Ambulatory Payment Classifications (APCs)
Browse the complete index of Medicare Ambulatory Payment Classifications (APCs). Select an APC to view comprehensive historical data on payment rates, status indicators, and IOCE editing logic.
1335 APCs Available
| APC | Description |
|---|---|
| 00701 |
Sr89 strontium
$4146.34 OPPS Payment
|
| 00702 |
Inj, human-lans, per i.u
$1.72 OPPS Payment
|
| 00703 |
Inj daxibotulinumtoxina-lanm
$3.09 OPPS Payment
|
| 00704 |
Inj, aflibercept hd, 1 mg
$301.18 OPPS Payment
|
| 00705 |
Inj avacincaptad pegol 0.1mg
$103.40 OPPS Payment
|
| 00706 |
Inj talquetamab-tgvs 0.25 mg
$74.88 OPPS Payment
|
| 00707 |
Cantharidin top, applicator
$667.07 OPPS Payment
|
| 00708 |
Inj, elranatamab-bcmm, 1 mg
$186.79 OPPS Payment
|
| 00709 |
Flortaucipir inj 1 millicuri
$371.00 OPPS Payment
|
| 00710 |
Inj velmanase alfa-tycv 1 mg
$465.23 OPPS Payment
|
| 00711 |
Inj, artesunate, 1mg
$51.83 OPPS Payment
|
| 00712 |
Inj, dinutuximab, 0.1 mg
$93.67 OPPS Payment
|
| 00713 |
Inj roctavian ml 2x10^13vc g
$12553.71 OPPS Payment
|
| 00714 |
Inj delandistrogene mox rokl
$3321376.38 OPPS Payment
|
| 00715 |
Pegunigalsidase alfa-iwxj
$223.40 OPPS Payment
|
| 00716 |
Vyjuvek 5x10^9pfu/ml, 0.1 ml
$1004.58 OPPS Payment
|
| 00717 |
Instill adstiladrin, tx dose
$64282.30 OPPS Payment
|
| 00718 |
Inj, carmustine (accord)
$259.70 OPPS Payment
|
| 00719 |
Inj cyclophos frindovyx 5 mg
$9.10 OPPS Payment
|
| 00720 |
Inj glofitamab gxbm, 2.5 mg
$2840.68 OPPS Payment
|
| 00721 |
Inj rozanolixizum-noli 1 mg
$23.40 OPPS Payment
|
| 00722 |
Dexmedetomidine film, 1 mcg
$0.64 OPPS Payment
|
| 00723 |
Inj efgart-alfa 2mg hya-qvfc
$34.33 OPPS Payment
|
| 00724 |
Inj. olanzapine, 0.5mg
$0.98 OPPS Payment
|
| 00725 |
Inj secukinumab intrav 1mg
$18.04 OPPS Payment
|
| 00726 |
Dexrazoxane HCl injection
$49.74 OPPS Payment
|
| 00727 |
Inj, adzynma, 10 iu
$35.58 OPPS Payment
|
| 00728 |
Inj, mirikizumab-mrkz, 1 mg
$42.09 OPPS Payment
|
| 00729 |
Inj, motixafortide, 0.25 mg
$26.48 OPPS Payment
|
| 00730 |
Inj melphalan (hepzato) 1 mg
$795.00 OPPS Payment
|
| 00731 |
Sargramostim injection
$61.89 OPPS Payment
|
| 00732 |
Inj, brixadi, 7 days or less
$417.21 OPPS Payment
|
| 00733 |
Inj brixadi, more than 7 day
$1668.84 OPPS Payment
|
| 00734 |
Inj, levothyroxine, freskabi
$6.96 OPPS Payment
|
| 00735 |
Inj, levothyroxine, hikma
$5.14 OPPS Payment
|
| 00736 |
Amphotericin b liposome inj
$22.81 OPPS Payment
|
| 00737 |
Inj, cipaglucosidase, 5 mg
$92.40 OPPS Payment
|
| 00738 |
Rasburicase
$382.19 OPPS Payment
|
| 00739 |
Inj, rykindo, 0.5 mg
$13.03 OPPS Payment
|
| 00740 |
Inj hydroxocobalamin iv 25mg
$5.44 OPPS Payment
|
| 00741 |
Inj cyclophos dr reddys 5 mg
$0.50 OPPS Payment
|
| 00742 |
Anacaulase-bcdb 8.8% gel 1 g
$58.31 OPPS Payment
|
| 00743 |
Inj, cyclophosphamide, nos
$0.77 OPPS Payment
|
| 00744 |
Inst tauro 1.35mg/hep 100u
$5.03 OPPS Payment
|
| 00745 |
Inj, toripalimab-tpzi, 1 mg
$39.99 OPPS Payment
|
| 00746 |
Inj, betibeglogene autotemce
$2938320.00 OPPS Payment
|
| 00747 |
Inj, zolbetuximab-clzb, 2 mg
$33.65 OPPS Payment
|
| 00748 |
Inj, lovotibeglogene autotem
$3245381.39 OPPS Payment
|
| 00749 |
Inj travoprost intra impl
$196.88 OPPS Payment
|
| 00750 |
Inj, nithiodote, 3mg / 125mg
$2.17 OPPS Payment
|
| 00751 |
Mechlorethamine hcl inj
$11.74 OPPS Payment
|
| 00752 |
Dactinomycin injection
$337.67 OPPS Payment
|
| 00753 |
Inj cefazolin (wg crit care)
$1.00 OPPS Payment
|
| 00754 |
Daptomycin (xellia) unrefrig
$0.05 OPPS Payment
|
| 00755 |
Oral methotrexate (jylamvo)
$18.71 OPPS Payment
|
| 00756 |
Oral methotrexate (xatmep)
$22.30 OPPS Payment
|
| 00757 |
Docetaxel (docivyx), 1 mg
$50.61 OPPS Payment
|
| 00758 |
Inj pemetrexed (bluepoint)
|
| 00759 |
Naltrexone, depot form
$4.25 OPPS Payment
|
| 00760 |
Tc-99m graphite crucible
$328.60 OPPS Payment
|
| 00761 |
Inj, focinvez, 1mg
$2.55 OPPS Payment
|
| 00762 |
Bupivacaine implant, 1 mg
$0.88 OPPS Payment
|
| 00763 |
Inj, bupivacaine liposome
$1.41 OPPS Payment
|
| 00764 |
Ketorolac tromethamine inj
$0.34 OPPS Payment
|
| 00765 |
Inj, donanemab-azbt, 2 mg
$4.14 OPPS Payment
|
| 00766 |
Tc99m exametazime
$927.71 OPPS Payment
|
| 00767 |
Inj, nogapendekin pmln 1 mcg
$94.60 OPPS Payment
|
| 00768 |
Inj, tarlatamab-dlle, 1 mg
$1567.72 OPPS Payment
|
| 00769 |
In111 ibritumomab, dx
$798.02 OPPS Payment
|
| 00770 |
In111 oxyquinoline
$831.46 OPPS Payment
|
| 00771 |
In111 pentetate
$745.62 OPPS Payment
|
| 00772 |
Inj, pegulicianine, 1 mg
$37.51 OPPS Payment
|
| 00773 |
Inj, beqvez, per tx dose
$3710000.00 OPPS Payment
|
| 00774 |
Tc99m bicisate
$775.52 OPPS Payment
|
| 00775 |
Technetium tc99m arcitumomab
$809.51 OPPS Payment
|
| 00776 |
Technetium tc-99m auto wbc
$934.13 OPPS Payment
|
| 00777 |
Indium in-111 auto wbc
$1103.19 OPPS Payment
|
| 00778 |
Inj, vasopressin (baxter)
$1.53 OPPS Payment
|
| 00779 |
Indium in-111 pentetreotide
$2000.94 OPPS Payment
|
| 00780 |
Iodine i-123 iobenguane
$2317.50 OPPS Payment
|
| 00781 |
Iodine i-123 ioflupane
$1387.74 OPPS Payment
|
| 00782 |
Inj, pemrydi rtu, 10 mg
$70.48 OPPS Payment
|
| 00784 |
Inj, tyenne, 1 mg
$4.44 OPPS Payment
|
| 00785 |
Inj, cyclophosphamd, sandoz
$3.65 OPPS Payment
|
| 00786 |
Inj, tofidence, 1 mg
$5.26 OPPS Payment
|
| 00787 |
Inj, idacio, 20 mg
|
| 00788 |
Inj cefazolin sodium, hikma
$0.91 OPPS Payment
|
| 00789 |
Inj daptomycin (xellia)
$0.04 OPPS Payment
|
| 00790 |
Inj, methylpred acetate 1 mg
$0.12 OPPS Payment
|
| 00791 |
Inj, hydromorphone, 0.1 mg
$0.09 OPPS Payment
|
| 00792 |
Inj, glycopyrrolate, 0.1 mg
$0.43 OPPS Payment
|
| 00793 |
Inj glycopyrrolate fres kabi
$1.85 OPPS Payment
|
| 00794 |
Inj, bumetanide, 0.5 mg
$0.61 OPPS Payment
|
| 00795 |
Inj, lidocaine in d5w, 1 mg
|
| 00796 |
Inj meropenem (wg crit care)
$1.62 OPPS Payment
|
| 00797 |
Inj, immphentiv, 20 mcg
$0.13 OPPS Payment
|
| 00798 |
Inj, sezaby, 1 mg
$1.13 OPPS Payment
|
| 00799 |
Inj fluphenazine hcl 1.25 mg
$7.43 OPPS Payment
|
| 00800 |
Leuprolide acetate
$1765.57 OPPS Payment
|
| 00801 |
Inj, methylpred sod succ 5mg
$0.26 OPPS Payment
|
| 00802 |
Etoposide oral 50 mg
$86.84 OPPS Payment
|
| 00803 |
Hydroxocobalamin im 10mcg
$0.01 OPPS Payment
|
| 00804 |
Capecitabine, oral, 50 mg
$0.03 OPPS Payment
|
| 00805 |
Hiv prep, inj, cabotegravir
$7.15 OPPS Payment
|
| 00806 |
Hiv prep, ftc/tdf 200/300mg
$0.49 OPPS Payment
|
| 00807 |
Aldesleukin injection
$3338.87 OPPS Payment
|
| 00808 |
Hiv prep, ftc/taf 200/25mg
$71.44 OPPS Payment
|
| 00810 |
Goserelin acetate implant
$733.67 OPPS Payment
|
| 00811 |
Inj, nyposi 1 mcg
$1.03 OPPS Payment
|
| 00812 |
Carmustine injection
$241.80 OPPS Payment
|
| 00813 |
Injection, imetelstat, 1 mg
$58.17 OPPS Payment
|
| 00814 |
Inj, magtrace per study dose
$1254.00 OPPS Payment
|
| 00815 |
Inj, palonosetron (posfrea)
$55.29 OPPS Payment
|
| 00816 |
Inj, tislelizumab-jsgr
$58.27 OPPS Payment
|
| 00817 |
Inj, adalimumab, 1 mg
$91.73 OPPS Payment
|
| 00818 |
Inj, crovalimab-akkz, 10 mg
$551.51 OPPS Payment
|
| 00819 |
Inj, alyglo, 500 mg
$123.13 OPPS Payment
|
| 00820 |
Daunorubicin injection
$19.76 OPPS Payment
|
| 00821 |
Indigotindisulfonate sod 1mg
$9.30 OPPS Payment
|
| 00822 |
Inj, romiplostim 1 microgram
$11.11 OPPS Payment
|
| 00823 |
Docetaxel injection
$0.87 OPPS Payment
|
| 00824 |
Inj, exagamglogene autotem
$2332000.00 OPPS Payment
|
| 00825 |
Nelarabine injection
$52.71 OPPS Payment
|
| 00826 |
Inj adalimumab-fkjp, 1 mg
$87.14 OPPS Payment
|
| 00827 |
Floxuridine injection
$4250.97 OPPS Payment
|
| 00828 |
Inj adalimumab-aaty, 1 mg
$43.57 OPPS Payment
|
| 00829 |
Inj adalimumab-ryvk, 1 mg
$10.64 OPPS Payment
|
| 00830 |
Inj adalimumab-adbm, 1 mg
$10.43 OPPS Payment
|
| 00831 |
Obecbtge autol up to 400 mil
$278250.00 OPPS Payment
|
| 00833 |
Inj, idacio, 1 mg
$8.92 OPPS Payment
|
| 00834 |
Inj, abrilada, 1 mg
$26.63 OPPS Payment
|
| 00835 |
Datopotamab deruxtecan, 1 mg
$51.52 OPPS Payment
|
| 00836 |
Interferon alfa-2b inj
$28.66 OPPS Payment
|
| 00837 |
Inj, treosulfan, 50 mg
$31.61 OPPS Payment
|
| 00839 |
Inj axatilimab-csfr 0.1 mg
$55.65 OPPS Payment
|
| 00840 |
Inj melpha hydroch nos 50 mg
$120.67 OPPS Payment
|
| 00841 |
Inj, docetaxel (beizray) 1mg
$46.09 OPPS Payment
|
| 00842 |
Inj, melphalan (apotex) 1 mg
$64.78 OPPS Payment
|
| 00843 |
Pegaspargase injection
$28424.06 OPPS Payment
|
| 00844 |
Pentostatin injection
$2626.33 OPPS Payment
|
| 00845 |
Inj, atidarsagene autotemcel
$4505000.00 OPPS Payment
|
| 00846 |
Inj, eculizumab-aeeb, 2 mg
$41.79 OPPS Payment
|
| 00847 |
Inj thiotepa nos 1 mg
$5.74 OPPS Payment
|
| 00848 |
Inj nivolumab 2 mg hyaluron
$27.73 OPPS Payment
|
| 00850 |
Streptozocin injection
$370.18 OPPS Payment
|
| 00851 |
Thiotepa injection
$221.75 OPPS Payment
|
| 00852 |
Inj, eculizumab-aagh, 2 mg
$31.93 OPPS Payment
|
| 00853 |
Inj zenocutuzumab-zbco 1 mg
$33.57 OPPS Payment
|
| 00854 |
In111 capromab
$1730.29 OPPS Payment
|
| 00855 |
Inj ustekinumab-stba, 1 mg
$3.21 OPPS Payment
|
| 00856 |
Porfimer sodium injection
$24228.42 OPPS Payment
|
| 00857 |
Inj ustekinumab-kfce, 1 mg
$3.17 OPPS Payment
|
| 00858 |
Inj cladribine per 1 mg
$8.73 OPPS Payment
|
| 00859 |
Inj ustekinumab-aekn, 1 mg
$11.75 OPPS Payment
|
| 00860 |
I131 iodobenguate, dx
$953.01 OPPS Payment
|
| 00861 |
I125 serum albumin, dx
$469.06 OPPS Payment
|
| 00862 |
Cr51 chromate
$1917.96 OPPS Payment
|
| 00863 |
I125 iothalamate, dx
$649.64 OPPS Payment
|
| 00864 |
Mitoxantrone hydrochl
$38.61 OPPS Payment
|
| 00865 |
Inj, hercessi, 10 mg
$37.87 OPPS Payment
|
| 00866 |
Inj, sod thiosulfate (hope)
$0.88 OPPS Payment
|
| 00869 |
Inj ustekinumab-kfce, 1 mg
$3.35 OPPS Payment
|
| 00870 |
Inj. calaspargase pegol-mknl
$82.08 OPPS Payment
|
| 00871 |
Inj pemetrexed (bluepoint)
$10.60 OPPS Payment
|
| 00872 |
Inj. denosumab-bbdz, 1 mg
$27.91 OPPS Payment
|
| 00873 |
Hyalgan supartz visco-3 dose
$74.85 OPPS Payment
|
| 00874 |
Synvisc or synvisc-one
$6.96 OPPS Payment
|
| 00875 |
Euflexxa inj per dose
$105.58 OPPS Payment
|
| 00876 |
Gallium gozellix 1 millicuri
$1171.30 OPPS Payment
|
| 00877 |
Orthovisc inj per dose
$109.09 OPPS Payment
|
| 00878 |
Aztreonam/avibactam 10 mg
$1.68 OPPS Payment
|
| 00879 |
Inj ceftobipole medocarl 3mg
$1.10 OPPS Payment
|
| 00880 |
Hiv prep, inj, lenacapavir
$16.10 OPPS Payment
|
| 00881 |
Hiv prep, oral lenacapavir
$621.96 OPPS Payment
|
| 00882 |
Inj glucagon (gvoke) 0.01 mg
$2.37 OPPS Payment
|
| 00883 |
Inj, ethacrynate sod, 1 mg
$18.27 OPPS Payment
|
