CodeMap®
CodeMap® 




2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


2017-D October ASC Fee Schedule Updated     


2017-D October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q4 2017 CCI Edits Loaded     


Q4 2017 MUE Edits Loaded     


LCD Database Current Through 11/13/2017     

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Laboratory Fee Schedule

2018 Preliminary PAMA
2017
2016

Physician Fee Schedule

2017
2016

OPPS Fee Schedule

2017
2016

ASC Fee Schedule

2017
2016

APC Codes

2017
2016

DRG Codes

2017

ASP Drug Pricing Files




Fall 2017 Webinar Series Announcement-Click here for details

ALERT: Preliminary 2018 PAMA Rates Posted by CMS-Click here for details


2016 APC Codes

APC Code
Group Title
Status Indicator
2016 Payment Rate
0701
Sr89 strontium
K
$1160.34
0726
Dexrazoxane HCl injection
K
$146.38
0731
Sargramostim injection
K
$31.68
0736
Amphotericin b liposome inj
K
$18.23
0738
Rasburicase
K
$227.61
0747
Chlorothiazide sodium inj
K
$119.93
0751
Mechlorethamine hcl inj
K
$241.99
0752
Dactinomycin injection
K
$1164.57
0759
Naltrexone, depot form
K
$3.18
0800
Leuprolide acetate
K
$900.87
0802
Etoposide oral
K
$68.74
0807
Aldesleukin injection
K
$2667.51
0809
Bcg live intravesical vac
K
$122.88
0810
Goserelin acetate implant
K
$281.05
0812
Carmustine injection
K
$2973.34
0820
Daunorubicin injection
K
$26.45
0821
Daunorubicin citrate inj
K
$238.86
0823
Docetaxel injection
K
$3.49
0825
Nelarabine injection
K
$148.57
0827
Floxuridine injection
K
$67.69
0831
Ifosfamide injection
K
$32.20
0832
Idarubicin hcl injection
K
$34.88
0835
Cosyntropin injection NOS
K
$101.68
0836
Interferon alfa-2b inj
K
$24.05
0838
Interferon gamma 1-b inj
K
$5265.95
0840
Inj melphalan hydrochl
K
$1285.40
0843
Pegaspargase injection
K
$6189.74
0844
Pentostatin injection
K
$1471.48
0849
Rituximab injection
K
$748.70
0850
Streptozocin injection
K
$324.02
0851
Thiotepa injection
K
$630.70
0856
Porfimer sodium injection
K
$20438.61
0858
Inj cladribine
K
$20.91
0864
Mitoxantrone hydrochl
K
$32.12
0868
Oral aprepitant
K
$9.54
0873
Hyalgan/supartz inj per dose
K
$88.61
0874
Synvisc or synvisc-one
K
$12.87
0875
Euflexxa inj per dose
K
$152.00
0877
Orthovisc inj per dose
K
$172.63
0887
Azathioprine parenteral
K
$217.30
0890
Lymphocyte immune globulin
K
$1069.33
0901
Alpha 1 proteinase inhibitor
K
$4.45
0902
Injection,onabotulinumtoxinA
K
$5.72
0903
Cytomegalovirus imm IV /vial
K
$1064.77
0910
Interferon beta-1b / .25 MG
K
$357.22
0913
Ganciclovir long act implant
K
$16960.00
0925
Factor viii
K
$0.96
0927
Factor viii recombinant
K
$1.16
0928
Factor ix complex
K
$1.19
0929
Anti-inhibitor
K
$1.83
0931
Factor IX non-recombinant
K
$1.07
0932
Factor ix recombinant nos
K
$1.46
0934
Capecitabine, oral
K
$19.50
0943
Octagam injection
K
$42.80
0944
Gammagard liquid injection
K
$38.56
0946
Hepagam b im injection
K
$54.43
0947
Flebogamma injection
K
$35.66
0948
Gamunex-C/Gammaked
K
$40.30
0961
Albumin (human),5%, 50ml
K
$10.91
0963
Albumin (human), 5%, 250 ml
K
$54.54
0964
Albumin (human), 25%, 20 ml
K
$22.49
0965
Albumin (human), 25%, 50ml
K
$53.44
1015
Injection glatiramer acetate
K
$194.25
1052
Injection, voriconazole
K
$4.19
1064
I131 iodide cap, rx
K
$40.70
1083
Adalimumab injection
K
$742.96
1086
Temozolomide
K
$2.66
1138
Hepagam b intravenous, inj
K
$54.43
1139
Protein c concentrate
K
$15.12
1142
Supprelin LA implant
K
$22170.84
1150
I131 iodide sol, rx
K
$10.28
1166
Cytarabine liposome inj
K
$576.48
1168
Inj, temsirolimus
K
$62.50
1178
Busulfan injection
K
$33.20
1203
Verteporfin injection
K
$10.99
1207
Octreotide injection, depot
K
$156.94
1213
Antihemophilic viii/vwf comp
K
$0.96
1214
Inj IVIG privigen 500 mg
K
$38.05
1232
Mitomycin injection
K
$73.03
1235
Valrubicin injection
K
$1117.31
1236
Levoleucovorin injection
K
$1.92
1237
Inj iron dextran
K
$12.08
1238
Topotecan oral
K
$101.36
1253
Triamcinolone A inj PRS-free
K
$3.72
1263
Antithrombin iii injection
K
$3.37
1268
Xyntha inj
K
