosiran 0.5 mg		K2		$107.96
J0224		"Inj. lumasiran, 0.5 mg"		K2		$305.49
J0256		Alpha 1 proteinase inhibitor		K2		$4.61
J0257		Glassia injection		K2		$5.15
J0278		Amikacin sulfate injection		N1		
J0280		Aminophyllin 250 mg inj		N1		
J0282		Amiodarone hcl		N1		
J0285		Amphotericin b		N1		
J0287		Amphotericin b lipid complex		K2		$10.20
J0288		Ampho b cholesteryl sulfate		K5		
J0289		Amphotericin b liposome inj		K2		$26.36
J0290		Ampicillin 500 mg inj		N1		
J0291		"Inj., plazomicin, 5 mg"		K2		$3.13
J0295		Ampicillin sulbactam 1.5 gm		N1		
J0300		Amobarbital 125 mg inj		K2		$125.22
J0330		Succinycholine chloride inj		N1		
J0348		Anidulafungin injection		N1		
J0350		Injection anistreplase 30 u		K5		
J0360		Hydralazine hcl injection		N1		
J0364		Apomorphine hydrochloride		K5		
J0365		"Aprotonin, 10,000 kiu"		K5		
J0380		Inj metaraminol bitartrate		K5		
J0390		Chloroquine injection		K2		$165.22
J0395		Arbutamine hcl injection		K5		
J0400		Aripiprazole injection		N1		
J0401		Inj aripiprazole ext rel 1mg		K2		$6.31
J0456		Azithromycin		N1		
J0461		Atropine sulfate injection		N1		
J0470		Dimecaprol injection		N1		
J0475		Baclofen 10 mg injection		K2		$182.02
J0476		Baclofen intrathecal trial		N1		
J0480		Basiliximab		K2		"$4,087.67"
J0485		Belatacept injection		K2		$3.78
J0490		Belimumab injection		K2		$49.44
J0491		Inj anifrolumab-fnia 1mg		K2		$16.18
J0500		Dicyclomine injection		N1		
J0515		Inj benztropine mesylate		N1		
J0517		"Inj., benralizumab, 1 mg"		K2		$168.86
J0520		Bethanechol chloride inject		K5		
J0558		Peng benzathine/procaine inj		K2		$12.86
J0561		Penicillin g benzathine inj		K2		$16.48
J0565		"Inj, bezlotoxumab, 10 mg"		K2		$39.87
J0567		"Inj., cerliponase alfa 1 mg"		K5		
J0570		Buprenorphine implant 74.2mg		K2		"$1,311.75"
J0583		Bivalirudin		N1		
J0584		"Injection, burosumab-twza 1m"		K2		$401.50
J0585		"Injection,onabotulinumtoxina"		K2		$6.21
J0586		Abobotulinumtoxina		K2		$8.52
J0587		"Inj, rimabotulinumtoxinb"		K2		$12.17
J0588		Incobotulinumtoxin a		K2		$5.06
J0592		Buprenorphine hydrochloride		N1		
J0593		"Inj., lanadelumab-flyo, 1 mg"		K5		
J0594		Busulfan injection		K2		$2.04
J0595		Butorphanol tartrate 1 mg		N1		
J0596		"Injection, ruconest"		K2		$31.60
J0597		"C-1 esterase, berinert"		K2		$60.77
J0598		"C-1 esterase, cinryze"		K2		$60.67
J0599		"Inj., haegarda 10 units"		N1		
J0600		Edetate calcium disodium inj		K2		"$5,708.59"
J0606		"Inj, etelcalcetide, 0.1 mg"		N1		
J0610		Calcium gluconate injection		N1		
J0620		Calcium glycer & lact/10 ml		N1		
J0630		Calcitonin salmon injection		K2		"$2,231.39"
J0636		Inj calcitriol per 0.1 mcg		N1		
J0637		Caspofungin acetate		N1		
J0638		Canakinumab injection		K2		$118.61
J0640		Leucovorin calcium injection		N1		
J0641		Inj levoleucovorin nos 0.5mg		N1		
J0642		"Injection, khapzory, 0.5 mg"	*	K2		$1.46
J0670		Inj mepivacaine hcl/10 ml		N1		
J0690		Cefazolin sodium injection		N1		
J0691		Inj lefamulin 1 mg		K2		$0.72
J0692		Cefepime hcl for injection		N1		
J0694		Cefoxitin sodium injection		N1		
J0695		Inj ceftolozane tazobactam		K2		$6.40
J0696		Ceftriaxone sodium injection		N1		
J0697		Sterile cefuroxime injection		N1		
J0698		Cefotaxime sodium injection		N1		
J0699		"Inj, cefiderocol, 10 mg"		K2		$2.11
J0702		Betamethasone acet&sod phosp		N1		
J0706		Caffeine citrate injection		N1		
J0710		Cephapirin sodium injection		K5		
J0712		Ceftaroline fosamil inj		K2		$3.73
J0713		Inj ceftazidime per 500 mg		N1		
J0714		Ceftazidime and avibactam		K2		$91.79
J0715		Ceftizoxime sodium / 500 mg		N1		
J0716		Centruroides immune f(ab)		K2		"$5,190.15"
J0717		Certolizumab pegol inj 1mg		K2		$5.58
J0720		Chloramphenicol sodium injec		N1		
J0725		Chorionic gonadotropin/1000u		N1		
J0735		Clonidine hydrochloride		N1		
J0740		Cidofovir injection		K2		$583.01
J0741		"Inj, cabote rilpivir 2mg 3mg"		K2		$21.05
J0742		Inj imip 4 cilas 4 releb 2mg		K2		$2.38
J0743		Cilastatin sodium injection		N1		
J0744		Ciprofloxacin iv		N1		
J0745		Inj codeine phosphate /30 mg		K2		$135.64
J0770		Colistimethate sodium inj		N1		
J0775		"Collagenase, clost hist inj"		K2		$58.87
J0780		Prochlorperazine injection		N1		
J0791		Inj crizanlizumab-tmca 5mg		K2		$125.06
J0795		Corticorelin ovine triflutal		K2		$9.67
J0800		Corticotropin injection		N1		
J0834		"Inj., cosyntropin, 0.25 mg"		N1		
J0840		Crotalidae poly immune fab		K2		"$2,605.39"
J0841		Inj crotalidae im f(ab')2 eq		K2		"$1,072.21"
J0850		Cytomegalovirus imm iv /vial		K2		"$1,654.66"
J0875		"Injection, dalbavancin"		K2		$14.91
J0878		Daptomycin injection		N1		
J0881		"Darbepoetin alfa, non-esrd"		K2		$3.32
J0882		"Darbepoetin alfa, esrd use"		K2		$3.32
J0883		Argatroban nonesrd use 1mg		K2		$1.39
J0884		Argatroban esrd dialysis 1mg		K2		$1.39
J0885		"Epoetin alfa, non-esrd"		K2		$8.22
J0887		Epoetin beta esrd use		N1		
J0888		Epoetin beta non esrd		K2		$1.62
J0894		Decitabine injection		K2		$1.59
J0895		Deferoxamine mesylate inj		N1		
J0896		Inj luspatercept-aamt 0.25mg		K2		$37.94
J0897		Denosumab injection		K2		$22.26
J0945		Brompheniramine maleate inj		N1		
J1000		Depo-estradiol cypionate inj		N1		