| 00884 |
Inj, fosdenopterin, 0.1mg
$17.59 OPPS Payment
|
| 00885 |
Inj, isoniazid, 1 mg
$0.30 OPPS Payment
|
| 00886 |
Inj. remestemcel-l-rknd/ td
$202713.58 OPPS Payment
|
| 00887 |
Azathioprine parenteral
$254.76 OPPS Payment
|
| 00888 |
Inj. concizumab-mtci, 0.5 mg
$83.47 OPPS Payment
|
| 00889 |
Injection fitusiran 0.04 mg
$132.63 OPPS Payment
|
| 00890 |
Lymphocyte immune globulin
$5292.43 OPPS Payment
|
| 00891 |
Inj, denosumab-bmwo, 1 mg
$26.21 OPPS Payment
|
| 00892 |
Inj, denosumab-bnht, 1 mg
$29.80 OPPS Payment
|
| 00893 |
Inj, nipocalimab-aahu, 3 mg
$32.67 OPPS Payment
|
| 00894 |
Telisotuzumab vedotin-tllv
$145.99 OPPS Payment
|
| 00895 |
Inj ustekinumab-aauz 1 mg
$14.05 OPPS Payment
|
| 00896 |
Inj, carboprost, 0.1 mg
$15.56 OPPS Payment
|
| 00897 |
Revakinagene, per implant
$262233.77 OPPS Payment
|
| 00898 |
Inj meloxicam (azurity) 1mg
$1.06 OPPS Payment
|
| 00899 |
Inj., haegarda 10 units
|
| 00900 |
Inj, liothyronine, 1 mcg
$39.29 OPPS Payment
|
| 00901 |
Alpha 1 proteinase inhibitor
$5.14 OPPS Payment
|
| 00902 |
Injection,onabotulinumtoxinA
$6.51 OPPS Payment
|
| 00903 |
Cytomegalovirus imm IV /vial
$1808.61 OPPS Payment
|
| 00904 |
Testosterone pellet 75 mg
$74.97 OPPS Payment
|
| 00905 |
Inj, posaconazole, 1 mg
$0.35 OPPS Payment
|
| 00906 |
Inj elivaldogene autotemecel
$3180000.00 OPPS Payment
|
| 00907 |
Inj, cyclophos (baxter) 5mg
$3.72 OPPS Payment
|
| 00908 |
Topi adm prad zami per treat
$3335820.00 OPPS Payment
|
| 00909 |
Inj gemcitabin (avyxa) 200mg
$410.44 OPPS Payment
|
| 00910 |
Interferon beta-1b / .25 MG
$392.03 OPPS Payment
|
| 00911 |
Inj pozelimab-bbfg, 1 mg
$91.73 OPPS Payment
|
| 00912 |
Inj, wezlana, iv, 1 mg
$4.54 OPPS Payment
|
| 00913 |
Mitomycin intravesical inst
$278.33 OPPS Payment
|
| 00914 |
Ustekinumab-ttwe iv inj 1 mg
$4.53 OPPS Payment
|
| 00915 |
Inj cosibelimab-ipdl, 2 mg
$22.92 OPPS Payment
|
| 00916 |
Inj linvoseltamab-gcpt 1 mg
$99.50 OPPS Payment
|
| 00917 |
Inj, carboplatin (avyxa)
$5.24 OPPS Payment
|
| 00918 |
Inj, jobevne, 10 mg
$84.38 OPPS Payment
|
| 00919 |
Inj, zymfentra, 10 mg
$99.76 OPPS Payment
|
| 00920 |
Tc99m succimer
$659.93 OPPS Payment
|
| 00921 |
Inj, tyruko, 1 mg
$24.32 OPPS Payment
|
| 00922 |
Inj onase abepar-brve treat
$2664228.59 OPPS Payment
|
| 00923 |
Inj yimmugo 100 mg
$24.32 OPPS Payment
|
| 00924 |
Inj zopapogene per ther dose
$121900.00 OPPS Payment
|
| 00925 |
Factor viii
$1.39 OPPS Payment
|
| 00926 |
Gemcitabine intravesical sys
$73088.26 OPPS Payment
|
| 00927 |
Factor viii recombinant
$1.57 OPPS Payment
|
| 00928 |
Factor ix complex
$1.70 OPPS Payment
|
| 00929 |
Anti-inhibitor
$2.42 OPPS Payment
|
| 00930 |
Pembrolizumab 1mg berahyalur
$32.13 OPPS Payment
|
| 00931 |
Factor IX non-recombinant
$1.37 OPPS Payment
|
| 00932 |
Factor ix recombinant nos
$1.84 OPPS Payment
|
| 00933 |
Suzetrigine, orl, 1mg
$0.33 OPPS Payment
|
| 00934 |
Inj, denosumab-nxxp, 1 mg
$15.84 OPPS Payment
|
| 00935 |
Inj. ferumoxytol, 1 mg
|
| 00936 |
Inj, leucovorin cal (avyxa)
|
| 00937 |
Inj fosfomycin disodium 20mg
|
| 00938 |
Narsoplimab-wuug, 1 mg
|
| 00939 |
Inj, qivigy, 100mg
|
| 00940 |
Inj depemokimab-ulaa 1 mg
|
| 00941 |
Riboflavin epioxa/hd<=2ml
|
| 00942 |
Inj amivantamab 5mg hyaluron
|
| 00943 |
Octagam injection
$47.04 OPPS Payment
|
| 00944 |
Gammagard liquid/erc inj
$49.08 OPPS Payment
|
| 00946 |
Hepagam b im injection
$70.23 OPPS Payment
|
| 00947 |
Flebogamma injection
$90.74 OPPS Payment
|
| 00948 |
Gamunex-C/Gammaked
$49.73 OPPS Payment
|
| 00949 |
Inj, den (eno/xtr), bio, 1mg
|
| 00950 |
Inj, tocilizumab-anoh, 1 mg
|
| 00951 |
Inj, denosumab-kyqq, 1 mg
|
| 00952 |
Inj ustekinumab-srlf, 1 mg
|
| 00953 |
Ibuprofen injection
|
| 00957 |
Inj belantamab mafodot blmf
|
| 00961 |
Albumin (human),5%, 50ml
$10.62 OPPS Payment
|
| 00963 |
Albumin (human), 5%, 250 ml
$53.08 OPPS Payment
|
| 00964 |
Albumin (human), 25%, 20 ml
$21.23 OPPS Payment
|
| 00965 |
Albumin (human), 25%, 50ml
$53.08 OPPS Payment
|
| 01015 |
Injection glatiramer acetate
$160.39 OPPS Payment
|
| 01064 |
I131 iodide cap, rx
$24.07 OPPS Payment
|
| 01083 |
Adalimumab injection
$1834.49 OPPS Payment
|
| 01138 |
Hepagam b intravenous, inj
$70.23 OPPS Payment
|
| 01139 |
Protein c concentrate
$15.05 OPPS Payment
|
| 01142 |
Supprelin LA implant
$41173.43 OPPS Payment
|
| 01150 |
I131 iodide sol, rx
$20.77 OPPS Payment
|
| 01166 |
Cytarabine liposome inj
$492.92 OPPS Payment
|
| 01168 |
Inj, temsirolimus
$30.08 OPPS Payment
|
| 01178 |
Busulfan injection
$0.68 OPPS Payment
|
| 01203 |
Verteporfin injection
$11.57 OPPS Payment
|
| 01207 |
Octreotide injection, depot
$188.35 OPPS Payment
|
| 01213 |
Antihemophilic viii/vwf comp
$1.25 OPPS Payment
|
| 01214 |
Inj IVIG privigen 500 mg
$49.53 OPPS Payment
|
| 01232 |
Mitomycin injection
$28.46 OPPS Payment
|
| 01233 |
Inj, vasopressin, 1 unit
$1.93 OPPS Payment
|
| 01234 |
Inj vasopressin (am reg) 1 u
$0.46 OPPS Payment
|
| 01235 |
Valrubicin injection
$1270.52 OPPS Payment
|
| 01236 |
Inj levoleucovorin nos 0.5mg
$0.02 OPPS Payment
|
| 01237 |
Inj iron dextran
$18.11 OPPS Payment
|
| 01238 |
Topotecan oral
$125.22 OPPS Payment
|
| 01253 |
Triamcinolone a inj prs-free
$18.78 OPPS Payment
|
| 01263 |
Antithrombin iii injection
$4.10 OPPS Payment
|
| 01268 |
Xyntha inj
$1.49 OPPS Payment
|
| 01274 |
Edetate calcium disodium inj
$6102.87 OPPS Payment
|
| 01281 |
Bevacizumab injection
$1.86 OPPS Payment
|
| 01289 |
AbobotulinumtoxinA
$8.90 OPPS Payment
|
| 01295 |
Sm 153 lexidronam
$3159.80 OPPS Payment
|
| 01296 |
Degarelix injection
$4.46 OPPS Payment
|
| 01297 |
Ferumoxytol, non-esrd
$0.23 OPPS Payment
|
| 01311 |
Canakinumab injection
$149.57 OPPS Payment
|
| 01312 |
Hizentra injection
$14.52 OPPS Payment
|
| 01327 |
Imiglucerase injection
$42.83 OPPS Payment
|
| 01331 |
Olanzapine long-acting inj
$2.92 OPPS Payment
|
| 01340 |
Collagenase, clost hist inj
$78.35 OPPS Payment
|
| 01341 |
Amobarbital 125 MG inj
$114.24 OPPS Payment
|
| 01352 |
Wilate injection
$1.32 OPPS Payment
|
| 01353 |
Belimumab injection
$57.19 OPPS Payment
|
| 01408 |
Cyclophosphamide 100 MG inj
$17.94 OPPS Payment
|
| 01413 |
Lumizyme injection
$207.51 OPPS Payment
|
| 01415 |
Glassia injection
$5.66 OPPS Payment
|
| 01416 |
Factor xiii anti-hem factor
$10.78 OPPS Payment
|
| 01417 |
Gel-one
$526.79 OPPS Payment
|
| 01420 |
Aflibercept injection
$731.89 OPPS Payment
|
| 01421 |
Imported lipodox inj
$298.74 OPPS Payment
|
| 01426 |
Eribulin mesylate injection
$76.76 OPPS Payment
|
| 01431 |
Centruroides immune f(ab)
$4871.94 OPPS Payment
|
| 01433 |
Calcitonin salmon injection
$835.80 OPPS Payment
|
| 01440 |
Inj desmopressin acetate
$3.89 OPPS Payment
|
| 01441 |
Dom nonHEU Tc99m add-on/dose
$10.00 OPPS Payment
|
| 01442 |
Non-HEU TC-99M add-on/dose
$10.00 OPPS Payment
|
| 01443 |
Icatibant injection
$116.41 OPPS Payment
|
| 01446 |
Visualization adjunct
$10.29 OPPS Payment
|
| 01458 |
Phentolaine mesylate inj
$257.45 OPPS Payment
|
| 01464 |
Factor viii (porcine)
$5.46 OPPS Payment
|
| 01466 |
Inj, vincristine sul lip 1mg
$3420.78 OPPS Payment
|
| 01467 |
Factor ix recombinan rixubis
$1.74 OPPS Payment
|
| 01468 |
Inj, abilify maintena, 1 mg
$7.27 OPPS Payment
|
| 01469 |
Inj filgrastim excl biosimil
$1.02 OPPS Payment
|
| 01471 |
Injection, Pertuzumab, 1 mg
$17.02 OPPS Payment
|
| 01472 |
Inj beta interferon im 1 mcg
$57.47 OPPS Payment
|
| 01474 |
Certolizumab pegol inj 1mg
$3.79 OPPS Payment
|
| 01475 |
Golimumab for iv use 1mg
$11.29 OPPS Payment
|
| 01476 |
Obinutuzumab inj
$81.81 OPPS Payment
|
| 01478 |
Inj human fibrinogen con nos
$1.52 OPPS Payment
|
| 01480 |
Elosulfase alfa, injection
$311.95 OPPS Payment
|
| 01482 |
Darbepoetin alfa, esrd use
$3.07 OPPS Payment
|
| 01485 |
Ferumoxytol, esrd use
$0.23 OPPS Payment
|
| 01486 |
Factor ix fc fusion recomb
$3.58 OPPS Payment
|
| 01488 |
Injection, ramucirumab
$75.47 OPPS Payment
|
| 01489 |
Inj vedolizumab iv 1 mg
$20.98 OPPS Payment
|
| 01490 |
Inj pembrolizumab
$61.25 OPPS Payment
|
| 01491 |
New Technology - Level 1A ($0-$10)
$5.00 OPPS Payment
|
| 01492 |
New Technology - Level 1B ($11-$20)
$15.50 OPPS Payment
|
| 01493 |
New Technology - Level 1C ($21-$30)
$25.50 OPPS Payment
|
| 01494 |
New Technology - Level 1D ($31-$40)
$35.50 OPPS Payment
|
| 01495 |
New Technology - Level 1E ($41-$50)
$45.50 OPPS Payment
|
| 01496 |
New Technology - Level 1A ($0-$10)
$5.00 OPPS Payment
|
| 01497 |
New Technology - Level 1B ($11-$20)
$15.50 OPPS Payment
|
| 01498 |
New Technology - Level 1C ($21-$30)
$25.50 OPPS Payment
|
| 01499 |
New Technology - Level 1D ($31-$40)
$35.50 OPPS Payment
|
| 01500 |
New Technology - Level 1E ($41-$50)
$45.50 OPPS Payment
|
| 01502 |
New Technology - Level 2 ($51 - $100)
$75.50 OPPS Payment
|
| 01503 |
New Technology - Level 3 ($101 - $200)
$150.50 OPPS Payment
|
| 01504 |
New Technology - Level 4 ($201 - $300)
$250.50 OPPS Payment
|
| 01505 |
New Technology - Level 5 ($301 - $400)
$350.50 OPPS Payment
|
| 01506 |
New Technology - Level 6 ($401 - $500)
$450.50 OPPS Payment
|
| 01507 |
New Technology - Level 7 ($501 - $600)
$550.50 OPPS Payment
|
| 01508 |
New Technology - Level 8 ($601 - $700)
$650.50 OPPS Payment
|
| 01509 |
New Technology - Level 9 ($701 - $800)
$750.50 OPPS Payment
|
| 01510 |
New Technology - Level 10 ($801 - $900)
$850.50 OPPS Payment
|
| 01511 |
New Technology - Level 11 ($901 - $1000)
$950.50 OPPS Payment
|
| 01512 |
New Technology - Level 12 ($1001 - $1100)
$1050.50 OPPS Payment
|
| 01513 |
New Technology - Level 13 ($1101 - $1200)
$1150.50 OPPS Payment
|
| 01514 |
New Technology - Level 14 ($1201- $1300)
$1250.50 OPPS Payment
|
| 01515 |
New Technology - Level 15 ($1301 - $1400)
$1350.50 OPPS Payment
|
| 01516 |
New Technology - Level 16 ($1401 - $1500)
$1450.50 OPPS Payment
|
| 01517 |
New Technology - Level 17 ($1501-$1600)
$1550.50 OPPS Payment
|
| 01518 |
New Technology - Level 18 ($1601-$1700)
$1650.50 OPPS Payment
|
| 01519 |
New Technology - Level 19 ($1701-$1800)
$1750.50 OPPS Payment
|
| 01520 |
New Technology - Level 20 ($1801-$1900)
$1850.50 OPPS Payment
|
| 01521 |
New Technology - Level 21 ($1901-$2000)
$1950.50 OPPS Payment
|
| 01522 |
New Technology - Level 22 ($2001-$2500)
$2250.50 OPPS Payment
|
| 01523 |
New Technology - Level 23 ($2501-$3000)
$2750.50 OPPS Payment
|
| 01524 |
New Technology - Level 24 ($3001-$3500)
$3250.50 OPPS Payment
|
| 01525 |
New Technology - Level 25 ($3501-$4000)
$3750.50 OPPS Payment