$1.42
1272
Acetylcysteine injection
K
$2.00
1274
Edetate calcium disodium inj
K
$5594.42
1280
Corticotropin injection
K
$3468.13
1281
Bevacizumab injection
K
$1.74
1289
AbobotulinumtoxinA
K
$8.06
1291
Rilonacept injection
K
$24.09
1295
Sm 153 lexidronam
K
$10962.42
1296
Degarelix injection
K
$3.59
1297
Ferumoxytol, non-esrd
K
$0.81
1311
Canakinumab injection
K
$91.78
1312
Hizentra injection
K
$8.47
1327
Imiglucerase injection
K
$42.00
1331
Olanzapine long-acting inj
K
$2.92
1332
Antithrombin recombinant
K
$103.35
1338
Methyl aminolevulinate, top
K
$83.69
1340
Collagenase, clost hist inj
K
$38.06
1341
Amobarbital 125 MG inj
K
$194.26
1352
Wilate injection
K
$1.02
1353
Belimumab injection
K
$40.54
1354
Hydroxyprogesterone caproate
K
$2.61
1356
Zoledronic Acid 1mg
K
$34.97
1361
Enfuvirtide injection
K
$18.63
1408
Cyclophosphamide 100 MG inj
K
$48.95
1413
Lumizyme injection
K
$153.60
1415
Glassia injection
K
$4.11
1416
Factor xiii anti-hem factor
K
$7.41
1417
Gel-one
K
$578.11
1420
Aflibercept injection
K
$980.50
1421
Imported lipodox inj
K
$508.43
1424
Nabilone oral
K
$34.10
1426
Eribulin mesylate injection
K
$102.53
1431
Centruroides immune f(ab)
K
$3635.80
1433
Calcitonin salmon injection
K
$2006.85
1440
Inj desmopressin acetate
K
$8.97
1442
Non-HEU TC-99M add-on/dose
K
$10.00
1443
Icatibant injection
K
$298.90
1446
Visualization adjunct
K
$10.80
1457
Totazoline hcl injection
K
$1600.40
1458
Phentolaine mesylate inj
K
$159.00
1460
Interferon alfa-2a inj
K
$733.57
1464
Factor VIII (porcine)
K
$0.20
1465
Tacrol astagraf ex rel oral
G
$0.39
1466
Inj, vincristine sul lip 1mg
G
$2321.82
1467
Factor ix recombinan rixubis
G
$1.23
1468
Inj Aripiprazole Ext Rel 1mg
K
$4.10
1469
Inj filgrastim excl biosimil
K
$1.00
1471
Injection, Pertuzumab, 1 mg
K
$10.22
1472
Inj beta interferon im 1 mcg
K
$40.52
1474
Certolizumab pegol inj 1mg
K
$6.62
1475
Golimumab for iv use 1mg
K
$24.33
1476
Obinutuzumab inj
G
$54.21
1478
Human fibrinogen conc inj
K
$1.05
1479
Theraskin
G
$36.00
1480
Elosulfase alfa, injection
G
$221.54
1482
Darbepoetin alfa, esrd use
K
$4.38
1484
Pentazocine injection
K
$121.83
1485
Ferumoxytol, esrd use
K
$0.81
1486
Factor ix fc fusion recomb
G
$2.81
1487
Testosterone undecanoate 1mg
G
$1.17
1488
Injection, ramucirumab
G
$53.97
1489
Injection, vedolizumab
G
$17.03
1490
Inj pembrolizumab
G
$45.69
1491
New Technology - Level 1A ($0-$10)
S
$5.00
1492
New Technology - Level 1B ($10-$20)
S
$15.00
1493
New Technology - Level 1C ($20-$30)
S
$25.00
1494
New Technology - Level 1D ($30-$40)
S
$35.00
1495
New Technology - Level 1E ($40-$50)
S
$45.00
1496
New Technology - Level 1A ($0-$10)
T
$5.00
1497
New Technology - Level 1B ($10-$20)
T
$15.00
1498
New Technology - Level 1C ($20-$30)
T
$25.00
1499
New Technology - Level 1D ($30-$40)
T
$35.00
1500
New Technology - Level 1E ($40-$50)
T
$45.00
1502
New Technology - Level 2 ($50 - $100)
S
$75.00
1503
New Technology - Level 3 ($100 - $200)
S
$150.00
1504
New Technology - Level 4 ($200 - $300)
S
$250.00
1505
New Technology - Level 5 ($300 - $400)
S
$350.00
1506
New Technology - Level 6 ($400 - $500)
S
$450.00
1507
New Technology - Level 7 ($500 - $600)
S
$550.00
1508
New Technology - Level 8 ($600 - $700)
S
$650.00
1509
New Technology - Level 9 ($700 - $800)
S
$750.00
1510
New Technology - Level 10 ($800 - $900)
S
$850.00
1511
New Technology - Level 11 ($900 - $1000)
S
$950.00
1512
New Technology - Level 12 ($1000 - $1100)
S
$1050.00
1513
New Technology - Level 13 ($1100 - $1200)
S
$1150.00
1514
New Technology - Level 14 ($1200- $1300)
S
$1250.00
1515
New Technology - Level 15 ($1300 - $1400)
S
$1350.00
1516
New Technology - Level 16 ($1400 - $1500)
S
$1450.00
1517
New Technology - Level 17 ($1500-$1600)
S
$1550.00
1518
New Technology - Level 18 ($1600-$1700)
S
$1650.00
1519
New Technology - Level 19 ($1700-$1800)
S
$1750.00
1520
New Technology - Level 20 ($1800-$1900)
S
$1850.00
1521
New Technology - Level 21 ($1900-$2000)
S
$1950.00
1522
