	Addendum A.-Final OPPS APCs for CY 2017																																																																																																																																																																																																																											
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																																																						
0701	Sr89 strontium	K		"$1,281.39"	.	$256.28																																																																																																																																																																																																																						
0726	Dexrazoxane HCl injection	K		$184.05	.	$36.81																																																																																																																																																																																																																						
0731	Sargramostim injection	K		$36.23	.	$7.25																																																																																																																																																																																																																						
0736	Amphotericin b liposome inj	K		$19.01	.	$3.81																																																																																																																																																																																																																						
0738	Rasburicase	K		$254.11	.	$50.83																																																																																																																																																																																																																						
0747	Chlorothiazide sodium inj	K		$86.68	.	$17.34																																																																																																																																																																																																																						
0751	Mechlorethamine hcl inj	K		$265.89	.	$53.18																																																																																																																																																																																																																						
0752	Dactinomycin injection	K		"$1,276.38"	.	$255.28																																																																																																																																																																																																																						
0759	"Naltrexone, depot form"	K		$3.24	.	$0.65																																																																																																																																																																																																																						
0800	Leuprolide acetate	K		"$1,038.70"	.	$207.74																																																																																																																																																																																																																						
0802	Etoposide oral	K		$71.61	.	$14.33																																																																																																																																																																																																																						
0807	Aldesleukin injection	K		"$3,067.64"	.	$613.53																																																																																																																																																																																																																						
0809	Bcg live intravesical vac	K		$123.20	.	$24.64																																																																																																																																																																																																																						
0810	Goserelin acetate implant	K		$327.12	.	$65.43																																																																																																																																																																																																																						
0812	Carmustine injection	K		"$3,847.56"	.	$769.52																																																																																																																																																																																																																						
0820	Daunorubicin injection	K		$40.03	.	$8.01																																																																																																																																																																																																																						
0821	Daunorubicin citrate inj	K		$243.67	.	$48.74																																																																																																																																																																																																																						
0823	Docetaxel injection	K		$2.72	.	$0.55																																																																																																																																																																																																																						
0825	Nelarabine injection	K		$152.21	.	$30.45																																																																																																																																																																																																																						
0827	Floxuridine injection	K		$52.80	.	$10.56																																																																																																																																																																																																																						
0831	Ifosfamide injection	K		$28.18	.	$5.64																																																																																																																																																																																																																						
0832	Idarubicin hcl injection	K		$29.76	.	$5.96																																																																																																																																																																																																																						
0836	Interferon alfa-2b inj	K		$26.86	.	$5.38																																																																																																																																																																																																																						
0838	Interferon gamma 1-b inj	K		"$5,739.88"	.	"$1,147.98"																																																																																																																																																																																																																						
0840	Inj melphalan hydrochl	K		"$1,871.63"	.	$374.33																																																																																																																																																																																																																						
0843	Pegaspargase injection	K		"$13,911.23"	.	"$2,782.25"																																																																																																																																																																																																																						
0844	Pentostatin injection	K		"$1,887.77"	.	$377.56																																																																																																																																																																																																																						
0849	Rituximab injection	K		$792.92	.	$158.59																																																																																																																																																																																																																						
0850	Streptozocin injection	K		$323.60	.	$64.72																																																																																																																																																																																																																						
0851	Thiotepa injection	K		"$1,035.21"	.	$207.05																																																																																																																																																																																																																						
0856	Porfimer sodium injection	K		"$20,910.92"	.	"$4,182.19"																																																																																																																																																																																																																						
0858	Inj cladribine	K		$21.75	.	$4.35																																																																																																																																																																																																																						
0864	Mitoxantrone hydrochl	K		$36.75	.	$7.35																																																																																																																																																																																																																						
0868	Oral aprepitant	K		$11.11	.	$2.23																																																																																																																																																																																																																						
0873	Hyalgan/supartz inj per dose	K		$87.73	.	$17.55																																																																																																																																																																																																																						
0874	Synvisc or synvisc-one	K		$12.77	.	$2.56																																																																																																																																																																																																																						
0875	Euflexxa inj per dose	K		$155.32	.	$31.07																																																																																																																																																																																																																						
0877	Orthovisc inj per dose	K		$159.28	.	$31.86																																																																																																																																																																																																																						
0887	Azathioprine parenteral	K		$255.53	.	$51.11																																																																																																																																																																																																																						
0890	Lymphocyte immune globulin	K		"$1,438.74"	.	$287.75																																																																																																																																																																																																																						
0901	Alpha 1 proteinase inhibitor	K		$4.83	.	$0.97																																																																																																																																																																																																																						
0902	"Injection,onabotulinumtoxinA"	K		$5.93	.	$1.19																																																																																																																																																																																																																						
0903	Cytomegalovirus imm IV /vial	K		"$1,126.55"	.	$225.31																																																																																																																																																																																																																						
0910	Interferon beta-1b / .25 MG	K		$390.11	.	$78.03																																																																																																																																																																																																																						
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																																																						
0925	Factor viii	K		$0.98	.	$0.20																																																																																																																																																																																																																						
0927	Factor viii recombinant	K		$1.20	.	$0.24																																																																																																																																																																																																																						
0928	Factor ix complex	K		$1.29	.	$0.26																																																																																																																																																																																																																						
0929	Anti-inhibitor	K		$1.92	.	$0.39																																																																																																																																																																																																																						
0931	Factor IX non-recombinant	K		$1.11	.	$0.23																																																																																																																																																																																																																						
0932	Factor ix recombinant nos	K		$1.52	.	$0.31																																																																																																																																																																																																																						
0943	Octagam injection	K		$35.98	.	$7.20																																																																																																																																																																																																																						
0944	Gammagard liquid injection	K		$40.00	.	$8.00																																																																																																																																																																																																																						
0946	Hepagam b im injection	K		$56.06	.	$11.22																																																																																																																																																																																																																						
0947	Flebogamma injection	K		$36.80	.	$7.36																																																																																																																																																																																																																						
0948	Gamunex-C/Gammaked	K		$38.58	.	$7.72																																																																																																																																																																																																																						
0961	"Albumin (human),5%, 50ml"	K		$11.02	.	$2.21																																																																																																																																																																																																																						
0963	"Albumin (human), 5%, 250 ml"	K		$54.72	.	$10.95																																																																																																																																																																																																																						
0964	"Albumin (human), 25%, 20 ml"	K		$22.49	.	$4.50																																																																																																																																																																																																																						
0965	"Albumin (human), 25%, 50ml"	K		$53.44	.	$10.69																																																																																																																																																																																																																						
1015	Injection glatiramer acetate	K		$198.58	.	$39.72																																																																																																																																																																																																																						
1052	"Injection, voriconazole"	K		$4.64	.	$0.93																																																																																																																																																																																																																						
1064	"I131 iodide cap, rx"	K		$40.70	.	$8.14																																																																																																																																																																																																																						
1083	Adalimumab injection	K		$861.45	.	$172.29																																																																																																																																																																																																																						
1086	Temozolomide	K		$2.66	.	$0.54																																																																																																																																																																																																																						
1138	"Hepagam b intravenous, inj"	K		$56.06	.	$11.22																																																																																																																																																																																																																						
1139	Protein c concentrate	K		$15.23	.	$3.05																																																																																																																																																																																																																						
1142	Supprelin LA implant	K		"$26,205.50"	.	"$5,241.10"																																																																																																																																																																																																																						
1150	"I131 iodide sol, rx"	K		$10.28	.	$2.06																																																																																																																																																																																																																						
1166	Cytarabine liposome inj	K		$595.76	.	$119.16																																																																																																																																																																																																																						
1168	"Inj, temsirolimus"	K		$66.67	.	$13.34																																																																																																																																																																																																																						
1178	Busulfan injection	K		$38.37	.	$7.68																																																																																																																																																																																																																						
1203	Verteporfin injection	K		$10.88	.	$2.18																																																																																																																																																																																																																						
1207	"Octreotide injection, depot"	K		$168.11	.	$33.63																																																																																																																																																																																																																						
1213	Antihemophilic viii/vwf comp	K		$0.97	.	$0.20																																																																																																																																																																																																																						
1214	Inj IVIG privigen 500 mg	K		$37.90	.	$7.58																																																																																																																																																																																																																						
1232	Mitomycin injection	K		$103.17	.	$20.64																																																																																																																																																																																																																						
1235	Valrubicin injection	K		"$1,148.73"	.	$229.75																																																																																																																																																																																																																						
1236	Levoleucovorin injection	K		$0.90	.	$0.18																																																																																																																																																																																																																						
1237	Inj iron dextran	K		$12.41	.	$2.49																																																																																																																																																																																																																						
1238	Topotecan oral	K		$103.85	.	$20.77																																																																																																																																																																																																																						
1253	Triamcinolone A inj PRS-free	K		$3.70	.	$0.74																																																																																																																																																																																																																						
1263	Antithrombin iii injection	K		$3.43	.	$0.69																																																																																																																																																																																																																						
1268	Xyntha inj	K		$1.20	.	$0.24																																																																																																																																																																																																																						
1274	Edetate calcium disodium inj	K 		"$5,594.42"	.	"$1,118.89"																																																																																																																																																																																																																						
1280	Corticotropin injection	K		"$3,555.35"	.	$711.07																																																																																																																																																																																																																						
1281	Bevacizumab injection	K		$1.81	.	$0.37																																																																																																																																																																																																																						
1289	AbobotulinumtoxinA	K		$7.90	.	$1.58																																																																																																																																																																																																																						
1291	Rilonacept injection	K		$24.09	.	$4.82																																																																																																																																																																																																																						
1295	Sm 153 lexidronam	K		"$12,113.48"	.	"$2,422.70"																																																																																																																																																																																																																						