|
| 01526 |
New Technology - Level 26 ($4001-$4500)
$4250.50 OPPS Payment
|
| 01527 |
New Technology - Level 27 ($4501-$5000)
$4750.50 OPPS Payment
|
| 01528 |
New Technology - Level 28 ($5001-$5500)
$5250.50 OPPS Payment
|
| 01529 |
New Technology - Level 29 ($5501-$6000)
$5750.50 OPPS Payment
|
| 01530 |
New Technology - Level 30 ($6001-$6500)
$6250.50 OPPS Payment
|
| 01531 |
New Technology - Level 31 ($6501-$7000)
$6750.50 OPPS Payment
|
| 01532 |
New Technology - Level 32 ($7001-$7500)
$7250.50 OPPS Payment
|
| 01533 |
New Technology - Level 33 ($7501-$8000)
$7750.50 OPPS Payment
|
| 01534 |
New Technology - Level 34 ($8001-$8500)
$8250.50 OPPS Payment
|
| 01535 |
New Technology - Level 35 ($8501-$9000)
$8750.50 OPPS Payment
|
| 01536 |
New Technology - Level 36 ($9001-$9500)
$9250.50 OPPS Payment
|
| 01537 |
New Technology - Level 37 ($9501-$10000)
$9750.50 OPPS Payment
|
| 01539 |
New Technology - Level 2 ($51 - $100)
$75.50 OPPS Payment
|
| 01540 |
New Technology - Level 3 ($101 - $200)
$150.50 OPPS Payment
|
| 01541 |
New Technology - Level 4 ($201 - $300)
$250.50 OPPS Payment
|
| 01542 |
New Technology - Level 5 ($301 - $400)
$350.50 OPPS Payment
|
| 01543 |
New Technology - Level 6 ($401 - $500)
$450.50 OPPS Payment
|
| 01544 |
New Technology - Level 7 ($501 - $600)
$550.50 OPPS Payment
|
| 01545 |
New Technology - Level 8 ($601 - $700)
$650.50 OPPS Payment
|
| 01546 |
New Technology - Level 9 ($701 - $800)
$750.50 OPPS Payment
|
| 01547 |
New Technology - Level 10 ($801 - $900)
$850.50 OPPS Payment
|
| 01548 |
New Technology - Level 11 ($901 - $1000)
$950.50 OPPS Payment
|
| 01549 |
New Technology - Level 12 ($1001 - $1100)
$1050.50 OPPS Payment
|
| 01550 |
New Technology - Level 13 ($1101 - $1200)
$1150.50 OPPS Payment
|
| 01551 |
New Technology - Level 14 ($1201- $1300)
$1250.50 OPPS Payment
|
| 01552 |
New Technology - Level 15 ($1301 - $1400)
$1350.50 OPPS Payment
|
| 01553 |
New Technology - Level 16 ($1401 - $1500)
$1450.50 OPPS Payment
|
| 01554 |
New Technology - Level 17 ($1501-$1600)
$1550.50 OPPS Payment
|
| 01555 |
New Technology - Level 18 ($1601-$1700)
$1650.50 OPPS Payment
|
| 01556 |
New Technology - Level 19 ($1701-$1800)
$1750.50 OPPS Payment
|
| 01557 |
New Technology - Level 20 ($1801-$1900)
$1850.50 OPPS Payment
|
| 01558 |
New Technology - Level 21 ($1901-$2000)
$1950.50 OPPS Payment
|
| 01559 |
New Technology - Level 22 ($2001-$2500)
$2250.50 OPPS Payment
|
| 01560 |
New Technology - Level 23 ($2501-$3000)
$2750.50 OPPS Payment
|
| 01561 |
New Technology - Level 24 ($3001-$3500)
$3250.50 OPPS Payment
|
| 01562 |
New Technology - Level 25 ($3501-$4000)
$3750.50 OPPS Payment
|
| 01563 |
New Technology - Level 26 ($4001-$4500)
$4250.50 OPPS Payment
|
| 01564 |
New Technology - Level 27 ($4501-$5000)
$4750.50 OPPS Payment
|
| 01565 |
New Technology - Level 28 ($5001-$5500)
$5250.50 OPPS Payment
|
| 01566 |
New Technology - Level 29 ($5501-$6000)
$5750.50 OPPS Payment
|
| 01567 |
New Technology - Level 30 ($6001-$6500)
$6250.50 OPPS Payment
|
| 01568 |
New Technology - Level 31 ($6501-$7000)
$6750.50 OPPS Payment
|
| 01569 |
New Technology - Level 32 ($7001-$7500)
$7250.50 OPPS Payment
|
| 01570 |
New Technology - Level 33 ($7501-$8000)
$7750.50 OPPS Payment
|
| 01571 |
New Technology - Level 34 ($8001-$8500)
$8250.50 OPPS Payment
|
| 01572 |
New Technology - Level 35 ($8501-$9000)
$8750.50 OPPS Payment
|
| 01573 |
New Technology - Level 36 ($9001-$9500)
$9250.50 OPPS Payment
|
| 01574 |
New Technology - Level 37 ($9501-$10000)
$9750.50 OPPS Payment
|
| 01575 |
New Technology - Level 38 ($10,001-$15,000)
$12500.50 OPPS Payment
|
| 01576 |
New Technology - Level 39 ($15,001-$20,000)
$17500.50 OPPS Payment
|
| 01577 |
New Technology - Level 40 ($20,001-$25,000)
$22500.50 OPPS Payment
|
| 01578 |
New Technology - Level 41 ($25,001-$30,000)
$27500.50 OPPS Payment
|
| 01579 |
New Technology - Level 42 ($30,001-$40,000)
$35000.50 OPPS Payment
|
| 01580 |
New Technology - Level 43 ($40,001-$50,000)
$45000.50 OPPS Payment
|
| 01581 |
New Technology - Level 44 ($50,001-$60,000)
$55000.50 OPPS Payment
|
| 01582 |
New Technology - Level 45 ($60,001-$70,000)
$65000.50 OPPS Payment
|
| 01583 |
New Technology - Level 46 ($70,001-$80,000)
$75000.50 OPPS Payment
|
| 01584 |
New Technology - Level 47 ($80,001-$90,000)
$85000.50 OPPS Payment
|
| 01585 |
New Technology - Level 48 ($90,001-$100,000)
$95000.50 OPPS Payment
|
| 01589 |
New Technology - Level 38 ($10,001-$15,000)
$12500.50 OPPS Payment
|
| 01590 |
New Technology - Level 39 ($15,001-$20,000)
$17500.50 OPPS Payment
|
| 01591 |
New Technology - Level 40 ($20,001-$25,000)
$22500.50 OPPS Payment
|
| 01592 |
New Technology - Level 41 ($25,001-$30,000)
$27500.50 OPPS Payment
|
| 01593 |
New Technology - Level 42 ($30,001-$40,000)
$35000.50 OPPS Payment
|
| 01594 |
New Technology - Level 43 ($40,001-$50,000)
$45000.50 OPPS Payment
|
| 01595 |
New Technology - Level 44 ($50,001-$60,000)
$55000.50 OPPS Payment
|
| 01596 |
New Technology - Level 45 ($60,001-$70,000)
$65000.50 OPPS Payment
|
| 01597 |
New Technology - Level 46 ($70,001-$80,000)
$75000.50 OPPS Payment
|
| 01598 |
New Technology - Level 47 ($80,001-$90,000)
$85000.50 OPPS Payment
|
| 01599 |
New Technology - Level 48 ($90,001-$100,000)
$95000.50 OPPS Payment
|
| 01607 |
Eptifibatide injection
$3.92 OPPS Payment
|
| 01608 |
Etanercept injection
$1080.88 OPPS Payment
|
| 01609 |
Rho(D) immune globulin h, sd
$34.26 OPPS Payment
|
| 01613 |
Trastuzumab injection
$73.43 OPPS Payment
|
| 01630 |
Hep b ig, im
$140.21 OPPS Payment
|
| 01643 |
Y90 ibritumomab, rx
$56824.55 OPPS Payment
|
| 01656 |
Factor viii fc fusion recomb
$2.46 OPPS Payment
|
| 01658 |
Injection, belinostat, 10mg
$53.11 OPPS Payment
|
| 01660 |
Injection, oritavancin
$28.57 OPPS Payment
|
| 01662 |
Inj tedizolid phosphate
$1.96 OPPS Payment
|
| 01664 |
Florbetapir f18
$1825.64 OPPS Payment
|
| 01669 |
Erythro lactobionate /500 mg
$69.79 OPPS Payment
|
| 01670 |
Tetanus immune globulin inj
$558.12 OPPS Payment
|
| 01675 |
P32 na phosphate
$278.24 OPPS Payment
|
| 01683 |
Basiliximab
$4812.31 OPPS Payment
|
| 01684 |
Corticorelin ovine triflutal
$9.67 OPPS Payment
|
| 01685 |
Darbepoetin alfa, non-esrd
$3.07 OPPS Payment
|
| 01686 |
Epoetin alfa, non-esrd
$7.31 OPPS Payment
|
| 01687 |
Digoxin immune fab (ovine)
$5166.99 OPPS Payment
|
| 01688 |
Ethanolamine oleate
$518.63 OPPS Payment
|
| 01689 |
Fomepizole
$6.54 OPPS Payment
|
| 01690 |
Hemin
$35.31 OPPS Payment
|
| 01694 |
Ziconotide injection
$10.46 OPPS Payment
|
| 01695 |
Nesiritide injection
$74.80 OPPS Payment
|
| 01696 |
Palifermin injection
$36.72 OPPS Payment
|
| 01700 |
Inj secretin synthetic human
$40.23 OPPS Payment
|
| 01701 |
Treprostinil injection
$55.19 OPPS Payment
|
| 01704 |
Humate-P, inj
$1.49 OPPS Payment
|
| 01705 |
Factor viia recomb novoseven
$2.64 OPPS Payment
|
| 01709 |
Azacitidine injection
$0.67 OPPS Payment
|
| 01710 |
Clofarabine injection
$10.94 OPPS Payment
|
| 01711 |
Vantas implant
$1567.97 OPPS Payment
|
| 01712 |
Paclitaxel protein bound
$6.02 OPPS Payment
|
| 01739 |
Pegademase bovine, 25 iu
$4.06 OPPS Payment
|
| 01743 |
Nandrolone decanoate 50 mg
$21.69 OPPS Payment
|
| 01744 |
Zidovudine
$1.51 OPPS Payment
|
| 01745 |
Radium ra223 dichloride ther
$171.09 OPPS Payment
|
| 01746 |
Factor xiii recomb a-subunit
$18.33 OPPS Payment
|
| 01747 |
Monovisc inj per dose
$655.34 OPPS Payment
|
| 01748 |
Inj tbo filgrastim 1 microg
$0.25 OPPS Payment
|
| 01761 |
Rolapitant, oral, 1mg
$1.85 OPPS Payment
|
| 01809 |
Injection, alemtuzumab
$2440.42 OPPS Payment
|
| 01822 |
Injection, zarxio
$0.35 OPPS Payment
|
| 01823 |
Injection, dalbavancin
$15.00 OPPS Payment
|
| 01824 |
Ceftaroline fosamil inj
$4.25 OPPS Payment
|
| 01825 |
Ceftazidime and avibactam
$104.75 OPPS Payment
|
| 01826 |
Hyqvia 100mg immuneglobulin
$18.80 OPPS Payment
|
| 01827 |
Factor viii recomb obizur
$3.24 OPPS Payment
|
| 01829 |
Penicillin g benzathine inj
$31.47 OPPS Payment
|
| 01831 |
Chloramphenicol sodium injec
$50.26 OPPS Payment
|
| 01832 |
Dimethyl sulfoxide 50% 50 ml
$748.98 OPPS Payment
|
| 01836 |
Penicillin g procaine inj
$47.19 OPPS Payment
|
| 01844 |
Factor viii pegylated recomb
$2.14 OPPS Payment
|
| 01846 |
Factor viii nuwiq recomb 1iu
$1.18 OPPS Payment
|
| 01847 |
Injection, inflectra
$26.04 OPPS Payment
|
| 01848 |
Artiss fibrin sealant
$143.70 OPPS Payment
|
| 01849 |
Foscarnet sodium injection
$15.58 OPPS Payment
|
| 01850 |
Gamma globulin 1 cc inj
$48.95 OPPS Payment
|
| 01851 |
Gamma globulin > 10 cc inj
$160.29 OPPS Payment
|
| 01852 |
Interferon beta-1a inj
$2203.14 OPPS Payment
|
| 01853 |
Minocycline hydrochloride
$2.66 OPPS Payment
|
| 01854 |
Pentobarbital sodium inj
$36.84 OPPS Payment
|
| 01856 |
Factor viii recomb novoeight
$1.41 OPPS Payment
|
| 01857 |
Inj, factor x, (human), 1iu
$9.95 OPPS Payment
|
| 01859 |
Argatroban nonesrd use 1mg
$1.01 OPPS Payment
|
| 01861 |
Inj., bendeka 1 mg
$12.90 OPPS Payment
|
| 01862 |
Gelsyn-3 injection 0.1 mg
$0.68 OPPS Payment
|
| 01901 |
New Technology - Level 49 ($100,001-$115,000)
$107500.50 OPPS Payment
|
| 01902 |
New Technology - Level 49 ($100,001-$115,000)
$107500.50 OPPS Payment
|
| 01903 |
New Technology - Level 50 ($115,001-$130,000)
$122500.50 OPPS Payment
|
| 01904 |
New Technology - Level 50 ($115,001-$130,000)
$122500.50 OPPS Payment
|
| 01905 |
New Technology - Level 51 ($130,001-$145,000)
$137500.50 OPPS Payment
|
| 01906 |
New Technology - Level 51 ($130,001-$145,000)
$137500.50 OPPS Payment
|
| 01907 |
New Technology - Level 52 ($145,001-$160,000)
$152500.50 OPPS Payment
|
| 01908 |
New Technology - Level 52 ($145,001-$160,000)
$152500.50 OPPS Payment
|
| 02024 |
Generator, ccm, implant
|
| 02025 |
Cath, pressure,valve-occlu
|
| 02026 |
Orth/devic/drug bn/bn,tis/bn
|
| 02027 |
Probe, robotic, water-jet
|
| 02028 |
Iris prosthesis
|
| 02029 |
Endoscope, single, UGI
|
| 02030 |
Gen, neuro, carot sinus baro
|
| 02031 |
Hemostatic agent, GI, topic
|
| 02032 |
Intravertebral fx aug impl
|
| 02033 |
Cath, trans intra litho/coro
|
| 02034 |
Personalized interbody cage
|
| 02035 |
Auto cell process sys
|
| 02036 |
Cardiac monitor sys
|
| 02037 |
Pressure sensor system, IM
|
| 02038 |
Gen, neuro, clo loop, rechg
|
| 02039 |
Gen, neuro, imp led, ex cntr
|
| 02040 |
Endo, single, urinary tract
|
| 02041 |
Cath, bladed, vasc prep
|
| 02042 |
Endo, single, pulmonary
|
| 02043 |
