Procedure code directory

Page 14 of 14, in code order. Codes Q5103 to V2785.

• Q5103Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg$11.76
• Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mg$29.21
• Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units$7.27
• Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg$25.75
• Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg$140.11
• Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram$0.27
• Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg$138.77
• Q5114Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg$51.75
• Q5115Injection, rituximab-abbs, biosimilar, (truxima), 10 mg$32.57
• Q5118Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg$20.91
• Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg$20.05
• Q5121Injection, infliximab-axxq, biosimilar, (avsola), 10 mg$23.34
• Q5122Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg$72.46
• Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mg$39.68
• Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg$169.39
• Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram$0.48
• Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg$57.38
• Q5127Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg$324.04
• Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg$227.58
• Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg$63.66
• Q5130Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg$192.88
• Q9950Injection, sulfur hexafluoride lipid microspheres, per ml$18.49
• Q9956Injection, octafluoropropane microspheres, per ml$41.27
• Q9957Injection, perflutren lipid microspheres, per ml$41.40
• Q9958High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml$0.08
• Q9960High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml$0.27
• Q9961High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml$0.28
• Q9963High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml$0.21
• Q9965Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml$1.37
• Q9966Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml$0.36
• Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml$0.13
• Q9968Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg$7.59
• Q9969Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose$14.28
• Q9982Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries$3525.03
• Q9983Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries$3080.60
• R0070Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one $227.43
• R0075Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more$88.05
• U00022019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets)$50.05
• V2632Posterior chamber intraocular lens$136.49
• V2785Processing, preserving and transporting corneal tissue$4481.92