	Addendum A.- Final OPPS APCs for CY 2021								
 APC 	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 	"Note: Actual copayments would be lower due to the cap on copayments at the Inpatient Deductible of  $1,484.00 "	Drug Pass-Through Expiration during Calendar Year	* Indicates a Change 
0701	Sr89 strontium	K		"$3,975.000"	.	$795.00			*
0726	Dexrazoxane HCl injection	K		$195.983	.	$39.20			*
0731	Sargramostim injection	K		$48.832	.	$9.77			*
0736	Amphotericin b liposome inj	K		$27.239	.	$5.45			*
0738	Rasburicase	K		$306.135	.	$61.23			*
0751	Mechlorethamine hcl inj	K		$328.290	.	$65.66			*
0752	Dactinomycin injection	K		$934.158	.	$186.84			*
0759	"Naltrexone, depot form"	K		$3.428	.	$0.69			*
0800	Leuprolide acetate	K		"$1,582.132"	.	$316.43			*
0802	Etoposide oral	K		$75.769	.	$15.16			*
0807	Aldesleukin injection	K		"$3,795.260"	.	$759.06			*
0810	Goserelin acetate implant	K		$501.266	.	$100.26			*
0812	Carmustine injection	K		"$1,743.245"	.	$348.65			*
0820	Daunorubicin injection	K		$42.520	.	$8.51			*
0825	Nelarabine injection	K		$151.888	.	$30.38			*
0836	Interferon alfa-2b inj	K		$33.990	.	$6.80			*
0840	Inj melpha hydroch nos 50 mg	K		$228.788	.	$45.76			*
0843	Pegaspargase injection	K		"$19,717.463"	.	"$3,943.50"	*		*
0844	Pentostatin injection	K		"$2,001.895"	.	$400.38			*
0850	Streptozocin injection	K		$348.727	.	$69.75			*
0851	Thiotepa injection	K		$454.817	.	$90.97			*
0856	Porfimer sodium injection	K		"$21,856.352"	.	"$4,371.28"	*		*
0858	Inj cladribine	K		$21.023	.	$4.21			*
0864	Mitoxantrone hydrochl	K		$24.140	.	$4.83			*
0874	Synvisc or synvisc-one	K		$10.671	.	$2.14			*
0875	Euflexxa inj per dose	K		$135.139	.	$27.03			*
0877	Orthovisc inj per dose	K		$128.547	.	$25.71			*
0887	Azathioprine parenteral	K		$245.170	.	$49.04			*
0890	Lymphocyte immune globulin	K		"$2,257.645"	.	$451.53			*
0901	Alpha 1 proteinase inhibitor	K		$4.523	.	$0.91			*
0902	"Injection,onabotulinumtoxinA"	K		$6.063	.	$1.22			*
0903	Cytomegalovirus imm IV /vial	K		"$1,467.015"	.	$293.41			*
0910	Interferon beta-1b / .25 MG	K		$393.469	.	$78.70			*
0925	Factor viii	K		$1.070	.	$0.22			*
0927	Factor viii recombinant	K		$1.348	.	$0.27			*
0928	Factor ix complex	K		$1.480	.	$0.30			*
0929	Anti-inhibitor	K		$2.085	.	$0.42			*
0931	Factor IX non-recombinant	K		$1.192	.	$0.24			*
0932	Factor ix recombinant nos	K		$1.532	.	$0.31			*
0943	Octagam injection	K		$41.632	.	$8.33			*
0944	Gammagard liquid injection	K		$43.626	.	$8.73			*
0946	Hepagam b im injection	K		$65.605	.	$13.13			*
0947	Flebogamma injection	K		$36.859	.	$7.38			*
0948	Gamunex-C/Gammaked	K		$43.673	.	$8.74			*
0961	"Albumin (human),5%, 50ml"	K		$10.490	.	$2.10			*
0963	"Albumin (human), 5%, 250 ml"	K		$52.450	.	$10.49			*
0964	"Albumin (human), 25%, 20 ml"	K		$20.980	.	$4.20			*
0965	"Albumin (human), 25%, 50ml"	K		$52.450	.	$10.49			*
1015	Injection glatiramer acetate	K		$153.120	.	$30.63			*
1064	"I131 iodide cap, rx"	K		$20.120	.	$4.03			*
1083	Adalimumab injection	K		"$1,430.920"	.	$286.19			*
1138	"Hepagam b intravenous, inj"	K		$66.748	.	$13.35			*
1139	Protein c concentrate	K		$15.084	.	$3.02			*
1142	Supprelin LA implant	K		"$40,116.002"	.	"$8,023.21"	*		*
1150	"I131 iodide sol, rx"	K		$13.340	.	$2.67			*
1168	"Inj, temsirolimus"	K		$42.858	.	$8.58			*
1178	Busulfan injection	K		$2.130	.	$0.43			*
1203	Verteporfin injection	K		$11.246	.	$2.25			*
1207	"Octreotide injection, depot"	K		$205.658	.	$41.14			*
1213	Antihemophilic viii/vwf comp	K		$1.123	.	$0.23			*
1214	Inj IVIG privigen 500 mg	K		$42.427	.	$8.49			*
1232	Mitomycin injection	K		$54.238	.	$10.85			*
1235	Valrubicin injection	K		"$1,513.404"	.	$302.69			*
1236	Inj levoleucovorin nos 0.5mg	K		$0.115	.	$0.03			*
1237	Inj iron dextran	K		$15.054	.	$3.02			*
1263	Antithrombin iii injection	K		$3.480	.	$0.70			*
1268	Xyntha inj	K		$1.230	.	$0.25			*
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"			*
1281	Bevacizumab injection	K		$1.879	.	$0.38			*
1289	AbobotulinumtoxinA	K		$8.270	.	$1.66			*
1295	Sm 153 lexidronam	K		"$17,089.609"	.	"$3,417.93"	*		*
1296	Degarelix injection	K		$3.890	.	$0.78			*
1297	"Ferumoxytol, non-esrd"	K		$0.932	.	$0.19			*
1311	Canakinumab injection	K		$113.258	.	$22.66			*
1312	Hizentra injection	K		$11.094	.	$2.22			*
1327	Imiglucerase injection	K		$43.380	.	$8.68			*
1331	Olanzapine long-acting inj	K		$2.917	.	$0.59			*
1340	"Collagenase, clost hist inj"	K		$52.616	.	$10.53			*
1341	Amobarbital 125 MG inj	K		$125.220	.	$25.05			*
1352	Wilate injection	K		$1.035	.	$0.21			*
1353	Belimumab injection	K		$46.835	.	$9.37			*
1408	Cyclophosphamide 100 MG inj	K		$31.164	.	$6.24			*
1413	Lumizyme injection	K		$174.632	.	$34.93			*
1415	Glassia injection	K		$4.887	.	$0.98			*
1416	Factor xiii anti-hem factor	K		$8.783	.	$1.76			*
1417	Gel-one	K		"$1,219.000"	.	$243.80			*
1420	Aflibercept injection	K		$921.755	.	$184.36			*
1421	Imported lipodox inj	K		$311.040	.	$62.21			*
1426	Eribulin mesylate injection	K		$117.762	.	$23.56			*
1431	Centruroides immune f(ab)	K		"$5,063.557"	.	"$1,012.72"			*
1433	Calcitonin salmon injection	K		"$2,830.550"	.	$566.11			*
1440	Inj desmopressin acetate	K		$10.572	.	$2.12			*
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00			
1443	Icatibant injection	K		$273.603	.	$54.73			*
1446	Visualization adjunct	K		$6.204	.	$1.25			*
1458	Phentolaine mesylate inj	K		$356.884	.	$71.38			*
1466	"Inj, vincristine sul lip 1mg"	K		"$3,320.397"	.	$664.08			*
1467	Factor ix recombinan rixubis	K		$1.455	.	$0.30			*
1468	Inj Aripiprazole Ext Rel 1mg	K		$5.703	.	$1.15			*
1469	Inj filgrastim excl biosimil	K		$0.938	.	$0.19			*
1471	"Injection, Pertuzumab, 1 mg"	K		$12.985	.	$2.60			*
1472	Inj beta interferon im 1 mcg	K		$54.417	.	$10.89			*
1474	Certolizumab pegol inj 1mg	K		$8.182	.	$1.64			*