New Technology - Level 22 ($2000-$2500)
S
$2250.00
1523
New Technology - Level 23 ($2500-$3000)
S
$2750.00
1524
New Technology - Level 24 ($3000-$3500)
S
$3250.00
1525
New Technology - Level 25 ($3500-$4000)
S
$3750.00
1526
New Technology - Level 26 ($4000-$4500)
S
$4250.00
1527
New Technology - Level 27 ($4500-$5000)
S
$4750.00
1528
New Technology - Level 28 ($5000-$5500)
S
$5250.00
1529
New Technology - Level 29 ($5500-$6000)
S
$5750.00
1530
New Technology - Level 30 ($6000-$6500)
S
$6250.00
1531
New Technology - Level 31 ($6500-$7000)
S
$6750.00
1532
New Technology - Level 32 ($7000-$7500)
S
$7250.00
1533
New Technology - Level 33 ($7500-$8000)
S
$7750.00
1534
New Technology - Level 34 ($8000-$8500)
S
$8250.00
1535
New Technology - Level 35 ($8500-$9000)
S
$8750.00
1536
New Technology - Level 36 ($9000-$9500)
S
$9250.00
1537
New Technology - Level 37 ($9500-$10000)
S
$9750.00
1539
New Technology - Level 2 ($50 - $100)
T
$75.00
1540
New Technology - Level 3 ($100 - $200)
T
$150.00
1541
New Technology - Level 4 ($200 - $300)
T
$250.00
1542
New Technology - Level 5 ($300 - $400)
T
$350.00
1543
New Technology - Level 6 ($400 - $500)
T
$450.00
1544
New Technology - Level 7 ($500 - $600)
T
$550.00
1545
New Technology - Level 8 ($600 - $700)
T
$650.00
1546
New Technology - Level 9 ($700 - $800)
T
$750.00
1547
New Technology - Level 10 ($800 - $900)
T
$850.00
1548
New Technology - Level 11 ($900 - $1000)
T
$950.00
1549
New Technology - Level 12 ($1000 - $1100)
T
$1050.00
1550
New Technology - Level 13 ($1100 - $1200)
T
$1150.00
1551
New Technology - Level 14 ($1200- $1300)
T
$1250.00
1552
New Technology - Level 15 ($1300 - $1400)
T
$1350.00
1553
New Technology - Level 16 ($1400 - $1500)
T
$1450.00
1554
New Technology - Level 17 ($1500-$1600)
T
$1550.00
1555
New Technology - Level 18 ($1600-$1700)
T
$1650.00
1556
New Technology - Level 19 ($1700-$1800)
T
$1750.00
1557
New Technology - Level 20 ($1800-$1900)
T
$1850.00
1558
New Technology - Level 21 ($1900-$2000)
T
$1950.00
1559
New Technology - Level 22 ($2000-$2500)
T
$2250.00
1560
New Technology - Level 23 ($2500-$3000)
T
$2750.00
1561
New Technology - Level 24 ($3000-$3500)
T
$3250.00
1562
New Technology - Level 25 ($3500-$4000)
T
$3750.00
1563
New Technology - Level 26 ($4000-$4500)
T
$4250.00
1564
New Technology - Level 27 ($4500-$5000)
T
$4750.00
1565
New Technology - Level 28 ($5000-$5500)
T
$5250.00
1566
New Technology - Level 29 ($5500-$6000)
T
$5750.00
1567
New Technology - Level 30 ($6000-$6500)
T
$6250.00
1568
New Technology - Level 31 ($6500-$7000)
T
$6750.00
1569
New Technology - Level 32 ($7000-$7500)
T
$7250.00
1570
New Technology - Level 33 ($7500-$8000)
T
$7750.00
1571
New Technology - Level 34 ($8000-$8500)
T
$8250.00
1572
New Technology - Level 35 ($8500-$9000)
T
$8750.00
1573
New Technology - Level 36 ($9000-$9500)
T
$9250.00
1574
New Technology - Level 37 ($9500-$10000)
T
$9750.00
1575
New Technology - Level 38 ($10,000-$15,000)
S
$12500.00
1576
New Technology - Level 39 ($15,000-$20,000)
S
$17500.00
1577
New Technology - Level 40 ($20,000-$25,000)
S
$22500.00
1578
New Technology - Level 41 ($25,000-$30,000)
S
$27500.00
1579
New Technology - Level 42 ($30,000-$40,000)
S
$35000.00
1580
New Technology - Level 43 ($40,000-$50,000)
S
$45000.00
1581
New Technology - Level 44 ($50,000-$60,000)
S
$55000.00
1582
New Technology - Level 45 ($60,000-$70,000)
S
$65000.00
1583
New Technology - Level 46 ($70,000-$80,000)
S
$75000.00
1584
New Technology - Level 47 ($80,000-$90,000)
S
$85000.00
1585
New Technology - Level 48 ($90,000-$100,000)
S
$95000.00
1589
New Technology - Level 38 ($10,000-$15,000)
T
$12500.00
1590
New Technology - Level 39 ($15,000-$20,000)
T
$17500.00
1591
New Technology - Level 40 ($20,000-$25,000)
T
$22500.00
1592
New Technology - Level 41 ($25,000-$30,000)
T
$27500.00
1593
New Technology - Level 42 ($30,000-$40,000)
T
$35000.00
1594
New Technology - Level 43 ($40,000-$50,000)
T
$45000.00
1595
New Technology - Level 44 ($50,000-$60,000)
