2021 HCPCS	2021 Short Description	2021 Days	2021 Units	2021 Total Cost	2021 Minimum Unit Cost	2021 Maximum Unit Cost	2021 Arithmetic Mean Unit Cost	2021 Geometric Mean Unit Cost	2021 Geometric Mean Day Cost	2021 Median Unit Cost	2021 Median Day Cost	2021 CV (%) of Unit Cost	Proposed CY 2023 XRef HCPCS/CPT Code(s)	Proposed CY 2023 XRef SI	Proposed CY 2023  XRef APC	Proposed CY 2023 Payment Rate
P9010	Whole blood for transfusion	112	156	41459.55	40.96	915.48	265.77	235.73	297.65	235.33	235.33	58.23	P9010	R	9510	$235.73
P9011	Blood split unit	671	797	150898.4	15.39	1536.83	189.33	145.48	165.01	132.48	170.46	93.204	P9011	R	9520	$145.48
P9012	Cryoprecipitate each unit	424	2368	224518.66	11.93	831.2	94.81	76.98	334.77	75.81	323.81	183.679	P9012	R	9511	$76.98
P9016	Rbc leukocytes reduced	224647	334219	75928178.75	22.9	1642.54	227.18	194.44	273.07	204.6	274.73	70.052	P9016	R	9512	$194.44
P9017	Plasma 1 donor frz w/in 8 hr	2350	7647	819050.56	3.94	845.65	107.11	87.35	192.62	79.33	203.98	137.068	P9017	R	9508	$87.35
P9019	"Platelets, each unit"	313	1203	105135.66	29.43	489.15	87.39	79.67	275.8	106.03	424.12	108.33	P9019	R	9515	$79.67
P9020	Plaelet rich plasma unit	21	21	9673.78	450.48	625.23	460.66	459.45	459.45	452.53	452.53	8.186	P9020	R	9516	$459.45
P9021	Red blood cells unit	4922	7565	1374630.23	12.28	1900.51	181.71	140.24	193.88	124.2	171.62	97.563	P9021	R	9517	$140.24
P9022	Washed red blood cells unit	686	1488	747637.14	21.91	1364.06	502.44	409.8	679.04	406.65	630.53	92.594	P9022	R	9518	$409.80
P9023	"Frozen plasma, pooled, sd"	105	291	28202.83	29.4	299.24	96.92	94.34	239.53	105.28	315.83	39.179	P9023	R	9509	$94.34
P9031	Platelets leukocytes reduced	419	1371	233567.39	22.38	1271.19	170.36	132.3	384.11	131.93	413.78	166.437	P9031	R	9526	$132.30
P9032	"Platelets, irradiated"	448	1852	273612.56	146.23	171.87	147.74	147.73	606.47	146.23	584.91	2.694	P9032	R	9500	$147.73
P9033	Platelets leukoreduced irrad	1942	4648	1540580.89	45.18	1201.97	331.45	267.67	600.37	288.55	604.14	106.718	P9033	R	9521	$267.67
P9034	"Platelets, pheresis"	1866	2237	1143808.15	15.08	4253.17	511.31	349.29	407.81	501.24	536.63	85.048	P9034	R	9507	$349.29
P9035	Platelet pheres leukoreduced	22697	27163	15770011.29	72.22	3014.35	580.57	500.11	577.12	509.6	583.18	60.968	P9035	R	9501	$500.11
P9036	Platelet pheresis irradiated	846	923	618959.27	233.55	1539.83	670.6	632.38	678.81	593.85	779.16	33.697	P9036	R	9502	$632.38
P9037	Plate pheres leukoredu irrad	35142	39587	29984163.39	105.11	4365.38	757.42	658.54	725.3	691.19	753.88	55.923	P9037	R	9530	$658.54
P9038	Rbc irradiated	1139	1595	395052.52	62.09	797.48	247.68	202.52	277.65	211.41	242.53	74.467	P9038	R	9505	$202.52
P9039	Rbc deglycerolized	21	29	19699.54	94.4	1718.73	679.29	431.82	673.48	516.85	693.18	99.655	P9039	R	9504	$431.82
P9040	Rbc leukoreduced irradiated	105206	140788	42130296.42	44.85	1556.23	299.25	266.38	337.33	268.26	338.76	56.507	P9040	R	9522	$266.38
P9044	Cryoprecipitatereducedplasma	149	297	21892.36	23.16	285.97	73.71	66.01	127.02	51.78	103.56	82.308	P9044	R	9523	$66.01
P9048	"Plasmaprotein fract,5%,250ml"	8	49	7744.19	37.54	169.39	158.04	152.11	511.14	169.39	946.09	53.391	P9048	R	9519	$152.11
P9051	"Blood, l/r, cmv-neg"	432	663	152198.07	12.98	715.92	229.56	204.22	284.51	184.81	268.42	59.428	P9051	R	9524	$204.22
P9052	"Platelets, hla-m, l/r, unit"	1018	1212	1225057.05	199.08	3161.95	1010.77	883.18	1029.74	918.5	997.79	58.092	P9052	R	9525	$883.18
P9053	"Plt, pher, l/r cmv-neg, irr"	580	703	441486.44	147.03	2693.69	628	554.01	646.4	621.03	623.45	69.603	P9053	R	9531	$554.01
P9054	"Blood, l/r, froz/degly/wash"	92	129	66284.37	41.42	2328.36	513.83	311.12	406.47	222.61	407.45	153.413	P9054	R	9527	$311.12
P9055	"Plt, aph/pher, l/r, cmv-neg"	151	183	76846.94	156.8	1024.32	419.93	345.21	408.58	235.32	330.06	77.047	P9055	R	9528	$345.21
P9056	"Blood, l/r, irradiated"	459	685	87213.67	40.34	544.32	127.32	110.7	157.81	116.17	149.5	69.345	P9056	R	9529	$110.70
P9057	"Rbc, frz/deg/wsh, l/r, irrad"	152	261	111780.92	171.21	999.36	428.28	405.81	666.55	354.58	709.15	48.153	P9057	R	9532	$405.81
P9058	"Rbc, l/r, cmv-neg, irrad"	1470	1984	594320.27	58.52	1035.13	299.56	260.31	344.09	274.42	347.98	67.075	P9058	R	9533	$260.31
P9059	"Plasma, frz between 8-24hour"	2074	6079	564898.58	5	797.28	92.93	77.83	154.01	87.42	135.42	99.975	P9059	R	9513	$77.83
P9060	Fr frz plasma donor retested	11	11	705.06	40.94	200.35	64.1	57.09	57.09	51.19	51.19	70.692	P9060	R	9503	$57.09
P9070	Pathogen reduced plasma pool	4	8	1844.61	40.27	1499.47	230.58	75.08	191.78	52.92	146.11	339.682	P9070	R	9534	$75.08
P9071	Pathogen reduced plasma sing	8	13	2119.42	31.96	1008.46	163.03	91.42	133.2	99.3	99.3	208.599	P9071	R	9535	$91.42
P9073	Platelets pheresis path redu	29098	32477	22399855.8	87.45	2924.56	689.71	594.14	647.85	613.62	679.42	56.103	P9073	R	9536	$594.14
P9099	Blood component/product noc	87	87	37412.24	263.5	796.95	430.03	419.48	419.48	416.07	416.07	24.853	P9099	R	9537	$419.48