J1020		Methylprednisolone 20 mg inj		N1		
J1030		Methylprednisolone 40 mg inj		N1		
J1040		Methylprednisolone 80 mg inj		N1		
J1050		Medroxyprogesterone acetate		N1		
J1071		Inj testosterone cypionate		N1		
J1094		Inj dexamethasone acetate		N1		
J1095		"Injection, dexamethasone 9%"	*	K2		$0.86
J1096		Dexametha opth insert 0.1 mg	*	K2		$131.92
J1097		Phenylep ketorolac opth soln		K2		$97.10
J1100		Dexamethasone sodium phos		N1		
J1110		Inj dihydroergotamine mesylt		N1		
J1120		Acetazolamid sodium injectio		N1		
J1130		Inj diclofenac sodium 0.5mg		N1		
J1160		Digoxin injection		N1		
J1162		Digoxin immune fab (ovine)		K2		"$4,293.36"
J1165		Phenytoin sodium injection		N1		
J1170		Hydromorphone injection		N1		
J1180		Dyphylline injection		K5		
J1190		Dexrazoxane hcl injection		K2		$168.78
J1200		Diphenhydramine hcl injectio		N1		
J1201		Inj. cetirizine hcl 0.5mg		K2		$15.09
J1205		Chlorothiazide sodium inj		N1		
J1212		Dimethyl sulfoxide 50% 50 ml		K2		$636.41
J1230		Methadone injection		N1		
J1240		Dimenhydrinate injection		N1		
J1245		Dipyridamole injection		N1		
J1250		Inj dobutamine hcl/250 mg		N1		
J1260		Dolasetron mesylate		N1		
J1265		Dopamine injection		N1		
J1267		Doripenem injection		N1		
J1270		"Injection, doxercalciferol"		N1		
J1290		Ecallantide injection		K2		$513.74
J1300		Eculizumab injection		K2		$228.02
J1301		"Injection, edaravone, 1 mg"		K2		$20.99
J1303		"Inj., ravulizumab-cwvz 10 mg"	*	K2		$224.09
J1305		"Inj, evinacumab-dgnb, 5mg"		K2		$169.43
J1306		"Injection, inclisiran, 1 mg"		K2		$11.79
J1320		Amitriptyline injection		N1		
J1322		"Elosulfase alfa, injection"		K2		$262.31
J1324		Enfuvirtide injection		K5		
J1325		Epoprostenol injection		N1		
J1327		Eptifibatide injection		K2		$2.13
J1330		Ergonovine maleate injection		K5		
J1335		Ertapenem injection		N1		
J1364		Erythro lactobionate /500 mg		N1		
J1380		Estradiol valerate 10 mg inj		N1		
J1410		Inj estrogen conjugate 25 mg		K2		$353.67
J1426		"Injection, casimersen, 10 mg"		K2		$166.29
J1427		Inj. viltolarsen		K2		$58.94
J1428		"Inj, eteplirsen, 10 mg"		K5		
J1429		Inj golodirsen 10 mg		K2		$166.23
J1430		Ethanolamine oleate 100 mg		K2		$454.17
J1435		Injection estrone per 1 mg		K5		
J1437		Inj. fe derisomaltose 10 mg		K2		$23.03
J1438		Etanercept injection		K2		$790.78
J1439		Inj ferric carboxymaltos 1mg		K2		$1.11
J1442		Inj filgrastim excl biosimil		K2		$1.00
J1443		Inj ferric pyrophosphate cit		K5		
J1444		Fe pyro cit pow 0.1 mg iron		K5		
J1445		Inj triferic avnu 0.1mg iron		K5		
J1447		Inj tbo filgrastim 1 microg		K2		$0.42
J1448		"Injection, trilaciclib, 1mg"		K2		$4.94
J1450		Fluconazole		N1		
J1451		"Fomepizole, 15 mg"		K2		$4.69
J1452		Intraocular fomivirsen na		K5		
J1453		Fosaprepitant injection		N1		
J1454		"Inj fosnetupitant, palonoset"		K2		$466.07
J1455		Foscarnet sodium injection		K2		$71.20
J1457		Gallium nitrate injection		K5		
J1458		Galsulfase injection		K2		$432.43
J1459		Inj ivig privigen 500 mg		K2		$46.93
J1460		Gamma globulin 1 cc inj		K2		$46.16
J1551		Inj cutaquig 100 mg		K2		$12.03
J1554		Inj. asceniv		K2		$481.77
J1555		"Inj cuvitru, 100 mg"		K2		$14.97
J1556		"Inj, imm glob bivigam, 500mg"		K2		$70.49
J1557		Gammaplex injection		K2		$48.34
J1558		"Inj. xembify, 100 mg"		K2		$13.57
J1559		Hizentra injection		K2		$12.35
J1560		Gamma globulin > 10 cc inj		K2		$461.64
J1561		Gamunex-c/gammaked		K2		$43.39
J1562		"Vivaglobin, inj"		K5		
J1566		"Immune globulin, powder"		K2		$73.18
J1568		Octagam injection		K2		$42.02
J1569		Gammagard liquid injection		K2		$45.00
J1570		Ganciclovir sodium injection		N1		
J1571		Hepagam b im injection		K2		$75.14
J1572		Flebogamma injection		K2		$40.52
J1573		"Hepagam b intravenous, inj"		K2		$75.14
J1575		Hyqvia 100mg immuneglobulin		K2		$15.89
J1580		Garamycin gentamicin inj		N1		
J1595		Injection glatiramer acetate		K2		$138.45
J1599		"Ivig non-lyophilized, nos"		N1		
J1600		Gold sodium thiomaleate inj		K5		
J1602		Golimumab for iv use 1mg		K2		$14.69
J1610		Glucagon hydrochloride/1 mg		K2		$171.60
J1620		Gonadorelin hydroch/ 100 mcg		K5		
J1626		Granisetron hcl injection		N1		
J1627		"Inj, granisetron, xr, 0.1 mg"		K2		$6.45
J1628		"Inj., guselkumab, 1 mg"		K2		$82.37
J1630		Haloperidol injection		N1		
J1631		Haloperidol decanoate inj		N1		
J1632		"Inj., brexanolone, 1 mg"		K2		$70.89
J1640		"Hemin, 1 mg"		K2		$28.92
J1642		Inj heparin sodium per 10 u		N1		
J1644		Inj heparin sodium per 1000u		N1		
J1645		Dalteparin sodium		N1		
J1650		Inj enoxaparin sodium		N1		
J1652		Fondaparinux sodium		N1		
J1655		Tinzaparin sodium injection		N1		
J1670		Tetanus immune globulin inj		K2		$516.49
J1700		Hydrocortisone acetate inj		N1		
J1710		Hydrocortisone sodium ph inj		N1		
J1720		Hydrocortisone sodium succ i		N1		
J1726		"Makena, 10 mg"		K2		$16.72
J1729		Inj hydroxyprogst capoat nos		K2		$21.54
J1730		Diazoxide injection		K5		
J1738		Inj. meloxicam 1 mg		K2		$3.00
J1740		Ibandronate sodium injection		N1		
J1741		Ibuprofen injection		N1		
J1742		Ibutilide fumarate injection		K2		$78.18
J1743		Idursulfase injection		N1		
J1744		Icatibant injection		K2		$216.72
J1745		Infliximab not biosimil 10mg		K2		$35.71