T
$55000.00
1596
New Technology - Level 45 ($60,000-$70,000)
T
$65000.00
1597
New Technology - Level 46 ($70,000-$80,000)
T
$75000.00
1598
New Technology - Level 47 ($80,000-$90,000)
T
$85000.00
1599
New Technology - Level 48 ($90,000-$100,000)
T
$95000.00
1605
Abciximab injection
K
$965.13
1607
Eptifibatide injection
K
$32.39
1608
Etanercept injection
K
$330.81
1609
Rho(D) immune globulin h, sd
K
$19.40
1612
Daclizumab, parenteral
K
$526.34
1613
Trastuzumab injection
K
$87.36
1630
Hep b ig, im
K
$110.39
1631
Baclofen intrathecal trial
K
$76.07
1633
Alefacept
K
$41.64
1643
Y90 ibritumomab, rx
K
$46304.42
1656
Factor viii fc fusion recomb
G
$1.90
1657
Puraply, puraply antimic
G
$109.18
1658
Injection, belinostat, 10mg
G
$31.64
1660
Injection, oritavancin
G
$25.07
1661
Gen, neuro, HF, rechg bat
H
$0.00
1662
Inj tedizolid phosphate
G
$0.12
1663
Inj, phenylephrine ketorolac
G
$492.90
1664
Florbetapir f18
G
$2756.00
1665
Capsaicin 8% patch
K
$2.81
1666
Tetracyclin injection
K
$97.97
1668
Chorionic gonadotropin/1000u
K
$22.59
1669
Erythro lactobionate /500 mg
K
$50.75
1670
Tetanus immune globulin inj
K
$255.21
1675
P32 Na phosphate
K
$213.56
1676
P32 chromic phosphate
K
$906.62
1683
Basiliximab
K
$2851.52
1684
Corticorelin ovine triflutal
K
$7.74
1685
Darbepoetin alfa, non-esrd
K
$4.38
1686
Epoetin alfa, non-esrd
K
$12.62
1687
Digoxin immune fab (ovine)
K
$2639.26
1688
Ethanolamine oleate
K
$404.09
1689
Fomepizole
K
$7.01
1690
Hemin
K
$21.77
1693
Lepirudin
K
$235.52
1694
Ziconotide injection
K
$7.08
1695
Nesiritide injection
K
$72.98
1696
Palifermin injection
K
$15.59
1697
Pegaptanib sodium injection
K
$1031.85
1700
Inj secretin synthetic human
K
$34.78
1701
Treprostinil injection
K
$61.24
1704
Humate-P, inj
K
$0.99
1705
Factor viia
K
$2.07
1709
Azacitidine injection
K
$3.05
1710
Clofarabine injection
K
$138.38
1711
Vantas implant
K
$3012.29
1712
Paclitaxel protein bound
K
$9.77
1738
Oxaliplatin
K
$0.48
1739
Pegademase bovine, 25 iu
K
$281.12
1741
Urofollitropin, 75 iu
K
$64.69
1743
Nandrolone decanoate 50 mg
K
$122.78
1745
Radium ra223 dichloride ther
K
$112.30
1746
Factor xiii recomb a-subunit
G
$14.07
1747
Monovisc inj per dose
K
$958.45
1748
Inj tbo filgrastim 1 microg
G
$3.86
1807
Menb pr w/omv vaccine im
K
$155.70
1808
Menb rlp vaccine im
K
$122.70
1809
Injection, alemtuzumab
K
$1743.19
1822
Inj filgrastim gcsf biosimil
G
$0.97
1823
Injection, dalbavancin
G
$14.28
1824
Ceftaroline fosamil inj
K
$2.14
1825
Ceftazidime and avibactam
K
$75.53
1826
Hyqvia 100mg immuneglobulin
K
$10.96
1827
Factor viii recomb obizur
K
$4.90
1828
Carbidopa levodopa enteral
K
$2.14
1829
Penicillin g benzathine inj
K
$7.84
1831
Chloramphenicol sodium injec
K
$31.74
1832
Dimethyl sulfoxide 50% 50 ml
K
$211.57
1833
Epoetin beta esrd use
K
$11.29
1834
Digoxin injection
K
$114.94
1835
Ergonovine maleate injection
K
$91.15
1836
Penicillin g procaine inj
K
$21.59
1837
Methocarbamol injection
K
$46.19
1838
Urokinase 250,000 iu inj
K
$262.79
1839
Oral busulfan
K
$12.62
1842
Leuprolide acetate implant
K
$168.48
1843
Menacwy vaccine im
K
$101.36
2613
Lung bx plug w/del sys
H
$0.00
2616
Brachytx, non-str,Yttrium-90
U
$16021.70
2623
Cath, translumin, drug-coat
H
$0.00
2624
Wireless pressure sensor
H
$0.00
2632
Iodine I-125 sodium iodide
U
$7.14
2634
Brachytx, non-str, HA, I-125
U
$85.18
2635
Brachytx, non-str, HA, P-103
U
$35.24
2636
Brachy linear, non-str,P-103
U
$14.24
2638
Brachytx, stranded, I-125
U
$38.09
2639
Brachytx, non-stranded,I-125
U
$36.64
2640
Brachytx, stranded, P-103
U
$68.78
2641
Brachytx, non-stranded,P-103
U
$66.23
2642
Brachytx, stranded, C-131
U
$86.59
2643
Brachytx, non-stranded,C-131
U
$52.18
2644
Brachytx cesium-131 chloride
U
$12.41
2645
Brachytx, non-str, Gold-198
U
$45.54
2646
Brachytx, non-str, HDR Ir-192
U
$294.04
2647
Brachytx, NS, Non-HDRIr-192
U
$93.11
2698
Brachytx, stranded, NOS
U
$38.09
2699
Brachytx, non-stranded, NOS
U
$14.24
2731
Immune globulin, powder
K
$33.11
2770
Quinupristin/dalfopristin