1475	Golimumab for iv use 1mg	K		$18.124	.	$3.63			*
1476	Obinutuzumab inj	K		$63.543	.	$12.71			*
1478	Inj human fibrinogen con nos	K		$1.257	.	$0.26			*
1480	"Elosulfase alfa, injection"	K		$245.342	.	$49.07			*
1482	"	Darbepoetin alfa, esrd use"	K		$3.558	.	$0.72			*
1485	"	Ferumoxytol, esrd use"	K		$0.932	.	$0.19			*
1486	Factor ix fc fusion recomb	K		$3.257	.	$0.66			*
1488	"Injection, ramucirumab"	K		$61.657	.	$12.34			*
1489	"Injection, vedolizumab"	K		$20.348	.	$4.07			*
1490	Inj pembrolizumab	K		$50.648	.	$10.13			*
1491	New Technology  - Level 1A ($0-$10)	S		$5.00	.	$1.01			
1492	New Technology  - Level 1B ($11-$20)	S		$15.50	.	$3.10			
1493	New Technology  - Level 1C ($21-$30)	S		$25.50	.	$5.11			
1494	New Technology  - Level 1D ($31-$40)	S		$35.50	.	$7.11			
1495	New Technology  - Level 1E ($41-$50)	S		$45.50	.	$9.10			
1496	New Technology  - Level 1A ($0-$10)	T		$5.00	.	$1.01			
1497	New Technology  - Level 1B ($11-$20)	T		$15.50	.	$3.10			
1498	New Technology  - Level 1C ($21-$30)	T		$25.50	.	$5.11			
1499	New Technology  - Level 1D ($31-$40)	T		$35.50	.	$7.11			
1500	New Technology  - Level 1E ($41-$50)	T		$45.50	.	$9.10			
1502	New Technology - Level 2 ($51 - $100)	S		$75.50	.	$15.11			
1503	New Technology - Level 3 ($101 - $200)	S		$150.50	.	$30.10			
1504	New Technology - Level 4 ($201 - $300)	S		$250.50	.	$50.11			
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	.	$110.11			
1508	New Technology - Level 8 ($601 - $700)	S		$650.50	.	$130.11			
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	.	$190.11			
1512	New Technology - Level 12 ($1001 - $1100)	S		"$1,050.50"	.	$210.11			
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"	.	$270.11			
1516	New Technology - Level 16  ($1401 - $1500)	S		"$1,450.50"	.	$290.11			
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"	.	$350.11			
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"	.	$650.11			
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"	.	$950.11			
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"	.	"$1,250.11"			
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"	.	"$1,550.11"	*		
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"	.	"$1,850.11"	*		
1537	New Technology - Level 37 ($9501-$10000)	S		"$9,750.50"	.	"$1,950.10"	*		
1539	New Technology - Level 2 ($51 - $100)	T		$75.50	.	$15.11			
1540	New Technology - Level 3 ($101 - $200)	T		$150.50	.	$30.10			
1541	New Technology - Level 4 ($201 - $300)	T		$250.50	.	$50.11			
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	.	$110.11			
1545	New Technology - Level 8 ($601 - $700)	T		$650.50	.	$130.11			
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	.	$190.11			
1549	New Technology - Level 12 ($1001 - $1100)	T		"$1,050.50"	.	$210.11			
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"	.	$270.11			
1553	New Technology - Level 16 ($1401 - $1500)	T		"$1,450.50"	.	$290.11			
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"	.	$350.11			
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"	.	$650.11			
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"	.	$950.11			
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"	.	"$1,250.11"			
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"	.	"$1,550.11"	*		
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"	.	"$1,850.11"	*		
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"	.	"$2,500.11"	*		
1576	"New Technology - Level 39 ($15,001-$20,000)"	S		"$17,500.50"	.	"$3,500.11"	*		
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"	.	"$5,500.11"	*		
1579	"New Technology - Level 42 ($30,001-$40,000)"	S		"$35,000.50"	.	"$7,000.11"	*		
1580	"New Technology - Level 43 ($40,001-$50,000)"	S		"$45,000.50"	.	"$9,000.11"	*		
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"	.	"$15,000.11"	*		
1584	"New Technology - Level 47 ($80,001-$90,000)"	S		"$85,000.50"	.	"$17,000.11"	*		
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"	.	"$2,500.11"	*		
1590	"New Technology - Level 39 ($15,001-$20,000)"	T		"$17,500.50"	.	"$3,500.11"	*		
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"	.	"$5,500.11"	*		
1593	"New Technology - Level 42 ($30,001-$40,000)"	T		"$35,000.50"	.	"$7,000.11"	*		
1594	"New Technology - Level 43 ($40,001-$50,000)"	T		"$45,000.50"	.	"$9,000.11"	*		
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"	.	"$15,000.11"	*		
1598	"New Technology - Level 47 ($80,001-$90,000)"	T		"$85,000.50"	.	"$17,000.11"	*		
1599	"New Technology - Level 48 ($90,001-$100,000)"	T		"$95,000.50"	.	"$19,000.10"	*		
1608	Etanercept injection	K		$736.295	.	$147.26			*
1609	"Rho(D) immune globulin h, sd"	K		$29.402	.	$5.89			*
1613	Inj trastuzumab excl biosimi	K		$97.921	.	$19.59			*
1630	"Hep b ig, im"	K		$126.858	.	$25.38			*
1643	"Y90 ibritumomab, rx"	K		"$58,910.178"	.	"$11,782.04"	*		*
1656	Factor viii fc fusion recomb	K		$2.173	.	$0.44			*
1658	"Injection, belinostat, 10mg"	K		$42.702	.	$8.55			*
1660	"Injection, oritavancin"	K		$23.818	.	$4.77			*
1662	Inj tedizolid phosphate	K		$1.587	.	$0.32			*
1669	Erythro lactobionate /500 mg	K		$76.845	.	$15.37			
1670	Tetanus immune globulin inj	K		$469.950	.	$93.99			*
1675	P32 Na phosphate	K		$458.340	.	$91.67			*
1683	Basiliximab	K		"$4,019.070"	.	$803.82			*
1684	Corticorelin ovine triflutal	K		$9.570	.	$1.92			*
1685	"Darbepoetin alfa, non-esrd"	K		$3.558	.	$0.72			*
1686	"Epoetin alfa, non-esrd"	K		$8.824	.	$1.77			*
1687	Digoxin immune fab (ovine)	K		"$3,969.268"	.	$793.86			*
1688	Ethanolamine oleate	K		$444.099	.	$88.82			*
1689	Fomepizole	K		$7.389	.	$1.48			*
1690	Hemin	K		$24.431	.	$4.89			*
1694	Ziconotide injection	K		$8.480	.	$1.70			*
1696	Palifermin injection	K		$22.821	.	$4.57			*
1700	Inj secretin synthetic human	K		$34.781	.	$6.96			*
1701	Treprostinil injection	K		$64.031	.	$12.81			*