J1746		"Inj., ibalizumab-uiyk, 10 mg"		K2		$69.76
J1750		Inj iron dextran		K2		$16.37
J1756		Iron sucrose injection		N1		
J1786		Imuglucerase injection		K2		$44.15
J1790		Droperidol injection		N1		
J1800		Propranolol injection		N1		
J1815		Insulin injection		N1		
J1817		Insulin for insulin pump use		N1		
J1823		"Inj. inebilizumab-cdon, 1 mg"		K2		$462.87
J1826		Interferon beta-1a inj		K2		"$2,293.85"
J1830		Interferon beta-1b / .25 mg		K2		$392.03
J1833		"Injection, isavuconazonium"		K2		$0.86
J1835		Itraconazole injection		K5		
J1840		Kanamycin sulfate 500 mg inj		N1		
J1850		Kanamycin sulfate 75 mg inj		K5		
J1885		Ketorolac tromethamine inj		N1		
J1890		Cephalothin sodium injection		N1		
J1930		Lanreotide injection		K2		$65.97
J1931		Laronidase injection		K2		$35.88
J1940		Furosemide injection		N1		
J1943		"Inj., aristada initio, 1 mg"		K2		$2.94
J1944		Aripirazole lauroxil 1 mg		K2		$2.92
J1945		Lepirudin		K5		
J1950		Leuprolide acetate /3.75 mg		K2		"$1,495.37"
J1951		Inj fensolvi 0.25 mg		K2		$133.46
J1952		"Leuprolide inj, camcevi, 1mg"		K5		
J1953		Levetiracetam injection		N1		
J1956		Levofloxacin injection		N1		
J1960		Levorphanol tartrate inj		N1		
J1980		Hyoscyamine sulfate inj		N1		
J1990		Chlordiazepoxide injection		N1		
J2001		Lidocaine injection		N1		
J2010		Lincomycin injection		N1		
J2020		Linezolid injection		N1		
J2060		Lorazepam injection		N1		
J2062		Loxapine for inhalation 1 mg		K5		
J2150		Mannitol injection		N1		
J2170		Mecasermin injection		N1		
J2175		Meperidine hydrochl /100 mg		N1		
J2180		Meperidine/promethazine inj		N1		
J2182		"Injection, mepolizumab, 1mg"		K2		$29.11
J2185		Meropenem		N1		
J2186		"Inj., meropenem, vaborbactam"		K2		$1.93
J2210		Methylergonovin maleate inj		N1		
J2212		Methylnaltrexone injection		N1		
J2248		Micafungin sodium injection		N1		
J2250		Inj midazolam hydrochloride		N1		
J2260		Inj milrinone lactate / 5 mg		N1		
J2265		Minocycline hydrochloride		K2		$2.22
J2270		Morphine sulfate injection		N1		
J2274		Inj morphine pf epid ithc		N1		
J2278		Ziconotide injection		K2		$9.08
J2280		"Inj, moxifloxacin 100 mg"		N1		
J2300		Inj nalbuphine hydrochloride		N1		
J2310		Inj naloxone hydrochloride		N1		
J2315		"Naltrexone, depot form"		K2		$3.54
J2320		Nandrolone decanoate 50 mg		N1		
J2323		Natalizumab injection		K2		$24.17
J2326		"Inj, nusinersen, 0.1mg"		K2		"$1,122.58"
J2350		"Injection, ocrelizumab, 1 mg"		K2		$60.49
J2353		"Octreotide injection, depot"		K2		$207.51
J2354		"Octreotide inj, non-depot"		N1		
J2355		Oprelvekin injection		K5		
J2356		"Inj tezepelumab-ekko, 1mg"		K2		$17.82
J2357		Omalizumab injection		K2		$38.12
J2358		Olanzapine long-acting inj		K2		$2.91
J2360		Orphenadrine injection		N1		
J2370		Phenylephrine hcl injection		N1		
J2400		Chloroprocaine hcl injection		N1		
J2405		Ondansetron hcl injection		N1		
J2406		"Injection, oritavancin 10 mg"		K2		$42.27
J2407		"Injection, oritavancin"		K2		$25.59
J2410		Oxymorphone hcl injection		N1		
J2425		Palifermin injection		K2		$25.13
J2426		Paliperidone palmitate inj		K2		$13.13
J2430		Pamidronate disodium /30 mg		N1		
J2440		Papaverin hcl injection		N1		
J2460		Oxytetracycline injection		K5		
J2469		Palonosetron hcl		N1		
J2501		Paricalcitol		N1		
J2502		"Inj, pasireotide long acting"		K2		$391.51
J2503		Pegaptanib sodium injection		N1		
J2504		"Pegademase bovine, 25 iu"		N1		
J2506		Inj pegfilgrast ex bio 0.5mg		K2		$155.83
J2507		Pegloticase injection		K2		"$3,110.56"
J2510		Penicillin g procaine inj		N1		
J2513		Pentastarch 10% solution		K5		
J2515		Pentobarbital sodium inj		N1		
J2540		Penicillin g potassium inj		N1		
J2543		Piperacillin/tazobactam		N1		
J2547		"Injection, peramivir"		K2		$1.68
J2550		Promethazine hcl injection		N1		
J2560		Phenobarbital sodium inj		K2		$40.30
J2562		Plerixafor injection		K2		$402.54
J2590		Oxytocin injection		N1		
J2597		Inj desmopressin acetate		K2		$7.71
J2650		Prednisolone acetate inj		N1		
J2670		Totazoline hcl injection		K5		
J2675		Inj progesterone per 50 mg		N1		
J2680		Fluphenazine decanoate 25 mg		N1		
J2690		Procainamide hcl injection		N1		
J2700		Oxacillin sodium injeciton		N1		
J2704		"Inj, propofol, 10 mg"		N1		
J2710		Neostigmine methylslfte inj		N1		
J2720		Inj protamine sulfate/10 mg		N1		
J2724		Protein c concentrate		K2		$15.06
J2725		Inj protirelin per 250 mcg		K5		
J2730		Pralidoxime chloride inj		N1		
J2760		Phentolaine mesylate inj		K2		$392.68
J2765		Metoclopramide hcl injection		N1		
J2770		Quinupristin/dalfopristin		K2		$337.47
J2778		Ranibizumab injection		K2		$275.14
J2779		"Inj, susvimo 0.1 mg"		K2		$83.23
J2780		Ranitidine hydrochloride inj		N1		
J2783		Rasburicase		K2		$330.90
J2785		Regadenoson injection		N1		
J2786		"Injection, reslizumab, 1mg"		K2		$9.95
J2788		Rho d immune globulin 50 mcg		N1		
J2790		Rho d immune globulin inj		N1		
J2791		Rhophylac injection		N1		
J2792		"Rho(d) immune globulin h, sd"		K2		$31.91
J2793		Rilonacept injection		K5		
J2794		"Inj risperdal consta, 0.5 mg"		K2		$11.47
J2795		Ropivacaine hcl injection		N1		
J2796		Romiplostim injection		K2		$87.74
J2798		"Inj., perseris, 0.5 mg"		K2		$10.92