Orth/matrx/bn fill drug-elut
|
| 02044 |
Ret dev, laser, ivc filter
|
| 02045 |
Grft, trnsmurl/trnsvens byps
|
| 02046 |
Pmkr, dual, leadless
|
| 02047 |
Adapter, us to endoscope
|
| 02048 |
Pump elastomc non-opioid dev
|
| 02049 |
Suprt dev, a-v fistula, imp
|
| 02050 |
Cath coronary drug-delivery
|
| 02051 |
Cath renal denerv radiofreq
|
| 02052 |
Cath renal denerv ultrasnd
|
| 02053 |
Si&pelvis fusn&fixn dev
|
| 02054 |
Power endo us-guid bx dev
|
| 02055 |
Tissue marker, detectable
|
| 02056 |
Pump perist non-opioid dev
|
| 02057 |
Nerve stim non-opioid dev
|
| 02058 |
Cryo probe non-opioid dev
|
| 02059 |
Cryo needle non-opioid dev
|
| 02060 |
Cold therapy non-opioid dev
|
| 02061 |
Obecabtagene car pos t
|
| 02062 |
Inj zanidatamab-hrii, 2 mg
$25.00 OPPS Payment
|
| 02063 |
Inj zolbetuximab, 1 mg
|
| 02064 |
Inj marstacim-hncq, 0.5 mg
$50.19 OPPS Payment
|
| 02065 |
Flurpiridaz f18, diag, 1 mci
$530.00 OPPS Payment
|
| 02066 |
Inj bortezomib boruzu 0.1 mg
$25.41 OPPS Payment
|
| 02067 |
Afamitresgene autoleucel
$770620.00 OPPS Payment
|
| 02068 |
Inj, aflibercept-ayyh, 1 mg
$821.40 OPPS Payment
|
| 02069 |
Inj, testosterone, azmiro
$0.14 OPPS Payment
|
| 02070 |
Inj, eculizumab, 2 mg
$44.70 OPPS Payment
|
| 02071 |
Inj ocrelizumab 1mg hya-ocsq
$46.79 OPPS Payment
|
| 02072 |
Inj, erzofri, 1 mg
$14.49 OPPS Payment
|
| 02073 |
Inj atezolizumb 5mg hya-tqjs
$31.95 OPPS Payment
|
| 02074 |
Lt vent pacing syst, sequen
|
| 02075 |
Inj acetaminoph 10mg/ibu 3mg
$0.09 OPPS Payment
|
| 02076 |
Inj, pemetrexed dipotassium
$82.02 OPPS Payment
|
| 02077 |
Anchor/screw bone absorb
|
| 02078 |
Pressure sens syst, cont im
|
| 02079 |
Elec amb pmp nonopioid dev
|
| 02080 |
Echgnc nv ndls nonopioid dev
|
| 02081 |
Prf infs cth nonopioid dev
|
| 02082 |
Echognc cathr nonopioid dev
|
| 02083 |
Peristlc pmp nonopioid dev
|
| 02084 |
Pmp prs reusbl nonopioid dev
|
| 02085 |
Crypnm cmprs nonopioid dev
|
| 02086 |
Neurostim integ rechg
|
| 02087 |
Prosthesis, dual mob cmc1
|
| 02088 |
Scafld endovas resrb drg elu
|
| 02089 |
Vert dev motion-preserv
|
| 02616 |
Brachytx, non-str,Yttrium-90
$17771.01 OPPS Payment
|
| 02632 |
Iodine I-125 sodium iodide
$396.32 OPPS Payment
|
| 02634 |
Brachytx, non-str, HA, I-125
$174.06 OPPS Payment
|
| 02635 |
Brachytx, non-str, HA, P-103
$106.75 OPPS Payment
|
| 02636 |
Brachy linear, non-str,P-103
$89.40 OPPS Payment
|
| 02638 |
Brachytx, stranded, I-125
$35.26 OPPS Payment
|
| 02639 |
Brachytx, non-stranded,I-125
$36.64 OPPS Payment
|
| 02640 |
Brachytx, stranded, P-103
$88.26 OPPS Payment
|
| 02641 |
Brachytx, non-stranded,P-103
$64.48 OPPS Payment
|
| 02642 |
Brachytx, stranded, C-131
$119.11 OPPS Payment
|
| 02643 |
Brachytx, non-stranded,C-131
$99.80 OPPS Payment
|
| 02645 |
Brachytx, non-str, Gold-198
$513.57 OPPS Payment
|
| 02646 |
Brachytx, non-str, HDR Ir-192
$357.49 OPPS Payment
|
| 02647 |
Brachytx, NS, Non-HDRIr-192
$908.70 OPPS Payment
|
| 02648 |
Brachytx planar, p-103
$4.69 OPPS Payment
|
| 02698 |
Brachytx, stranded, NOS
$35.26 OPPS Payment
|
| 02699 |
Brachytx, non-stranded, NOS
$36.64 OPPS Payment
|
| 02731 |
Immune globulin, powder
$80.40 OPPS Payment
|
| 02770 |
Quinupristin/dalfopristin
$4.26 OPPS Payment
|
| 02993 |
Gen, neuro, trans sen/stim
|
| 04001 |
Echo guidance radiotherapy
$139.34 OPPS Payment
|
| 04002 |
Stereoscopic x-ray guidance
$52.73 OPPS Payment
|
| 04003 |
Radiation treatment delivery, MeV <= 5; simple
$145.10 OPPS Payment
|
| 04004 |
Radiation treatment delivery, 6-10 MeV; simple
$117.61 OPPS Payment
|
| 04005 |
Radiation treatment delivery, 11-19 MeV; simple
$117.61 OPPS Payment
|
| 04006 |
Radiation treatment delivery, MeV>=20; simple
$116.97 OPPS Payment
|
| 04007 |
Radiation treatment delivery, MeV<=5; intermediate
$208.69 OPPS Payment
|
| 04008 |
Radiation treatment delivery, 6-10 MeV; intermediate
$162.04 OPPS Payment
|
| 04009 |
Radiation treatment delivery, 11-19 MeV; intermediate
$163.31 OPPS Payment
|
| 04010 |
Radiation treatment delivery, MeV >=20; intermediate
$160.74 OPPS Payment
|
| 04011 |
Radiation treatment delivery, MeV<=5; complex
$213.48 OPPS Payment
|
| 04012 |
Radiation treatment delivery, 6-10 MeV; complex
$213.80 OPPS Payment
|
| 04013 |
Radiation treatment delivery, 11-19 MeV; complex
$214.77 OPPS Payment
|
| 04014 |
Radiation treatment delivery, MeV >=20; complex
$213.48 OPPS Payment
|
| 04015 |
Radiation tx delivery imrt
$333.33 OPPS Payment
|
| 04016 |
Delivery comp imrt
$332.05 OPPS Payment
|
| 04017 |
Radiation tx delivery lvl 1
$79.49 OPPS Payment
|
| 04018 |
Radiation tx delivery lvl 2
$317.64 OPPS Payment
|
| 04019 |
Radiation tx delivery lvl 3
$391.46 OPPS Payment
|
| 04020 |
Payer Only Testing
$5063.98 OPPS Payment
|
| 04021 |
Payer Only Testing
$5158.49 OPPS Payment
|
| 04022 |
Payer Only Testing
$7047.38 OPPS Payment
|
| 04023 |
Payer Only Testing
$7717.44 OPPS Payment
|
| 04024 |
Payer Only Testing
$6323.36 OPPS Payment
|
| 04025 |
Payer Only Testing
$9111.74 OPPS Payment
|
| 04026 |
Payer Only Testing
$6238.96 OPPS Payment
|
| 04027 |
Payer Only Testing
$4119.92 OPPS Payment
|
| 04028 |
Payer Only Testing
$7064.58 OPPS Payment
|
| 04029 |
Payer Only Testing
$10550.61 OPPS Payment
|
| 04030 |
Payer Only Testing
$7616.58 OPPS Payment
|
| 04031 |
Payer Only Testing
$7388.54 OPPS Payment
|
| 05012 |
Clinic Visits and Related Services
$136.02 OPPS Payment
|
| 05021 |
Level 1 Type A ED Visits
$86.15 OPPS Payment
|
| 05022 |
Level 2 Type A ED Visits
$156.87 OPPS Payment
|
| 05023 |
Level 3 Type A ED Visits
$278.89 OPPS Payment
|
| 05024 |
Level 4 Type A ED Visits
$426.30 OPPS Payment
|
| 05025 |
Level 5 Type A ED Visits
$608.43 OPPS Payment
|
| 05031 |
Level 1 Type B ED Visits
$75.94 OPPS Payment
|
| 05032 |
Level 2 Type B ED Visits
$94.90 OPPS Payment
|
| 05033 |
Level 3 Type B ED Visits
$175.61 OPPS Payment
|
| 05034 |
Level 4 Type B ED Visits
$270.03 OPPS Payment
|
| 05035 |
Level 5 Type B ED Visits
$419.62 OPPS Payment
|
| 05041 |
Critical Care
$843.92 OPPS Payment
|
| 05045 |
Trauma Response with Critical Care
$1361.78 OPPS Payment
|
| 05051 |
Level 1 Skin Procedures
$204.98 OPPS Payment
|
| 05052 |
Level 2 Skin Procedures
$415.32 OPPS Payment
|
| 05053 |
Level 3 Skin Procedures
$755.08 OPPS Payment
|
| 05054 |
Level 4 Skin Procedures
$2107.97 OPPS Payment
|
| 05055 |
Level 5 Skin Procedures
$3620.48 OPPS Payment
|
| 05061 |
Hyperbaric Oxygen
$140.59 OPPS Payment
|
| 05071 |
Level 1 Excision/ Biopsy/ Incision and Drainage
$723.47 OPPS Payment
|
| 05072 |
Level 2 Excision/ Biopsy/ Incision and Drainage
$1687.37 OPPS Payment
|
| 05073 |
Level 3 Excision/ Biopsy/ Incision and Drainage
$2967.63 OPPS Payment
|
| 05091 |
Level 1 Breast/Lymphatic Surgery and Related Procedures
$4000.24 OPPS Payment
|
| 05092 |
Level 2 Breast/Lymphatic Surgery and Related Procedures
$6783.99 OPPS Payment
|
| 05093 |
Level 3 Breast/Lymphatic Surgery and Related Procedures
$8350.42 OPPS Payment
|
| 05094 |
Level 4 Breast/Lymphatic Surgery and Related Procedures
$14079.44 OPPS Payment
|
| 05101 |
Level 1 Strapping and Cast Application
$166.02 OPPS Payment
|
| 05102 |
Level 2 Strapping and Cast Application
$285.75 OPPS Payment
|
| 05111 |
Level 1 Musculoskeletal Procedures
$252.01 OPPS Payment
|
| 05112 |
Level 2 Musculoskeletal Procedures
$1642.82 OPPS Payment
|
| 05113 |
Level 3 Musculoskeletal Procedures
$3342.87 OPPS Payment
|
| 05114 |
Level 4 Musculoskeletal Procedures
$7413.38 OPPS Payment
|
| 05115 |
Level 5 Musculoskeletal Procedures
$13116.76 OPPS Payment
|
| 05116 |
Level 6 Musculoskeletal Procedures
$17913.59 OPPS Payment
|
| 05117 |
Level 7 Musculoskeletal Procedures
$27721.73 OPPS Payment
|
| 05151 |
Level 1 Airway Endoscopy
$203.93 OPPS Payment
|
| 05152 |
Level 2 Airway Endoscopy
$399.59 OPPS Payment
|
| 05153 |
Level 3 Airway Endoscopy
$1818.45 OPPS Payment
|
| 05154 |
Level 4 Airway Endoscopy
$3809.10 OPPS Payment
|
| 05155 |
Level 5 Airway Endoscopy
$7210.32 OPPS Payment
|
| 05161 |
Level 1 ENT Procedures
$241.98 OPPS Payment
|
| 05162 |
Level 2 ENT Procedures
$551.01 OPPS Payment
|
| 05163 |
Level 3 ENT Procedures
$1585.19 OPPS Payment
|
| 05164 |
Level 4 ENT Procedures
$3387.27 OPPS Payment
|
| 05165 |
Level 5 ENT Procedures
$6048.05 OPPS Payment
|
| 05166 |
Cochlear Implant Procedure
$33686.28 OPPS Payment
|
| 05181 |
Level 1 Vascular Procedures
$640.89 OPPS Payment
|
| 05182 |
Level 2 Vascular Procedures
$1608.25 OPPS Payment
|
| 05183 |
Level 3 Vascular Procedures
$3225.87 OPPS Payment
|
| 05184 |
Level 4 Vascular Procedures
$5685.01 OPPS Payment
|
| 05191 |
Level 1 Endovascular Procedures
$3312.15 OPPS Payment
|
| 05192 |
Level 2 Endovascular Procedures
$5814.84 OPPS Payment
|
| 05193 |
Level 3 Endovascular Procedures
$11794.23 OPPS Payment
|
| 05194 |
Level 4 Endovascular Procedures
$18728.69 OPPS Payment
|
| 05200 |
Implantation Wireless PA Pressure Monitor
$29304.62 OPPS Payment
|
| 05211 |
Level 1 Electrophysiologic Procedures
$1243.91 OPPS Payment
|
| 05212 |
Level 2 Electrophysiologic Procedures
$7968.60 OPPS Payment
|
| 05213 |
Level 3 Electrophysiologic Procedures
$26703.99 OPPS Payment
|
| 05221 |
Level 1 Pacemaker and Similar Procedures
$3817.90 OPPS Payment
|
| 05222 |
Level 2 Pacemaker and Similar Procedures
$8454.63 OPPS Payment
|
| 05223 |
Level 3 Pacemaker and Similar Procedures
$10678.38 OPPS Payment
|
| 05224 |
Level 4 Pacemaker and Similar Procedures
$19678.89 OPPS Payment
|
| 05231 |
Level 1 ICD and Similar Procedures
$22725.36 OPPS Payment
|
| 05232 |
Level 2 ICD and Similar Procedures
$32068.73 OPPS Payment
|
| 05241 |
Level 1 Blood Product Exchange and Related Services
$450.73 OPPS Payment
|
| 05242 |
Level 2 Blood Product Exchange and Related Services
$1591.16 OPPS Payment
|
| 05243 |
Level 3 Blood Product Exchange and Related Services
$4449.84 OPPS Payment
|
| 05244 |
Level 4 Blood Product Exchange and Related Services
$64263.52 OPPS Payment
|
| 05301 |
Level 1 Upper GI Procedures
$926.63 OPPS Payment
|
| 05302 |
Level 2 Upper GI Procedures
$1960.47 OPPS Payment
|
| 05303 |
Level 3 Upper GI Procedures
$3938.98 OPPS Payment
|
| 05311 |
Level 1 Lower GI Procedures
$950.10 OPPS Payment
|
| 05312 |
Level 2 Lower GI Procedures
$1222.56 OPPS Payment
|
| 05313 |
Level 3 Lower GI Procedures
$2835.78 OPPS Payment
|
| 05331 |
Complex GI Procedures
$6202.39 OPPS Payment
|
| 05341 |
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures
$3657.95 OPPS Payment
|
| 05342 |