1704	"Humate-P, inj"	K		$1.220	.	$0.25			*
1705	Factor viia recomb novoseven	K		$2.263	.	$0.46			*
1709	Azacitidine injection	K		$0.914	.	$0.19			*
1710	Clofarabine injection	K		$30.178	.	$6.04			*
1711	Vantas implant	K		"$4,586.214"	.	$917.25			*
1712	Paclitaxel protein bound	K		$13.431	.	$2.69			*
1739	"Pegademase bovine, 25 iu"	K		"$1,471.845"	.	$294.37			*
1745	Radium ra223 dichloride ther	K		$143.387	.	$28.68			*
1746	Factor xiii recomb a-subunit	K		$15.451	.	$3.10			*
1747	Monovisc inj per dose	K		$785.187	.	$157.04			*
1748	Inj tbo filgrastim 1 microg	K		$0.459	.	$0.10			*
1761	"Rolapitant, oral, 1mg"	K		$2.341	.	$0.47			*
1809	"Injection, alemtuzumab"	K		"$2,017.449"	.	$403.49			*
1822	"Injection, zarxio"	K		$0.413	.	$0.09			*
1823	"Injection, dalbavancin"	K		$15.393	.	$3.08			*
1824	"	Ceftaroline fosamil inj"	K		$3.347	.	$0.67			*
1825	Ceftazidime and avibactam	K		$92.283	.	$18.46			*
1826	Hyqvia 100mg immuneglobulin	K		$14.336	.	$2.87			*
1827	Factor viii recomb obizur	K		$3.191	.	$0.64			*
1829	"	Penicillin g benzathine inj"	K		$15.104	.	$3.03			*
1832	Dimethyl sulfoxide 50% 50 ml	K		$635.873	.	$127.18			*
1844	Factor viii pegylated recomb	K		$1.848	.	$0.37			*
1846	Factor viii nuwiq recomb 1iu	K		$1.259	.	$0.26			*
1847	"Injection, inflectra"	K		$43.059	.	$8.62			*
1848	Artiss fibrin sealant	K		$156.842	.	$31.37			*
1849	Foscarnet sodium injection	K		$82.268	.	$16.46			*
1850	Gamma globulin 1 cc inj	K		$43.296	.	$8.66			*
1851	Gamma globulin > 10 cc inj	K		$432.957	.	$86.60			*
1852	Interferon beta-1a inj	K		"$2,293.850"	.	$458.77			*
1853	Minocycline hydrochloride	K		$1.996	.	$0.40			*
1854	Pentobarbital sodium inj	K		$29.871	.	$5.98			*
1856	Factor viii recomb novoeight	K		$1.361	.	$0.28			*
1857	"Inj, factor x, (human), 1iu"	K		$7.891	.	$1.58			*
1859	Argatroban nonesrd use 1mg	K		$1.453	.	$0.30			*
1861	"Inj., bendeka 1 mg"	K		$20.173	.	$4.04			*
1862	Gelsyn-3 injection 0.1 mg	K		$2.177	.	$0.44			*
1901	"New Technology - Level 49 ($100,001-$115,000)"	S		"$107,500.50"	.	"$21,500.11"	*		
1902	"New Technology - Level 49 ($100,001-$115,000)"	T		"$107,500.50"	.	"$21,500.11"	*		
1903	"New Technology - Level 50 ($115,001-$130,000)"	S		"$122,500.50"	.	"$24,500.10"	*		
1904	"New Technology - Level 50 ($115,001-$130,000)"	T		"$122,500.50"	.	"$24,500.10"	*		
1905	"New Technology - Level 51 ($130,001-$145,000)"	S		"$137,500.50"	.	"$27,500.10"	*		
1906	"New Technology - Level 51 ($130,001-$145,000)"	T		"$137,500.50"	.	"$27,500.10"	*		
1907	"New Technology - Level 52 ($145,001-$160,000)"	S		"$152,500.50"	.	"$30,500.10"	*		
1908	"New Technology - Level 52 ($145,001-$160,000)"	T		"$152,500.50"	.	"$30,500.10"	*		
2024	"Generator, CCM, implant"	H 			.	.			
2025	"Cath, pressure,valve-occlu"	H 			.	.			
2026	"Orth/devic/drug bn/bn,tis/bn "	H 			.	.			
2027	"Probe, robotic, water-jet"	H 			.	.			
2028	Iris prosthesis	H 			.	.			
2029	"Endoscope, single, UGI"	H 			.	.			
2030	"Gen, neuro, carot sinus baro"	H 			.	.			
2031	"Hemostatic agent, GI, topic"	H 			.	.			
2032	Intravertebral fx aug impl	H 			.	.			
2616	"Brachytx, non-str,Yttrium-90"	U	210.1240	"$17,397.64"	.	"$3,479.53"	*		
2632	Iodine I-125 sodium iodide	U	0.3228	$26.73	.	$5.35			
2634	"Brachytx, non-str, HA, I-125"	U	1.7886	$148.09	.	$29.62			
2635	"Brachytx, non-str, HA, P-103"	U	0.5501	$45.55	.	$9.11			
2636	"Brachy linear, non-str,P-103"	U	0.3793	$31.40	.	$6.29			
2638	"Brachytx, stranded, I-125"	U	0.4517	$37.40	.	$7.48			
2639	"Brachytx, non-stranded,I-125"	U	0.4119	$34.10	.	$6.83			
2640	"Brachytx, stranded, P-103"	U	1.0598	$87.75	.	$17.55			
2641	"Brachytx, non-stranded,P-103"	U	0.8394	$69.50	.	$13.90			
2642	"Brachytx, stranded, C-131"	U	0.8679	$71.86	.	$14.38			
2643	"Brachytx, non-stranded,C-131"	U	0.9705	$80.35	.	$16.08			
2645	"Brachytx, non-str, Gold-198"	U	3.4827	$288.36	.	$57.68			
2646	"Brachytx, non-str, HDR Ir-192"	U	4.0423	$334.69	.	$66.94			
2647	"Brachytx, NS, Non-HDRIr-192"	U	3.4112	$282.44	.	$56.49			
2648	"Brachytx planar, p-103"	U	0.0566	$4.69	.	$0.94			
2698	"Brachytx, stranded, NOS"	U	0.4517	$37.40	.	$7.48			
2699	"Brachytx, non-stranded, NOS"	U	0.3793	$31.40	.	$6.29			
2731	"Immune globulin, powder"	K		$66.972	.	$13.40			*
2770	Quinupristin/dalfopristin	K		$458.830	.	$91.77			*
2993	"Gen, neuro, trans sen/stim"	H			.	.			
4001	Echo guidance radiotherapy	S		$124.57	.	$24.91			*
4002	Stereoscopic x-ray guidance 	S		$56.53	.	$11.31			*
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$156.67	.	$31.33			*
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$144.81	.	$28.96			*
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$145.16	.	$29.03			*
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$144.46	.	$28.89			*
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$275.31	.	$55.06			*
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$200.29	.	$40.06			*
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$198.89	.	$39.78			*
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$198.54	.	$39.71			*
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$266.23	.	$53.25			*
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$264.84	.	$52.97			*
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$265.54	.	$53.11			*
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$264.84	.	$52.97			*
4015	Radiation tx delivery imrt	S		$385.57	.	$77.11			*
4016	Delivery comp imrt	S		$384.52	.	$76.90			*
5012	Clinic Visits and Related Services	V	1.4341	$118.74	.	$23.75			
5021	Level 1 Type A ED Visits	V	0.8768	$72.60	.	$14.52			
5022	Level 2 Type A ED Visits	V	1.5893	$131.59	.	$26.32			
5023	Level 3 Type A ED Visits	V	2.7972	$231.60	.	$46.32			
5024	Level 4 Type A ED Visits	V	4.3931	$363.74	.	$72.75			
5025	Level 5 Type A ED Visits	V	6.3060	$522.12	.	$104.43			