J2800		Methocarbamol injection		N1		
J2805		Sincalide injection		N1		
J2810		Inj theophylline per 40 mg		N1		
J2820		Sargramostim injection		K2		$55.32
J2840		Inj sebelipase alfa 1 mg		K2		$539.24
J2850		Inj secretin synthetic human		K2		$38.09
J2860		"Injection, siltuximab"		K2		$128.49
J2910		Aurothioglucose injeciton		K5		
J2916		Na ferric gluconate complex		N1		
J2920		Methylprednisolone injection		N1		
J2930		Methylprednisolone injection		N1		
J2940		Somatrem injection		K5		
J2941		Somatropin injection		N1		
J2950		Promazine hcl injection		N1		
J2993		Reteplase injection		K2		"$2,417.17"
J2995		Inj streptokinase /250000 iu		K5		
J2997		Alteplase recombinant		K2		$85.82
J2998		Inj plasminogen tvmh 1mg		K2		$30.85
J3000		Streptomycin injection		N1		
J3010		Fentanyl citrate injection		N1		
J3030		Sumatriptan succinate / 6 mg		N1		
J3031		"Inj., fremanezumab-vfrm 1 mg"	*	K2		$2.34
J3032		Inj. eptinezumab-jjmr 1 mg		K2		$16.42
J3060		"Inj, taliglucerase alfa 10 u"		K2		$41.69
J3070		Pentazocine injection		N1		
J3090		Inj tedizolid phosphate		K2		$1.74
J3095		Telavancin injection		K2		$7.00
J3101		Tenecteplase injection		K2		$139.48
J3105		Terbutaline sulfate inj		N1		
J3111		Inj. romosozumab-aqqg 1 mg	*	K2		$9.70
J3121		Inj testostero enanthate 1mg		N1		
J3145		Testosterone undecanoate 1mg		K2		$1.65
J3230		Chlorpromazine hcl injection		N1		
J3240		Thyrotropin injection		K2		"$1,906.93"
J3241		Inj. teprotumumab-trbw 10 mg		K2		$321.37
J3243		Tigecycline injection		N1		
J3245		"Inj., tildrakizumab, 1 mg"	*	K2		$138.64
J3246		Tirofiban hcl		K2		$3.59
J3250		Trimethobenzamide hcl inj		N1		
J3260		Tobramycin sulfate injection		N1		
J3262		Tocilizumab injection		K2		$5.80
J3265		Injection torsemide 10 mg/ml		N1		
J3280		Thiethylperazine maleate inj		K5		
J3285		Treprostinil injection		K2		$55.71
J3299		Inj xipere 1 mg		K2		$42.85
J3300		Triamcinolone a inj prs-free		N1		
J3301		Triamcinolone acet inj nos		N1		
J3302		Triamcinolone diacetate inj		N1		
J3303		Triamcinolone hexacetonl inj		N1		
J3304		Inj triamcinolone ace xr 1mg		K2		$16.99
J3305		Inj trimetrexate glucoronate		K5		
J3310		Perphenazine injeciton		N1		
J3315		Triptorelin pamoate		K2		$363.57
J3316		"Inj., triptorelin xr 3.75 mg"		K2		"$3,062.71"
J3320		Spectinomycn di-hcl inj		K5		
J3350		Urea injection		K5		
J3355		"Urofollitropin, 75 iu"		K5		
J3357		"Ustekinumab sub cu inj, 1 mg"		K2		$174.69
J3358		"Ustekinumab, iv inject, 1 mg"		K2		$12.29
J3360		Diazepam injection		N1		
J3364		Urokinase 5000 iu injection		N1		
J3365		"Urokinase 250,000 iu inj"		K5		
J3370		Vancomycin hcl injection		N1		
J3380		"Injection, vedolizumab"		K2		$22.76
J3385		Velaglucerase alfa		K2		$359.73
J3396		Verteporfin injection		K2		$11.38
J3397		"Inj., vestronidase alfa-vjbk"		K5		
J3398		Inj luxturna 1 billion vec g		K2		"$2,909.90"
J3400		Triflupromazine hcl inj		K5		
J3410		Hydroxyzine hcl injection		N1		
J3411		Thiamine hcl 100 mg		N1		
J3415		Pyridoxine hcl 100 mg		N1		
J3420		Vitamin b12 injection		N1		
J3430		Vitamin k phytonadione inj		N1		
J3465		"Injection, voriconazole"		N1		
J3470		Hyaluronidase injection		N1		
J3471		"Ovine, up to 999 usp units"		N1		
J3472		"Ovine, 1000 usp units"		N1		
J3473		Hyaluronidase recombinant		N1		
J3475		Inj magnesium sulfate		N1		
J3480		Inj potassium chloride		N1		
J3485		Zidovudine		N1		
J3486		Ziprasidone mesylate		N1		
J3489		Zoledronic acid 1mg		N1		
J3490		Drugs unclassified injection		N1		
J3530		Nasal vaccine inhalation		N1		
J3590		Unclassified biologics		N1		
J7030		Normal saline solution infus		N1		
J7040		Normal saline solution infus		N1		
J7042		5% dextrose/normal saline		N1		
J7050		Normal saline solution infus		N1		
J7060		5% dextrose/water		N1		
J7070		D5w infusion		N1		
J7100		Dextran 40 infusion		N1		
J7110		Dextran 75 infusion		N1		
J7120		Ringers lactate infusion		N1		
J7121		5% dextrose in lac ringers		N1		
J7131		Hypertonic saline sol		N1		
J7168		Prothrombin complex kcentra		K2		$2.09
J7169		"Inj andexxa, 10 mg"	*	K2		$286.10
J7170		"Inj., emicizumab-kxwh 0.5 mg"		K2		$49.90
J7175		"Inj, factor x, (human), 1iu"		K2		$8.55
J7177		"Inj., fibryga, 1 mg"		N1		
J7178		Inj human fibrinogen con nos		K2		$1.34
J7179		Vonvendi inj 1 iu vwf:rco		K2		$1.86
J7180		Factor xiii anti-hem factor		K2		$9.37
J7181		Factor xiii recomb a-subunit		K2		$16.35
J7182		Factor viii recomb novoeight		K2		$1.26
J7183		Wilate injection		K2		$1.15
J7185		Xyntha inj		K2		$1.25
J7186		Antihemophilic viii/vwf comp		K2		$1.14
J7187		"Humate-p, inj"		K2		$1.29
J7188		Factor viii recomb obizur		K2		$3.20
J7189		Factor viia recomb novoseven		K2		$2.35
J7190		Factor viii		K2		$1.14
J7191		Factor viii (porcine)		K5		
J7192		Factor viii recombinant nos		K2		$1.45
J7193		Factor ix non-recombinant		K2		$1.16
J7194		Factor ix complex		K2		$1.54
J7195		Factor ix recombinant nos		K2		$1.63
J7196		Antithrombin recombinant		N1		
J7197		Antithrombin iii injection		K2		$3.59
J7198		Anti-inhibitor		K2		$2.28
J7200		Factor ix recombinan rixubis		K2		$1.49
J7201		Factor ix alprolix recomb		K2		$3.37
J7202		Factor ix idelvion inj		K2		$4.71