1296	Degarelix injection	K		$3.62	.	$0.73																																																																																																																																																																																																																						
1297	"Ferumoxytol, non-esrd"	K		$0.88	.	$0.18																																																																																																																																																																																																																						
1311	Canakinumab injection	K		$92.49	.	$18.50																																																																																																																																																																																																																						
1312	Hizentra injection	K		$9.83	.	$1.97																																																																																																																																																																																																																						
1327	Imiglucerase injection	K		$41.93	.	$8.39																																																																																																																																																																																																																						
1331	Olanzapine long-acting inj	K		$2.92	.	$0.59																																																																																																																																																																																																																						
1332	Antithrombin recombinant	K		$103.35	.	$20.67																																																																																																																																																																																																																						
1338	"Methyl aminolevulinate, top"	K		$83.69	.	$16.74																																																																																																																																																																																																																						
1340	"Collagenase, clost hist inj"	K		$41.42	.	$8.29																																																																																																																																																																																																																						
1341	Amobarbital 125 MG inj	K		$194.26	.	$38.86																																																																																																																																																																																																																						
1352	Wilate injection	K		$0.97	.	$0.20																																																																																																																																																																																																																						
1353	Belimumab injection	K		$42.02	.	$8.41																																																																																																																																																																																																																						
1354	Hydroxyprogesterone caproate	K		$2.69	.	$0.54																																																																																																																																																																																																																						
1361	Enfuvirtide injection	K		$18.63	.	$3.73																																																																																																																																																																																																																						
1408	Cyclophosphamide 100 MG inj	K		$43.97	.	$8.80																																																																																																																																																																																																																						
1413	Lumizyme injection	K		$159.39	.	$31.88																																																																																																																																																																																																																						
1415	Glassia injection	K		$4.37	.	$0.88																																																																																																																																																																																																																						
1416	Factor xiii anti-hem factor	K		$8.18	.	$1.64																																																																																																																																																																																																																						
1417	Gel-one	K		$587.58	.	$117.52																																																																																																																																																																																																																						
1420	Aflibercept injection	K		$980.46	.	$196.10																																																																																																																																																																																																																						
1421	Imported lipodox inj	K		$508.43	.	$101.69																																																																																																																																																																																																																						
1424	Nabilone oral	K		$38.19	.	$7.64																																																																																																																																																																																																																						
1426	Eribulin mesylate injection	K		$106.08	.	$21.22																																																																																																																																																																																																																						
1431	Centruroides immune f(ab)	K		"$4,246.69"	.	$849.34																																																																																																																																																																																																																						
1433	Calcitonin salmon injection	K		"$2,321.14"	.	$464.23																																																																																																																																																																																																																						
1440	Inj desmopressin acetate	K		$14.04	.	$2.81																																																																																																																																																																																																																						
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00																																																																																																																																																																																																																						
1443	Icatibant injection	K		$325.48	.	$65.10																																																																																																																																																																																																																						
1446	Visualization adjunct	K		$2.22	.	$0.45																																																																																																																																																																																																																						
1457	Totazoline hcl injection	K		"$1,600.40"	.	$320.08																																																																																																																																																																																																																						
1458	Phentolaine mesylate inj	K		$402.51	.	$80.51																																																																																																																																																																																																																						
1460	Interferon alfa-2a inj	K		$733.57	.	$146.72																																																																																																																																																																																																																						
1464	Factor VIII (porcine)	K		$0.20	.	$0.04																																																																																																																																																																																																																						
1466	"Inj, vincristine sul lip 1mg"	K		"$2,506.49"	.	$501.30																																																																																																																																																																																																																						
1467	Factor ix recombinan rixubis	K		$1.25	.	$0.25																																																																																																																																																																																																																						
1468	Inj Aripiprazole Ext Rel 1mg	K		$4.38	.	$0.88																																																																																																																																																																																																																						
1469	Inj filgrastim excl biosimil	K		$1.00	.	$0.20																																																																																																																																																																																																																						
1471	"Injection, Pertuzumab, 1 mg"	K		$10.65	.	$2.13																																																																																																																																																																																																																						
1472	Inj beta interferon im 1 mcg	K		$45.37	.	$9.08																																																																																																																																																																																																																						
1474	Certolizumab pegol inj 1mg	K		$7.06	.	$1.42																																																																																																																																																																																																																						
1475	Golimumab for iv use 1mg	K		$24.79	.	$4.96																																																																																																																																																																																																																						
1476	Obinutuzumab inj	K		$56.20	.	$11.24																																																																																																																																																																																																																						
1478	"	Human fibrinogen conc inj"	K		$1.14	.	$0.23																																																																																																																																																																																																																						
1480	"Elosulfase alfa, injection"	K		$221.77	.	$44.36																																																																																																																																																																																																																						
1482	"	Darbepoetin alfa, esrd use"	K		$3.93	.	$0.79																																																																																																																																																																																																																						
1484	"	Pentazocine injection"	K		$140.39	.	$28.08																																																																																																																																																																																																																						
1485	"	Ferumoxytol, esrd use"	K		$0.88	.	$0.18																																																																																																																																																																																																																						
1486	Factor ix fc fusion recomb	K		$2.82	.	$0.57																																																																																																																																																																																																																						
1488	"Injection, ramucirumab"	K		$55.93	.	$11.19																																																																																																																																																																																																																						
1489	"Injection, vedolizumab"	K		$17.43	.	$3.49																																																																																																																																																																																																																						
1490	Inj pembrolizumab	G		$46.50	.	$9.30																																																																																																																																																																																																																						
1491	New Technology  - Level 1A ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																																																						
1492	New Technology  - Level 1B ($11-$20)	S		$15.50	.	$3.10																																																																																																																																																																																																																						
1493	New Technology  - Level 1C ($21-$30)	S		$25.50	.	$5.10																																																																																																																																																																																																																						
1494	New Technology  - Level 1D ($31-$40)	S		$35.50	.	$7.10																																																																																																																																																																																																																						
1495	New Technology  - Level 1E ($41-$50)	S		$45.50	.	$9.10																																																																																																																																																																																																																						
1496	New Technology  - Level 1A ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																																																						
1497	New Technology  - Level 1B ($11-$20)	T		$15.50	.	$3.10																																																																																																																																																																																																																						
1498	New Technology  - Level 1C ($21-$30)	T		$25.50	.	$5.10																																																																																																																																																																																																																						
1499	New Technology  - Level 1D ($31-$40)	T		$35.50	.	$7.10																																																																																																																																																																																																																						
1500	New Technology  - Level 1E ($41-$50)	T		$45.50	.	$9.10																																																																																																																																																																																																																						
1502	New Technology - Level 2 ($51 - $100)	S		$75.50	.	$15.10																																																																																																																																																																																																																						
1503	New Technology - Level 3 ($101 - $200)	S		$150.50	.	$30.10																																																																																																																																																																																																																						
1504	New Technology - Level 4 ($201 - $300)	S		$250.50	.	$50.10																																																																																																																																																																																																																						
1505	New Technology - Level 5 ($301 - $400)	S		$350.50	.	$70.10																																																																																																																																																																																																																						
1506	New Technology - Level 6 ($401 - $500)	S		$450.50	.	$90.10																																																																																																																																																																																																																						
1507	New Technology - Level 7 ($501 - $600)	S		$550.50	.	$110.10																																																																																																																																																																																																																						
1508	New Technology - Level 8 ($601 - $700)	S		$650.50	.	$130.10																																																																																																																																																																																																																						
1509	New Technology - Level 9 ($701 - $800)	S		$750.50	.	$150.10																																																																																																																																																																																																																						
1510	New Technology - Level 10 ($801 - $900)	S		$850.50	.	$170.10																																																																																																																																																																																																																						
1511	New Technology - Level 11 ($901 - $1000)	S		$950.50	.	$190.10																																																																																																																																																																																																																						
1512	New Technology - Level 12 ($1001 - $1100)	S		"$1,050.50"	.	$210.10																																																																																																																																																																																																																						
1513	New Technology - Level 13 ($1101 - $1200)	S		"$1,150.50"	.	$230.10																																																																																																																																																																																																																						
1514	New Technology - Level 14 ($1201- $1300)	S		"$1,250.50"	.	$250.10																																																																																																																																																																																																																						
1515	New Technology - Level 15 ($1301 - $1400)	S		"$1,350.50"	.	$270.10																																																																																																																																																																																																																						
1516	New Technology - Level 16  ($1401 - $1500)	S		"$1,450.50"	.	$290.10																																																																																																																																																																																																																						
1517	New Technology - Level 17 ($1501-$1600)	S		"$1,550.50"	.	$310.10																																																																																																																																																																																																																						
1518	New Technology - Level 18 ($1601-$1700)	S		"$1,650.50"	.	$330.10																																																																																																																																																																																																																						
1519	New Technology - Level 19 ($1701-$1800)	S		"$1,750.50"	.	$350.10																																																																																																																																																																																																																						
1520	New Technology - Level 20 ($1801-$1900)	S		"$1,850.50"	.	$370.10																																																																																																																																																																																																																						
1521	New Technology - Level 21 ($1901-$2000)	S		"$1,950.50"	.	$390.10																																																																																																																																																																																																																						
1522	New Technology - Level 22 ($2001-$2500)	S		"$2,250.50"	.	$450.10																																																																																																																																																																																																																						
1523	New Technology - Level 23 ($2501-$3000)	S		"$2,750.50"	.	$550.10																																																																																																																																																																																																																						
1524	New Technology - Level 24 ($3001-$3500)	S		"$3,250.50"	.	$650.10																																																																																																																																																																																																																						
1525	New Technology - Level 25 ($3501-$4000)	S		"$3,750.50"	.	$750.10																																																																																																																																																																																																																						
1526	New Technology - Level 26 ($4001-$4500)	S		"$4,250.50"	.	$850.10																																																																																																																																																																																																																						
1527	New Technology - Level 27 ($4501-$5000)	S		"$4,750.50"	.	$950.10																																																																																																																																																																																																																						
1528	New Technology - Level 28 ($5001-$5500)	S		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																																																						
1529	New Technology - Level 29 ($5501-$6000)	S		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																																																						
1530	New Technology - Level 30 ($6001-$6500)	S		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																																																						
1531	New Technology - Level 31 ($6501-$7000)	S		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																																																						
1532	New Technology - Level 32 ($7001-$7500)	S		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																																																						