K
$311.04
3041
Bivalirudin
K
$3.71
5011
Level 1 Examinations and Related Services
V
$54.41
5012
Level 2 Examinations and Related Services
V
$102.12
5013
Level 3 Examinations and Related Services
V
$480.69
5021
Level 1 Type A ED Visits
V
$59.30
5022
Level 2 Type A ED Visits
V
$109.50
5023
Level 3 Type A ED Visits
V
$195.98
5024
Level 4 Type A ED Visits
V
$326.99
5025
Level 5 Type A ED Visits
V
$486.04
5031
Level 1 Type B ED Visits
V
$79.22
5032
Level 2 Type B ED Visits
V
$76.17
5033
Level 3 Type B ED Visits
V
$115.20
5034
Level 4 Type B ED Visits
V
$196.25
5035
Level 5 Type B ED Visits
V
$315.88
5041
Critical Care
S
$666.27
5045
Trauma Response with Critical Care
S
$851.40
5051
Level 1 Skin Procedures
T
$117.83
5052
Level 2 Skin Procedures
T
$225.55
5053
Level 3 Skin Procedures
T
$428.67
5054
Level 4 Skin Procedures
T
$1411.21
5055
Level 5 Skin Procedures
T
$2137.49
5061
Hyperbaric Oxygen
S
$107.71
5071
Level 1 Excision/ Biopsy/ Incision and Drainage
T
$228.27
5072
Level 2 Excision/ Biopsy/ Incision and Drainage
T
$480.64
5073
Level 3 Excision/ Biopsy/ Incision and Drainage
T
$941.98
5074
Level 4 Excision/ Biopsy/ Incision and Drainage
T
$1414.28
5091
Level 1 Breast/Lymphatic Surgery and Related Procedures
T
$2187.94
5092
Level 2 Breast/Lymphatic Surgery and Related Procedures
T
$3647.06
5093
Level 3 Breast/Lymphatic Surgery and Related Procedures
J1
$7557.75
5101
Level 1 Strapping and Cast Application
S
$119.24
5102
Level 2 Strapping and Cast Application
S
$207.88
5111
Level 1 Closed Treatment Fracture and Related Services
T
$172.33
5112
Level 2 Closed Treatment Fracture and Related Services
T
$237.50
5113
Level 3 Closed Treatment Fracture and Related Services
T
$1096.45
5121
Level1 Musculoskeletal Procedures
T
$1455.26
5122
Level 2 Musculoskeletal Procedures
T
$2395.59
5123
Level 3 Musculoskeletal Procedures
J1
$4969.26
5124
Level 4 Musculoskeletal Procedures
J1
$7064.07
5125
Level 5 Musculoskeletal Procedures
J1
$10537.90
5141
Thoracoscopy
T
$3152.92
5151
Level 1 Airway Endoscopy
T
$141.31
5152
Level 2 Airway Endoscopy
T
$375.13
5153
Level 3 Airway Endoscopy
T
$1037.50
5154
Level 4 Airway Endoscopy
T
$1991.92
5155
Level 5 Airway Endoscopy
T
$3066.48
5161
Level 1 ENT Procedures
T
$129.29
5162
Level 2 ENT Procedures
T
$312.93
5163
Level 3 ENT Procedures
T
$689.63
5164
Level 4 ENT Procedures
T
$1616.90
5165
Level 5 ENT Procedures
J1
$3955.98
5166
Level 6 ENT Procedures
J1
$30427.58
5181
Level 1 Vascular Procedures
T
$862.51
5182
Level 2 Vascular Procedures
T
$2247.33
5183
Level 3 Vascular Procedures
T
$3795.28
5188
Diagnostic Cardiac Catheterization
T
$2549.12
5191
Level 1 Endovascular Procedures
J1
$4592.15
5192
Level 2 Endovascular Procedures
J1
$9542.35
5193
Level 3 Endovascular Procedures
J1
$14612.17
5211
Level 1 Electrophysiologic Procedures
J1
$845.04
5212
Level 2 Electrophysiologic Procedures
J1
$4697.97
5213
Level 3 Electrophysiologic Procedures
J1
$15561.11
5221
Level1 Pacemaker and Similar Procedures
T
$2489.69
5222
Level 2 Pacemaker and Similar Procedures
J1
$6696.85
5223
Level 3 Pacemaker and Similar Procedures
J1
$9273.40
5224
Level 4 Pacemaker and Similar Procedures
J1
$16914.40
5231
Level 1 ICD and Similar Procedures
J1
$21930.03
5232
Level 2 ICD and Similar Procedures
J1
$30489.78
5241
Transfusion
S
$349.14
5271
Blood Product Exchange and Related Services
S
$1047.76
5281
Apheresis/Stem Cell and Related Services
S
$3015.06
5291
Thrombolysis and Other Device Revisions
T
$199.80
5301
Level 1 Upper GI Procedures
T
$745.36
5302
Level 2 Upper GI Procedures
T
$1088.00
5303
Level 3 Upper GI Procedures
T
$1980.43
5311
Level 1 Lower GI Procedures
T
$492.45
5312
Level 2 Lower GI Procedures
T
$752.76
5313
Level 3 Lower GI Procedures
T
$1661.50
5314
Level 4 Lower GI Procedures
T
$2326.64
5331
Complex GI Procedures
J1
$3613.57
5341
Peritoneal and Abdominal Procedures
T
$2612.57
5351
Level 1 Percutaneous Abdominal/Biliary Procedures and Related Procedures
T
$2177.11
5352