J7203		Factor ix recomb gly rebinyn		K2		$4.20
J7204		Inj recombin esperoct per iu		K2		$2.10
J7205		Factor viii fc fusion recomb		K2		$2.17
J7207		Factor viii pegylated recomb		K2		$1.99
J7208		Inj. jivi 1 iu	*	K2		$2.16
J7209		Factor viii nuwiq recomb 1iu		K2		$1.27
J7210		"Inj, afstyla, 1 i.u."		K2		$1.39
J7211		"Inj, kovaltry, 1 i.u."		K2		$1.27
J7212		Factor viia recomb sevenfact		K2		$1.97
J7308		Aminolevulinic acid hcl top		K2		$392.09
J7309		"Methyl aminolevulinate, top"		K5		
J7310		Ganciclovir long act implant		K5		
J7311		"Inj., retisert, 0.01 mg"		K2		$332.61
J7312		Dexamethasone intra implant		K2		$200.10
J7313		"Inj., iluvien, 0.01 mg"		K2		$490.95
J7314		"Inj., yutiq, 0.01 mg"		K2		$518.14
J7315		Ophthalmic mitomycin		N1		
J7316		"Inj, ocriplasmin, 0.125 mg"		K2		"$1,046.93"
J7318		"Inj, durolane 1 mg"		K2		$10.36
J7320		"Genvisc 850, inj, 1mg"		K2		$6.75
J7321		Hyalgan or supartz inj dose		N1		
J7322		Hymovis injection 1 mg		K2		$15.71
J7323		Euflexxa inj per dose		K2		$131.03
J7324		Orthovisc inj per dose		K2		$131.88
J7325		Synvisc or synvisc-one		K2		$9.77
J7326		Gel-one		K2		$488.09
J7327		Monovisc inj per dose		K2		$754.90
J7328		Gelsyn-3 injection 0.1 mg		K2		$1.28
J7329		"Inj, trivisc 1 mg"		K2		$13.31
J7331		"Synojoynt, inj., 1 mg"		K2		$18.02
J7332		"Inj., triluron, 1 mg"		K5		
J7336		Capsaicin 8% patch		K2		$3.24
J7340		Carbidopa levodopa ent 100ml		K2		$211.50
J7342		Ciprofloxacin otic susp 6 mg		K2		$29.98
J7345		"Aminolevulinic acid, 10% gel"		K2		$1.58
J7351		Inj bimatoprost itc imp1mcg		K2		$206.40
J7352		"Afamelanotide implant, 1 mg"		K2		"$3,218.90"
J7402		Mometasone sinus sinuva		K2		$10.93
J7500		Azathioprine oral 50mg		N1		
J7501		Azathioprine parenteral		K2		$235.61
J7502		Cyclosporine oral 100 mg		N1		
J7503		Tacrol envarsus ex rel oral		N1		
J7504		Lymphocyte immune globulin		K2		"$2,898.30"
J7505		Monoclonal antibodies		N1		
J7507		Tacrolimus imme rel oral 1mg		N1		
J7508		Tacrol astagraf ex rel oral		N1		
J7509		Methylprednisolone oral		N1		
J7510		Prednisolone oral per 5 mg		N1		
J7511		Antithymocyte globuln rabbit		K2		$896.71
J7512		Prednisone ir or dr oral 1mg		N1		
J7513		"Daclizumab, parenteral"		K5		
J7515		Cyclosporine oral 25 mg		N1		
J7516		Cyclosporin parenteral 250mg		N1		
J7517		Mycophenolate mofetil oral		N1		
J7518		Mycophenolic acid		N1		
J7520		"Sirolimus, oral"		N1		
J7525		Tacrolimus injection		K2		$231.22
J7527		Oral everolimus		N1		
J7599		Immunosuppressive drug noc		N1		
J7665		Mannitol for inhaler		N1		
J7674		"Methacholine chloride, neb"		N1		
J7799		Non-inhalation drug for dme		N1		
J7999		"Compounded drug, noc"		N1		
J8501		Oral aprepitant		N1		
J8510		Oral busulfan		N1		
J8520		"Capecitabine, oral, 150 mg"		N1		
J8521		"Capecitabine, oral, 500 mg"		N1		
J8530		Cyclophosphamide oral 25 mg		N1		
J8540		Oral dexamethasone		N1		
J8560		Etoposide oral 50 mg		K2		$76.09
J8562		Oral fludarabine phosphate		K5		
J8565		Gefitinib oral		K5		
J8597		Antiemetic drug oral nos		N1		
J8600		Melphalan oral 2 mg		N1		
J8610		Methotrexate oral 2.5 mg		N1		
J8650		Nabilone oral		K5		
J8655		"Oral netupitant, palonosetro"		K2		$379.06
J8670		"Rolapitant, oral, 1mg"		K2		$1.76
J8700		Temozolomide		N1		
J8705		Topotecan oral		N1		
J9000		Doxorubicin hcl injection		N1		
J9015		Aldesleukin injection		K2		"$3,795.26"
J9017		Arsenic trioxide injection		K2		$12.33
J9019		Erwinaze injection		K2		$427.27
J9020		"Asparaginase, nos"		K5		
J9021		"Inj, aspara, rylaze, 0.1 mg"		K2		$46.53
J9022		"Inj, atezolizumab,10 mg"		K2		$82.27
J9023		"Injection, avelumab, 10 mg"		K2		$88.38
J9025		Azacitidine injection		K2		$0.67
J9027		Clofarabine injection		K2		$48.40
J9030		Bcg live intravesical 1mg		N1		
J9032		"Injection, belinostat, 10mg"		K2		$44.36
J9033		"Inj., treanda 1 mg"		K2		$17.70
J9034		"Inj., bendeka 1 mg"		K2		$17.84
J9035		Bevacizumab injection		K2		$69.23
J9036		Inj. belrapzo/bendamustine	*	K2		$19.37
J9037		Inj belantamab mafodont blmf		K2		$44.13
J9039		"Injection, blinatumomab"		K2		$129.82
J9040		Bleomycin sulfate injection		N1		
J9041		"Inj., velcade 0.1 mg"		K2		$44.01
J9042		Brentuximab vedotin inj		K2		$205.56
J9043		Cabazitaxel injection		K2		$196.61
J9044		"Inj, bortezomib, nos, 0.1 mg"		K2		$14.87
J9045		Carboplatin injection		N1		
J9047		"Injection, carfilzomib, 1 mg"		K2		$43.24
J9050		Carmustine injection		K2		$760.83
J9055		Cetuximab injection		K2		$69.41
J9057		"Inj., copanlisib, 1 mg"		K2		$82.46
J9060		Cisplatin 10 mg injection		N1		
J9061		"Inj, amivantamab-vmjw"		K2		$18.66
J9065		Inj cladribine per 1 mg		K2		$21.66
J9070		Cyclophosphamide 100 mg inj		K2		$26.87
J9071		Inj cyclophosphamd auromedic		K2		$3.01
J9098		Cytarabine liposome inj		K5		
J9100		Cytarabine hcl 100 mg inj		N1		
J9118		Inj. calaspargase pegol-mknl		K5		
J9119		"Inj., cemiplimab-rwlc, 1 mg"	*	K2		$27.25
J9120		Dactinomycin injection		K2		$633.77
J9130		Dacarbazine 100 mg inj		N1		
J9144		"Daratumumab, hyaluronidase"		K2		$46.58
J9145		"Injection, daratumumab 10 mg"		K2		$58.75
J9150		Daunorubicin injection		K2		$44.05
J9151		Daunorubicin citrate inj		K5		