1533	New Technology - Level 33 ($7501-$8000)	S		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																																																						
1534	New Technology - Level 34 ($8001-$8500)	S		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																																																						
1535	New Technology - Level 35 ($8501-$9000)	S		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																																																						
1536	New Technology - Level 36 ($9001-$9500)	S		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																																																						
1537	New Technology - Level 37 ($9501-$10000)	S		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																																																						
1539	New Technology - Level 2 ($51 - $100)	T		$75.50	.	$15.10																																																																																																																																																																																																																						
1540	New Technology - Level 3 ($101 - $200)	T		$150.50	.	$30.10																																																																																																																																																																																																																						
1541	New Technology - Level 4 ($201 - $300)	T		$250.50	.	$50.10																																																																																																																																																																																																																						
1542	New Technology - Level 5 ($301 - $400)	T		$350.50	.	$70.10																																																																																																																																																																																																																						
1543	New Technology - Level 6 ($401 - $500)	T		$450.50	.	$90.10																																																																																																																																																																																																																						
1544	New Technology - Level 7 ($501 - $600)	T		$550.50	.	$110.10																																																																																																																																																																																																																						
1545	New Technology - Level 8 ($601 - $700)	T		$650.50	.	$130.10																																																																																																																																																																																																																						
1546	New Technology - Level 9 ($701 - $800)	T		$750.50	.	$150.10																																																																																																																																																																																																																						
1547	New Technology - Level 10 ($801 - $900)	T		$850.50	.	$170.10																																																																																																																																																																																																																						
1548	New Technology - Level 11 ($901 - $1000)	T		$950.50	.	$190.10																																																																																																																																																																																																																						
1549	New Technology - Level 12 ($1001 - $1100)	T		"$1,050.50"	.	$210.10																																																																																																																																																																																																																						
1550	New Technology - Level 13 ($1101 - $1200)	T		"$1,150.50"	.	$230.10																																																																																																																																																																																																																						
1551	New Technology - Level 14 ($1201- $1300)	T		"$1,250.50"	.	$250.10																																																																																																																																																																																																																						
1552	New Technology - Level 15 ($1301 - $1400)	T		"$1,350.50"	.	$270.10																																																																																																																																																																																																																						
1553	New Technology - Level 16 ($1401 - $1500)	T		"$1,450.50"	.	$290.10																																																																																																																																																																																																																						
1554	New Technology - Level 17 ($1501-$1600)	T		"$1,550.50"	.	$310.10																																																																																																																																																																																																																						
1555	New Technology - Level 18 ($1601-$1700)	T		"$1,650.50"	.	$330.10																																																																																																																																																																																																																						
1556	New Technology - Level 19 ($1701-$1800)	T		"$1,750.50"	.	$350.10																																																																																																																																																																																																																						
1557	New Technology - Level 20 ($1801-$1900)	T		"$1,850.50"	.	$370.10																																																																																																																																																																																																																						
1558	New Technology - Level 21 ($1901-$2000)	T		"$1,950.50"	.	$390.10																																																																																																																																																																																																																						
1559	New Technology - Level 22 ($2001-$2500)	T		"$2,250.50"	.	$450.10																																																																																																																																																																																																																						
1560	New Technology - Level 23 ($2501-$3000)	T		"$2,750.50"	.	$550.10																																																																																																																																																																																																																						
1561	New Technology - Level 24 ($3001-$3500)	T		"$3,250.50"	.	$650.10																																																																																																																																																																																																																						
1562	New Technology - Level 25 ($3501-$4000)	T		"$3,750.50"	.	$750.10																																																																																																																																																																																																																						
1563	New Technology - Level 26 ($4001-$4500)	T		"$4,250.50"	.	$850.10																																																																																																																																																																																																																						
1564	New Technology - Level 27 ($4501-$5000)	T		"$4,750.50"	.	$950.10																																																																																																																																																																																																																						
1565	New Technology - Level 28 ($5001-$5500)	T		"$5,250.50"	.	"$1,050.10"																																																																																																																																																																																																																						
1566	New Technology - Level 29 ($5501-$6000)	T		"$5,750.50"	.	"$1,150.10"																																																																																																																																																																																																																						
1567	New Technology - Level 30 ($6001-$6500)	T		"$6,250.50"	.	"$1,250.10"																																																																																																																																																																																																																						
1568	New Technology - Level 31 ($6501-$7000)	T		"$6,750.50"	.	"$1,350.10"																																																																																																																																																																																																																						
1569	New Technology - Level 32 ($7001-$7500)	T		"$7,250.50"	.	"$1,450.10"																																																																																																																																																																																																																						
1570	New Technology - Level 33 ($7501-$8000)	T		"$7,750.50"	.	"$1,550.10"																																																																																																																																																																																																																						
1571	New Technology - Level 34 ($8001-$8500)	T		"$8,250.50"	.	"$1,650.10"																																																																																																																																																																																																																						
1572	New Technology - Level 35 ($8501-$9000)	T		"$8,750.50"	.	"$1,750.10"																																																																																																																																																																																																																						
1573	New Technology - Level 36 ($9001-$9500)	T		"$9,250.50"	.	"$1,850.10"																																																																																																																																																																																																																						
1574	New Technology - Level 37 ($9501-$10000)	T		"$9,750.50"	.	"$1,950.10"																																																																																																																																																																																																																						
1575	"New Technology - Level 38 ($10,001-$15,000)"	S		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																																																						
1576	"New Technology - Level 39 ($15,001-$20,000)"	S		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																																																						
1577	"New Technology - Level 40 ($20,001-$25,000)"	S		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																																																						
1578	"New Technology - Level 41 ($25,001-$30,000)"	S		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																																																						
1579	"New Technology - Level 42 ($30,001-$40,000)"	S		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																																																						
1580	"New Technology - Level 43 ($40,001-$50,000)"	S		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																																																						
1581	"New Technology - Level 44 ($50,001-$60,000)"	S		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																																																						
1582	"New Technology - Level 45 ($60,001-$70,000)"	S		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																																																						
1583	"New Technology - Level 46 ($70,001-$80,000)"	S		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																																																						
1584	"New Technology - Level 47 ($80,001-$90,000)"	S		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																																																						
1585	"New Technology - Level 48 ($90,001-$100,000)"	S		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																																																						
1589	"New Technology - Level 38 ($10,001-$15,000)"	T		"$12,500.50"	.	"$2,500.10"																																																																																																																																																																																																																						
1590	"New Technology - Level 39 ($15,001-$20,000)"	T		"$17,500.50"	.	"$3,500.10"																																																																																																																																																																																																																						
1591	"New Technology - Level 40 ($20,001-$25,000)"	T		"$22,500.50"	.	"$4,500.10"																																																																																																																																																																																																																						
1592	"New Technology - Level 41 ($25,001-$30,000)"	T		"$27,500.50"	.	"$5,500.10"																																																																																																																																																																																																																						
1593	"New Technology - Level 42 ($30,001-$40,000)"	T		"$35,000.50"	.	"$7,000.10"																																																																																																																																																																																																																						
1594	"New Technology - Level 43 ($40,001-$50,000)"	T		"$45,000.50"	.	"$9,000.10"																																																																																																																																																																																																																						
1595	"New Technology - Level 44 ($50,001-$60,000)"	T		"$55,000.50"	.	"$11,000.10"																																																																																																																																																																																																																						
1596	"New Technology - Level 45 ($60,001-$70,000)"	T		"$65,000.50"	.	"$13,000.10"																																																																																																																																																																																																																						
1597	"New Technology - Level 46 ($70,001-$80,000)"	T		"$75,000.50"	.	"$15,000.10"																																																																																																																																																																																																																						
1598	"New Technology - Level 47 ($80,001-$90,000)"	T		"$85,000.50"	.	"$17,000.10"																																																																																																																																																																																																																						
1599	"New Technology - Level 48 ($90,001-$100,000)"	T		"$95,000.50"	.	"$19,000.10"																																																																																																																																																																																																																						
1605	Abciximab injection	K		"$1,136.51"	.	$227.31																																																																																																																																																																																																																						
1607	Eptifibatide injection	K		$31.29	.	$6.26																																																																																																																																																																																																																						
1608	Etanercept injection	K		$404.62	.	$80.93																																																																																																																																																																																																																						
1609	"Rho(D) immune globulin h, sd"	K		$21.33	.	$4.27																																																																																																																																																																																																																						
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27																																																																																																																																																																																																																						
1613	Trastuzumab injection	K		$92.09	.	$18.42																																																																																																																																																																																																																						
1630	"Hep b ig, im"	K		$111.33	.	$22.27																																																																																																																																																																																																																						
1631	Baclofen intrathecal trial	K		$76.96	.	$15.40																																																																																																																																																																																																																						
1633	Alefacept	K		$41.64	.	$8.33																																																																																																																																																																																																																						
1643	"Y90 ibritumomab, rx"	K		"$46,942.38"	.	"$9,388.48"																																																																																																																																																																																																																						
1656	Factor viii fc fusion recomb	K		$1.89	.	$0.38																																																																																																																																																																																																																						
1657	Puraply or puraply am	G		$119.12	.	$0.00																																																																																																																																																																																																																						
1658	"Injection, belinostat, 10mg"	G		$33.54	.	$6.71																																																																																																																																																																																																																						
1660	"Injection, oritavancin"	G		$24.64	.	$4.93																																																																																																																																																																																																																						
1661	"Gen, neuro, HF, rechg bat"	H			.	.																																																																																																																																																																																																																						
1662	Inj tedizolid phosphate	G		$1.28	.	$0.26																																																																																																																																																																																																																						
1663	"Inj, phenylephrine ketorolac"	G		$487.12	.	$0.00																																																																																																																																																																																																																						
1664	Florbetapir f18	G		"$2,756.00"	.	$0.00																																																																																																																																																																																																																						
1666	"	Tetracyclin injection"	K		$97.97	.	$19.60																																																																																																																																																																																																																						
1669	Erythro lactobionate /500 mg	K		$59.29	.	$11.86																																																																																																																																																																																																																						
1670	Tetanus immune globulin inj	K		$433.06	.	$86.62																																																																																																																																																																																																																						
1675	P32 Na phosphate	K		$213.56	.	$42.72																																																																																																																																																																																																																						
1676	P32 chromic phosphate	K		$906.62	.	$181.33																																																																																																																																																																																																																						
1683	Basiliximab	K		"$3,196.11"	.	$639.23																																																																																																																																																																																																																						
1684	Corticorelin ovine triflutal	K		$8.12	.	$1.63																																																																																																																																																																																																																						
1685	"Darbepoetin alfa, non-esrd"	K		$3.93	.	$0.79																																																																																																																																																																																																																						
1686	"Epoetin alfa, non-esrd"	K		$12.59	.	$2.52																																																																																																																																																																																																																						
1687	Digoxin immune fab (ovine)	K		"$3,039.53"	.	$607.91																																																																																																																																																																																																																						
1688	Ethanolamine oleate	K		$404.09	.	$80.82																																																																																																																																																																																																																						
1689	Fomepizole	K		$7.94	.	$1.59																																																																																																																																																																																																																						