5031	Level 1 Type B ED Visits	V	0.8520	$70.54	.	$14.11			
5032	Level 2 Type B ED Visits	V	1.1523	$95.41	.	$19.09			
5033	Level 3 Type B ED Visits	V	2.1857	$180.97	.	$36.20			
5034	Level 4 Type B ED Visits	V	2.7608	$228.59	.	$45.72			
5035	Level 5 Type B ED Visits	V	3.8454	$318.39	.	$63.68			
5041	Critical Care	S	8.3660	$692.68	.	$138.54			
5045	Trauma Response with Critical Care	S	11.3852	$942.66	.	$188.54			
5051	Level 1 Skin Procedures	T	2.1685	$179.55	.	$35.91			
5052	Level 2 Skin Procedures	T	4.1770	$345.84	.	$69.17			
5053	Level 3 Skin Procedures	T	6.3308	$524.17	.	$104.84			
5054	Level 4 Skin Procedures	T	20.7177	"$1,715.36"	.	$343.08			
5055	Level 5 Skin Procedures	T	42.5396	"$3,522.15"	.	$704.44			
5061	Hyperbaric Oxygen	S	1.4406	$119.28	.	$23.86			
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	7.5120	$621.97	.	$124.40			
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	J1	16.9934	"$1,407.00"	.	$281.41			
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	J1	28.6243	"$2,370.01"	.	$474.01			
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	J1	38.1383	"$3,157.74"	.	$631.55			
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	J1	66.8375	"$5,533.94"	.	"$1,106.79"			
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	107.7339	"$8,920.04"	.	"$1,784.01"	*		
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	J1	180.3049	"$14,928.70"	.	"$2,985.75"	*		
5101	Level 1 Strapping and Cast Application	T	1.7051	$141.18	.	$28.24			
5102	Level 2 Strapping and Cast Application	T	2.9128	$241.17	.	$48.24			
5111	Level 1 Musculoskeletal Procedures	T	2.4903	$206.19	.	$41.24			
5112	Level 2 Musculoskeletal Procedures	J1	16.8164	"$1,392.35"	.	$278.47			
5113	Level 3 Musculoskeletal Procedures	J1	34.1848	"$2,830.40"	.	$566.08			
5114	Level 4 Musculoskeletal Procedures	J1	75.6664	"$6,264.95"	.	"$1,253.00"			
5115	Level 5 Musculoskeletal Procedures	J1	148.7344	"$12,314.76"	.	"$2,462.96"	*		
5116	Level 6 Musculoskeletal Procedures	J1	191.6510	"$15,868.13"	.	"$3,173.63"	*		
5151	Level 1 Airway Endoscopy	T	1.9855	$164.39	.	$32.88			
5152	Level 2 Airway Endoscopy	T	4.5474	$376.51	.	$75.31			
5153	Level 3 Airway Endoscopy	J1	18.0730	"$1,496.39"	.	$299.28			
5154	Level 4 Airway Endoscopy	J1	37.4170	"$3,098.02"	.	$619.61			
5155	Level 5 Airway Endoscopy	J1	70.3257	"$5,822.76"	.	"$1,164.56"			
5161	Level 1 ENT Procedures	T	2.5557	$211.60	.	$42.33			
5162	Level 2 ENT Procedures	T	5.4635	$452.36	.	$90.48			
5163	Level 3 ENT Procedures	J1	16.3386	"$1,352.79"	.	$270.56			
5164	Level 4 ENT Procedures	J1	33.0494	"$2,736.39"	.	$547.28			
5165	Level 5 ENT Procedures	J1	61.4280	"$5,086.05"	.	"$1,017.22"			
5166	Cochlear Implant Procedure	J1	415.8068	"$34,427.56"	"$7,683.79"	"$6,885.52"	*		
5181	Level 1 Vascular Procedures	T	6.5415	$541.62	.	$108.33			
5182	Level 2 Vascular Procedures	J1	16.9830	"$1,406.14"	.	$281.23			
5183	Level 3 Vascular Procedures	J1	34.5624	"$2,861.66"	.	$572.34			
5184	Level 4 Vascular Procedures	J1	57.6153	"$4,770.37"	.	$954.08			
5191	Level 1 Endovascular Procedures	J1	35.0136	"$2,899.02"	$864.64	$579.81			
5192	Level 2 Endovascular Procedures	J1	59.8674	"$4,956.84"	.	$991.37			
5193	Level 3 Endovascular Procedures	J1	121.2960	"$10,042.94"	.	"$2,008.59"	*		
5194	Level 4 Endovascular Procedures	J1	194.0167	"$16,064.00"	.	"$3,212.81"	*		
5200	Implantation Wireless PA Pressure Monitor	J1	348.0247	"$28,815.40"	.	"$5,763.09"	*		
5211	Level 1 Electrophysiologic Procedures	J1	13.4398	"$1,112.78"	.	$222.56			
5212	Level 2 Electrophysiologic Procedures	J1	73.4142	"$6,078.48"	.	"$1,215.70"			
5213	Level 3 Electrophysiologic Procedures	J1	259.2414	"$21,464.41"	.	"$4,292.89"	*		
5221	Level1 Pacemaker and Similar Procedures	T	41.5519	"$3,440.37"	.	$688.08			
5222	Level 2 Pacemaker and Similar Procedures	J1	98.4647	"$8,152.58"	.	"$1,630.52"	*		
5223	Level 3 Pacemaker and Similar Procedures	J1	125.6102	"$10,400.15"	.	"$2,080.03"	*		
5224	Level 4 Pacemaker and Similar Procedures	J1	224.7818	"$18,611.26"	.	"$3,722.26"	*		
5231	Level 1 ICD and Similar Procedures	J1	278.2729	"$23,040.16"	.	"$4,608.04"	*		
5232	Level 2 ICD and Similar Procedures	J1	396.6193	"$32,838.89"	.	"$6,567.78"	*		
5241	Level 1 Blood Product Exchange and Related Services	S	4.7956	$397.06	.	$79.42			
5242	Level 2 Blood Product Exchange and Related Services	S	16.4639	"$1,363.16"	.	$272.64			
5243	Level 3 Blood Product Exchange and Related Services	S	48.7664	"$4,037.71"	.	$807.55			
5244	Level 4 Blood Product Exchange and Related Services	J1	384.5324	"$31,838.13"	.	"$6,367.63"	*		
5301	Level 1 Upper GI Procedures	T	9.7781	$809.60	.	$161.92			
5302	Level 2 Upper GI Procedures 	J1	19.6265	"$1,625.02"	.	$325.01			
5303	Level 3 Upper GI Procedures	J1	37.2090	"$3,080.79"	.	$616.16			
5311	Level 1 Lower GI Procedures 	T	9.5855	$793.65	.	$158.74			
5312	Level 2 Lower GI Procedures 	T	12.5241	"$1,036.96"	.	$207.40			
5313	Level 3 Lower GI Procedures 	J1	29.5106	"$2,443.39"	.	$488.68			
5331	Complex GI Procedures	J1	60.7331	"$5,028.52"	.	"$1,005.71"			
5341	Abdominal/Peritoneal/Biliary and Related Procedures	J1	38.4484	"$3,183.41"	.	$636.69			
5361	Level 1 Laparoscopy and Related Services	J1	61.1186	"$5,060.44"	.	"$1,012.09"			
5362	Level 2 Laparoscopy and Related Services	J1	107.5843	"$8,907.66"	.	"$1,781.54"	*		
5371	Level 1 Urology and Related Services	T	3.2144	$266.14	.	$53.23			
5372	Level 2 Urology and Related Services	T	6.9419	$574.77	.	$114.96			
5373	Level 3 Urology and Related Services	J1	21.6552	"$1,792.99"	.	$358.60			
5374	Level 4 Urology and Related Services	J1	37.1552	"$3,076.34"	.	$615.27			
5375	Level 5 Urology and Related Services	J1	53.3099	"$4,413.90"	.	$882.78			
5376	Level 6 Urology and Related Services	J1	99.7395	"$8,258.13"	.	"$1,651.63"	*		
5377	Level 7 Urology and Related Services	J1	138.7492	"$11,488.02"	.	"$2,297.61"	*		