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures
$6614.04 OPPS Payment
|
| 05361 |
Level 1 Laparoscopy and Related Services
$6176.47 OPPS Payment
|
| 05362 |
Level 2 Laparoscopy and Related Services
$10860.07 OPPS Payment
|
| 05371 |
Level 1 Urology and Related Services
$255.26 OPPS Payment
|
| 05372 |
Level 2 Urology and Related Services
$712.40 OPPS Payment
|
| 05373 |
Level 3 Urology and Related Services
$2135.66 OPPS Payment
|
| 05374 |
Level 4 Urology and Related Services
$3601.33 OPPS Payment
|
| 05375 |
Level 5 Urology and Related Services
$5477.93 OPPS Payment
|
| 05376 |
Level 6 Urology and Related Services
$9671.50 OPPS Payment
|
| 05377 |
Level 7 Urology and Related Services
$13479.22 OPPS Payment
|
| 05378 |
Level 8 Urology and Related Services
$21175.04 OPPS Payment
|
| 05401 |
Dialysis
$701.18 OPPS Payment
|
| 05411 |
Level 1 Gynecologic Procedures
$206.55 OPPS Payment
|
| 05412 |
Level 2 Gynecologic Procedures
$311.33 OPPS Payment
|
| 05413 |
Level 3 Gynecologic Procedures
$941.00 OPPS Payment
|
| 05414 |
Level 4 Gynecologic Procedures
$3307.24 OPPS Payment
|
| 05415 |
Level 5 Gynecologic Procedures
$5110.80 OPPS Payment
|
| 05416 |
Level 6 Gynecologic Procedures
$7576.05 OPPS Payment
|
| 05431 |
Level 1 Nerve Procedures
$1995.02 OPPS Payment
|
| 05432 |
Level 2 Nerve Procedures
$3490.14 OPPS Payment
|
| 05433 |
Level 3 Nerve Procedures
$8965.93 OPPS Payment
|
| 05441 |
Level 1 Nerve Injections
$313.60 OPPS Payment
|
| 05442 |
Level 2 Nerve Injections
$721.17 OPPS Payment
|
| 05443 |
Level 3 Nerve Injections
$903.63 OPPS Payment
|
| 05461 |
Level 1 Neurostimulator and Related Procedures
$3571.83 OPPS Payment
|
| 05462 |
Level 2 Neurostimulator and Related Procedures
$6511.03 OPPS Payment
|
| 05463 |
Level 3 Neurostimulator and Related Procedures
$11384.04 OPPS Payment
|
| 05464 |
Level 4 Neurostimulator and Related Procedures
$19820.31 OPPS Payment
|
| 05465 |
Level 5 Neurostimulator and Related Procedures
$31526.06 OPPS Payment
|
| 05471 |
Implantation of Drug Infusion Device
$18414.24 OPPS Payment
|
| 05481 |
Laser Eye Procedures
$561.91 OPPS Payment
|
| 05491 |
Level 1 Intraocular Procedures
$2357.81 OPPS Payment
|
| 05492 |
Level 2 Intraocular Procedures
$4222.95 OPPS Payment
|
| 05493 |
Level 3 Intraocular Procedures
$5436.56 OPPS Payment
|
| 05494 |
Level 4 Intraocular Procedures
$14820.30 OPPS Payment
|
| 05495 |
Level 5 Intraocular Procedures
$14255.17 OPPS Payment
|
| 05496 |
Level 6 Intraocular Procedures
$16817.36 OPPS Payment
|
| 05501 |
Level 1 Extraocular, Repair, and Plastic Eye Procedures
$324.28 OPPS Payment
|
| 05502 |
Level 2 Extraocular, Repair, and Plastic Eye Procedures
$1018.47 OPPS Payment
|
| 05503 |
Level 3 Extraocular, Repair, and Plastic Eye Procedures
$2428.98 OPPS Payment
|
| 05504 |
Level 4 Extraocular, Repair, and Plastic Eye Procedures
$4016.55 OPPS Payment
|
| 05521 |
Level 1 Imaging without Contrast
$88.91 OPPS Payment
|
| 05522 |
Level 2 Imaging without Contrast
$106.81 OPPS Payment
|
| 05523 |
Level 3 Imaging without Contrast
$243.77 OPPS Payment
|
| 05524 |
Level 4 Imaging without Contrast
$558.25 OPPS Payment
|
| 05571 |
Level 1 Imaging with Contrast
$179.20 OPPS Payment
|
| 05572 |
Level 2 Imaging with Contrast
$356.43 OPPS Payment
|
| 05573 |
Level 3 Imaging with Contrast
$800.90 OPPS Payment
|
| 05591 |
Level 1 Nuclear Medicine and Related Services
$408.43 OPPS Payment
|
| 05592 |
Level 2 Nuclear Medicine and Related Services
$554.73 OPPS Payment
|
| 05593 |
Level 3 Nuclear Medicine and Related Services
$1322.69 OPPS Payment
|
| 05594 |
Level 4 Nuclear Medicine and Related Services
$1460.92 OPPS Payment
|
| 05611 |
Level 1 Therapeutic Radiation Treatment Preparation
$137.32 OPPS Payment
|
| 05612 |
Level 2 Therapeutic Radiation Treatment Preparation
$382.54 OPPS Payment
|
| 05613 |
Level 3 Therapeutic Radiation Treatment Preparation
$1414.11 OPPS Payment
|
| 05621 |
Level 1 Radiation Therapy
$104.24 OPPS Payment
|
| 05622 |
Level 2 Radiation Therapy
$394.05 OPPS Payment
|
| 05623 |
Level 3 Radiation Therapy
$564.51 OPPS Payment
|
| 05624 |
Level 4 Radiation Therapy
$711.56 OPPS Payment
|
| 05625 |
Level 5 Radiation Therapy
$1276.81 OPPS Payment
|
| 05626 |
Level 6 Radiation Therapy
$1826.78 OPPS Payment
|
| 05627 |
Level 7 Radiation Therapy
$7524.82 OPPS Payment
|
| 05661 |
Therapeutic Nuclear Medicine
$238.39 OPPS Payment
|
| 05671 |
Level 1 Pathology
$53.24 OPPS Payment
|
| 05672 |
Level 2 Pathology
$174.06 OPPS Payment
|
| 05673 |
Level 3 Pathology
$366.21 OPPS Payment
|
| 05674 |
Level 4 Pathology
$823.13 OPPS Payment
|
| 05691 |
Level 1 Drug Administration
$47.84 OPPS Payment
|
| 05692 |
Level 2 Drug Administration
$73.56 OPPS Payment
|
| 05693 |
Level 3 Drug Administration
$217.31 OPPS Payment
|
| 05694 |
Level 4 Drug Administration
$337.46 OPPS Payment
|
| 05721 |
Level 1 Diagnostic Tests and Related Services
$131.46 OPPS Payment
|
| 05722 |
Level 2 Diagnostic Tests and Related Services
$220.60 OPPS Payment
|
| 05723 |
Level 3 Diagnostic Tests and Related Services
$381.24 OPPS Payment
|
| 05724 |
Level 4 Diagnostic Tests and Related Services
$877.34 OPPS Payment
|
| 05731 |
Level 1 Minor Procedures
$29.55 OPPS Payment
|
| 05732 |
Level 2 Minor Procedures
$38.16 OPPS Payment
|
| 05733 |
Level 3 Minor Procedures
$60.27 OPPS Payment
|
| 05734 |
Level 4 Minor Procedures
$135.93 OPPS Payment
|
| 05735 |
Level 5 Minor Procedures
$456.40 OPPS Payment
|
| 05741 |
Level 1 Electronic Analysis of Devices
$38.13 OPPS Payment
|
| 05742 |
Level 2 Electronic Analysis of Devices
$97.13 OPPS Payment
|
| 05743 |
Level 3 Electronic Analysis of Devices
$313.79 OPPS Payment
|
| 05771 |
Cardiac Rehabilitation
$131.70 OPPS Payment
|
| 05781 |
Resuscitation and Cardioversion
$675.26 OPPS Payment
|
| 05791 |
Pulmonary Treatment
$223.72 OPPS Payment
|
| 05801 |
Ventilation Initiation and Management
$631.17 OPPS Payment
|
| 05811 |
Manipulation Therapy
$22.06 OPPS Payment
|
| 05821 |
Level 1 Health and Behavior Services
$38.28 OPPS Payment
|
| 05822 |
Level 2 Health and Behavior Services
$103.79 OPPS Payment
|
| 05823 |
Level 3 Health and Behavior Services
$181.34 OPPS Payment
|
| 05851 |
Intensive Outpatient (3 services) for CMHCs
$127.74 OPPS Payment
|
| 05852 |
Intensive Outpatient (4 or more services) for CMHCs
$167.38 OPPS Payment
|
| 05853 |
Partial Hospitalization (3 services) for CMHCs
$127.74 OPPS Payment
|
| 05854 |
Partial Hospitalization (4 or more services) for CMHCs
$167.38 OPPS Payment
|
| 05861 |
Intensive Outpatient (3 services) for Hospital-based IOPs
$319.38 OPPS Payment
|
| 05862 |
Intensive Outpatient (4 or more services) for Hospital-based IOPs
$418.45 OPPS Payment
|
| 05863 |
Partial Hospitalization (3 services) for Hospital-based PHPs
$319.38 OPPS Payment
|
| 05864 |
Partial Hospitalization (4 or more services) for Hospital-based PHPs
$418.45 OPPS Payment
|
| 05871 |
Dental Procedures
$660.49 OPPS Payment
|
| 05881 |
Ancillary Outpatient Services When Patient Dies
$14228.88 OPPS Payment
|
| 06000 |
PMA Skin Substitute Products
$127.14 OPPS Payment
|
| 06001 |
510K Skin Substitute Products
$127.14 OPPS Payment
|
| 06002 |
HCT/P Skin Substitute Products
$127.14 OPPS Payment
|
| 07000 |
Amifostine
$1135.69 OPPS Payment
|
| 07011 |
Oprelvekin injection
$1.34 OPPS Payment
|
| 07035 |
Teniposide
$2645.71 OPPS Payment
|
| 07041 |
Tirofiban hcl
$3.96 OPPS Payment
|
| 07043 |
Infliximab not biosimil 10mg
$31.04 OPPS Payment
|
| 07046 |
Doxorubicin inj 10mg
$71.86 OPPS Payment
|
| 07048 |
Alteplase recombinant
$95.09 OPPS Payment
|
| 07308 |
Aminolevulinic acid hcl top
$390.02 OPPS Payment
|
| 08004 |
Ultrasound Composite
$300.57 OPPS Payment
|
| 08005 |
CT and CTA without Contrast Composite
$226.07 OPPS Payment
|
| 08006 |
CT and CTA with Contrast Composite
$438.90 OPPS Payment
|
| 08007 |
MRI and MRA without Contrast Composite
$537.85 OPPS Payment
|
| 08008 |
MRI and MRA with Contrast Composite
$867.08 OPPS Payment
|
| 08010 |
Mental Health Services Composite
$418.45 OPPS Payment
|
| 08011 |
Comprehensive Observation Services
$2672.15 OPPS Payment
|
| 09002 |
Tenecteplase injection
$197.44 OPPS Payment
|
| 09003 |
Rsv mab im 50mg
$436.75 OPPS Payment
|
| 09004 |
Injection, inclisiran, 1 mg
$12.61 OPPS Payment
|
| 09005 |
Reteplase injection
$2904.58 OPPS Payment
|
| 09006 |
Tacrolimus injection
$259.96 OPPS Payment
|
| 09007 |
Inj cutaquig 100 mg
$13.93 OPPS Payment
|
| 09008 |
Inj tezepelumab-ekko, 1mg
$17.58 OPPS Payment
|
| 09009 |
Inj, vutrisiran, 1 mg
$5019.27 OPPS Payment
|
| 09010 |
Inj efgartigimod 2mg
$32.61 OPPS Payment
|
| 09011 |
Mmrv vaccine sc
$132.69 OPPS Payment
|
| 09012 |
Arsenic trioxide injection
$5.86 OPPS Payment
|
| 09013 |
Inj risankizumab-rzaa 1 mg
$14.60 OPPS Payment
|
| 09014 |
Inj., cerliponase alfa 1 mg
$121.17 OPPS Payment
|
| 09015 |
Inj., haegarda 10 units
$10.25 OPPS Payment
|
| 09016 |
Inj., triptorelin xr 3.75 mg
$3723.76 OPPS Payment
|
| 09017 |
Inj. byooviz, 0.1 mg
$70.90 OPPS Payment
|
| 09018 |
Inj, rimabotulinumtoxinB
$13.28 OPPS Payment
|
| 09019 |
Caspofungin acetate
$9.81 OPPS Payment
|
| 09020 |
Argatroban nonesrd (accord)
$1.82 OPPS Payment
|
| 09021 |
Argatroban dialysis (accord)
$4.20 OPPS Payment
|
| 09022 |
Argatroban nonesrd (auromed)
$1.45 OPPS Payment
|
| 09023 |
Argatroban dialysis, auromed
$1.39 OPPS Payment
|
| 09024 |
Amphotericin b lipid complex
$10.30 OPPS Payment
|
| 09025 |
Inj glucagon hcl, fresenius
$135.00 OPPS Payment
|
| 09026 |
Inj, bortezomib, dr. reddy's
$3.46 OPPS Payment
|
| 09027 |
Inj, bortezomib freseniuskab
$6.97 OPPS Payment
|
| 09028 |
Inj inotuzumab ozogam 0.1 mg
$2816.77 OPPS Payment
|
| 09029 |
Inj., guselkumab, 1 mg
$67.81 OPPS Payment
|
| 09030 |
Inj., copanlisib, 1 mg
$89.16 OPPS Payment
|
| 09031 |
Inj, etelcalcetide, 0.1 mg
$2.36 OPPS Payment
|
| 09032 |
Baclofen 10 MG injection
$178.05 OPPS Payment
|
| 09033 |
Cidofovir injection
$560.79 OPPS Payment
|
| 09034 |
Inj cuvitru, 100 mg
$17.58 OPPS Payment
|
| 09035 |
Axicabtagene ciloleucel car+
$531849.12 OPPS Payment
|
| 09036 |
Injection, renflexis
$26.80 OPPS Payment
|
| 09037 |
Aripiprazole injection
$5.25 OPPS Payment
|
| 09038 |
Inj estrogen conjugate
$391.72 OPPS Payment
|
| 09039 |
Dimecaprol injection
$59.81 OPPS Payment
|
| 09040 |
Corticotropin injection
$3894.40 OPPS Payment
|
| 09041 |
Epoetin beta esrd use
$1.08 OPPS Payment
|
| 09042 |
Glucagon hydrochloride
$146.33 OPPS Payment
|
| 09043 |
Inj, afstyla, 1 i.u.