1690	Hemin	K		$22.86	.	$4.58																																																																																																																																																																																																																						
1693	Lepirudin	K		$235.52	.	$47.11																																																																																																																																																																																																																						
1694	Ziconotide injection	K		$7.31	.	$1.47																																																																																																																																																																																																																						
1695	Nesiritide injection	K		$72.73	.	$14.55																																																																																																																																																																																																																						
1696	Palifermin injection	K		$17.68	.	$3.54																																																																																																																																																																																																																						
1697	Pegaptanib sodium injection	K		"$1,054.70"	.	$210.94																																																																																																																																																																																																																						
1700	Inj secretin synthetic human	K		$34.78	.	$6.96																																																																																																																																																																																																																						
1701	Treprostinil injection	K		$61.24	.	$12.25																																																																																																																																																																																																																						
1704	"Humate-P, inj"	K		$1.04	.	$0.21																																																																																																																																																																																																																						
1705	Factor viia	K		$1.90	.	$0.38																																																																																																																																																																																																																						
1709	Azacitidine injection	K		$2.84	.	$0.57																																																																																																																																																																																																																						
1710	Clofarabine injection	K		$152.44	.	$30.49																																																																																																																																																																																																																						
1711	Vantas implant	K		"$3,138.04"	.	$627.61																																																																																																																																																																																																																						
1712	Paclitaxel protein bound	K		$10.32	.	$2.07																																																																																																																																																																																																																						
1738	Oxaliplatin	K		$0.39	.	$0.08																																																																																																																																																																																																																						
1739	"Pegademase bovine, 25 iu"	K		$319.67	.	$63.94																																																																																																																																																																																																																						
1741	"Urofollitropin, 75 iu"	K		$132.66	.	$26.54																																																																																																																																																																																																																						
1743	Nandrolone decanoate 50 mg	K		$122.78	.	$24.56																																																																																																																																																																																																																						
1745	Radium ra223 dichloride ther	K		$127.07	.	$25.42																																																																																																																																																																																																																						
1746	Factor xiii recomb a-subunit	K		$14.62	.	$2.93																																																																																																																																																																																																																						
1747	Monovisc inj per dose	K		$917.77	.	$183.56																																																																																																																																																																																																																						
1761	"rolapitant, oral, 1mg"	K		$12.65	.	$2.53																																																																																																																																																																																																																						
1809	"Injection, alemtuzumab"	K		"$1,738.36"	.	$347.68																																																																																																																																																																																																																						
1822	Inj filgrastim gcsf biosimil	G		$0.83	.	$0.17																																																																																																																																																																																																																						
1823	"Injection, dalbavancin"	G		$15.22	.	$3.05																																																																																																																																																																																																																						
1824	"	Ceftaroline fosamil inj"	K		$2.48	.	$0.50																																																																																																																																																																																																																						
1825	Ceftazidime and avibactam	K		$77.05	.	$15.41																																																																																																																																																																																																																						
1826	Hyqvia 100mg immuneglobulin	K		$12.74	.	$2.55																																																																																																																																																																																																																						
1827	Factor viii recomb obizur	K		$4.53	.	$0.91																																																																																																																																																																																																																						
1828	Carbidopa levodopa ent 100ml	K		$2.14	.	$0.43																																																																																																																																																																																																																						
1829	"	Penicillin g benzathine inj"	K		$10.31	.	$2.07																																																																																																																																																																																																																						
1832	Dimethyl sulfoxide 50% 50 ml	K		$481.94	.	$96.39																																																																																																																																																																																																																						
1836	"	Penicillin g procaine inj"	K		$26.77	.	$5.36																																																																																																																																																																																																																						
1838	"Urokinase 250,000 iu inj"	K		$262.79	.	$52.56																																																																																																																																																																																																																						
1839	"	Oral busulfan"	K		$23.69	.	$4.74																																																																																																																																																																																																																						
1842	"	Leuprolide acetate implant"	K		$168.48	.	$33.70																																																																																																																																																																																																																						
1844	Factor viii pegylated recomb	G		$1.55	.	$0.31																																																																																																																																																																																																																						
1845	Tacrol envarsus ex rel oral	G		$1.23	.	$0.25																																																																																																																																																																																																																						
1846	Factor viii nuwiq recomb 1iu	G		$1.50	.	$0.30																																																																																																																																																																																																																						
1848	Artiss fibrin sealant	K		$241.78	.	$48.36																																																																																																																																																																																																																						
1849	Foscarnet sodium injection	K		$47.28	.	$9.46																																																																																																																																																																																																																						
1850	Gamma globulin 1 cc inj	K		$36.41	.	$7.29																																																																																																																																																																																																																						
1851	Gamma globulin > 10 cc inj	K		$364.12	.	$72.83																																																																																																																																																																																																																						
1852	Interferon beta-1a inj	K		$482.21	.	$96.45																																																																																																																																																																																																																						
1853	Minocycline hydrochloride	K		$1.54	.	$0.31																																																																																																																																																																																																																						
1854	Pentobarbital sodium inj	K		$47.18	.	$9.44																																																																																																																																																																																																																						
1855	Pralidoxime chloride inj	K		$141.19	.	$28.24																																																																																																																																																																																																																						
1856	Factor viii recomb novoeight	K		$1.31	.	$0.27																																																																																																																																																																																																																						
1857	"Inj, factor x, (human), 1iu"	K		$6.51	.	$1.31																																																																																																																																																																																																																						
1858	Leuprolide acetate injeciton	K		$17.90	.	$3.58																																																																																																																																																																																																																						
1859	Argatroban nonesrd use 1mg	K		$2.14	.	$0.43																																																																																																																																																																																																																						
1860	Monoclonal antibodies	K		$231.22	.	$46.25																																																																																																																																																																																																																						
1861	"Inj., bendeka 1 mg"	G		$23.79		$4.76																																																																																																																																																																																																																						
1901	"New Technology - Level 49 ($100,001-$120,000)"	S		"$110,000.50"	.	"$22,000.10"																																																																																																																																																																																																																						
1902	"New Technology - Level 49 ($100,001-$120,000)"	T		"$110,000.50"	.	"$22,000.10"																																																																																																																																																																																																																						
1903	"New Technology - Level 50 ($120,001-$140,000)"	S		"$130,000.50"	.	"$26,000.10"																																																																																																																																																																																																																						
1904	"New Technology - Level 50 ($120,001-$140,000)"	T		"$130,000.50"	.	"$26,000.10"																																																																																																																																																																																																																						
1905	"New Technology - Level 51 ($140,001-$160,000)"	S		"$150,000.50"	.	"$30,000.10"																																																																																																																																																																																																																						
1906	"New Technology - Level 51 ($140,001-$160,000)"	T		"$150,000.50"	.	"$30,000.10"																																																																																																																																																																																																																						
2613	Lung bx plug w/del sys	H			.	.																																																																																																																																																																																																																						
2616	"Brachytx, non-str,Yttrium-90"	U	220.0072	"$16,500.76"	.	"$3,300.16"																																																																																																																																																																																																																						
2623	"Cath, translumin, drug-coat"	H			.	.																																																																																																																																																																																																																						
2632	Iodine I-125 sodium iodide	U	0.3990	$29.93	.	$5.99																																																																																																																																																																																																																						
2634	"Brachytx, non-str, HA, I-125"	U	1.6062	$120.47	.	$24.10																																																																																																																																																																																																																						
2635	"Brachytx, non-str, HA, P-103"	U	0.3424	$25.68	.	$5.14																																																																																																																																																																																																																						
2636	"Brachy linear, non-str,P-103"	U	0.2485	$18.64	.	$3.73																																																																																																																																																																																																																						
2638	"Brachytx, stranded, I-125"	U	0.5061	$37.96	.	$7.60																																																																																																																																																																																																																						
2639	"Brachytx, non-stranded,I-125"	U	0.4758	$35.69	.	$7.14																																																																																																																																																																																																																						
2640	"Brachytx, stranded, P-103"	U	0.9758	$73.19	.	$14.64																																																																																																																																																																																																																						
2641	"Brachytx, non-stranded,P-103"	U	0.8724	$65.43	.	$13.09																																																																																																																																																																																																																						
2642	"Brachytx, stranded, C-131"	U	1.1676	$87.57	.	$17.52																																																																																																																																																																																																																						
2643	"Brachytx, non-stranded,C-131"	U	0.7888	$59.16	.	$11.84																																																																																																																																																																																																																						
2645	"Brachytx, non-str, Gold-198"	U	1.8033	$135.25	.	$27.05																																																																																																																																																																																																																						
2646	"Brachytx, non-str, HDR Ir-192"	U	3.7528	$281.46	.	$56.30																																																																																																																																																																																																																						
2647	"Brachytx, NS, Non-HDRIr-192"	U	0.4508	$33.81	.	$6.77																																																																																																																																																																																																																						
2648	"Brachytx planar, p-103"	U	0.0625	$4.69	.	$0.94																																																																																																																																																																																																																						
2698	"Brachytx, stranded, NOS"	U	0.5061	$37.96	.	$7.60																																																																																																																																																																																																																						
2699	"Brachytx, non-stranded, NOS"	U	0.2485	$18.64	.	$3.73																																																																																																																																																																																																																						
2731	"Immune globulin, powder"	K		$33.07	.	$6.62																																																																																																																																																																																																																						
2770	Quinupristin/dalfopristin	K		$413.52	.	$82.71																																																																																																																																																																																																																						
3041	Bivalirudin	K		$1.53	.	$0.31																																																																																																																																																																																																																						
4001	Echo guidance radiotherapy	S		$21.89	.	$4.38																																																																																																																																																																																																																						
4002	Stereoscopic x-ray guidance 	S		$55.99	.	$11.20																																																																																																																																																																																																																						
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$193.08	.	$38.62																																																																																																																																																																																																																						
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$146.43	.	$29.29																																																																																																																																																																																																																						
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$146.07	.	$29.21																																																																																																																																																																																																																						
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$146.07	.	$29.21																																																																																																																																																																																																																						
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$301.82	.	$60.36																																																																																																																																																																																																																						
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$201.69	.	$40.34																																																																																																																																																																																																																						