5378	Level 8 Urology and Related Services	J1	220.5195	"$18,258.35"	.	"$3,651.68"	*		
5401	Dialysis	S	7.9030	$654.34	.	$130.87			
5411	Level 1 Gynecologic Procedures	T	2.0571	$170.32	.	$34.07			
5412	Level 2 Gynecologic Procedures	T	3.3997	$281.48	.	$56.30			
5413	Level 3 Gynecologic Procedures	T	7.6501	$633.41	.	$126.69			
5414	Level 4 Gynecologic Procedures	J1	31.6824	"$2,623.21"	.	$524.65			
5415	Level 5 Gynecologic Procedures	J1	53.2572	"$4,409.54"	$902.82	$881.91			
5416	Level 6 Gynecologic Procedures	J1	82.0598	"$6,794.31"	"$1,405.70"	"$1,358.87"			
5431	Level 1 Nerve Procedures	J1	21.1890	"$1,754.39"	.	$350.88			
5432	Level 2 Nerve Procedures	J1	68.8466	"$5,700.29"	.	"$1,140.06"			
5441	Level 1 Nerve Injections	T	3.1543	$261.17	.	$52.24			
5442	Level 2 Nerve Injections	T	7.6644	$634.59	.	$126.92			
5443	Level 3 Nerve Injections	T	9.9334	$822.46	.	$164.50			
5461	Level 1 Neurostimulator and Related Procedures	J1	39.5582	"$3,275.30"	.	$655.06			
5462	Level 2 Neurostimulator and Related Procedures	J1	74.4071	"$6,160.68"	.	"$1,232.14"			
5463	Level 3 Neurostimulator and Related Procedures	J1	135.7079	"$11,236.21"	.	"$2,247.25"	*		
5464	Level 4 Neurostimulator and Related Procedures	J1	247.3493	"$20,479.78"	.	"$4,095.96"	*		
5465	Level 5 Neurostimulator and Related Procedures	J1	355.6230	"$29,444.52"	.	"$5,888.91"	*		
5471	Implantation of Drug Infusion Device	J1	205.7067	"$17,031.90"	.	"$3,406.38"	*		
5481	Laser Eye Procedures	T	6.0855	$503.86	$100.90	$100.78			
5491	Level 1 Intraocular Procedures	J1	25.1115	"$2,079.16"	.	$415.84			
5492	Level 2 Intraocular Procedures	J1	47.3174	"$3,917.74"	.	$783.55			
5493	Level 3 Intraocular Procedures	J1	88.6006	"$7,335.86"	.	"$1,467.18"			
5494	Level 4 Intraocular Procedures	J1	181.2793	"$15,009.38"	.	"$3,001.88"	*		
5495	Level 5 Intraocular Procedures	J1	250.8129	"$20,766.56"	.	"$4,153.32"	*		
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.1557	$261.28	.	$52.26			
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	9.7774	$809.54	.	$161.91			
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	J1	24.1839	"$2,002.35"	.	$400.48			
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	J1	39.9223	"$3,305.45"	.	$661.09			
5521	Level 1 Imaging without Contrast	S	0.9771	$80.90	.	$16.19			
5522	Level 2 Imaging without Contrast	S	1.3161	$108.97	.	$21.80			
5523	Level 3 Imaging without Contrast	S	2.7794	$230.13	.	$46.03			
5524	Level 4 Imaging without Contrast	S	5.8322	$482.89	.	$96.58			
5571	Level 1 Imaging with Contrast	S	2.1565	$178.55	.	$35.72			
5572	Level 2 Imaging with Contrast	S	4.4460	$368.12	.	$73.63			
5573	Level 3 Imaging with Contrast	S	8.6377	$715.18	.	$143.04			
5591	Level 1 Nuclear Medicine and Related Services 	S	4.5547	$377.12	.	$75.43			
5592	Level 2 Nuclear Medicine and Related Services	S	5.9108	$489.40	.	$97.88			
5593	Level 3 Nuclear Medicine and Related Services 	S	15.7728	"$1,305.94"	.	$261.19			
5594	Level 4 Nuclear Medicine and Related Services	S	17.8791	"$1,480.34"	.	$296.07			
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.5323	$126.87	$32.03	$25.38			
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	4.0905	$338.68	.	$67.74			
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	15.2443	"$1,262.18"	.	$252.44			
5621	Level 1 Radiation Therapy	S	1.4559	$120.54	.	$24.11			
5622	Level 2 Radiation Therapy	S	2.9190	$241.68	.	$48.34			
5623	Level 3 Radiation Therapy	S	6.5528	$542.55	.	$108.52			
5624	Level 4 Radiation Therapy	S	8.5566	$708.46	.	$141.70			
5625	Level 5 Radiation Therapy	S	15.6759	"$1,297.92"	.	$259.59			
5626	Level 6 Radiation Therapy	S 	20.9396	"$1,733.74"	.	$346.75			
5627	Level 7 Radiation Therapy	J1	93.8773	"$7,772.76"	.	"$1,554.56"	*		
5661	Therapeutic Nuclear Medicine	S	3.0149	$249.62	.	$49.93			
5671	Level 1 Pathology	S	0.6010	$49.76	.	$9.96			
5672	Level 2 Pathology	S	1.8015	$149.16	.	$29.84			
5673	Level 3 Pathology	S	3.5177	$291.26	.	$58.26			
5674	Level 4 Pathology	S	7.9248	$656.15	.	$131.23			
5691	Level 1 Drug Administration	S	0.4831	$40.00	.	$8.00			
5692	Level 2 Drug Administration	S	0.7485	$61.97	.	$12.40			
5693	Level 3 Drug Administration	S	2.4578	$203.50	.	$40.70			
5694	Level 4 Drug Administration	S	3.7532	$310.75	.	$62.16			
5721	Level 1 Diagnostic Tests and Related Services	S	1.6854	$139.55	.	$27.91			
5722	Level 2 Diagnostic Tests and Related Services	S	3.1939	$264.45	.	$52.89			
5723	Level 3 Diagnostic Tests and Related Services	S	5.8913	$487.78	.	$97.56			
5724	Level 4 Diagnostic Tests and Related Services	S	11.1093	$919.82	.	$183.97			
5731	Level 1 Minor Procedures	S	0.2980	$24.67	.	$4.94			
5732	Level 2 Minor Procedures	S	0.4087	$33.84	.	$6.77			
5733	Level 3 Minor Procedures	S	0.6722	$55.66	.	$11.14			
5734	Level 4 Minor Procedures	S	1.3521	$111.95	.	$22.39			
5735	Level 5 Minor Procedures	S	3.2637	$270.22	.	$54.05			
5741	Level 1 Electronic Analysis of Devices	S	0.4487	$37.15	.	$7.44			
5742	Level 2 Electronic Analysis of Devices	S	1.2115	$100.31	.	$20.07			
5743	Level 3 Electronic Analysis of Devices	S	3.2908	$272.47	.	$54.50			
5771	Cardiac Rehabilitation	S	1.4018	$116.06	.	$23.22			
5781	Resuscitation and Cardioversion	S	6.7866	$561.91	.	$112.39			
5791	Pulmonary Treatment	S	2.2692	$187.88	.	$37.58			
5801	Ventilation Initiation and Management	S	5.8609	$485.26	.	$97.06			
5811	Manipulation Therapy	S	0.3207	$26.55	.	$5.32			
5821	Level 1 Health and Behavior Services	S	0.3168	$26.23	.	$5.25			
5822	Level 2 Health and Behavior Services	S	0.9043	$74.87	.	$14.98			
5823	Level 3 Health and Behavior Services	S	1.6139	$133.63	.	$26.73			
5853	Partial Hospitalization (3 or more services) for CMHCs	P	1.6879	$139.75	.	$27.96			
5863	Partial Hospitalization (3 or more services) for Hospital-based PHPs	P	3.1461	$260.49	.	$52.10			