$1.57 OPPS Payment
|
| 09044 |
Ibutilide fumarate injection
$219.22 OPPS Payment
|
| 09045 |
Idursulfase injection
$558.22 OPPS Payment
|
| 09046 |
Inj., fibryga, 1 mg
$1.24 OPPS Payment
|
| 09047 |
Leuprolide acetate injeciton
$4.65 OPPS Payment
|
| 09048 |
Inj, alymsys, 10 mg
$51.59 OPPS Payment
|
| 09049 |
Inj, oliceridine 0.1 mg
$1.30 OPPS Payment
|
| 09050 |
Leuprolide inj, camcevi, 1mg
$39.95 OPPS Payment
|
| 09051 |
Inj, lanreotide, (cipla) 1mg
$32.19 OPPS Payment
|
| 09052 |
Fluciclovine f-18
$322.27 OPPS Payment
|
| 09053 |
Fluorodopa f-18 diag per mci
$855.55 OPPS Payment
|
| 09054 |
Lutetium lu 177 vipivotide
$259.60 OPPS Payment
|
| 09055 |
Gallium locametz 1 millicuri
$362.50 OPPS Payment
|
| 09056 |
Gallium ga-68
$49.63 OPPS Payment
|
| 09057 |
Inj nivol relatlimab 3mg/1mg
$201.76 OPPS Payment
|
| 09058 |
Buprenorphine implant 74.2mg
$1311.75 OPPS Payment
|
| 09059 |
Vonvendi inj 1 iu vwf:rco
$1.83 OPPS Payment
|
| 09063 |
Rh ig minidose im
$80.00 OPPS Payment
|
| 09065 |
Argatroban esrd dialysis 1mg
$0.82 OPPS Payment
|
| 09067 |
Lutetium lu 177 dotatat ther
$319.94 OPPS Payment
|
| 09068 |
Smallpox&monkeypox vac 0.5ml
$0.01 OPPS Payment
|
| 09069 |
Phenobarbital sodium inj
$39.38 OPPS Payment
|
| 09070 |
Inj luxturna 1 billion vec g
$3070.09 OPPS Payment
|
| 09071 |
Capsaicin 8% patch
$3.42 OPPS Payment
|
| 09073 |
Buprenorph xr 100 mg or less
$1996.56 OPPS Payment
|
| 09074 |
Makena, 10 mg
$13.82 OPPS Payment
|
| 09075 |
Inj, kovaltry, 1 i.u.
$1.56 OPPS Payment
|
| 09077 |
Epoetin beta non esrd
$1.41 OPPS Payment
|
| 09078 |
Testosterone undecanoate 1mg
$2.13 OPPS Payment
|
| 09079 |
Genvisc 850, inj, 1mg
$3.68 OPPS Payment
|
| 09080 |
Fludarabine phosphate inj
$71.65 OPPS Payment
|
| 09084 |
Florbetapir f18
$3028.84 OPPS Payment
|
| 09085 |
Inj sulf hexa lipid microsph
$19.06 OPPS Payment
|
| 09086 |
Hepa vacc ped/adol 3 dose
$29.53 OPPS Payment
|
| 09087 |
Inj, clevidipine, 1 mg
$2.84 OPPS Payment
|
| 09088 |
Peng benzathine/procaine inj
$19.52 OPPS Payment
|
| 09089 |
Oral fludarabine phosphate
$81.42 OPPS Payment
|
| 09090 |
Melphalan oral 2 mg
$12.00 OPPS Payment
|
| 09091 |
Daunorubicin citrate inj
$0.32 OPPS Payment
|
| 09092 |
Interferon alfa-2a inj
$407.24 OPPS Payment
|
| 09093 |
Plicamycin (mithramycin) inj
$115.40 OPPS Payment
|
| 09094 |
Radiesse injection
$349.19 OPPS Payment
|
| 09095 |
Inj, sculptra, 0.5mg
$2.16 OPPS Payment
|
| 09096 |
Inj retacrit esrd on dialysi
$0.76 OPPS Payment
|
| 09097 |
Inj retacrit non-esrd use
$7.88 OPPS Payment
|
| 09098 |
Chorionic gonadotropin/1000u
$22.37 OPPS Payment
|
| 09099 |
Inj fosnetupitant, palonoset
$524.18 OPPS Payment
|
| 09100 |
Inj, bortezomib, hospira
$1.92 OPPS Payment
|
| 09101 |
Vaccinia vrs vac 0.3 ml perq
$0.01 OPPS Payment
|
| 09102 |
Inj, fulvestrant (teva)
$41.67 OPPS Payment
|
| 09103 |
Inj, fulvestrant (fresenius)
$27.11 OPPS Payment
|
| 09104 |
Antithymocyte globuln rabbit
$1023.12 OPPS Payment
|
| 09105 |
Inj pemetrexed (teva) 10mg
$10.99 OPPS Payment
|
| 09106 |
Inj, bupivacaine (posimir)
$0.51 OPPS Payment
|
| 09107 |
Inj, aponvie, 1 mg
$1.91 OPPS Payment
|
| 09108 |
Thyrotropin injection
$2125.34 OPPS Payment
|
| 09109 |
Inj, elahere, 1 mg
$71.13 OPPS Payment
|
| 09110 |
Inj, tremelimumab-actl, 1 mg
$143.23 OPPS Payment
|
| 09111 |
Inj teclistamab cqyv 0.5 mg
$34.50 OPPS Payment
|
| 09112 |
Inj teplizumab mzwv 5 mcg
$38.39 OPPS Payment
|
| 09113 |
Inj olipudase alfa-rpcp 1mg
$395.60 OPPS Payment
|
| 09114 |
Inj eflapegrastim-xnst 0.1mg
$38.96 OPPS Payment
|
| 09115 |
Inj, spesolimab-sbzo, 1 mg
$65.73 OPPS Payment
|
| 09116 |
Chloroprocaine opht gel, 1mg
$0.58 OPPS Payment
|
| 09117 |
Inj, cimerli, 0.1 mg
$83.48 OPPS Payment
|
| 09118 |
Inj, fylnetra, 0.5 mg
$112.13 OPPS Payment
|
| 09119 |
Inj, pedmark, 100 mg
$95.45 OPPS Payment
|
| 09120 |
Injection, Fulvestrant
$6.98 OPPS Payment
|
| 09122 |
Triptorelin pamoate
$469.38 OPPS Payment
|
| 09123 |
Inj pemetrexed, hospira 10mg
$5.20 OPPS Payment
|
| 09124 |
Daptomycin injection
$0.14 OPPS Payment
|
| 09125 |
Risperidone, long acting
$10.80 OPPS Payment
|
| 09126 |
Natalizumab injection
$24.32 OPPS Payment
|
| 09127 |
Inj pemetrexed (accord) 10mg
$9.66 OPPS Payment
|
| 09128 |
Inj pemetrexed (sandoz) 10mg
$1.12 OPPS Payment
|
| 09129 |
Inj, stimufend, 0.5 mg
$158.26 OPPS Payment
|
| 09130 |
Inj, imm glob bivigam, 500mg
$79.44 OPPS Payment
|
| 09131 |
Inj, Ado-trastuzumab Emt 1mg
$42.20 OPPS Payment
|
| 09132 |
Prothrombin complex kcentra
$2.05 OPPS Payment
|
| 09133 |
Rabies ig, im/sc
$275.18 OPPS Payment
|
| 09134 |
Rabies ig, heat treated
$352.44 OPPS Payment
|
| 09135 |
Varicella-zoster ig, im
$2363.25 OPPS Payment
|
| 09136 |
Inj leu acet lutr dpt 7.5 mg
$693.56 OPPS Payment
|
| 09138 |
Inj, hemgenix, per tx dose
$3691450.00 OPPS Payment
|
| 09139 |
Rabies vaccine, im
$315.22 OPPS Payment
|
| 09140 |
Rabies vaccine, id
$236.86 OPPS Payment
|
| 09141 |
Inj onase abepar-xioi treat
$2587087.26 OPPS Payment
|
| 09142 |
Fecal microbiota jslm 1 ml
$64.32 OPPS Payment
|
| 09143 |
Inj acetaminophen -fresenius
$0.05 OPPS Payment
|
| 09144 |
Inj, panzyga, 500 mg
$73.83 OPPS Payment
|
| 09145 |
Inj, invega hafyera/trinza
$12.95 OPPS Payment
|
| 09146 |
Inj, ixinity, 1 i.u.
$1.97 OPPS Payment
|
| 09149 |
Inj ublituximab-xiiy, 1 mg
$68.75 OPPS Payment
|
| 09150 |
Inj mosunetuzumab-axgb, 1 mg
$654.54 OPPS Payment
|
| 09151 |
Inj apotex/bendamustine 1 mg
$18.82 OPPS Payment
|
| 09152 |
Paclitaxel (american regent)
$15.40 OPPS Payment
|
| 09153 |
Inj bendamustine, baxter 1mg
$18.82 OPPS Payment
|
| 09154 |
Inj, vivimusta, 1 mg
$31.74 OPPS Payment
|
| 09155 |
Inj lenacapavir (hiv tx) 1mg
$22.30 OPPS Payment
|
| 09156 |
Inj pemetrexed ditromethamin
$0.13 OPPS Payment
|
| 09157 |
Lecanemab-irmb, for iv inj
$1.34 OPPS Payment
|
| 09158 |
Inj, pegcetacoplan, 1mg
$147.81 OPPS Payment
|
| 09159 |
Inj, vegzelma, 10 mg
$34.65 OPPS Payment
|
| 09160 |
Inj, acetaminophen (b braun)
$0.05 OPPS Payment
|
| 09161 |
Inj cefazolin sodium, baxter
$1.27 OPPS Payment
|
| 09162 |
Inj. cefepime hcl (baxter)
$5.69 OPPS Payment
|
| 09163 |
Inj, cefepime hcl (b braun)
$5.13 OPPS Payment
|
| 09164 |
Inj, daptomycin (hospira)
$0.06 OPPS Payment
|
| 09165 |
Inj, decitabine (sun pharma)
$2.12 OPPS Payment
|
| 09166 |
Inj, fosaprepitant (teva)
$0.04 OPPS Payment
|
| 09167 |
Inj, linezolid (hospira)
$14.34 OPPS Payment
|
| 09168 |
Inj, meropenem (b. braun)
$2.11 OPPS Payment
|
| 09169 |
Inj, micafungin (par pharm)
$0.49 OPPS Payment
|
| 09170 |
Inj midazolam (wg crit care)
$0.28 OPPS Payment
|
| 09171 |
Factor ix idelvion inj
$5.32 OPPS Payment
|
| 09172 |
Injection, dexamethasone 9%
$0.86 OPPS Payment
|
| 09173 |
Injection, fulphila
$79.50 OPPS Payment
|
| 09174 |
Inj, durolane 1 mg
$6.73 OPPS Payment
|
| 09175 |
Puraply 1 sq cm
$113.56 OPPS Payment
|
| 09176 |
Puraply am 1 sq cm
$109.65 OPPS Payment
|
| 09177 |
Antithrombin recombinant
$103.35 OPPS Payment
|
| 09178 |
Inj., meropenem, vaborbactam
$2.17 OPPS Payment
|
| 09179 |
Inj., aristada initio, 1 mg
$3.25 OPPS Payment
|
| 09180 |
Inj., patisiran, 0.1 mg
$100.90 OPPS Payment
|
| 09181 |
Inj., perseris, 0.5 mg
$12.17 OPPS Payment
|
| 09182 |
Inj mogamulizumab-kpkc, 1 mg
$253.47 OPPS Payment
|
| 09183 |
Inj., plazomicin, 5 mg
$3.51 OPPS Payment
|
| 09184 |
Iodine i-131 iobenguane, dx
$320.12 OPPS Payment
|
| 09185 |
Iodine i-131 iobenguane, tx
$320.12 OPPS Payment
|
| 09186 |
Inj., rituximab, 10 mg
$74.16 OPPS Payment
|
| 09187 |
Injection, burosumab-twza 1m
$498.72 OPPS Payment
|
| 09188 |
Inj crotalidae im f(ab')2 eq
$1045.15 OPPS Payment
|
| 09189 |
Inj., ibalizumab-uiyk, 10 mg
$77.68 OPPS Payment
|
| 09190 |
Inj., vestronidase alfa-vjbk
$280.15 OPPS Payment
|
| 09191 |
Inj., fibryga, 1 mg
$1.19 OPPS Payment
|
| 09192 |
Inj, bortezomib, nos, 0.1 mg
$14.87 OPPS Payment
|
| 09193 |
Nivestym
$0.28 OPPS Payment
|
| 09194 |
Tisagenlecleucel car-pos t
$614180.81 OPPS Payment
|
| 09195 |
Injection, udenyca 0.5 mg
$135.89 OPPS Payment
|
| 09196 |
Inj, trivisc 1 mg
$3.27 OPPS Payment
|
| 09197 |
Inj., fremanezumab-vfrm 1 mg
$1.86 OPPS Payment
|
| 09198 |
Inj andexxa, 10 mg
$131.16 OPPS Payment
|
| 09199 |
Injection, caplacizumab-yhdp
$801.26 OPPS Payment
|
| 09200 |
Inj, remdesivir, 1 mg
$6.90 OPPS Payment
|
| 09201 |
Rabies ig ht&sol human im/sc
$242.18 OPPS Payment
|
| 09202 |
Difelikefalin, esrd on dialy
$0.08 OPPS Payment
|
| 09203 |
Inj cyclophosphamd auromedic
$0.52 OPPS Payment
|
| 09204 |
Inj tisotu vedotin-tftv, 1mg
$196.12 OPPS Payment
|
| 09205 |
Inj lon tesirin-lpyl 0.075mg
$221.49 OPPS Payment
|
| 09206 |
Inj plasminogen tvmh 1mg
$38.39 OPPS Payment
|
| 09207 |
Injection, bortezomib, 0.1mg
$1.73 OPPS Payment
|
| 09208 |
Agalsidase beta injection
$227.58 OPPS Payment
|
| 09209 |
Laronidase injection
$39.95 OPPS Payment
|
| 09210 |
Palonosetron hcl
$8.93 OPPS Payment
|
| 09211 |
Inj, morphine (fresenius)
$7.43 OPPS Payment
|
| 09212 |
Inj moxifloxacin (fres kabi)
$7.56 OPPS Payment
|
| 09213 |
Inj. pemetrexed nos 10mg
$4.04 OPPS Payment
|
| 09214 |
Bevacizumab injection
$74.36 OPPS Payment
|
| 09215 |
Cetuximab injection
$80.46 OPPS Payment
|
| 09216 |
Inj, naloxone hcl (zimhi)
$7.71 OPPS Payment
|
| 09217 |
Leuprolide acetate suspnsion
$176.20 OPPS Payment
|
| 09218 |
Chloroprocaine hcl injection