J9153		"Inj daunorubicin, cytarabine"		K2		$215.41
J9155		Degarelix injection		K2		$4.03
J9160		Denileukin diftitox inj		K5		
J9165		Diethylstilbestrol injection		K5		
J9171		Docetaxel injection		N1		
J9173		"Inj., durvalumab, 10 mg"		K2		$78.20
J9175		Elliotts b solution per ml		N1		
J9176		"Injection, elotuzumab, 1mg"		K2		$6.95
J9177		Inj enfort vedo-ejfv 0.25mg		K2		$31.36
J9178		"Inj, epirubicin hcl, 2 mg"		N1		
J9179		Eribulin mesylate injection		K2		$132.80
J9181		Etoposide injection		N1		
J9185		Fludarabine phosphate inj		N1		
J9190		Fluorouracil injection		N1		
J9198		"Inj. infugem, 100 mg"		K2		$25.78
J9200		Floxuridine injection		N1		
J9201		In gemcitabine hcl nos 200mg		N1		
J9202		Goserelin acetate implant		K2		$576.10
J9203		Gemtuzumab ozogamicin 0.1 mg		K2		$214.28
J9204		"Inj mogamulizumab-kpkc, 1 mg"		K2		$216.25
J9205		Inj irinotecan liposome 1 mg		K2		$60.14
J9206		Irinotecan injection		N1		
J9207		Ixabepilone injection		K2		$117.06
J9208		Ifosfamide injection		N1		
J9209		Mesna injection		N1		
J9210		"Inj., emapalumab-lzsg, 1 mg"	*	K2		$380.39
J9211		Idarubicin hcl injection		N1		
J9212		Interferon alfacon-1 inj		K5		
J9213		Interferon alfa-2a inj		K5		
J9214		Interferon alfa-2b inj		K2		$31.85
J9215		Interferon alfa-n3 inj		K5		
J9216		Interferon gamma 1-b inj		K5		
J9217		Leuprolide acetate suspnsion		K2		$179.27
J9218		Leuprolide acetate injeciton		N1		
J9219		Leuprolide acetate implant		K5		
J9223		"Inj. lurbinectedin, 0.1 mg"		K2		$183.98
J9225		Vantas implant		K2		"$5,166.29"
J9226		Supprelin la implant		K2		"$42,302.58"
J9227		Inj. isatuximab-irfc 10 mg		K2		$70.50
J9228		Ipilimumab injection		K2		$163.66
J9229		Inj inotuzumab ozogam 0.1 mg		K2		"$2,443.31"
J9230		Mechlorethamine hcl inj		K2		$11.74
J9245		Inj melpha hydroch nos 50 mg		K2		$181.51
J9246		"Inj., evomela, 1 mg"		K2		$18.02
J9247		"Inj, melphalan flufenami 1mg"		K2		$503.50
J9250		Methotrexate sodium inj		N1		
J9260		Methotrexate sodium inj		N1		
J9261		Nelarabine injection		K2		$130.14
J9262		"Inj, omacetaxine mep, 0.01mg"		K2		$3.61
J9263		Oxaliplatin		N1		
J9264		Paclitaxel protein bound		K2		$14.69
J9266		Pegaspargase injection		K2		"$23,554.48"
J9267		Paclitaxel injection		N1		
J9268		Pentostatin injection		K2		"$2,076.08"
J9269		Inj. tagraxofusp-erzs 10 mcg	*	K2		$309.41
J9270		Plicamycin (mithramycin) inj		K2		$115.40
J9271		Inj pembrolizumab		K2		$53.14
J9272		"Inj, dostarlimab-gxly, 10 mg"		K2		$220.43
J9273		"Inj tisotu vedotin-tftv, 1mg"		K2		$155.91
J9280		Mitomycin injection		K2		$47.16
J9281		Mitomycin instillation		K2		$285.36
J9285		"Inj, olaratumab, 10 mg"		K2		$52.07
J9293		Mitoxantrone hydrochl / 5 mg		K2		$35.79
J9295		"Injection, necitumumab, 1 mg"		K2		$5.74
J9299		"Injection, nivolumab"		K2		$29.69
J9301		Obinutuzumab inj		K2		$66.01
J9302		Ofatumumab injection		K2		$63.96
J9303		Panitumumab injection		K2		$136.97
J9304		"Inj. pemetrexed, 10 mg"		K2		$79.25
J9305		Inj. pemetrexed nos 10mg		K2		$78.39
J9306		"Injection, pertuzumab, 1 mg"		K2		$14.15
J9307		Pralatrexate injection		K2		$321.09
J9308		"Injection, ramucirumab"		K2		$65.67
J9309		"Inj, polatuzumab vedotin 1mg"		K2		$117.81
J9311		"Inj rituximab, hyaluronidase"		K2		$37.90
J9312		"Inj., rituximab, 10 mg"		K2		$84.17
J9313		"Inj., lumoxiti, 0.01 mg"	*	K2		$23.39
J9316		"Pertuzu, trastuzu, 10 mg"		K2		$70.37
J9317		Sacituzumab govitecan-hziy		K2		$32.03
J9318		Inj romidepsin non-lyo 0.1mg		K2		$33.91
J9319		Inj romidepsin lyophil 0.1mg		K2		$33.23
J9320		Streptozocin injection		K2		$349.38
J9325		Inj talimogene laherparepvec		K2		$59.68
J9328		Temozolomide injection		K2		$10.40
J9330		Temsirolimus injection		K2		$32.91
J9331		Inj sirolimus prot part 1 mg		K2		$101.58
J9332		Inj efgartigimod 2mg		K2		$31.53
J9340		Thiotepa injection		K2		$298.19
J9348		"Inj. naxitamab-gqgk, 1 mg"		K2		$557.38
J9349		"Inj., tafasitamab-cxix"		K2		$12.97
J9351		Topotecan injection		N1		
J9352		Injection trabectedin 0.1mg		K2		$330.18
J9353		"Inj. margetuximab-cmkb, 5 mg"		K2		$44.03
J9354		"Inj, ado-trastuzumab emt 1mg"		K2		$35.62
J9355		Inj trastuzumab excl biosimi		K2		$86.61
J9356		"Inj. herceptin hylecta, 10mg"	*	K2		$68.73
J9357		Valrubicin injection		K2		"$1,437.85"
J9358		Inj fam-trastu deru-nxki 1mg		K2		$25.17
J9359		Inj lon tesirin-lpyl 0.075mg		K2		$188.30
J9360		Vinblastine sulfate inj		N1		
J9370		Vincristine sulfate 1 mg inj		N1		
J9371		"Inj, vincristine sul lip 1mg"		K2		"$3,420.78"
J9390		Vinorelbine tartrate inj		N1		
J9395		"Injection, fulvestrant"		K2		$14.02
J9400		"Inj, ziv-aflibercept, 1mg"		K2		$8.09
J9600		Porfimer sodium injection		K2		"$21,856.35"
J9999		Chemotherapy drug		N1		
L8600		Implant breast silicone/eq		N1		
L8603		Collagen imp urinary 2.5 ml		N1		
L8604		Dextranomer/hyaluronic acid		N1		
L8605		Inj bulking agent anal canal		N1		
L8606		Synthetic implnt urinary 1ml		N1		
L8607		Inj vocal cord bulking agent		N1		
L8609		Artificial cornea		N1		
L8610		Ocular implant		N1		
L8612		Aqueous shunt prosthesis		N1		
L8613		Ossicular implant		N1		
L8614		Cochlear device		N1		
L8630		Metacarpophalangeal implant		N1		
L8631		Mcp joint repl 2 pc or more		N1		