5871	Dental Procedures	S	16.8307	"$1,393.53"	.	$278.71			
5881	Ancillary Outpatient Services When Patient Dies	J1	105.6186	"$8,744.90"	.	"$1,748.99"	*		
7000	Amifostine	K		"$1,135.691"	.	$227.14			*
7035	Teniposide	K		"$2,645.707"	.	$529.15			*
7041	Tirofiban HCl	K		$2.405	.	$0.49			*
7043	Infliximab not biosimil 10mg	K		$44.902	.	$8.99			*
7046	Doxorubicin inj 10mg	K		$298.802	.	$59.77			*
7048	Alteplase recombinant	K		$87.432	.	$17.49			*
7308	Aminolevulinic acid hcl top	K		$388.418	.	$77.69			*
8004	Ultrasound Composite	S	3.6033	$298.34	.	$59.67			
8005	CT and CTA without Contrast Composite	S	2.7094	$224.33	.	$44.87			
8006	CT and CTA with Contrast Composite	S	5.2554	$435.13	.	$87.03			
8007	MRI and MRA without Contrast Composite	S	6.3141	$522.79	.	$104.56			
8008	MRI and MRA with Contrast Composite	S	10.1835	$843.16	.	$168.64			
8010	Mental Health Services Composite	S	3.1461	$260.49	.	$52.10			
8011	Comprehensive Observation Services	J2	27.5754	"$2,283.16"	.	$456.64			
9002	Tenecteplase injection	K		$129.274	.	$25.86			*
9003	Palivizumab	K		"$1,185.670"	.	$237.14			*
9005	Reteplase injection	K		"$2,395.938"	.	$479.19			*
9006	Tacrolimus injection	K		$212.219	.	$42.45			*
9012	Arsenic trioxide injection	K		$17.823	.	$3.57			*
9015	"Inj., haegarda 10 units"	K		$9.951	.	$1.99			*
9016	"Inj., triptorelin xr 3.75 mg"	K		"$3,044.011"	.	$608.81			*
9018	"Inj, rimabotulinumtoxinB"	K		$11.967	.	$2.40			*
9024	Amphotericin b lipid complex	K		$9.373	.	$1.88			*
9028	Inj inotuzumab ozogam 0.1 mg	K		"$2,341.297"	.	$468.26			*
9029	"Inj., guselkumab, 1 mg"	K		$88.396	.	$17.68			*
9030	"Inj., copanlisib, 1 mg"	G		$79.090	.	$15.82		*	*
9032	Baclofen 10 MG injection	K		$172.780	.	$34.56			*
9033	Cidofovir injection	K		$590.291	.	$118.06			*
9034	"Inj cuvitru, 100 mg"	K		$13.944	.	$2.79			*
9035	Axicabtagene ciloleucel car+	G		"$395,380.000"	.	"$79,076.00"	*	*	*
9036	"Injection, renflexis"	G		$42.086	.	$8.42		*	*
9038	Inj estrogen conjugate	K		$325.507	.	$65.11			*
9042	Glucagon hydrochloride	K		$194.420	.	$38.89			*
9043	"Inj, afstyla, 1 i.u."	K		$1.352	.	$0.28			*
9044	Ibutilide fumarate injection	K		$273.156	.	$54.64			*
9058	Buprenorphine implant 74.2mg	K		"$1,204.989"	.	$241.00			*
9059	Vonvendi inj 1 iu vwf:rco	K		$1.890	.	$0.38			*
9063	Rh ig minidose im	K		$151.410	.	$30.29			*
9065	Argatroban esrd dialysis 1mg	K 		$1.453	.	$0.30			*
9067	Lutetium lu 177 dotatat ther	G		$266.590	.	$53.32		*	*
9069	Phenobarbital sodium inj	K 		$45.656	.	$9.14			*
9070	Inj luxturna 1 billion vec g	G		"$2,915.236"	.	$583.05		*	*
9071	Capsaicin 8% patch	K		$3.250	.	$0.65			*
9073	Buprenorph xr 100 mg or less	G		"$1,737.257"	.	$347.46		*	*
9074	"Makena, 10 mg"	K		$16.051	.	$3.22			*
9075	"Inj, kovaltry, 1 i.u."	K		$1.224	.	$0.25			*
9077	Epoetin beta non esrd	K		$1.496	.	$0.30			*
9078	Testosterone undecanoate 1mg	K		$1.531	.	$0.31			*
9079	"Genvisc 850, inj, 1mg"	K		$16.918	.	$3.39			*
9087	"Inj, clevidipine butyrate"	K		$2.870	.	$0.58			*
9088	Peng benzathine/procaine inj	K		$12.008	.	$2.41			*
9093	Plicamycin (mithramycin) inj	K		$115.400	.	$23.09			*
9094	Radiesse injection	K		$257.370	.	$51.48			*
9095	"Inj, sculptra, 0.5mg"	K		$2.490	.	$0.50			*
9096	Inj retacrit esrd on dialysi	G		$0.855	.	$0.18		*	*
9097	Inj retacrit non-esrd use	G		$8.547	.	$1.71		*	*
9099	"Inj fosnetupitant, palonoset"	G		$695.558	.	$139.12		*	*
9104	Antithymocyte globuln rabbit	K		$790.601	.	$158.13			*
9108	Thyrotropin injection	K		"$1,776.212"	.	$355.25			*
9119	"Injection, pegfilgrastim 6mg"	K		"$3,079.488"	.	$615.90			*
9120	"Injection, Fulvestrant"	K		$54.765	.	$10.96			*
9122	Triptorelin pamoate	K		$503.806	.	$100.77			*
9125	"Inj risperdal consta, 0.5 mg"	K		$10.532	.	$2.11			*
9126	Natalizumab injection	K		$22.385	.	$4.48			*
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$70.490	.	$14.10			*
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$32.847	.	$6.57			*
9132	"Kcentra, per i.u."	K		$2.102	.	$0.43			*
9133	"Rabies ig, im/sc"	K		$271.366	.	$54.28			*
9134	"Rabies ig, heat treated"	K		$237.368	.	$47.48			*
9135	"Varicella-zoster ig, im"	K		"$1,912.388"	.	$382.48			*
9139	"Rabies vaccine, im"	K		$318.056	.	$63.62			*
9140	"Rabies vaccine, id"	K		$189.630	.	$37.93			*
9171	Factor ix idelvion inj	K		$4.463	.	$0.90			*
9172	"Injection, dexamethasone 9%"	G		$1.110	.	$0.23			*
9173	"Injection, fulphila"	G		$248.162	.	$49.64			*
9174	"Inj, durolane 1 mg"	G		$17.225	.	$3.45		*	*
9178	"Inj., meropenem, vaborbactam"	K		$1.769	.	$0.36			*
9179	"Injection, Aristada Initio"	G		$2.910	.	$0.59			*
9180	"Inj., patisiran, 0.1 mg"	G		$97.682	.	$19.54			*
9181	"Inj., perseris, 0.5 mg"	G		$10.161	.	$2.04			*
9182	"Inj mogamulizumab-kpkc, 1 mg"	G		$206.424	.	$41.29			*
9183	"Inj., plazomicin, 5 mg"	G		$3.072	.	$0.62			*
9186	"Inj., rituximab, 10 mg"	K		$91.264	.	$18.26			*
9187	"Injection, burosumab-twza 1m"	K		$361.954	.	$72.40			*
9188	Inj crotalidae im f(ab')2 eq	K		"$1,263.491"	.	$252.70			*
9189	"Inj., ibalizumab-uiyk, 10 mg"	K		$64.050	.	$12.81			*
9192	"Inj, bortezomib, nos, 0.1 mg"	K		$21.101	.	$4.23			*
9193	Nivestym	G		$0.523	.	$0.11			*
9194	Tisagenlecleucel car-pos t	G		"$425,159.012"	.	"$85,031.81"	*	*	*
9195	"Injection, udenyca 0.5 mg"	G		$267.786	.	$53.56			*
9196	"Inj, trivisc 1 mg"	K		$7.195	.	$1.44			*
9197	"Inj., fremanezumab-vfrm 1 mg"	G		$2.277	.	$0.46			*
9198	"Inj andexxa, 10 mg"	G		$291.500	.	$58.30			*
9199	"Injection, caplacizumab-yhdp"	G		$691.288	.	$138.26			*
9207	"Inj., velcade 0.1 mg"	K		$44.666	.	$8.94			*
9208	Agalsidase beta injection	K		$189.286	.	$37.86			*
9209	Laronidase injection	K		$33.123	.	$6.63			*
9213	Inj. pemetrexed nos 10mg	K		$73.186	.	$14.64			*
9214	Bevacizumab injection	K		$75.157	.	$15.04			*
9215	Cetuximab injection	K		$65.483	.	$13.10			*