$0.03 OPPS Payment
|
| 09219 |
Procainamide hcl injection
$214.81 OPPS Payment
|
| 09220 |
Inj. tigecycline (accord)
$2.65 OPPS Payment
|
| 09221 |
Inj, vancomycin hcl (mylan)
$5.94 OPPS Payment
|
| 09222 |
Inj, vancomycin hcl (xellia)
$6.48 OPPS Payment
|
| 09223 |
Bladder calculi irrig sol
$146.92 OPPS Payment
|
| 09224 |
Galsulfase injection
$513.60 OPPS Payment
|
| 09225 |
Fluocinolone acetonide implt
$338.79 OPPS Payment
|
| 09226 |
Inj, calcium gluconate, nos
$0.04 OPPS Payment
|
| 09227 |
Micafungin sodium injection
$1.11 OPPS Payment
|
| 09228 |
Tigecycline injection
$1.00 OPPS Payment
|
| 09229 |
Ibandronate sodium injection
$29.31 OPPS Payment
|
| 09230 |
Abatacept injection
$44.72 OPPS Payment
|
| 09231 |
Decitabine injection
$1.59 OPPS Payment
|
| 09232 |
Idursulfase injection
$542.92 OPPS Payment
|
| 09233 |
Ranibizumab injection
$67.85 OPPS Payment
|
| 09234 |
Alglucosidase alfa injection
$148.86 OPPS Payment
|
| 09235 |
Panitumumab injection
$174.39 OPPS Payment
|
| 09236 |
Eculizumab injection
$224.63 OPPS Payment
|
| 09237 |
Inj, lanreotide acetate
$35.72 OPPS Payment
|
| 09238 |
Calcium glucon (wg critical)
$0.09 OPPS Payment
|
| 09239 |
Buprenorphine xr over 100 mg
$1996.56 OPPS Payment
|
| 09240 |
Injection, ixabepilone
$139.75 OPPS Payment
|
| 09241 |
Inj sirolimus prot part 1 mg
$87.11 OPPS Payment
|
| 09242 |
Injection, fosaprepitant
$0.33 OPPS Payment
|
| 09243 |
Inj, bendamustine hcl, 1mg
$2.16 OPPS Payment
|
| 09244 |
Inj gemcitabine hcl (accord)
$7.78 OPPS Payment
|
| 09245 |
Romiplostim injection
$100.81 OPPS Payment
|
| 09246 |
Inj, abilify asimtufii, 1 mg
$6.02 OPPS Payment
|
| 09247 |
Inj, amisulpride, 1 mg
$9.56 OPPS Payment
|
| 09249 |
Inj buprenorph (brixadi) 1mg
$12.84 OPPS Payment
|
| 09250 |
Inj epcoritamab-bysp 0.16 mg
$56.92 OPPS Payment
|
| 09251 |
C1 esterase inhibitor inj
$65.50 OPPS Payment
|
| 09252 |
Plerixafor injection
$32.74 OPPS Payment
|
| 09253 |
Temozolomide injection
$10.40 OPPS Payment
|
| 09254 |
Flotufolastat f18 diag 1 mci
$671.22 OPPS Payment
|
| 09255 |
Inj, invega sustenna, 1 mg
$15.08 OPPS Payment
|
| 09256 |
Dexamethasone intra implant
$203.79 OPPS Payment
|
| 09257 |
Inj., emicizumab-kxwh 0.5 mg
$55.64 OPPS Payment
|
| 09258 |
Telavancin injection
$7.03 OPPS Payment
|
| 09259 |
Pralatrexate injection
$392.72 OPPS Payment
|
| 09260 |
Ofatumumab injection
$62.23 OPPS Payment
|
| 09261 |
Ustekinumab sub cu inj, 1 mg
$157.68 OPPS Payment
|
| 09262 |
Inj tofersen intrathec 1 mg
$160.01 OPPS Payment
|
| 09263 |
Ecallantide injection
$578.75 OPPS Payment
|
| 09264 |
Tocilizumab injection
$5.53 OPPS Payment
|
| 09265 |
Romidepsin injection
$336.63 OPPS Payment
|
| 09266 |
Inj, uzedy, 1 mg
$25.16 OPPS Payment
|
| 09267 |
Inj, rezafungin, 1 mg
$10.79 OPPS Payment
|
| 09268 |
Inj. acthar gel to 40 units
$4094.26 OPPS Payment
|
| 09269 |
C-1 esterase, berinert
$76.05 OPPS Payment
|
| 09270 |
Gammaplex IVIG
$64.65 OPPS Payment
|
| 09271 |
Velaglucerase alfa
$388.16 OPPS Payment
|
| 09272 |
Inj, denosumab
$29.51 OPPS Payment
|
| 09273 |
Sipuleucel-T auto CD54+
$56269.19 OPPS Payment
|
| 09274 |
Crotalidae poly immune fab
$1841.02 OPPS Payment
|
| 09275 |
Inj. (ani), up to 40 units
$3571.35 OPPS Payment
|
| 09276 |
Cabazitaxel injection
$231.05 OPPS Payment
|
| 09277 |
Altuviiio per factor viii iu
$4.49 OPPS Payment
|
| 09278 |
Incobotulinumtoxin A
$5.29 OPPS Payment
|
| 09279 |
Inj. mycophenolate mofetil
$0.54 OPPS Payment
|
| 09280 |
Inj, retifanlimab-dlwr, 1 mg
$30.40 OPPS Payment
|
| 09281 |
Injection, pegloticase
$3824.52 OPPS Payment
|
| 09282 |
Inj, acetaminophen (hikma)
$0.05 OPPS Payment
|
| 09283 |
Inj, epinephrine (belcher)
$1.86 OPPS Payment
|
| 09284 |
Ipilimumab injection
$187.17 OPPS Payment
|
| 09285 |
Inj allopurinol sodium 1 mg
$3.81 OPPS Payment
|
| 09286 |
Belatacept injection
$3.89 OPPS Payment
|
| 09287 |
Brentuximab vedotin inj
$268.73 OPPS Payment
|
| 09288 |
Injection, aztreonam, 100 mg
$2.13 OPPS Payment
|
| 09289 |
Erwinaze injection
$427.27 OPPS Payment
|
| 09290 |
Inj, bupivacaine, nos, 0.5mg
$0.01 OPPS Payment
|
| 09291 |
Inj, clindamycin phosp 300mg
$2.39 OPPS Payment
|
| 09292 |
Inj, clindamycin (baxter)
$3.26 OPPS Payment
|
| 09293 |
Injection, glucarpidase
$449.10 OPPS Payment
|
| 09294 |
Inj, taliglucerase alfa 10 u
$40.66 OPPS Payment
|
| 09295 |
Injection, Carfilzomib, 1 mg
$56.24 OPPS Payment
|
| 09296 |
Inj, ziv-aflibercept, 1mg
$8.61 OPPS Payment
|
| 09297 |
Inj, Omacetaxine Mep, 0.01mg
$7.49 OPPS Payment
|
| 09298 |
Inj, Ocriplasmin, 0.125 mg
$93.02 OPPS Payment
|
| 09299 |
Inj. jivi 1 iu
$2.66 OPPS Payment
|
| 09300 |
Omalizumab injection
$41.82 OPPS Payment
|
| 09301 |
Aminolevulinic acid, 10% gel
$1.77 OPPS Payment
|
| 09302 |
Inj daunorubicin, cytarabine
$261.20 OPPS Payment
|
| 09303 |
Injection, levoleucovorin
$4.12 OPPS Payment
|
| 09304 |
Inj., cemiplimab-rwlc, 1 mg
$29.76 OPPS Payment
|
| 09305 |
Inj., lumoxiti, 0.01 mg
$23.39 OPPS Payment
|
| 09306 |
Inj., tildrakizumab, 1 mg
$118.20 OPPS Payment
|
| 09307 |
Cocaine hcl nasal solution
$1.23 OPPS Payment
|
| 09308 |
Dexametha opth insert 0.1 mg
$92.55 OPPS Payment
|
| 09309 |
Inj. tagraxofusp-erzs 10 mcg
$357.28 OPPS Payment
|
| 09310 |
Inj., emapalumab-lzsg, 1 mg
$384.14 OPPS Payment
|
| 09311 |
Inj., omadacycline, 1 mg
$4.13 OPPS Payment
|
| 09312 |
Inj., ravulizumab-cwvz 10 mg
$223.68 OPPS Payment
|
| 09313 |
Inj. belrapzo/bendamustine
$13.94 OPPS Payment
|
| 09314 |
Inj. herceptin hylecta, 10mg
$59.91 OPPS Payment
|
| 09315 |
Diphtheria antitoxin
$2957.76 OPPS Payment
|
| 09316 |
Corticotropin injection
$3995.82 OPPS Payment
|
| 09317 |
Doripenem injection
$1.15 OPPS Payment
|
| 09318 |
Inj hydroxyprogst capoat nos
$18.18 OPPS Payment
|
| 09319 |
Somatropin injection
$48.92 OPPS Payment
|
| 09320 |
Carbidopa levodopa ent 100ml
$244.04 OPPS Payment
|
| 09321 |
Fosphenytoin inj pe
$1.33 OPPS Payment
|
| 09322 |
Bcg live intravesical 1mg
$3.39 OPPS Payment
|
| 09323 |
Gallium ga-68 dotatoc
$3.61 OPPS Payment
|
| 09324 |
Phenylep ketorolac opth soln
$96.61 OPPS Payment
|
| 09325 |
Inj., eravacycline, 1 mg
$1.29 OPPS Payment
|
| 09326 |
Inj., lanadelumab-flyo, 1 mg
$86.85 OPPS Payment
|
| 09327 |
Inj. romosozumab-aqqg 1 mg
$12.19 OPPS Payment
|
| 09328 |
Inj., yutiq, 0.01 mg
$529.89 OPPS Payment
|
| 09329 |
Inj mvasi 10 mg
$23.74 OPPS Payment
|
| 09330 |
Inj., kanjinti, 10 mg
$56.38 OPPS Payment
|
| 09331 |
Inj, polatuzumab vedotin 1mg
$137.23 OPPS Payment
|
| 09332 |
Inj lefamulin 1 mg
$0.72 OPPS Payment
|
| 09333 |
Inj., brexanolone, 1 mg
$71.07 OPPS Payment
|
| 09334 |
Injection, khapzory, 0.5 mg
$1.70 OPPS Payment
|
| 09335 |
Oral busulfan
$10.12 OPPS Payment
|
| 09336 |
Inj truxima 10 mg
$31.28 OPPS Payment
|
| 09337 |
Synojoynt, inj., 1 mg
$10.29 OPPS Payment
|
| 09338 |
Inj., triluron, 1 mg
$10.55 OPPS Payment
|
| 09339 |
Iodine i-131 iobenguane 1mci
$339.61 OPPS Payment
|
| 09340 |
Inj, brolucizumab-dbll, 1 mg
$353.07 OPPS Payment
|
| 09341 |
Inj ogivri 10 mg
$35.78 OPPS Payment
|
| 09342 |
Inj, crizanlizumab-tmca
|
| 09343 |
Inj givosiran 0.5 mg
$120.98 OPPS Payment
|
| 09344 |
Inj cetirizine hydrochloride
|
| 09345 |
Inj pegfilgrastim-bmez 0.5mg
$119.64 OPPS Payment
|
| 09346 |
Mometasone sinus sinuva
$11.35 OPPS Payment
|
| 09347 |
Inj luspatercept-aamt 0.25mg
$42.75 OPPS Payment
|
| 09348 |
Inj., zirabev, 10 mg
$25.85 OPPS Payment
|
| 09349 |
Inj herzuma 10 mg
$56.02 OPPS Payment
|
| 09350 |
Inj., trazimera, 10 mg
$10.43 OPPS Payment
|
| 09351 |
Inj bimatoprost itc imp 1mcg
$214.02 OPPS Payment
|
| 09352 |
Chloroquine injection
$0.71 OPPS Payment
|
| 09353 |
Inj fam-trastu deru-nxki 1mg
$31.26 OPPS Payment
|
| 09354 |
Inj recombin esperoct per iu
$2.23 OPPS Payment
|
| 09355 |
Inj. teprotumumab-trbw 10 mg
$367.91 OPPS Payment
|
| 09356 |
Inj golodirsen 10 mg
$166.06 OPPS Payment
|
| 09357 |
Inj. eptinezumab-jjmr 1 mg
$20.55 OPPS Payment
|
| 09358 |
Inj xipere 1 mg
$47.78 OPPS Payment
|
| 09359 |
Inj crizanlizumab-tmca 5mg
$129.94 OPPS Payment
|
| 09360 |
Inj heparin, pfizer, 1000u
$3.42 OPPS Payment
|
| 09361 |
Inj. cetirizine hcl 0.5mg
$16.92 OPPS Payment
|
| 09362 |
Inj imip 4 cilas 4 releb 2mg
$2.61 OPPS Payment
|
| 09363 |
Inj, esmolol hcl, 10mg
$0.26 OPPS Payment
|
| 09364 |
Inj enfort vedo-ejfv 0.25mg
$36.71 OPPS Payment
|
| 09365 |
Inj esmolol hcl wg crit care
$0.40 OPPS Payment
|
| 09366 |
Fiasp for insulin pump use
$7.76 OPPS Payment
|
| 09367 |
Inj ruxience, 10 mg
$13.69 OPPS Payment
|
| 09368 |
Lyumjev for insulin pump use
$15.53 OPPS Payment
|
| 09369 |
Inj, metronidazole, 10 mg
$0.03 OPPS Payment
|
| 09370 |
Fluoroestradiol F 18
$460.42 OPPS Payment
|
| 09371 |
Inj. meloxicam 1 mg
$3.01 OPPS Payment
|
| 09372 |
Inj. xembify, 100 mg
$15.37 OPPS Payment
|
| 09373 |
Inj onase abepar-xioi treat
$2206690.98 OPPS Payment
|
| 09374 |
Mitomycin instillation
$323.17 OPPS Payment
|
| 09375 |
Inj., evomela, 1 mg
$19.43 OPPS Payment
|
| 09376 |
Sacituzumab govitecan-hziy
$36.80 OPPS Payment
|
| 09377 |
Inj. isatuximab-irfc 10 mg
$83.58 OPPS Payment
|
| 09378 |
Daratumumab, hyaluronidase
$55.03 OPPS Payment
|
| 09379 |
Romidepsin non-lyophilized
$299.49 OPPS Payment
|
| 09380 |
Inj., cefiderocol, 5 mg
$0.97 OPPS Payment
|
| 09381 |
Inj. avsola, 10 mg
$28.04 OPPS Payment