L8641		Metatarsal joint implant		N1		
L8642		Hallux implant		N1		
L8658		Interphalangeal joint spacer		N1		
L8659		Interphalangeal joint repl		N1		
L8670		"Vascular graft, synthetic"		N1		
L8679		Imp neurosti pls gn any type		N1		
L8682		Implt neurostim radiofq rec		N1		
L8690		"Aud osseo dev, int/ext comp"		N1		
L8699		Prosthetic implant nos		N1		
L9900		O&p supply/accessory/service		N1		
P9041		"Albumin (human),5%, 50ml"		K2		$10.49
P9045		"Albumin (human), 5%, 250 ml"		K2		$52.45
P9046		"Albumin (human), 25%, 20 ml"		K2		$20.98
P9047		"Albumin (human), 25%, 50ml"		K2		$52.45
P9050		"Granulocytes, pheresis unit"		K5		
Q0138		"Ferumoxytol, non-esrd"		K2		$0.70
Q0139		"Ferumoxytol, esrd use"		K2		$0.70
Q0161		Chlorpromazine hcl 5mg oral		N1		
Q0162		Ondansetron oral		N1		
Q0163		Diphenhydramine hcl 50mg		N1		
Q0164		Prochlorperazine maleate 5mg		N1		
Q0166		Granisetron hcl 1 mg oral		N1		
Q0167		Dronabinol 2.5mg oral		N1		
Q0169		Promethazine hcl 12.5mg oral		N1		
Q0173		Trimethobenzamide hcl 250mg		N1		
Q0174		Thiethylperazine maleate10mg		K5		
Q0175		Perphenazine 4mg oral		N1		
Q0177		Hydroxyzine pamoate 25mg		N1		
Q0180		Dolasetron mesylate oral		N1		
Q0181		Unspecified oral anti-emetic		N1		
Q0240		Casirivi and imdevi 600 mg		L1		
Q0243		Casirivimab and imdevimab		L1		
Q0244		Casirivi and imdevi 1200 mg		L1		
Q0245		Bamlanivimab and etesevima		L1		
Q0247		Sotrovimab		L1		
Q0249		Tocilizumab for covid-19		L1		
Q0515		Sermorelin acetate injection		K5		
Q2004		Bladder calculi irrig sol		N1		
Q2009		Fosphenytoin inj pe		N1		
Q2017		"Teniposide, 50 mg"		K2		"$2,645.71"
Q2026		Radiesse injection		K2		$257.37
Q2028		"Inj, sculptra, 0.5mg"		K2		$2.49
Q2034	**	Agriflu vaccine		L1		
Q2035	**	"Afluria vacc, 3 yrs & >, im"		L1		
Q2036	**	"Flulaval vacc, 3 yrs & >, im"		L1		
Q2037	**	"Fluvirin vacc, 3 yrs & >, im"		L1		
Q2038	**	"Fluzone vacc, 3 yrs & >, im"		L1		
Q2039	**	"Influenza virus vaccine, nos"		L1		
Q2043		Sipuleucel-t auto cd54+		K2		"$55,114.75"
Q2049		Imported lipodox inj		K2		$311.04
Q2050		Doxorubicin inj 10mg		K2		$129.99
Q3027		Inj beta interferon im 1 mcg		K2		$56.07
Q3031		Collagen skin test		N1		
Q4100		"Skin substitute, nos"		N1		
Q4101		Apligraf		N1		
Q4102		Oasis wound matrix		N1		
Q4103		Oasis burn matrix		N1		
Q4104		Integra bmwd		N1		
Q4105		Integra drt or omnigraft		N1		
Q4106		Dermagraft		N1		
Q4107		Graftjacket		N1		
Q4108		Integra matrix		N1		
Q4110		Primatrix		N1		
Q4111		Gammagraft		N1		
Q4112		Cymetra injectable		N1		
Q4113		Graftjacket xpress		N1		
Q4114		Integra flowable wound matri		N1		
Q4115		Alloskin		N1		
Q4116		Alloderm		N1		
Q4117		Hyalomatrix		N1		
Q4118		Matristem micromatrix		N1		
Q4121		Theraskin		N1		
Q4122		"Dermacell, awm, porous sq cm"		N1		
Q4123		Alloskin		N1		
Q4124		Oasis tri-layer wound matrix		N1		
Q4125		Arthroflex		N1		
Q4126		Memoderm/derma/tranz/integup		N1		
Q4127		Talymed		N1		
Q4128		Flexhd/allopatchhd/matrixhd		N1		
Q4130		Strattice tm		N1		
Q4132		"Grafix core, grafixpl core"		N1		
Q4133		Grafix stravix prime pl sqcm		N1		
Q4134		Hmatrix		N1		
Q4135		Mediskin		N1		
Q4136		Ezderm		N1		
Q4137		Amnioexcel biodexcel 1sq cm		N1		
Q4138		"Biodfence dryflex, 1cm"		N1		
Q4139		"Amnio or biodmatrix, inj 1cc"		N1		
Q4140		Biodfence 1cm		N1		
Q4141		"Alloskin ac, 1 cm"		N1		
Q4142		Xcm biologic tiss matrix 1cm		N1		
Q4143		"Repriza, 1cm"		N1		
Q4145		"Epifix, inj, 1mg"		N1		
Q4146		"Tensix, 1cm"		N1		
Q4147		Architect ecm px fx 1 sq cm		N1		
Q4148		Neox neox rt or clarix cord		N1		
Q4149		"Excellagen, 0.1 cc"		N1		
Q4150		Allowrap ds or dry 1 sq cm		N1		
Q4151		"Amnioband, guardian 1 sq cm"		N1		
Q4152		Dermapure 1 square cm		N1		
Q4153		"Dermavest, plurivest sq cm"		N1		
Q4154		Biovance 1 square cm		N1		
Q4155		Neoxflo or clarixflo 1 mg		N1		
Q4156		Neox 100 or clarix 100		N1		
Q4157		Revitalon 1 square cm		N1		
Q4158		"Kerecis omega3, per sq cm"		N1		
Q4159		Affinity1 square cm		N1		
Q4160		Nushield 1 square cm		N1		
Q4161		Bio-connekt per square cm		N1		
Q4162		"Wndex flw, bioskn flw, 0.5cc"		N1		
Q4163		"Woundex, bioskin, per sq cm"		N1		
Q4164		"Helicoll, per square cm"		N1		
Q4165		"Keramatrix, kerasorb sq cm"		N1		
Q4166		"Cytal, per square centimeter"		N1		
Q4167		"Truskin, per sq centimeter"		N1		
Q4168		"Amnioband, 1 mg"		N1		
Q4169		"Artacent wound, per sq cm"		N1		
Q4170		"Cygnus, per sq cm"		N1		
Q4171		"Interfyl, 1 mg"		N1		
Q4173		Palingen or palingen xplus		N1		
Q4174		Palingen or promatrx		N1		
Q4175		Miroderm		N1		
Q4176		"Neopatch or therion, 1 sq cm"		N1		
Q4177		"Floweramnioflo, 0.1 cc"		N1		
Q4178		"Floweramniopatch, per sq cm"		N1		
Q4179		"Flowerderm, per sq cm"		N1		
Q4180		"Revita, per sq cm"		N1		
Q4181		"Amnio wound, per square cm"		N1		
Q4182		"Transcyte, per sq centimeter"		N1		
Q4183		"Surgigraft, 1 sq cm"		N1		
Q4184		Cellesta or duo per sq cm		N1		
Q4185		Cellesta flowab amnion 0.5cc		N1		
Q4186		Epifix 1 sq cm		N1		
Q4187		Epicord 1 sq cm		N1		
Q4188		Amnioarmor 1 sq cm		N1		
Q4189		"Artacent ac, 1 mg"		N1		
Q4190		Artacent ac 1 sq cm		N1		
Q4191		Restorigin 1 sq cm		N1		
Q4192		"Restorigin, 1 cc"		N1		