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$200.98	.	$40.20																																																																																																																																																																																																																						
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$200.26	.	$40.05																																																																																																																																																																																																																						
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$292.49	.	$58.50																																																																																																																																																																																																																						
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$267.01	.	$53.40																																																																																																																																																																																																																						
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$267.37	.	$53.47																																																																																																																																																																																																																						
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$267.73	.	$53.55																																																																																																																																																																																																																						
5012	Clinic Visits and Related Services	V	1.4208	$106.56	.	$21.32																																																																																																																																																																																																																						
5021	Level 1 Type A ED Visits	V	0.8178	$61.34	.	$12.27																																																																																																																																																																																																																						
5022	Level 2 Type A ED Visits	V	1.4856	$111.42	.	$22.29																																																																																																																																																																																																																						
5023	Level 3 Type A ED Visits	V	2.6822	$201.17	.	$40.24																																																																																																																																																																																																																						
5024	Level 4 Type A ED Visits	V	4.4302	$332.27	.	$66.46																																																																																																																																																																																																																						
5025	Level 5 Type A ED Visits	V	6.5137	$488.53	.	$97.71																																																																																																																																																																																																																						
5031	Level 1 Type B ED Visits	V	1.1345	$85.09	.	$17.02																																																																																																																																																																																																																						
5032	Level 2 Type B ED Visits	V	1.0072	$75.54	.	$15.11																																																																																																																																																																																																																						
5033	Level 3 Type B ED Visits	V	1.6660	$124.95	.	$24.99																																																																																																																																																																																																																						
5034	Level 4 Type B ED Visits	V	2.3796	$178.47	.	$35.70																																																																																																																																																																																																																						
5035	Level 5 Type B ED Visits	V	4.9030	$367.73	.	$73.55																																																																																																																																																																																																																						
5041	Critical Care	S	9.1582	$686.87	.	$137.38																																																																																																																																																																																																																						
5045	Trauma Response with Critical Care	S	11.6226	$871.71	.	$174.35																																																																																																																																																																																																																						
5051	Level 1 Skin Procedures	T	2.0407	$153.05	.	$30.61																																																																																																																																																																																																																						
5052	Level 2 Skin Procedures	T	3.8998	$292.49	.	$58.50																																																																																																																																																																																																																						
5053	Level 3 Skin Procedures	T	6.0387	$452.91	.	$90.59																																																																																																																																																																																																																						
5054	Level 4 Skin Procedures	T	19.0286	"$1,427.16"	.	$285.44																																																																																																																																																																																																																						
5055	Level 5 Skin Procedures	T	33.3813	"$2,503.63"	.	$500.73																																																																																																																																																																																																																						
5061	Hyperbaric Oxygen	S	1.4692	$110.19	.	$22.04																																																																																																																																																																																																																						
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.1850	$538.88	.	$107.78																																																																																																																																																																																																																						
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	16.4811	"$1,236.10"	.	$247.22																																																																																																																																																																																																																						
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	28.6396	"$2,148.00"	.	$429.60																																																																																																																																																																																																																						
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	33.3118	"$2,498.42"	.	$499.69																																																																																																																																																																																																																						
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	58.9005	"$4,417.60"	.	$883.52																																																																																																																																																																																																																						
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	86.4470	"$6,483.61"	.	"$1,296.73"																																																																																																																																																																																																																						
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	133.7690	"$10,032.81"	.	"$2,006.57"																																																																																																																																																																																																																						
5101	Level 1 Strapping and Cast Application	T	1.6680	$125.10	.	$25.02																																																																																																																																																																																																																						
5102	Level 2 Strapping and Cast Application	T	2.9421	$220.66	.	$44.14																																																																																																																																																																																																																						
5111	Level 1 Musculoskeletal Procedures	T	2.6633	$199.75	.	$39.95																																																																																																																																																																																																																						
5112	Level 2 Musculoskeletal Procedures	J1	16.2251	"$1,216.90"	.	$243.38																																																																																																																																																																																																																						
5113	Level 3 Musculoskeletal Procedures	J1	32.4970	"$2,437.31"	.	$487.47																																																																																																																																																																																																																						
5114	Level 4 Musculoskeletal Procedures	J1	69.5906	"$5,219.36"	.	"$1,043.88"																																																																																																																																																																																																																						
5115	Level 5 Musculoskeletal Procedures	J1	127.4276	"$9,557.20"	.	"$1,911.44"																																																																																																																																																																																																																						
5116	Level 6 Musculoskeletal Procedures	J1	195.9697	"$14,697.92"	.	"$2,939.59"																																																																																																																																																																																																																						
5151	Level 1 Airway Endoscopy	T	1.9485	$146.14	.	$29.23																																																																																																																																																																																																																						
5152	Level 2 Airway Endoscopy	T	4.8235	$361.77	.	$72.36																																																																																																																																																																																																																						
5153	Level 3 Airway Endoscopy	J1	16.9231	"$1,269.25"	.	$253.85																																																																																																																																																																																																																						
5154	Level 4 Airway Endoscopy	J1	32.4023	"$2,430.20"	.	$486.04																																																																																																																																																																																																																						
5155	Level 5 Airway Endoscopy	J1	58.1474	"$4,361.11"	.	$872.23																																																																																																																																																																																																																						
5161	Level 1 ENT Procedures	T	2.3602	$177.02	.	$35.41																																																																																																																																																																																																																						
5162	Level 2 ENT Procedures	T	5.8990	$442.43	.	$88.49																																																																																																																																																																																																																						
5163	Level 3 ENT Procedures	T	13.8413	"$1,038.11"	.	$207.63																																																																																																																																																																																																																						
5164	Level 4 ENT Procedures	J1	28.9698	"$2,172.76"	.	$434.56																																																																																																																																																																																																																						
5165	Level 5 ENT Procedures	J1	55.0553	"$4,129.20"	.	$825.84																																																																																																																																																																																																																						
5166	Cochlear Implant Procedure	J1	424.3083	"$31,823.55"	"$7,835.75"	"$6,364.71"																																																																																																																																																																																																																						
5181	Level 1 Vascular Procedures	T	9.1177	$683.84	.	$136.77																																																																																																																																																																																																																						
5182	Level 2 Vascular Procedures	T	31.4609	"$2,359.60"	.	$471.92																																																																																																																																																																																																																						
5183	Level 3 Vascular Procedures	T	52.3009	"$3,922.62"	.	$784.53																																																																																																																																																																																																																						
5191	Level 1 Endovascular Procedures	J1	37.7643	"$2,832.36"	$871.39	$566.48																																																																																																																																																																																																																						
5192	Level 2 Endovascular Procedures	J1	64.3080	"$4,823.16"	.	$964.64																																																																																																																																																																																																																						
5193	Level 3 Endovascular Procedures	J1	129.9758	"$9,748.31"	.	"$1,949.67"																																																																																																																																																																																																																						
5194	Level 4 Endovascular Procedures	J1	197.0094	"$14,775.90"	.	"$2,955.18"																																																																																																																																																																																																																						
5200	Implantation Wireless PA Pressure Monitor	J1	393.3962	"$29,505.11"	"$9,077.40"	"$5,901.03"																																																																																																																																																																																																																						
5211	Level 1 Electrophysiologic Procedures	J1	11.5530	$866.49	.	$173.30																																																																																																																																																																																																																						
5212	Level 2 Electrophysiologic Procedures	J1	66.7229	"$5,004.28"	.	"$1,000.86"																																																																																																																																																																																																																						
5213	Level 3 Electrophysiologic Procedures	J1	223.7057	"$16,778.15"	.	"$3,355.63"																																																																																																																																																																																																																						
5221	Level1 Pacemaker and Similar Procedures	T	34.1130	"$2,558.51"	.	$511.71																																																																																																																																																																																																																						
5222	Level 2 Pacemaker and Similar Procedures	J1	92.9804	"$6,973.62"	.	"$1,394.73"																																																																																																																																																																																																																						
5223	Level 3 Pacemaker and Similar Procedures	J1	125.4606	"$9,409.67"	.	"$1,881.94"																																																																																																																																																																																																																						
5224	Level 4 Pacemaker and Similar Procedures	J1	223.4609	"$16,759.79"	.	"$3,351.96"																																																																																																																																																																																																																						
5231	Level 1 ICD and Similar Procedures	J1	293.2054	"$21,990.70"	.	"$4,398.14"																																																																																																																																																																																																																						
5232	Level 2 ICD and Similar Procedures	J1	406.8523	"$30,514.33"	.	"$6,102.87"																																																																																																																																																																																																																						
5241	Level 1 Blood Product Exchange and Related Services	S	4.7252	$354.39	.	$70.88																																																																																																																																																																																																																						
5242	Level 2 Blood Product Exchange and Related Services	S	14.6428	"$1,098.22"	.	$219.65																																																																																																																																																																																																																						
5243	Level 3 Blood Product Exchange and Related Services	S	42.4859	"$3,186.48"	.	$637.30																																																																																																																																																																																																																						
5244	Level 4 Blood Product Exchange and Related Services	J1	370.0317	"$27,752.75"	.	"$5,550.55"																																																																																																																																																																																																																						
5301	Level 1 Upper GI Procedures	T	9.3264	$699.49	.	$139.90																																																																																																																																																																																																																						
5302	Level 2 Upper GI Procedures 	J1	17.7900	"$1,334.27"	.	$266.86																																																																																																																																																																																																																						
5303	Level 3 Upper GI Procedures	J1	33.4614	"$2,509.64"	.	$501.93																																																																																																																																																																																																																						
5311	Level 1 Lower GI Procedures 	T	8.8985	$667.40	.	$133.48																																																																																																																																																																																																																						
5312	Level 2 Lower GI Procedures 	T	11.6963	$877.23	.	$175.45																																																																																																																																																																																																																						
5313	Level 3 Lower GI Procedures 	J1	28.8876	"$2,166.60"	.	$433.32																																																																																																																																																																																																																						
5331	Complex GI Procedures	J1	52.5186	"$3,938.95"	.	$787.79																																																																																																																																																																																																																						
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	38.1532	"$2,861.53"	.	$572.31																																																																																																																																																																																																																						
5361	Level 1 Laparoscopy and Related Services	J1	55.9640	"$4,197.36"	.	$839.48																																																																																																																																																																																																																						
5362	Level 2 Laparoscopy and Related Services	J1	92.8906	"$6,966.89"	"$1,526.22"	"$1,393.38"																																																																																																																																																																																																																						
5371	Level 1 Urology and Related Services	T	2.8793	$215.95	.	$43.19																																																																																																																																																																																																																						
5372	Level 2 Urology and Related Services	T	7.3227	$549.21	.	$109.85																																																																																																																																																																																																																						