9217	Leuprolide acetate suspnsion	K		$228.932	.	$45.79			*
9224	Galsulfase injection	K		$404.072	.	$80.82			*
9225	"Inj., retisert, 0.01 mg"	K		$341.217	.	$68.25			*
9227	Micafungin sodium injection	K		$1.087	.	$0.22			*
9228	Tigecycline injection	K		$1.193	.	$0.24			*
9229	Ibandronate sodium injection	K		$41.539	.	$8.31			*
9230	Abatacept injection	K		$56.867	.	$11.38			*
9231	Decitabine injection	K		$3.426	.	$0.69			*
9233	Ranibizumab injection	K		$322.853	.	$64.58			*
9234	Alglucosidase alfa injection	K		$117.070	.	$23.42			*
9235	Panitumumab injection	K		$124.165	.	$24.84			*
9236	Eculizumab injection	K		$230.316	.	$46.07			*
9237	"Inj, lanreotide acetate"	K		$68.463	.	$13.70			*
9239	Buprenorphine xr over 100 mg	G		"$1,737.257"	.	$347.46		*	*
9240	"Injection, ixabepilone"	K		$102.119	.	$20.43			*
9242	"Injection, fosaprepitant"	K		$0.417	.	$0.09			*
9243	"Inj., treanda 1 mg"	K		$24.581	.	$4.92			*
9245	Romiplostim injection	K		$79.108	.	$15.83			*
9251	C1 esterase inhibitor inj	K		$56.411	.	$11.29			*
9252	Plerixafor injection	K		$365.015	.	$73.01			*
9253	Temozolomide injection	K		$10.375	.	$2.08			*
9255	Paliperidone palmitate inj	K		$12.122	.	$2.43			*
9256	Dexamethasone intra implant	K		$199.850	.	$39.97			*
9257	"Inj., emicizumab-kxwh 0.5 mg"	G		$47.752	.	$9.56		*	*
9258	Telavancin injection	K		$5.943	.	$1.19			*
9259	Pralatrexate injection	K		$310.932	.	$62.19			*
9260	Ofatumumab injection	K		$62.147	.	$12.43			*
9261	"Ustekinumab sub cu inj, 1 mg"	K		$180.116	.	$36.03			*
9263	Ecallantide injection	K		$492.117	.	$98.43			*
9264	Tocilizumab injection	K		$5.469	.	$1.10			*
9265	Romidepsin injection	K		$336.663	.	$67.34			*
9269	"C-1 esterase, berinert"	K		$54.326	.	$10.87			*
9270	Gammaplex IVIG	K		$49.810	.	$9.97			*
9271	Velaglucerase alfa	K		$346.625	.	$69.33			*
9272	"Inj, denosumab"	K		$20.107	.	$4.03			*
9273	Sipuleucel-T auto CD54+	K		"$49,649.408"	.	"$9,929.89"	*		*
9274	Crotalidae Poly Immune Fab	K		"$2,908.210"	.	$581.65			*
9276	Cabazitaxel injection	K		$184.846	.	$36.97			*
9278	Incobotulinumtoxin A	K		$5.055	.	$1.02			*
9281	"Injection, pegloticase"	K		"$2,771.289"	.	$554.26			*
9284	Ipilimumab injection	K		$157.225	.	$31.45			*
9286	Belatacept injection	K		$3.792	.	$0.76			*
9287	Brentuximab vedotin inj	K		$182.080	.	$36.42			*
9289	Erwinaze injection	K		$427.269	.	$85.46			*
9294	"Inj, taliglucerase alfa 10 u"	K		$40.964	.	$8.20			*
9295	"Injection, Carfilzomib, 1 mg"	K		$39.345	.	$7.87			*
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.496	.	$1.70			*
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$3.312	.	$0.67			*
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.927"	.	$209.39			*
9299	Inj. jivi 1 iu	G		$2.030	.	$0.41			*
9300	Omalizumab injection	K		$37.416	.	$7.49			*
9301	"Aminolevulinic acid, 10% gel"	K		$1.521	.	$0.31			*
9302	"Inj daunorubicin, cytarabine"	K		$201.686	.	$40.34			*
9304	"Inj., cemiplimab-rwlc, 1 mg"	G		$27.397	.	$5.48			*
9305	"Inj., lumoxiti, 0.01 mg"	G		$22.476	.	$4.50			*
9306	"Inj., tildrakizumab, 1 mg"	G		$132.708	.	$26.55			*
9307	Cocaine hcl nasal solution	G		$1.263	.	$0.26			*
9308	Dexametha opth insert 0.1 mg	G		$139.470	.	$27.90			*
9309	Inj. tagraxofusp-erzs 10 mcg	G		$283.327	.	$56.67			*
9310	"Inj., emapalumab-lzsg, 1 mg"	G		$393.159	.	$78.64			*
9311	"Inj., omadacycline, 1 mg"	G		$3.271	.	$0.66			*
9312	"Inj., ravulizumab-cwvz 10 mg"	G		$226.179	.	$45.24			*
9313	Inj. belrapzo/bendamustine	G		$22.273	.	$4.46			*
9314	"Inj. herceptin hylecta, 10mg"	G		$74.589	.	$14.92			*
9318	Inj hydroxyprogst capoat nos	K		$21.540	.	$4.31			*
9319	Somatropin injection	K		$36.540	.	$7.31			*
9320	Carbidopa levodopa ent 100ml	K		$213.763	.	$42.76			*
9323	Gallium ga-68 dotatoc	G		$8.640	.	$0.00			*
9327	Inj. romosozumab-aqqg 1 mg	G		$9.002	.	$1.81			*
9328	"Inj., yutiq, 0.01 mg"	K		$496.417	.	$99.29			*
9329	Inj mvasi 10 mg	G		$56.733	.	$11.35			*
9330	"Inj., kanjinti, 10 mg"	G		$72.499	.	$14.50			*
9331	"Inj, polatuzumab vedotin 1mg"	G		$112.115	.	$22.43			*
9332	Inj lefamulin 1 mg	G		$0.724	.	$0.15			*
9333	"Inj., brexanolone, 1 mg"	G		$76.141	.	$15.23			*
9334	"Injection, khapzory, 0.5 mg"	G		$1.870	.	$0.38			*
9336	Inj truxima 10 mg	G		$68.498	.	$13.70			*
9337	"Synojoynt, inj., 1 mg"	G		$18.016	.	$3.61			*
9339	Iodine i-131 iobenguane 1mci	G		$320.120	.	$64.03			*
9340	"Inj, brolucizumab-dbll, 1 mg"	G		$314.948	.	$62.99			*
9341	Inj ogivri 10 mg	G		$73.064	.	$14.62			*
9343	Inj givosiran 0.5 mg	G		$106.880	.	$21.38			*
9345	Inj pegfilgrastim-bmez 0.5mg	G		$297.962	.	$59.60			*
9346	Mometasone furoate (sinuva)	G		$10.252	.	$2.06			*
9347	Inj luspatercept-aamt 0.25mg	G		$36.307	.	$7.27			*
9348	"Inj., zirabev, 10 mg"	G		$59.471	.	$11.90			*
9349	Inj herzuma 10 mg	G		$86.425	.	$17.29			*
9350	"Inj., trazimera, 10 mg"	G		$74.023	.	$14.81			*
9351	Inj bimatoprost itc imp1mcg	G		$206.375	.	$41.28			*
9352	Chloroquine injection	K		$165.220	.	$33.05			*
9353	Inj fam-trastu deru-nxki 1mg	G		$24.131	.	$4.83			*
9354	Inj recombin esperoct per iu	G		$2.248	.	$0.45			*
9355	Inj. teprotumumab-trbw 10 mg	G		$315.880	.	$63.18			*
9356	Inj golodirsen 10 mg	G		$166.531	.	$33.31			*
9357	Inj. eptinezumab-jjmr 1 mg	G		$15.602	.	$3.13			*
9359	Inj crizanlizumab-tmca 5mg	G		$122.425	.	$24.49			*
9361	Inj. cetirizine hcl 0.5mg	G		$15.391	.	$3.08			*
9362	Inj imip 4 cilas 4 releb 2mg	G		$2.256	.	$0.46			*
9364	Inj enfort vedo-ejfv 0.25mg	G		$27.958	.	$5.60			*
9367	"Inj ruxience, 10 mg"	G		$67.323	.	$13.47			*
9370	Fluoroestradiol f 18	G		$626.583	.	$0.00			*
9371	Inj. meloxicam 1 mg	G		$3.255	.	$0.00			*
9372	"Inj. xembify, 100 mg"	K		$14.687	.	$2.94			*
9373	Inj onase abepar-xioi treat	K		"$2,206,690.978"	.	"$441,338.20"	*		*
9374	Mitomycin instillation	G		$282.172	.	$56.44			*
9375	"Inj., evomela, 1 mg"	K		$23.601	.	$4.73			*