Level 2 Percutaneous Abdominal/Biliary Procedures and Related Procedures
T
$4118.23
5361
Level 1 Laparoscopy
J1
$4001.15
5362
Level 2 Laparoscopy
J1
$6860.91
5371
Level 1 Urology and Related Services
T
$206.61
5372
Level 2 Urology and Related Services
T
$524.48
5373
Level 3 Urology and Related Services
T
$1506.42
5374
Level 4 Urology and Related Services
T
$2243.49
5375
Level 5 Urology and Related Services
J1
$3393.73
5376
Level 6 Urology and Related Services
J1
$7428.27
5377
Level 7 Urology and Related Services
J1
$14088.02
5391
Level 1 Tube/Catheter Changes/Thoracentesis/Lavage
T
$482.83
5392
Level 2 Tube/Catheter Changes/Thoracentesis/Lavage
T
$1207.75
5401
Dialysis
S
$546.67
5411
Level 1 Gynecologic Procedures
T
$140.59
5412
Level 2 Gynecologic Procedures
T
$250.90
5413
Level 3 Gynecologic Procedures
T
$636.84
5414
Level 4 Gynecologic Procedures
T
$1861.18
5415
Level 5 Gynecologic Procedures
J1
$3660.20
5416
Level 6 Gynecologic Procedures
J1
$5698.95
5431
Level 1 Nerve Procedures
T
$1392.56
5432
Level 2 Nerve Procedures
T
$3396.78
5441
Level 1 Nerve Injections
T
$223.76
5442
Level 2 Nerve Injections
T
$585.17
5443
Level 3 Nerve Injections
T
$822.10
5461
Level 1 Neurostimulator and Related Procedures
T
$2188.64
5462
Level 2 Neurostimulator and Related Procedures
J1
$5244.37
5463
Level 3 Neurostimulator and Related Procedures
J1
$17359.37
5464
Level 4 Neurostimulator and Related Procedures
J1
$26728.39
5471
Implantation of Drug Infusion Device
J1
$15350.22
5481
Laser Eye Procedures
T
$440.38
5491
Level 1 Intraocular Procedures
T
$1745.70
5492
Level 2 Intraocular Procedures
J1
$3380.77
5493
Level 3 Intraocular Procedures
J1
$9398.42
5494
Level 4 Intraocular Procedures
J1
$17550.83
5501
Level 1 Extraocular, Repair, and Plastic Eye Procedures
T
$261.03
5502
Level 2 Extraocular, Repair, and Plastic Eye Procedures
T
$696.71
5503
Level 3 Extraocular, Repair, and Plastic Eye Procedures
T
$1401.16
5504
Level 4 Extraocular, Repair, and Plastic Eye Procedures
T
$2510.35
5521
Level 1 X-Ray and Related Services
S
$60.80
5522
Level 2 X-Ray and Related Services
S
$100.69
5523
Level 3 X-Ray and Related Services
S
$191.97
5524
Level 4 X-Ray and Related Services
S
$351.71
5525
Level 5 X-Ray and Related Services
S
$667.93
5526
Level 6 X-Ray and Related Services
S
$2718.83
5531
Level 1 Ultrasound and Related Services
S
$92.07
5532
Level 2 Ultrasound and Related Services
S
$153.58
5533
Level 3 Ultrasound and Related Services
S
$416.80
5534
Level 4 Ultrasound and Related Services
S
$698.65
5561
Level 1 Echocardiogram with Contrast
S
$454.05
5562
Level 2 Echocardiogram with Contrast
S
$670.96
5570
Computed Tomography without Contrast
S
$112.49
5571
Level 1 Computed Tomography with Contrast and Computed Tomography Angiography
S
$236.86
5572
Level 2 Computed Tomography with Contrast and Computed Tomography Angiography
S
$347.72
5581
Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast
S
$273.54
5582
Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast
S
$454.32
5591
Level 1 Nuclear Medicine and Related Services
S
$332.65
5592
Level 2 Nuclear Medicine and Related Services
S
$441.36
5593
Level 3 Nuclear Medicine and Related Services
S
$1108.46
5594
Level 4 Nuclear Medicine and Related Services
S
$1285.17
5611
Level 1 Therapeutic Radiation Treatment Preparation
S
$107.40
5612
Level 2 Therapeutic Radiation Treatment Preparation
S
$166.65
5613
Level 3 Therapeutic Radiation Treatment Preparation
S
$291.77
5614
Level 4 Therapeutic Radiation Treatment Preparation
S
$1026.81
5621
Level 1 Radiation Therapy
S
$110.34
5622
Level 2 Radiation Therapy
S
$194.35
5623
Level 3 Radiation Therapy
S
$505.51
5624
Level 4 Radiation Therapy
S
$696.21
5625
Level 5 Radiation Therapy
S
$1150.69
5626
Level 6 Radiation Therapy
S
$1671.91
5627
Level 7 Radiation Therapy
J1
$7300.24
5661
Therapeutic Nuclear Medicine
S
$249.98
5671
Level 1 Pathology
S
$47.75
5672
Level 2 Pathology
S
$102.20
5673
Level 3 Pathology
S
$209.42
5674
Level 4 Pathology