5373	Level 3 Urology and Related Services	J1	21.9192	"$1,643.96"	.	$328.80																																																																																																																																																																																																																						
5374	Level 4 Urology and Related Services	J1	33.8861	"$2,541.49"	.	$508.30																																																																																																																																																																																																																						
5375	Level 5 Urology and Related Services	J1	46.4333	"$3,482.54"	.	$696.51																																																																																																																																																																																																																						
5376	Level 6 Urology and Related Services	J1	99.3256	"$7,449.52"	.	"$1,489.91"																																																																																																																																																																																																																						
5377	Level 7 Urology and Related Services	J1	191.4315	"$14,357.55"	.	"$2,871.51"																																																																																																																																																																																																																						
5401	Dialysis	S	7.3646	$552.35	.	$110.47																																																																																																																																																																																																																						
5411	Level 1 Gynecologic Procedures	T	2.0286	$152.15	.	$30.43																																																																																																																																																																																																																						
5412	Level 2 Gynecologic Procedures	T	3.6752	$275.64	.	$55.13																																																																																																																																																																																																																						
5413	Level 3 Gynecologic Procedures	T	8.8745	$665.60	.	$133.12																																																																																																																																																																																																																						
5414	Level 4 Gynecologic Procedures	J1	27.7941	"$2,084.59"	.	$416.92																																																																																																																																																																																																																						
5415	Level 5 Gynecologic Procedures	J1	50.7892	"$3,809.24"	$902.82	$761.85																																																																																																																																																																																																																						
5416	Level 6 Gynecologic Procedures	J1	78.1802	"$5,863.59"	"$1,405.70"	"$1,172.72"																																																																																																																																																																																																																						
5431	Level 1 Nerve Procedures	J1	20.8365	"$1,562.76"	.	$312.56																																																																																																																																																																																																																						
5432	Level 2 Nerve Procedures	J1	55.3341	"$4,150.11"	.	$830.03																																																																																																																																																																																																																						
5441	Level 1 Nerve Injections	T	3.0787	$230.91	.	$46.19																																																																																																																																																																																																																						
5442	Level 2 Nerve Injections	T	6.7596	$506.98	.	$101.40																																																																																																																																																																																																																						
5443	Level 3 Nerve Injections	T	8.5153	$638.66	.	$127.74																																																																																																																																																																																																																						
5461	Level 1 Neurostimulator and Related Procedures	T	35.8572	"$2,689.33"	.	$537.87																																																																																																																																																																																																																						
5462	Level 2 Neurostimulator and Related Procedures	J1	76.5682	"$5,742.69"	.	"$1,148.54"																																																																																																																																																																																																																						
5463	Level 3 Neurostimulator and Related Procedures	J1	237.2750	"$17,795.86"	.	"$3,559.18"																																																																																																																																																																																																																						
5464	Level 4 Neurostimulator and Related Procedures	J1	360.4710	"$27,035.69"	.	"$5,407.14"																																																																																																																																																																																																																						
5471	Implantation of Drug Infusion Device	J1	208.2103	"$15,615.98"	.	"$3,123.20"																																																																																																																																																																																																																						
5481	Laser Eye Procedures	T	6.2622	$469.67	$101.51	$93.94																																																																																																																																																																																																																						
5491	Level 1 Intraocular Procedures	J1	24.3142	"$1,823.59"	.	$364.72																																																																																																																																																																																																																						
5492	Level 2 Intraocular Procedures	J1	45.5636	"$3,417.32"	.	$683.47																																																																																																																																																																																																																						
5493	Level 3 Intraocular Procedures	J1	109.3074	"$8,198.16"	.	"$1,639.64"																																																																																																																																																																																																																						
5494	Level 4 Intraocular Procedures	J1	160.5605	"$12,042.20"	.	"$2,408.44"																																																																																																																																																																																																																						
5495	Level 5 Intraocular Procedures	J1	253.1130	"$18,983.73"	.	"$3,796.75"																																																																																																																																																																																																																						
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.5783	$268.38	.	$53.68																																																																																																																																																																																																																						
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	10.3231	$774.24	.	$154.85																																																																																																																																																																																																																						
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	22.6765	"$1,700.76"	.	$340.16																																																																																																																																																																																																																						
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	36.9816	"$2,773.66"	.	$554.74																																																																																																																																																																																																																						
5521	Level 1 Imaging without Contrast	S	0.7978	$59.84	.	$11.97																																																																																																																																																																																																																						
5522	Level 2 Imaging without Contrast	S	1.5025	$112.69	.	$22.54																																																																																																																																																																																																																						
5523	Level 3 Imaging without Contrast	S	3.0108	$225.81	.	$45.17																																																																																																																																																																																																																						
5524	Level 4 Imaging without Contrast	S	5.9932	$449.50	.	$89.90																																																																																																																																																																																																																						
5571	Level 1 Imaging with Contrast	S	3.5320	$264.90	.	$52.98																																																																																																																																																																																																																						
5572	Level 2 Imaging with Contrast	S	5.6845	$426.34	$111.70	$85.27																																																																																																																																																																																																																						
5573	Level 3 Imaging with Contrast	S	8.7550	$656.63	.	$131.33																																																																																																																																																																																																																						
5591	Level 1 Nuclear Medicine and Related Services 	S	4.4391	$332.94	.	$66.59																																																																																																																																																																																																																						
5592	Level 2 Nuclear Medicine and Related Services	S	5.7193	$428.95	.	$85.79																																																																																																																																																																																																																						
5593	Level 3 Nuclear Medicine and Related Services 	S	15.1793	"$1,138.46"	.	$227.70																																																																																																																																																																																																																						
5594	Level 4 Nuclear Medicine and Related Services	S	17.6127	"$1,320.97"	.	$264.20																																																																																																																																																																																																																						
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5671	$117.53	$32.44	$23.51																																																																																																																																																																																																																						
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.1524	$311.43	.	$62.29																																																																																																																																																																																																																						
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	14.2104	"$1,065.79"	.	$213.16																																																																																																																																																																																																																						
5621	Level 1 Radiation Therapy	S	1.5240	$114.30	.	$22.86																																																																																																																																																																																																																						
5622	Level 2 Radiation Therapy	S	2.7255	$204.42	.	$40.89																																																																																																																																																																																																																						
5623	Level 3 Radiation Therapy	S	6.5922	$494.42	.	$98.89																																																																																																																																																																																																																						
5624	Level 4 Radiation Therapy	S	9.8442	$738.32	.	$147.67																																																																																																																																																																																																																						
5625	Level 5 Radiation Therapy	S	13.2492	$993.70	.	$198.74																																																																																																																																																																																																																						
5626	Level 6 Radiation Therapy	S 	22.0076	"$1,650.59"	.	$330.12																																																																																																																																																																																																																						
5627	Level 7 Radiation Therapy	J1	99.3699	"$7,452.84"	.	"$1,490.57"																																																																																																																																																																																																																						
5661	Therapeutic Nuclear Medicine	S	2.8878	$216.59	.	$43.32																																																																																																																																																																																																																						
5671	Level 1 Pathology	S	0.5291	$39.68	.	$7.94																																																																																																																																																																																																																						
5672	Level 2 Pathology	S	1.3844	$103.83	.	$20.77																																																																																																																																																																																																																						
5673	Level 3 Pathology	S	2.4524	$183.93	.	$36.79																																																																																																																																																																																																																						
5674	Level 4 Pathology	S	6.0529	$453.97	.	$90.80																																																																																																																																																																																																																						
5691	Level 1 Drug Administration	S	0.4635	$34.76	.	$6.96																																																																																																																																																																																																																						
5692	Level 2 Drug Administration	S	0.7086	$53.15	.	$10.63																																																																																																																																																																																																																						
5693	Level 3 Drug Administration	S	2.3959	$179.69	.	$35.94																																																																																																																																																																																																																						
5694	Level 4 Drug Administration	S	3.7243	$279.33	.	$55.87																																																																																																																																																																																																																						
5721	Level1 Diagnostic Tests and Related Services	S	1.6940	$127.05	.	$25.41																																																																																																																																																																																																																						
5722	Level 2 Diagnostic Tests and Related Services	S	3.0961	$232.21	.	$46.45																																																																																																																																																																																																																						
5723	Level 3 Diagnostic Tests and Related Services	S	5.5425	$415.69	.	$83.14																																																																																																																																																																																																																						
5724	Level 4 Diagnostic Tests and Related Services	S	11.5223	$864.18	.	$172.84																																																																																																																																																																																																																						
5731	Level 1 Minor Procedures	S	0.1681	$12.61	.	$2.53																																																																																																																																																																																																																						
5732	Level 2 Minor Procedures	S	0.3782	$28.37	.	$5.68																																																																																																																																																																																																																						
5733	Level 3 Minor Procedures	S	0.7270	$54.53	.	$10.91																																																																																																																																																																																																																						
5734	Level 4 Minor Procedures	S	1.3330	$99.98	.	$20.00																																																																																																																																																																																																																						
5735	Level 5 Minor Procedures	S	3.5132	$263.49	.	$52.70																																																																																																																																																																																																																						
5741	Level 1 Electronic Analysis of Devices	S	0.4684	$35.13	.	$7.03																																																																																																																																																																																																																						
5742	Level 2 Electronic Analysis of Devices	S	1.4556	$109.17	.	$21.84																																																																																																																																																																																																																						
5743	Level 3 Electronic Analysis of Devices	S	3.3670	$252.53	.	$50.51																																																																																																																																																																																																																						
5771	Cardiac Rehabilitation	S	1.4690	$110.18	.	$22.04																																																																																																																																																																																																																						
5781	Resuscitation and Cardioversion	S	6.4151	$481.14	.	$96.23																																																																																																																																																																																																																						
5791	Pulmonary Treatment	S	2.1602	$162.02	.	$32.41																																																																																																																																																																																																																						
5801	Ventilation Initiation and Management	S	5.6502	$423.77	.	$84.76																																																																																																																																																																																																																						
5811	Manipulation Therapy	S	0.3282	$24.62	.	$4.93																																																																																																																																																																																																																						
5821	Level 1 Health and Behavior Services	S	0.3363	$25.22	.	$5.05																																																																																																																																																																																																																						
5822	Level 2 Health and Behavior Services	S	0.9364	$70.23	.	$14.05																																																																																																																																																																																																																						
5823	Level 3 Health and Behavior Services	S	1.6794	$125.96	.	$25.20																																																																																																																																																																																																																						
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.6197	$121.48	.	$24.30																																																																																																																																																																																																																						
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	2.7636	$207.27	.	$41.46																																																																																																																																																																																																																						
5871	Dental Procedures	S	6.8380	$512.86	.	$102.58																																																																																																																																																																																																																						