9376	Sacituzumab govitecan-hziy	G		$29.505	.	$5.91			*
9377	Inj. isatuximab-irfc 10 mg	G		$66.372	.	$13.28			*
9378	"Daratumumab, hyaluronidase"	G		$43.851	.	$8.78			*
9379	Romidepsin non-lyophilized	G		$311.842	.	$62.37			*
9380	"Inj., cefiderocol, 5 mg"	G		$0.972	.	$0.20			*
9381	"Inj. avsola, 10 mg"	G		$51.500	.	$10.30			*
9382	Inj ontruzant 10 mg	G		$88.166	.	$17.64			*
9383	"Copper cu-64, dotatate, dx"	G		$901.250	.	$0.00			*
9384	Belantamab mafodontin-blmf	G		$42.627	.	$8.53			*
9385	"Injection, tafasitamab-cxix"	G		$12.360	.	$2.48			*
9386	"Injection, viltolarsen"	G		$58.092	.	$11.62			*
9387	"Inj. infugem, 100 mg"	G		$39.140	.	$7.83			*
9388	Inj. fe derisomaltose 10 mg	G		$25.382	.	$5.08			*
9389	"Inj. lurbinectedin, 0.1 mg"	G		$170.800	.	$34.17			*
9390	"Pertuzu, trastuzu, 10 mg"	G		$72.709	.	$14.55			*
9391	Brexucabtagene autoleucel ca	G		"$384,190.000"	.	"$76,838.00"	*		*
9392	"Inj, imm glob asceniv"	G		$481.770	.	$96.36			*
9393	Inj codeine phosphate /30 mg	K		$135.640	.	$27.13			*
9394	"Inj. inebilizumab-cdon, 1 mg"	K		$449.767	.	$89.96			*
9395	Factor viia recomb sevenfact	K		$2.585	.	$0.52			*
9396	"Afamelanotide implant, 1 mg"	K		"$3,218.897"	.	$643.78			*
9441	Inj ferric carboxymaltos 1mg	K		$1.130	.	$0.23			*
9445	"Injection, ruconest"	K		$28.981	.	$5.80			*
9448	"Oral netupitant, palonosetro"	K		$270.650	.	$54.13			*
9449	"Injection, blinatumomab"	K		$118.116	.	$23.63			*
9450	"Inj., iluvien, 0.01 mg"	K		$490.931	.	$98.19			*
9451	"Injection, peramivir"	K		$1.596	.	$0.32			*
9452	Inj ceftolozane tazobactam	K		$6.427	.	$1.29			*
9453	"Injection, nivolumab"	K		$28.541	.	$5.71			*
9454	"Inj, pasireotide long acting"	K		$315.843	.	$63.17			*
9455	"Injection, siltuximab"	K		$111.496	.	$22.30			*
9456	"Injection, isavuconazonium"	K		$0.775	.	$0.16			*
9460	"Injection, cangrelor"	K		$15.461	.	$3.10			*
9462	"Injection, delafloxacin"	G		$0.286	.	$0.06		*	*
9463	"Inj., aprepitant, 1 mg"	G		$1.593	.	$0.32		*	*
9466	"Inj., benralizumab, 1 mg"	G		$171.300	.	$34.27		*	*
9467	"Inj rituximab, hyaluronidase"	G		$40.229	.	$8.05		*	*
9468	Factor ix recomb gly rebinyn	G		$3.959	.	$0.80		*	*
9469	Inj triamcinolone ace xr 1mg	G		$18.006	.	$3.61		*	*
9470	Aripirazole lauroxil 1 mg	K		$2.904	.	$0.59			*
9471	Hymovis injection 1 mg	K		$31.668	.	$6.34			*
9472	Inj talimogene laherparepvec	K		$54.017	.	$10.81			*
9473	"Injection, mepolizumab, 1mg"	K		$28.857	.	$5.78			*
9474	Inj irinotecan liposome 1 mg	K		$54.307	.	$10.87			*
9475	"Injection, necitumumab, 1 mg"	K		$5.737	.	$1.15			*
9476	"Injection, daratumumab 10 mg"	K		$56.037	.	$11.21			*
9477	"Injection, elotuzumab, 1mg"	K		$6.673	.	$1.34			*
9478	Inj sebelipase alfa 1 mg	K		$540.412	.	$108.09			*
9479	"Instill, ciprofloxacin otic"	K		$29.983	.	$6.00			*
9480	Injection trabectedin 0.1mg	K		$318.916	.	$63.79			*
9481	"Injection, reslizumab"	K		$9.754	.	$1.96			*
9482	Sotalol hydrochloride IV	K		$15.999	.	$3.20			*
9483	"Inj, atezolizumab,10 mg"	K		$78.181	.	$15.64			*
9485	"Inj, olaratumab, 10 mg"	K 		$52.067	.	$10.42			*
9487	"Ustekinumab, iv inject,1 mg"	K 		$11.951	.	$2.40			*
9488	Conivaptan hcl	K 		$36.168	.	$7.24			*
9489	"Inj, nusinersen, 0.1mg"	K 		"$1,122.059"	.	$224.42			*
9490	"Inj, bezlotoxumab, 10 mg"	K 		$39.666	.	$7.94			*
9491	"Injection, avelumab, 10 mg"	K 		$85.331	.	$17.07			*
9492	"Inj., durvalumab, 10 mg"	K 		$77.052	.	$15.42			*
9493	"Injection, edaravone, 1 mg"	K 		$19.895	.	$3.98			*
9494	"Injection, ocrelizumab"	K 		$57.326	.	$11.47			*
9495	Gemtuzumab ozogamicin inj	K 		$205.362	.	$41.08			*
9500	"Platelets, irradiated"	R	1.7113	$141.69	.	$28.34			
9501	Platelet pheres leukoreduced	R	5.8794	$486.80	.	$97.36			
9502	Platelet pheresis irradiated	R	7.3057	$604.89	.	$120.98			
9503	Fr frz plasma donor retested	R	0.7860	$65.08	.	$13.02			
9504	RBC deglycerolized	R	5.2738	$436.65	.	$87.34			
9505	RBC irradiated	R	2.0449	$169.31	.	$33.87			
9507	"Platelets, pheresis"	R	3.9131	$323.99	.	$64.80			
9508	Plasma 1 donor frz w/in 8 hr	R	0.9984	$82.66	.	$16.54			
9509	"Frozen plasma, pooled, sd"	R	1.0767	$89.15	.	$17.83			
9510	Whole blood for transfusion	R	1.8134	$150.14	.	$30.03			
9511	Cryoprecipitate each unit	R	0.9644	$79.85	.	$15.97			
9512	RBC leukocytes reduced	R	2.2768	$188.51	.	$37.71			
9513	"Plasma, frz between 8-24hour"	R	0.8593	$71.15	.	$14.23			
9514	"Plasma protein fract,5%,50ml"	R	0.0965	$7.99	.	$1.60			
9515	"Platelets, each unit"	R	0.8610	$71.29	.	$14.26			
9516	Plaelet rich plasma unit	R	2.4156	$200.00	.	$40.01			
9517	Red blood cells unit	R	1.6623	$137.63	.	$27.53			
9518	Washed red blood cells unit	R	4.5878	$379.86	.	$75.98			
9519	"Plasmaprotein fract,5%,250ml"	R	1.9366	$160.34	.	$32.07			
9520	Blood split unit	R	1.7824	$147.58	.	$29.52			
9521	Platelets leukoreduced irrad	R	2.5748	$213.19	.	$42.64			
9522	RBC leukoreduced irradiated	R	3.1468	$260.55	.	$52.11			
9523	Cryoprecipitatereducedplasma	R	0.7935	$65.70	.	$13.14			
9524	"Blood, l/r, cmv-neg"	R	2.5632	$212.23	.	$42.45			
9525	"Platelets, hla-m, l/r, unit"	R	9.7248	$805.18	.	$161.04			
9526	Platelets leukocytes reduced	R	1.8107	$149.92	.	$29.99			
9527	"Blood, l/r, froz/degly/wash"	R	3.7525	$310.70	.	$62.14			
9528	"Plt, aph/pher, l/r, cmv-neg"	R	5.7978	$480.04	.	$96.01			
9529	"Blood, l/r, irradiated"	R	1.8619	$154.16	.	$30.84			
9530	Plate pheres leukoredu irrad	R	7.4560	$617.33	.	$123.47			
9531	"Plt, pher, l/r cmv-neg, irr"	R	5.4025	$447.31	.	$89.47			
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	3.1473	$260.59	.	$52.12			
9533	"RBC, l/r, cmv-neg, irrad"	R	2.9454	$243.87	.	$48.78			
9534	Pathogen reduced plasma pool	R	0.6413	$53.10	.	$10.62			
9535	Pathogen reduced plasma sing	R	1.4834	$122.82	.	$24.57			
9536	Platelets pheresis path redu	R	7.0518	$583.87	.	$116.78			
9537	Blood component/product noc	R	0.0965	$7.99	.	$1.60			