S
$440.53
5681
Transfusion Laboratory Procedures
S
$103.02
5691
Level 1 Drug Administration
S
$30.87
5692
Level 2 Drug Administration
S
$42.31
5693
Level 3 Drug Administration
S
$92.40
5694
Level 4 Drug Administration
S
$173.18
5695
Level 5 Drug Administration
S
$280.27
5701
Dosimetric Drug Administration
S
$1971.61
5721
Level1 Diagnostic Tests and Related Services
S
$129.75
5722
Level 2 Diagnostic Tests and Related Services
S
$220.35
5723
Level 3 Diagnostic Tests and Related Services
S
$396.52
5724
Level 4 Diagnostic Tests and Related Services
S
$856.44
5731
Level 1 Minor Procedures
S
$12.70
5732
Level 2 Minor Procedures
S
$30.51
5733
Level 3 Minor Procedures
S
$55.94
5734
Level 4 Minor Procedures
S
$91.18
5741
Level 1 Electronic Analysis of Devices
S
$33.62
5742
Level 2 Electronic Analysis of Devices
S
$106.44
5743
Level 3 Electronic Analysis of Devices
S
$241.18
5771
Cardiac Rehabilitation
S
$103.92
5781
Resuscitation and Cardioversion
S
$467.09
5791
Pulmonary Treatment
S
$149.46
5801
Ventilation Initiation and Management
S
$457.11
5811
Manipulation Therapy
S
$22.95
5821
Level 1 Health and Behavior Services
S
$27.12
5822
Level 2 Health and Behavior Services
S
$69.65
5841
Psychotherapy
S
$125.04
5851
Level 1 Partial Hospitalization (3 services) for CMHCs
P
$94.49
5852
Level 2 Partial Hospitalization (4 or more services) for CMHCs
P
$143.00
5861
Level 1 Partial Hospitalization (3 services) for Hospital-based PHPs
P
$183.41
5862
Level 2 Partial Hospitalization (4 or more services) for Hospital-based PHPs
P
$212.67
5871
Dental Procedures
S
$371.21
5881
Ancillary Outpatient Services When Patient Dies
J1
$6143.75
7000
Amifostine
K
$363.93
7011
Oprelvekin injection
K
$417.79
7034
Somatropin injection
K
$81.59
7035
Teniposide
K
$3494.46
7041
Tirofiban HCl
K
$8.94
7042
Capecitabine, oral
K
$5.53
7043
Infliximab injection
K
$78.76
7046
Doxorubicin inj 10mg
K
$443.83
7048
Alteplase recombinant
K
$73.74
7308
Aminolevulinic acid hcl top
K
$292.79
8001
LDR Prostate Brachytherapy Composite
T
$3385.44
8004
Ultrasound Composite
S
$287.26
8005
CT and CTA without Contrast Composite
S
$284.12
8006
CT and CTA with Contrast Composite
S
$493.91
8007
MRI and MRA without Contrast Composite
S
$566.06
8008
MRI and MRA with Contrast Composite
S
$862.24
8010
Mental Health Services Composite
S
$212.67
8011
Comprehensive Observation Services
J2
$2174.14
9001
Linezolid injection
K
$31.62
9002
Tenecteplase injection
K
$93.96
9003
Palivizumab
K
$1947.49
9005
Reteplase injection
K
$2301.91
9006
Tacrolimus injection
K
$163.25
9012
Arsenic trioxide injection
K
$59.42
9018
Inj, rimabotulinumtoxinB
K
$11.65
9019
Caspofungin acetate
K
$12.75
9024
Amphotericin b lipid complex
K
$12.38
9032
Baclofen 10 MG injection
K
$170.03
9033
Cidofovir injection
K
$650.18
9038
Inj estrogen conjugate
K
$215.70
9042
Glucagon hydrochloride
K
$190.60
9044
Ibutilide fumarate injection
K
$63.10
9104
Antithymocyte globuln rabbit
K
$638.49
9108
Thyrotropin injection
K
$1432.17
9119
Injection, pegfilgrastim 6mg
K
$3772.79
9120
Injection, Fulvestrant
K
$93.44
9121
Injection, argatroban
K
$15.14
9122
Triptorelin pamoate
K
$144.59
9124
Daptomycin injection
K
$0.76
9125
Risperidone, long acting
K
$6.91
9126
Natalizumab injection
K
$16.24
9130
Inj, Imm Glob Bivigam, 500mg
K
$38.49
9131
Inj, Ado-trastuzumab Emt 1mg
K
$29.21
9132
Kcentra, per i.u.
K
$1.62
9133
Rabies ig, im/sc
K
$285.93
9134
Rabies ig, heat treated
K
$252.95
9135
Varicella-zoster ig, im
K
$1202.24
9137
Bcg vaccine, percut
K
$122.88
9139
Rabies vaccine, im
K
$263.54
9140
Rabies vaccine, id
K
$172.30
9143
Meningococcal vaccine, sc
K
$106.49
9207
Bortezomib injection
K
$46.75
9208
Agalsidase beta injection
K
$158.04
9209
Laronidase injection
K
$29.45
9210
Palonosetron hcl
K
$20.53
9213
Pemetrexed injection
K
$61.21
9214
Bevacizumab injection
K
$69.60
9215
Cetuximab injection
K
$53.48
9217
Leuprolide acetate suspnsion
K
$242.80
9224
Galsulfase injection
K
$364.78
9225
Fluocinolone acetonide implt