5881	Ancillary Outpatient Services When Patient Dies	J1	90.0188	"$6,751.50"	.	"$1,350.30"																																																																																																																																																																																																																						
7000	Amifostine	K		$416.53	.	$83.31																																																																																																																																																																																																																						
7011	Oprelvekin injection	K		$467.22	.	$93.45																																																																																																																																																																																																																						
7034	"	Somatropin injection"	K		$81.59	.	$16.32																																																																																																																																																																																																																						
7035	Teniposide	K		"$2,377.68"	.	$475.54																																																																																																																																																																																																																						
7041	Tirofiban HCl	K		$9.00	.	$1.80																																																																																																																																																																																																																						
7043	Infliximab not biosimil 10mg	K		$82.87	.	$16.58																																																																																																																																																																																																																						
7046	Doxorubicin inj 10mg	K		$435.44	.	$87.09																																																																																																																																																																																																																						
7048	Alteplase recombinant	K		$80.29	.	$16.06																																																																																																																																																																																																																						
7308	Aminolevulinic acid hcl top	K		$327.41	.	$65.49																																																																																																																																																																																																																						
8001	LDR Prostate Brachytherapy Composite	T	46.6497	"$3,498.77"	.	$699.76																																																																																																																																																																																																																						
8004	Ultrasound Composite	S	3.8431	$288.24	.	$57.65																																																																																																																																																																																																																						
8005	CT and CTA without Contrast Composite	S	3.6397	$272.98	.	$54.60																																																																																																																																																																																																																						
8006	CT and CTA with Contrast Composite	S	6.5222	$489.17	.	$97.84																																																																																																																																																																																																																						
8007	MRI and MRA without Contrast Composite	S	7.3535	$551.52	.	$110.31																																																																																																																																																																																																																						
8008	MRI and MRA with Contrast Composite	S	11.3509	$851.33	.	$170.27																																																																																																																																																																																																																						
8010	Mental Health Services Composite	S	2.7636	$207.27	.	$41.46																																																																																																																																																																																																																						
8011	Comprehensive Observation Services	J2	29.6223	"$2,221.70"	.	$444.34																																																																																																																																																																																																																						
9002	Tenecteplase injection	K		$102.43	.	$20.49																																																																																																																																																																																																																						
9003	Palivizumab	K		"$1,947.49"	.	$389.50																																																																																																																																																																																																																						
9005	Reteplase injection	K		"$2,301.91"	.	$460.39																																																																																																																																																																																																																						
9006	Tacrolimus injection	K		$163.77	.	$32.76																																																																																																																																																																																																																						
9012	Arsenic trioxide injection	K		$64.62	.	$12.93																																																																																																																																																																																																																						
9018	"Inj, rimabotulinumtoxinB"	K		$11.71	.	$2.35																																																																																																																																																																																																																						
9019	Caspofungin acetate	K		$12.21	.	$2.45																																																																																																																																																																																																																						
9024	Amphotericin b lipid complex	K		$13.41	.	$2.69																																																																																																																																																																																																																						
9032	Baclofen 10 MG injection	K		$173.43	.	$34.69																																																																																																																																																																																																																						
9033	Cidofovir injection	K		$554.48	.	$110.90																																																																																																																																																																																																																						
9038	Inj estrogen conjugate	K		$261.40	.	$52.28																																																																																																																																																																																																																						
9042	Glucagon hydrochloride	K		$199.12	.	$39.83																																																																																																																																																																																																																						
9043	Afstyla Factor VIII recomb	G		$1.95	.	$0.39																																																																																																																																																																																																																						
9044	Ibutilide fumarate injection	K		$186.19	.	$37.24																																																																																																																																																																																																																						
9052	Fluciciovine F-18	G		$389.55	.	$0.00																																																																																																																																																																																																																						
9056	Gallium Ga-68	G		$66.74	.	$0.00																																																																																																																																																																																																																						
9058	Buprenorphine implant 74.2mg	G		"$1,311.75"	.	$262.35																																																																																																																																																																																																																						
9059	Vonvendi inj 1 iu vwf:rco	G		$2.30	.	$0.46																																																																																																																																																																																																																						
9060	Diazoxide injection	K		$690.03	.	$138.01																																																																																																																																																																																																																						
9061	Inj milrinone lactate / 5 mg	K		$18.22	.	$3.65																																																																																																																																																																																																																						
9062	Topotecan injection	K		$3.06	.	$0.62																																																																																																																																																																																																																						
9104	Antithymocyte globuln rabbit	K		$690.84	.	$138.17																																																																																																																																																																																																																						
9108	Thyrotropin injection	K		"$1,571.30"	.	$314.26																																																																																																																																																																																																																						
9119	"Injection, pegfilgrastim 6mg"	K		"$4,040.69"	.	$808.14																																																																																																																																																																																																																						
9120	"Injection, Fulvestrant"	K		$95.77	.	$19.16																																																																																																																																																																																																																						
9122	Triptorelin pamoate	K		$460.85	.	$92.17																																																																																																																																																																																																																						
9124	Daptomycin injection	K		$0.90	.	$0.18																																																																																																																																																																																																																						
9125	"Risperidone, long acting"	K		$7.82	.	$1.57																																																																																																																																																																																																																						
9126	Natalizumab injection	K		$17.89	.	$3.58																																																																																																																																																																																																																						
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$39.52	.	$7.91																																																																																																																																																																																																																						
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$29.22	.	$5.85																																																																																																																																																																																																																						
9132	"Kcentra, per i.u."	K		$1.77	.	$0.36																																																																																																																																																																																																																						
9133	"Rabies ig, im/sc"	K		$305.48	.	$61.10																																																																																																																																																																																																																						
9134	"Rabies ig, heat treated"	K		$294.59	.	$58.92																																																																																																																																																																																																																						
9135	"Varicella-zoster ig, im"	K		"$1,230.98"	.	$246.20																																																																																																																																																																																																																						
9139	"Rabies vaccine, im"	K		$272.49	.	$54.50																																																																																																																																																																																																																						
9140	"Rabies vaccine, id"	K		$172.30	.	$34.46																																																																																																																																																																																																																						
9171	Factor ix idelvion inj	G		$4.18	.	$0.84																																																																																																																																																																																																																						
9207	Bortezomib injection	K		$46.52	.	$9.31																																																																																																																																																																																																																						
9208	Agalsidase beta injection	K		$164.42	.	$32.89																																																																																																																																																																																																																						
9209	Laronidase injection	K		$30.59	.	$6.12																																																																																																																																																																																																																						
9210	Palonosetron hcl	K		$22.88	.	$4.58																																																																																																																																																																																																																						
9213	Pemetrexed injection	K		$62.78	.	$12.56																																																																																																																																																																																																																						
9214	Bevacizumab injection	K		$72.31	.	$14.47																																																																																																																																																																																																																						
9215	Cetuximab injection	K		$55.63	.	$11.13																																																																																																																																																																																																																						
9217	Leuprolide acetate suspnsion	K		$225.01	.	$45.01																																																																																																																																																																																																																						
9224	Galsulfase injection	K		$364.41	.	$72.89																																																																																																																																																																																																																						
9225	Fluocinolone acetonide implt	K		"$20,126.60"	.	"$4,025.32"																																																																																																																																																																																																																						
9228	Tigecycline injection	K		$3.13	.	$0.63																																																																																																																																																																																																																						
9229	Ibandronate sodium injection	K		$101.96	.	$20.40																																																																																																																																																																																																																						
9230	Abatacept injection	K		$44.75	.	$8.95																																																																																																																																																																																																																						
9231	Decitabine injection	K		$20.83	.	$4.17																																																																																																																																																																																																																						
9232	Idursulfase injection	K		$522.04	.	$104.41																																																																																																																																																																																																																						
9233	Ranibizumab injection	K		$383.23	.	$76.65																																																																																																																																																																																																																						
9234	Alglucosidase alfa injection	K		$206.70	.	$41.34																																																																																																																																																																																																																						
9235	Panitumumab injection	K		$105.60	.	$21.12																																																																																																																																																																																																																						
9236	Eculizumab injection	K		$221.12	.	$44.23																																																																																																																																																																																																																						
9237	"Inj, lanreotide acetate"	K		$51.31	.	$10.27																																																																																																																																																																																																																						
9240	"Injection, ixabepilone"	K		$77.87	.	$15.58																																																																																																																																																																																																																						
9242	"Injection, fosaprepitant"	K		$1.89	.	$0.38																																																																																																																																																																																																																						
9243	"Inj., treanda 1 mg"	K		$27.01	.	$5.41																																																																																																																																																																																																																						
9245	Romiplostim injection	K		$62.14	.	$12.43																																																																																																																																																																																																																						
9248	"	Inj, clevidipine butyrate"	K		$2.89	.	$0.58																																																																																																																																																																																																																						
9251	C1 esterase inhibitor inj	K		$55.55	.	$11.11																																																																																																																																																																																																																						
9252	Plerixafor injection	K		$312.11	.	$62.43																																																																																																																																																																																																																						
9253	Temozolomide injection	K		$8.24	.	$1.65																																																																																																																																																																																																																						
9255	Paliperidone palmitate inj	K		$9.12	.	$1.83																																																																																																																																																																																																																						
9256	Dexamethasone intra implant	K		$200.90	.	$40.18																																																																																																																																																																																																																						
9258	Telavancin injection	K		$5.02	.	$1.01																																																																																																																																																																																																																						
9259	Pralatrexate injection	K		$229.72	.	$45.95																																																																																																																																																																																																																						
9260	Ofatumumab injection	K		$51.87	.	$10.38																																																																																																																																																																																																																						
9261	"Ustekinumab sub cu inj, 1 mg"	K		$174.57	.	$34.92																																																																																																																																																																																																																						
9263	Ecallantide injection	K		$399.56	.	$79.92																																																																																																																																																																																																																						