Q4193		Coll-e-derm 1 sq cm		N1		
Q4194		Novachor 1 sq cm		N1		
Q4195		Puraply 1 sq cm		N1		
Q4196		Puraply am 1 sq cm		N1		
Q4197		Puraply xt 1 sq cm		N1		
Q4198		Genesis amnio membrane 1sqcm		N1		
Q4199		"Cygnus matrix, per sq cm"		N1		
Q4200		Skin te 1 sq cm		N1		
Q4201		Matrion 1 sq cm		N1		
Q4202		"Keroxx (2.5g/cc), 1cc"		N1		
Q4203		"Derma-gide, 1 sq cm"		N1		
Q4204		Xwrap 1 sq cm		N1		
Q4205		Membrane graft or wrap sq cm		N1		
Q4206		Fluid flow or fluid gf 1 cc		N1		
Q4208		Novafix per sq cm		N1		
Q4209		Surgraft per sq cm		N1		
Q4210		Axolotl graf dualgraf sq cm		N1		
Q4211		Amnion bio or axobio sq cm		N1		
Q4214		Cellesta cord per sq cm		N1		
Q4216		Artacent cord per sq cm		N1		
Q4217		Woundfix biowound plus xplus		N1		
Q4218		Surgicord per sq cm		N1		
Q4219		Surgigraft dual per sq cm		N1		
Q4220		"Bellacell hd, surederm sq cm"		N1		
Q4221		Amniowrap2 per sq cm		N1		
Q4222		"Progenamatrix, per sq cm"		N1		
Q4224		Hhf10-p per sq cm		N1		
Q4225		"Amniobind, per sq cm"		N1		
Q4226		Myown harv prep proc sq cm		N1		
Q4227		Amniocore per sq cm		N1		
Q4229		Cogenex amnio memb per sq cm		N1		
Q4230		Cogenex flow amnion 0.5 cc		N1		
Q4231		"Corplex p, per cc"		N1		
Q4232		"Corplex, per sq cm"		N1		
Q4233		Surfactor /nudyn per 0.5 cc		N1		
Q4234		"Xcellerate, per sq cm"		N1		
Q4235		Amniorepair or altiply sq cm		N1		
Q4237		"Cryo-cord, per sq cm"		N1		
Q4238		"Derm-maxx, per sq cm"		N1		
Q4239		Amnio-maxx or lite per sq cm		N1		
Q4240		Corecyte topical only 0.5 cc		N1		
Q4241		"Polycyte, topical only 0.5cc"		N1		
Q4242		"Amniocyte plus, per 0.5 cc"		N1		
Q4244		"Procenta, per 200 mg"		N1		
Q4245		"Amniotext, per cc"		N1		
Q4246		"Coretext or protext, per cc"		N1		
Q4247		"Amniotext patch, per sq cm"		N1		
Q4248		Dermacyte amn mem allo sq cm		N1		
Q4249		"Amniply, per sq cm"		N1		
Q4250		Amnioamp-mp per sq cm		N1		
Q4251		"Vim, per square centimeter"		N1		
Q4252		"Vendaje, per square centimet"		N1		
Q4253		Zenith amniotic membrane psc		N1		
Q4254		Novafix dl per sq cm		N1		
Q4255		"Reguard, topical use per sq"		N1		
Q4256		"Mlg complet, per sq cm"		N1		
Q4257		"Relese, per sq cm"		N1		
Q4258		"Enverse, per sq cm"		N1		
Q4259		Celera per sq cm		N1		
Q4260		"Signature apatch, per sq cm"		N1		
Q4261		"Tag, per square centimeter"		N1		
Q5101		"Injection, zarxio"		K2		$0.23
Q5103		"Injection, inflectra"		K2		$33.26
Q5104		"Injection, renflexis"		K2		$51.25
Q5105		Inj retacrit esrd on dialysi		N1		
Q5106		Inj retacrit non-esrd use		K2		$8.40
Q5107		Inj mvasi 10 mg		K2		$32.24
Q5108		"Injection, fulphila"	*	K2		$165.27
Q5109		"Injection, ixifi, 10 mg"		K5		
Q5110		Nivestym	*	K2		$0.34
Q5111		"Injection, udenyca 0.5 mg"	*	K2		$171.87
Q5112		Inj ontruzant 10 mg		K2		$68.50
Q5113		Inj herzuma 10 mg		K2		$42.96
Q5114		Inj ogivri 10 mg		K2		$47.80
Q5115		Inj truxima 10 mg		K2		$48.34
Q5116		"Inj., trazimera, 10 mg"		K2		$45.48
Q5117		"Inj., kanjinti, 10 mg"		K2		$38.49
Q5118		"Inj., zirabev, 10 mg"		K2		$41.86
Q5119		"Inj ruxience, 10 mg"		K2		$44.03
Q5120		Inj pegfilgrastim-bmez 0.5mg		K2		$153.33
Q5121		"Inj. avsola, 10 mg"		K2		$38.65
Q5122		"Inj, nyvepria"		K2		$217.69
Q5123		"Inj. riabni, 10 mg"		K2		$49.84
Q9950		Inj sulf hexa lipid microsph		N1		
Q9951		"Locm >= 400 mg/ml iodine,1ml"		N1		
Q9953		"Inj fe-based mr contrast,1ml"		N1		
Q9954		"Oral mr contrast, 100 ml"		N1		
Q9955		"Inj perflexane lip micros,ml"		N1		
Q9956		"Inj octafluoropropane mic,ml"		N1		
Q9957		"Inj perflutren lip micros,ml"		N1		
Q9958		"Hocm <=149 mg/ml iodine, 1ml"		N1		
Q9959		"Hocm 150-199mg/ml iodine,1ml"		N1		
Q9960		"Hocm 200-249mg/ml iodine,1ml"		N1		
Q9961		"Hocm 250-299mg/ml iodine,1ml"		N1		
Q9962		"Hocm 300-349mg/ml iodine,1ml"		N1		
Q9963		"Hocm 350-399mg/ml iodine,1ml"		N1		
Q9964		"Hocm>= 400mg/ml iodine, 1ml"		N1		
Q9965		"Locm 100-199mg/ml iodine,1ml"		N1		
Q9966		"Locm 200-299mg/ml iodine,1ml"		N1		
Q9967		"Locm 300-399mg/ml iodine,1ml"		N1		
Q9968		Visualization adjunct		K2		$8.22
Q9982		Flutemetamol f18 diagnostic		N1		
Q9983		Florbetaben f18 diagnostic		N1		
Q9991		Buprenorph xr 100 mg or less		K2		"$1,858.61"
Q9992		Buprenorphine xr over 100 mg		K2		"$1,858.61"
V2630		Anter chamber intraocul lens		N1		
V2631		Iris support intraoclr lens		N1		
V2632		Post chmbr intraocular lens		N1		
V2785		Corneal tissue processing		F4		
V2790		Amniotic membrane		N1		
						
NOTE 1:  The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount except for most preventive services.  Sections 4104 and 10406 of the Affordable Care Act (ACA) waive coinsurance and the Part B deductible for most preventive services.  These preventive services are identified with a double asterisk (**).						
						
						
"NOTE 2:  In general, payment indicators Z2 and Z3 (certain radiology or diagnostic services) are based on a comparison of the final rates according to the ASC standard ratesetting methodology and the MPFS final rates effective January 1, 2022. MPFS final rates include changes to the MPFS as enacted by Public Law 117-71 on December 10, 2021. For a discussion of the MPFS rates, we refer readers to the CY 2022 MPFS final rule."						
						