|
| 09382 |
Inj ontruzant 10 mg
$29.81 OPPS Payment
|
| 09383 |
Copper cu 64 dotatate diag
$594.28 OPPS Payment
|
| 09384 |
Inj belantamab mafodot blmf
$46.78 OPPS Payment
|
| 09385 |
Inj., tafasitamab-cxix
$14.17 OPPS Payment
|
| 09386 |
Inj. viltolarsen
$58.81 OPPS Payment
|
| 09387 |
Inj. infugem, 100 mg
$40.28 OPPS Payment
|
| 09388 |
Inj. fe derisomaltose 10 mg
$21.93 OPPS Payment
|
| 09389 |
Inj. lurbinectedin, 0.1 mg
$212.10 OPPS Payment
|
| 09390 |
Pertuzu, trastuzu, 10 mg
$60.23 OPPS Payment
|
| 09391 |
Brexucabtagene car pos t
$489290.60 OPPS Payment
|
| 09392 |
Inj. asceniv
$500.93 OPPS Payment
|
| 09393 |
Inj codeine phosphate /30 mg
$31.65 OPPS Payment
|
| 09394 |
Inj. inebilizumab-cdon, 1 mg
$495.55 OPPS Payment
|
| 09395 |
Factor viia recomb sevenfact
$2.20 OPPS Payment
|
| 09396 |
Afamelanotide implant, 1 mg
$2943.42 OPPS Payment
|
| 09397 |
Covid-19 Vaccine Admin Dose 1 of 2
$41.52 OPPS Payment
|
| 09398 |
Covid-19 Vaccine Administration
$41.52 OPPS Payment
|
| 09399 |
Pneumococcal, Influenza, Hepatitis B, and/or Covid-19 Vaccine Home Administration
$36.85 OPPS Payment
|
| 09400 |
Inj, labetalol hcl, 5mg
$0.17 OPPS Payment
|
| 09401 |
Bebtelovimab 175 mg
$2394.00 OPPS Payment
|
| 09402 |
Inj labetalol hcl hikma, 5mg
$2.13 OPPS Payment
|
| 09403 |
Methylnaltrexone injection
$1.18 OPPS Payment
|
| 09404 |
Inj, nitroglycerin, 5 mg
$1.34 OPPS Payment
|
| 09405 |
Inj, biorphen, 20 micrograms
$0.17 OPPS Payment
|
| 09406 |
Inj, nyvepria
$133.31 OPPS Payment
|
| 09407 |
Inj. lumasiran, 0.5 mg
$327.72 OPPS Payment
|
| 09408 |
Inj. naxitamab-gqgk, 1 mg
$686.09 OPPS Payment
|
| 09409 |
Gallium ga-68 psma-11 ucsf
$550.13 OPPS Payment
|
| 09410 |
Gallium ga-68 psma-11, ucla
$363.50 OPPS Payment
|
| 09411 |
Inj. riabni, 10 mg
$20.26 OPPS Payment
|
| 09412 |
Injection, casimersen, 10 mg
$166.20 OPPS Payment
|
| 09413 |
lisocabtagene car pos t
$562260.84 OPPS Payment
|
| 09414 |
Inj, cabote rilpivir 2mg 3mg
$24.18 OPPS Payment
|
| 09415 |
Injection, trilaciclib, 1mg
$5.49 OPPS Payment
|
| 09416 |
Inj, evinacumab-dgnb, 5 mg
$197.63 OPPS Payment
|
| 09417 |
Inj, melphalan flufenami 1mg
$426.90 OPPS Payment
|
| 09418 |
Inj. margetuximab-cmkb, 5 mg
$53.27 OPPS Payment
|
| 09419 |
Inj fensolvi 0.25 mg
$140.71 OPPS Payment
|
| 09420 |
Eptifibatide injection
$3.26 OPPS Payment
|
| 09421 |
Inj, granisetron, xr, 0.1 mg
$3.88 OPPS Payment
|
| 09422 |
Idecabtagene vicleucel car
$559781.08 OPPS Payment
|
| 09423 |
Inj dostarlimab-gxly, 100 mg
|
| 09424 |
Inj, amivantamab-vmjw, 10 mg
|
| 09425 |
loncastuximab-lpyl, 0.1 mg
$242.05 OPPS Payment
|
| 09426 |
Inj, cefiderocol, 10 mg
$2.42 OPPS Payment
|
| 09427 |
Injection, oritavancin 10 mg
$43.72 OPPS Payment
|
| 09428 |
Inj romidepsin non-lyo 0.1mg
$28.52 OPPS Payment
|
| 09429 |
Inj romidepsin lyophil 0.1mg
$30.80 OPPS Payment
|
| 09430 |
Piflu f-18, dia 1 millicurie
$346.49 OPPS Payment
|
| 09431 |
Inj, dostarlimab-gxly, 10 mg
$247.08 OPPS Payment
|
| 09432 |
Inj, amivantamab-vmjw
$22.63 OPPS Payment
|
| 09433 |
Inj aval alfa-nqpt 4mg
$81.20 OPPS Payment
|
| 09434 |
Inj anifrolumab-fnia 1mg
$18.31 OPPS Payment
|
| 09435 |
Inj cyclophosphamd auromedic
$7.52 OPPS Payment
|
| 09436 |
Inj pegfilgrast ex bio 0.5mg
$127.38 OPPS Payment
|
| 09437 |
Inj, aspara, rylaze, 0.1 mg
$56.29 OPPS Payment
|
| 09438 |
Injection, aducanumab-avwa, 2 mg
$5.98 OPPS Payment
|
| 09439 |
Inj, susvimo 0.1 mg
$76.20 OPPS Payment
|
| 09440 |
Instill, bupivac and meloxic
$0.83 OPPS Payment
|
| 09441 |
Inj ferric carboxymaltos 1mg
$1.10 OPPS Payment
|
| 09442 |
Inj. pemetrexed, 10 mg
$7.99 OPPS Payment
|
| 09443 |
Gallium illuccix 1 millicure
$478.52 OPPS Payment
|
| 09444 |
Inj, sutimlimab-jome, 10 mg
$19.64 OPPS Payment
|
| 09445 |
Injection, ruconest
$36.68 OPPS Payment
|
| 09446 |
Inj, tebentafusp-tebn, 1 mcg
$222.49 OPPS Payment
|
| 09447 |
Inj, releuko 1 mcg
$0.32 OPPS Payment
|
| 09448 |
Oral netupitant, palonosetro
$397.79 OPPS Payment
|
| 09449 |
Injection, blinatumomab
$163.96 OPPS Payment
|
| 09450 |
Fluocinol acet intravit imp
$509.81 OPPS Payment
|
| 09451 |
Injection, peramivir
$1.68 OPPS Payment
|
| 09452 |
Inj ceftolozane tazobactam
$8.84 OPPS Payment
|
| 09453 |
Injection, nivolumab
$33.62 OPPS Payment
|
| 09454 |
Inj, pasireotide long acting
$596.30 OPPS Payment
|
| 09455 |
Injection, siltuximab
$174.08 OPPS Payment
|
| 09456 |
Injection, isavuconazonium
$1.01 OPPS Payment
|
| 09458 |
Florbetaben f18 diagnostic
$1584.67 OPPS Payment
|
| 09459 |
Flutemetamol f18 diagnostic
$1944.01 OPPS Payment
|
| 09460 |
Injection, cangrelor
$20.02 OPPS Payment
|
| 09461 |
Choline c-11
$2516.43 OPPS Payment
|
| 09462 |
Injection, delafloxacin
$0.39 OPPS Payment
|
| 09463 |
Inj., aprepitant, 1 mg
$1.69 OPPS Payment
|
| 09464 |
Inj., rolapitant, 0.5 mg
$0.94 OPPS Payment
|
| 09466 |
Inj., benralizumab, 1 mg
$163.36 OPPS Payment
|
| 09467 |
Inj rituximab, hyaluronidase
$36.28 OPPS Payment
|
| 09468 |
Factor ix recomb gly rebinyn
$4.50 OPPS Payment
|
| 09469 |
Inj triamcinolone ace xr 1mg
$18.64 OPPS Payment
|
| 09470 |
Aripirazole lauroxil 1 mg
$3.32 OPPS Payment
|
| 09471 |
Hyaluronan, hymo or hymo one
$18.13 OPPS Payment
|
| 09472 |
Inj talimogene laherparepvec
$73.94 OPPS Payment
|
| 09473 |
Injection, mepolizumab, 1mg
$31.82 OPPS Payment
|
| 09474 |
Inj irinotecan liposome 1 mg
$66.37 OPPS Payment
|
| 09475 |
Injection, necitumumab, 1 mg
$5.73 OPPS Payment
|
| 09476 |
Injection, daratumumab 10 mg
$70.77 OPPS Payment
|
| 09477 |
Injection, elotuzumab, 1mg
$8.04 OPPS Payment
|
| 09478 |
Inj sebelipase alfa 1 mg
$540.18 OPPS Payment
|
| 09479 |
Ciprofloxacin otic susp 6 mg
$30.02 OPPS Payment
|
| 09480 |
Injection trabectedin 0.1mg
$391.07 OPPS Payment
|
| 09481 |
Injection, reslizumab
$11.53 OPPS Payment
|
| 09482 |
Sotalol hydrochloride iv
$25.05 OPPS Payment
|
| 09483 |
Inj, atezolizumab,10 mg
$94.00 OPPS Payment
|
| 09484 |
Inj, eteplirsen, 10 mg
$167.51 OPPS Payment
|
| 09485 |
Inj, olaratumab, 10 mg
$52.07 OPPS Payment
|
| 09486 |
Inj, granisetron, xr, 0.1 mg
$2.74 OPPS Payment
|
| 09487 |
Ustekinumab, iv inject,1 mg
$11.62 OPPS Payment
|
| 09488 |
Conivaptan hcl
$47.24 OPPS Payment
|
| 09489 |
Inj, nusinersen, 0.1mg
$1285.78 OPPS Payment
|
| 09490 |
Inj, bezlotoxumab, 10 mg
$39.83 OPPS Payment
|
| 09491 |
Injection, avelumab, 10 mg
$105.55 OPPS Payment
|
| 09492 |
Inj., durvalumab, 10 mg
$86.15 OPPS Payment
|
| 09493 |
Injection, edaravone, 1 mg
$15.18 OPPS Payment
|
| 09494 |
Injection, ocrelizumab
$59.60 OPPS Payment
|
| 09495 |
Gemtuzumab ozogamicin inj
$240.17 OPPS Payment
|
| 09496 |
Inj, faricimab-svoa, 0.1mg
$32.87 OPPS Payment
|
| 09497 |
Loxapine for inhalation 1 mg
$15.90 OPPS Payment
|
| 09498 |
Ciltacabtagene car-pos t
$588494.81 OPPS Payment
|
| 09499 |
Adenovirus vaccine type 4
$46.00 OPPS Payment
|
| 09500 |
Platelets, irradiated
$392.97 OPPS Payment
|
| 09501 |
Platelet pheres leukoreduced
$511.59 OPPS Payment
|
| 09502 |
Platelet pheresis irradiated
$949.13 OPPS Payment
|
| 09503 |
Fr frz plasma donor retested
$53.25 OPPS Payment
|
| 09504 |
RBC deglycerolized
$313.00 OPPS Payment
|
| 09505 |
RBC irradiated
$145.22 OPPS Payment
|
| 09507 |
Platelets, pheresis
$308.96 OPPS Payment
|
| 09508 |
Plasma 1 donor frz w/in 8 hr
$85.98 OPPS Payment
|
| 09509 |
Frozen plasma, pooled, sd
$55.96 OPPS Payment
|
| 09510 |
Whole blood for transfusion
$189.84 OPPS Payment
|
| 09511 |
Cryoprecipitate each unit
$71.95 OPPS Payment
|
| 09512 |
RBC leukocytes reduced
$184.91 OPPS Payment
|
| 09513 |
Plasma, frz between 8-24hour
$73.77 OPPS Payment
|
| 09514 |
Plasma protein fract,5%,50ml
$8.11 OPPS Payment
|
| 09515 |
Platelets, each unit
$53.17 OPPS Payment
|
| 09516 |
Plaelet rich plasma unit
$559.79 OPPS Payment
|
| 09517 |
Red blood cells unit
$150.57 OPPS Payment
|
| 09518 |
Washed red blood cells unit
$368.58 OPPS Payment
|
| 09519 |
Plasmaprotein fract,5%,250ml
$35.32 OPPS Payment
|
| 09520 |
Blood split unit
$155.84 OPPS Payment
|
| 09521 |
Platelets leukoreduced irrad
$189.59 OPPS Payment
|
| 09522 |
RBC leukoreduced irradiated
$265.41 OPPS Payment
|
| 09523 |
Cryoprecipitatereducedplasma
$132.05 OPPS Payment
|
| 09524 |
Blood, l/r, cmv-neg
$151.58 OPPS Payment
|
| 09525 |
Platelets, hla-m, l/r, unit
$708.06 OPPS Payment
|
| 09526 |
Platelets leukocytes reduced
$144.26 OPPS Payment
|
| 09527 |
Blood, l/r, froz/degly/wash
$265.19 OPPS Payment
|
| 09528 |
Plt, aph/pher, l/r, cmv-neg
$250.49 OPPS Payment
|
| 09529 |
Blood, l/r, irradiated
$84.55 OPPS Payment
|
| 09530 |
Plate pheres leukoredu irrad
$680.61 OPPS Payment
|
| 09531 |
Plt, pher, l/r cmv-neg, irr
$503.45 OPPS Payment
|
| 09532 |
RBC, frz/deg/wsh, l/r, irrad
$422.69 OPPS Payment
|
| 09533 |
RBC, l/r, cmv-neg, irrad
$249.40 OPPS Payment
|
| 09534 |
Pathogen reduced plasma pool
$55.78 OPPS Payment
|
| 09535 |
Pathogen reduced plasma sing
$294.48 OPPS Payment
|
| 09536 |
Platelets pheresis path redu
$607.43 OPPS Payment
|
| 09537 |
Blood component/product noc
$35.32 OPPS Payment
|
| 09538 |
Plasma cryo redu path each
$133.76 OPPS Payment
|
| 09539 |
Cryo fib comp path redu each
$549.28 OPPS Payment
|
| 09540 |
Covid-19 convalescent plasma
$680.03 OPPS Payment
|
| 09541 |
Rbc o2 co2 reduced
$511.59 OPPS Payment
|
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