9264	Tocilizumab injection	K		$4.10	.	$0.82																																																																																																																																																																																																																						
9265	Romidepsin injection	K		$306.79	.	$61.36																																																																																																																																																																																																																						
9269	"C-1 esterase, berinert"	K		$46.52	.	$9.31																																																																																																																																																																																																																						
9270	Gammaplex IVIG	K		$37.03	.	$7.41																																																																																																																																																																																																																						
9271	Velaglucerase alfa	K		$343.35	.	$68.67																																																																																																																																																																																																																						
9272	"Inj, denosumab"	K		$16.23	.	$3.25																																																																																																																																																																																																																						
9273	Sipuleucel-T auto CD54+	K		"$37,763.36"	.	"$7,552.68"																																																																																																																																																																																																																						
9274	Crotalidae Poly Immune Fab	K		"$2,670.24"	.	$534.05																																																																																																																																																																																																																						
9276	Cabazitaxel injection	K		$154.57	.	$30.92																																																																																																																																																																																																																						
9278	Incobotulinumtoxin A	K		$4.91	.	$0.99																																																																																																																																																																																																																						
9281	"Injection, pegloticase"	K		"$1,642.46"	.	$328.50																																																																																																																																																																																																																						
9284	Ipilimumab injection	K		$142.65	.	$28.53																																																																																																																																																																																																																						
9286	Belatacept injection	K		$3.84	.	$0.77																																																																																																																																																																																																																						
9287	Brentuximab vedotin inj	K		$129.09	.	$25.82																																																																																																																																																																																																																						
9289	Erwinaze injection	K		$402.74	.	$80.55																																																																																																																																																																																																																						
9293	"Injection, glucarpidase "	K		$284.27	.	$56.86																																																																																																																																																																																																																						
9294	"Inj, Taliglucerace Alfa 10 u"	K		$40.46	.	$8.10																																																																																																																																																																																																																						
9295	"Injection, Carfilzomib, 1 mg"	K		$31.95	.	$6.39																																																																																																																																																																																																																						
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.45	.	$1.69																																																																																																																																																																																																																						
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.69	.	$0.54																																																																																																																																																																																																																						
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.75"	.	$209.35																																																																																																																																																																																																																						
9300	Omalizumab injection	K		$32.31	.	$6.47																																																																																																																																																																																																																						
9441	Inj ferric carboxymaltos 1mg	K		$1.05	.	$0.21																																																																																																																																																																																																																						
9445	"Injection, ruconest"	G		$27.95	.	$5.59																																																																																																																																																																																																																						
9448	Netupitant palonosetron oral	G		$461.97	.	$92.40																																																																																																																																																																																																																						
9449	"Injection, blinatumomab"	G		$98.79	.	$19.76																																																																																																																																																																																																																						
9450	Fluocinol acet intravit imp	G		$490.95	.	$98.19																																																																																																																																																																																																																						
9451	"Injection, peramivir"	G		$1.65	.	$0.33																																																																																																																																																																																																																						
9452	Inj ceftolozane tazobactam	G		$4.54	.	$0.91																																																																																																																																																																																																																						
9453	"Injection, nivolumab"	G		$26.06	.	$5.22																																																																																																																																																																																																																						
9454	"Inj, pasireotide long acting"	G		$265.36	.	$53.08																																																																																																																																																																																																																						
9455	"Injection, siltuximab"	G		$9.00	.	$1.80																																																																																																																																																																																																																						
9456	"Injection, isavuconazonium"	G		$0.64	.	$0.13																																																																																																																																																																																																																						
9457	Inj sulf hexa lipid microsph	G		$22.33	.	$0.00																																																																																																																																																																																																																						
9458	florbetaben f18 diagnostic	G		"$2,968.00"	.	$0.00																																																																																																																																																																																																																						
9459	flutemetamol f18 diagnostic	G		"$3,135.00"	.	$0.00																																																																																																																																																																																																																						
9460	"Injection, cangrelor"	G		$15.48	.	$3.10																																																																																																																																																																																																																						
9461	"Choline c-11, diagnostic, per study dose up to 20 millicuries"	G		"$5,700.00"	.	$0.00																																																																																																																																																																																																																						
9470	Aripiprazole lauroxil 1mg	G		$2.37	.	$0.48																																																																																																																																																																																																																						
9471	Hymovis injection 1 mg	G		$16.41	.	$3.29																																																																																																																																																																																																																						
9472	Inj talimogene laherparepvec	G		$46.28	.	$9.26																																																																																																																																																																																																																						
9473	"Injection, mepolizumab, 1mg"	G		$25.93	.	$5.19																																																																																																																																																																																																																						
9474	Inj irinotecan liposome 1 mg	G		$39.55	.	$7.91																																																																																																																																																																																																																						
9475	"Injection, necitumumab, 1 mg"	G		$5.28	.	$1.06																																																																																																																																																																																																																						
9476	"Injection, daratumumab 10 mg"	G		$46.85	.	$9.37																																																																																																																																																																																																																						
9477	"Injection, elotuzumab, 1mg"	G		$6.25	.	$1.25																																																																																																																																																																																																																						
9478	Inj sebelipase alfa 1 mg	G		$530.00	.	$106.00																																																																																																																																																																																																																						
9479	"Instill, ciprofloxacin otic"	G		$30.00	.	$6.00																																																																																																																																																																																																																						
9480	Injection trabectedin 0.1mg	G		$283.34	.	$56.67																																																																																																																																																																																																																						
9481	"Injection, reslizumab"	G		$8.67	.	$1.74																																																																																																																																																																																																																						
9482	Sotalol hydrochloride IV	G		$9.99	.	$2.00																																																																																																																																																																																																																						
9483	"Injection, atezolizumab"	G		$75.76	.	$15.16																																																																																																																																																																																																																						
9497	"Loxapine, inhalation powder"	K		$153.70	.	$30.74																																																																																																																																																																																																																						
9500	"Platelets, irradiated"	R	2.2312	$167.34	.	$33.47																																																																																																																																																																																																																						
9501	Platelet pheres leukoreduced	R	6.6631	$499.74	.	$99.95																																																																																																																																																																																																																						
9502	Platelet pheresis irradiated	R	7.4179	$556.35	.	$111.27																																																																																																																																																																																																																						
9503	Fr frz plasma donor retested	R	0.8955	$67.16	.	$13.44																																																																																																																																																																																																																						
9504	RBC deglycerolized	R	5.1122	$383.42	.	$76.69																																																																																																																																																																																																																						
9505	RBC irradiated	R	2.9180	$218.85	.	$43.77																																																																																																																																																																																																																						
9507	"Platelets, pheresis"	R	5.4922	$411.92	.	$82.39																																																																																																																																																																																																																						
9508	Plasma 1 donor frz w/in 8 hr	R	0.9826	$73.70	.	$14.74																																																																																																																																																																																																																						
9509	"Frozen plasma, pooled, sd"	R	0.8906	$66.80	.	$13.36																																																																																																																																																																																																																						
9510	Whole blood for transfusion	R	2.0725	$155.44	.	$31.09																																																																																																																																																																																																																						
9511	Cryoprecipitate each unit	R	0.7067	$53.00	.	$10.60																																																																																																																																																																																																																						
9512	RBC leukocytes reduced	R	2.4766	$185.75	.	$37.15																																																																																																																																																																																																																						
9513	"Plasma, frz between 8-24hour"	R	0.9863	$73.97	.	$14.80																																																																																																																																																																																																																						
9514	"Plasma protein fract,5%,50ml"	R	0.2634	$19.76	.	$3.96																																																																																																																																																																																																																						
9515	"Platelets, each unit"	R	1.2860	$96.45	.	$19.29																																																																																																																																																																																																																						
9516	Plaelet rich plasma unit	R	1.7550	$131.63	.	$26.33																																																																																																																																																																																																																						
9517	Red blood cells unit	R	1.8973	$142.30	.	$28.46																																																																																																																																																																																																																						
9518	Washed red blood cells unit	R	4.5896	$344.22	.	$68.85																																																																																																																																																																																																																						
9519	"Plasmaprotein fract,5%,250ml"	R	1.2351	$92.63	.	$18.53																																																																																																																																																																																																																						
9520	Blood split unit	R	1.7590	$131.93	.	$26.39																																																																																																																																																																																																																						
9521	Platelets leukoreduced irrad	R	2.1603	$162.02	.	$32.41																																																																																																																																																																																																																						
9522	RBC leukoreduced irradiated	R	3.5489	$266.17	.	$53.24																																																																																																																																																																																																																						
9523	Cryoprecipitatereducedplasma	R	0.8435	$63.26	.	$12.66																																																																																																																																																																																																																						
9524	"Blood, l/r, cmv-neg"	R	2.7518	$206.39	.	$41.28																																																																																																																																																																																																																						
9525	"Platelets, hla-m, l/r, unit"	R	9.8376	$737.83	.	$147.57																																																																																																																																																																																																																						
9526	Platelets leukocytes reduced	R	1.6757	$125.68	.	$25.14																																																																																																																																																																																																																						
9527	"Blood, l/r, froz/degly/wash"	R	3.6728	$275.46	.	$55.10																																																																																																																																																																																																																						
9528	"Plt, aph/pher, l/r, cmv-neg"	R	5.6242	$421.82	.	$84.37																																																																																																																																																																																																																						
9529	"Blood, l/r, irradiated"	R	1.6576	$124.32	.	$24.87																																																																																																																																																																																																																						
9530	Plate pheres leukoredu irrad	R	8.6282	$647.12	.	$129.43																																																																																																																																																																																																																						
9531	"Plt, pher, l/r cmv-neg, irr"	R	8.2483	$618.63	.	$123.73																																																																																																																																																																																																																						
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	2.7649	$207.37	.	$41.48																																																																																																																																																																																																																						
9533	"RBC, l/r, cmv-neg, irrad"	R	3.3332	$249.99	.	$50.00																																																																																																																																																																																																																						
9534	Pathogen reduced plasma pool	R	0.9863	$73.97	.	$14.80																																																																																																																																																																																																																						
9535	Pathogen reduced plasma sing	R	0.9826	$73.70	.	$14.74																																																																																																																																																																																																																						
9536	Pathogen reduced platelets	R	8.6282	$647.12	.	$129.43																																																																																																																																																																																																																						