K
$20138.08
9228
Tigecycline injection
K
$2.35
9229
Ibandronate sodium injection
K
$116.67
9230
Abatacept injection
K
$37.33
9231
Decitabine injection
K
$22.13
9232
Idursulfase injection
K
$497.48
9233
Ranibizumab injection
K
$391.41
9234
Alglucosidase alfa injection
K
$206.64
9235
Panitumumab injection
K
$100.91
9236
Eculizumab injection
K
$215.92
9237
Inj, lanreotide acetate
K
$47.18
9240
Injection, ixabepilone
K
$72.08
9242
Injection, fosaprepitant
K
$1.73
9243
Bendamustine injection
K
$24.66
9245
Romiplostim injection
K
$57.47
9248
Inj, clevidipine butyrate
K
$4.32
9251
C1 esterase inhibitor inj
K
$54.46
9252
Plerixafor injection
K
$305.98
9253
Temozolomide injection
K
$6.84
9255
Paliperidone palmitate inj
K
$8.45
9256
Dexamethasone intra implant
K
$201.03
9258
Telavancin injection
K
$4.91
9259
Pralatrexate injection
K
$212.80
9260
Ofatumumab injection
K
$49.47
9261
Ustekinumab injection
K
$166.99
9263
Ecallantide injection
K
$402.44
9264
Tocilizumab injection
K
$3.85
9265
Romidepsin injection
K
$290.84
9269
C-1 esterase, berinert
K
$40.52
9270
Gammaplex IVIG
K
$37.28
9271
Velaglucerase alfa
K
$346.08
9272
Inj, denosumab
K
$15.24
9273
Sipuleucel-T auto CD54+
K
$36704.05
9274
Crotalidae Poly Immune Fab
K
$2542.98
9276
Cabazitaxel injection
K
$148.66
9278
Incobotulinumtoxin A
K
$4.67
9281
Injection, pegloticase
K
$1239.16
9284
Ipilimumab injection
K
$138.83
9286
Belatacept injection
K
$3.80
9287
Brentuximab vedotin inj
K
$119.62
9289
Erwinaze injection
K
$376.49
9293
Injection, glucarpidase
K
$271.24
9294
Inj, Taliglucerace Alfa 10 u
K
$36.48
9295
Injection, Carfilzomib, 1 mg
K
$31.06
9296
Inj, ziv-aflibercept, 1mg
K
$8.32
9297
Inj, Omacetaxine Mep, 0.01mg
K
$2.48
9298
Inj, Ocriplasmin, 0.125 mg
K
$1046.75
9300
Omalizumab injection
K
$29.91
9441
Inj ferric carboxymaltos 1mg
G
$1.06
9445
Injection, ruconest
G
$23.29
9448
Netupitant palonosetron oral
G
$474.85
9449
Injection, blinatumomab
G
$96.00
9450
Fluocinol acet intravit imp
G
$490.95
9451
Injection, peramivir
G
$1.68
9452
Inj ceftolozane tazobactam
G
$0.42
9453
Injection, nivolumab
G
$25.38
9454
Inj, pasireotide long acting
G
$251.26
9455
Injection, siltuximab
G
$8.90
9456
Injection, isavuconazonium
G
$0.68
9457
Inj sulf hexa lipid microsph
G
$33.06
9458
Florbetaben f18
G
$989.33
9459
Flutemetamol f18
G
$3300.00
9460
Injection, cangrelor
G
$15.88
9497
Loxapine, inhalation powder
G
$147.34
9500
Platelets, irradiated
R
$159.09
9501
Platelet pheres leukoreduced
R
$488.29
9502
Platelet pheresis irradiated
R
$528.11
9503
Fr frz plasma donor retested
R
$51.42
9504
RBC deglycerolized
R
$380.32
9505
RBC irradiated
R
$205.82
9506
Granulocytes, pheresis unit
R
$1518.48
9507
Platelets, pheresis
R
$425.15
9508
Plasma 1 donor frz w/in 8 hr
R
$72.56
9509
Frozen plasma, pooled, sd
R
$75.90
9510
Whole blood for transfusion
R
$221.62
9511
Cryoprecipitate each unit
R
$59.64
9512
RBC leukocytes reduced
R
$184.34
9513
Plasma, frz between 8-24hour
R
$73.08
9514
Plasma protein fract,5%,50ml
R
$28.28
9515
Platelets, each unit
R
$118.03
9516
Plaelet rich plasma unit
R
$120.16
9517
Red blood cells unit
R
$145.79
9518
Washed red blood cells unit
R
$307.46
9519
Plasmaprotein fract,5%,250ml
R
$40.33
9520
Blood split unit
R
$102.50
9521
Platelets leukoreduced irrad
R
$162.08
9522
RBC leukoreduced irradiated
R
$267.63
9523
Cryoprecipitatereducedplasma
R
$51.12
9524
Blood, l/r, cmv-neg
R
$200.46
9525
Platelets, hla-m, l/r, unit
R
$704.98
9526
Platelets leukocytes reduced
R
$116.32
9527
Blood, l/r, froz/degly/wash
R
$321.28
9528
Plt, aph/pher, l/r, cmv-neg
R
$462.48
9529
Blood, l/r, irradiated
R
$127.41
9530
Plate pheres leukoredu irrad
R
$641.85
9531
Plt, pher, l/r cmv-neg, irr
R
$590.97
9532
RBC, frz/deg/wsh, l/r, irrad
R
$203.35
9533
RBC, l/r, cmv-neg, irrad
R
$249.23
9534
Pathogen reduced plasma pool
R
$73.08
9535
Pathogen reduced plasma sing
R
$72.56
9536
Pathogen reduced platelets
R
$641.85



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