	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
0701	Sr89 strontium	K		"$2,045.702"	.	$409.15		
0726	Dexrazoxane HCl injection	K		$199.929	.	$39.99		
0731	Sargramostim injection	K		$48.122	.	$9.63		
0736	Amphotericin b liposome inj	K		$26.563	.	$5.32		
0738	Rasburicase	K		$300.937	.	$60.19		
0751	Mechlorethamine hcl inj	K		$328.290	.	$65.66		
0752	Dactinomycin injection	K		"$1,044.534"	.	$208.91		
0759	"Naltrexone, depot form"	K		$3.261	.	$0.66		
0800	Leuprolide acetate	K		"$1,347.559"	.	$269.52		
0802	Etoposide oral	K		$75.493	.	$15.10		
0807	Aldesleukin injection	K		"$4,964.616"	.	$992.93		
0810	Goserelin acetate implant	K		$503.586	.	$100.72		
0812	Carmustine injection	K		"$2,016.270"	.	$403.26		
0820	Daunorubicin injection	K		$43.838	.	$8.77		
0825	Nelarabine injection	K		$152.151	.	$30.44		
0836	Interferon alfa-2b inj	K		$34.346	.	$6.87		
0840	Inj melphalan hydrochl 50 mg	K		$260.376	.	$52.08		
0843	Pegaspargase injection	K		"$19,717.763"	.	"$3,943.56"	*	
0844	Pentostatin injection	K		"$2,060.277"	.	$412.06		
0850	Streptozocin injection	K		$349.537	.	$69.91		
0851	Thiotepa injection	K		$475.392	.	$95.08		
0856	Porfimer sodium injection	K		"$21,856.352"	.	"$4,371.28"	*	
0858	Inj cladribine	K		$19.573	.	$3.92		
0864	Mitoxantrone hydrochl	K		$28.688	.	$5.74		
0874	Synvisc or synvisc-one	K		$10.218	.	$2.05		
0875	Euflexxa inj per dose	K		$140.312	.	$28.07		
0877	Orthovisc inj per dose	K		$128.409	.	$25.69		
0887	Azathioprine parenteral	K		$227.933	.	$45.59		
0890	Lymphocyte immune globulin	K		"$2,257.665"	.	$451.54		
0901	Alpha 1 proteinase inhibitor	K		$4.358	.	$0.88		
0902	"Injection,onabotulinumtoxinA"	K		$6.077	.	$1.22		
0903	Cytomegalovirus imm IV /vial	K		"$1,496.953"	.	$299.40		
0910	Interferon beta-1b / .25 MG	K		$393.833	.	$78.77		
0925	Factor viii	K		$1.015	.	$0.21		
0927	Factor viii recombinant	K		$1.378	.	$0.28		
0928	Factor ix complex	K		$1.491	.	$0.30		
0929	Anti-inhibitor	K		$2.051	.	$0.42		
0931	Factor IX non-recombinant	K		$1.164	.	$0.24		
0932	Factor ix recombinant nos	K		$1.534	.	$0.31		
0943	Octagam injection	K		$41.229	.	$8.25		
0944	Gammagard liquid injection	K		$43.201	.	$8.65		
0946	Hepagam b im injection	K		$63.403	.	$12.69		
0947	Flebogamma injection	K		$40.383	.	$8.08		
0948	Gamunex-C/Gammaked	K		$42.186	.	$8.44		
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		$157.420	.	$31.49		
1064	"I131 iodide cap, rx"	K		$20.690	.	$4.14		
1083	Adalimumab injection	K		"$1,430.922"	.	$286.19		
1138	"Hepagam b intravenous, inj"	K		$65.960	.	$13.20		
1139	Protein c concentrate	K		$15.064	.	$3.02		
1142	Supprelin LA implant	K		"$40,237.001"	.	"$8,047.41"	*	
1150	"I131 iodide sol, rx"	K		$13.360	.	$2.68		
1168	"Inj, temsirolimus"	K		$44.989	.	$9.00		
1178	Busulfan injection	K		$3.405	.	$0.69		
1203	Verteporfin injection	K		$11.227	.	$2.25		
1207	"Octreotide injection, depot"	K		$205.878	.	$41.18		
1213	Antihemophilic viii/vwf comp	K		$1.136	.	$0.23		
1214	Inj IVIG privigen 500 mg	K		$41.503	.	$8.31		
1232	Mitomycin injection	K		$49.879	.	$9.98		
1235	Valrubicin injection	K		"$1,403.170"	.	$280.64		
1236	Inj levoleucovorin nos 0.5mg	K		$0.280	.	$0.06		
1237	Inj iron dextran	K		$15.010	.	$3.01		
1263	Antithrombin iii injection	K		$3.504	.	$0.71		
1268	Xyntha inj	K		$1.306	.	$0.27		
1274	Edetate calcium disodium inj	K 		"$5,594.422"	.	"$1,118.89"		
1281	Bevacizumab injection	K		$1.909	.	$0.39		
1289	AbobotulinumtoxinA	K		$8.149	.	$1.63		
1295	Sm 153 lexidronam	K		"$17,259.853"	.	"$3,451.98"	*	
1296	Degarelix injection	K		$3.842	.	$0.77		
1297	"Ferumoxytol, non-esrd"	K		$0.983	.	$0.20		
1311	Canakinumab injection	K		$113.238	.	$22.65		
1312	Hizentra injection	K		$10.855	.	$2.18		
1327	Imiglucerase injection	K		$43.377	.	$8.68		
1331	Olanzapine long-acting inj	K		$2.917	.	$0.59		
1340	"Collagenase, clost hist inj"	K		$52.388	.	$10.48		
1341	Amobarbital 125 MG inj	K		$95.160	.	$19.04		
1352	Wilate injection	K		$1.023	.	$0.21		
1353	Belimumab injection	K		$46.179	.	$9.24		
1408	Cyclophosphamide 100 MG inj	K		$29.672	.	$5.94		
1413	Lumizyme injection	K		$174.488	.	$34.90		
1415	Glassia injection	K		$4.834	.	$0.97		
1416	Factor xiii anti-hem factor	K		$8.773	.	$1.76		
1417	Gel-one	K		"$1,219.000"	.	$243.80		
1420	Aflibercept injection	K		$928.241	.	$185.65		
1421	Imported lipodox inj	K		$482.060	.	$96.42		
1426	Eribulin mesylate injection	K		$117.663	.	$23.54		
1431	Centruroides immune f(ab)	K		"$5,063.557"	.	"$1,012.72"		
1433	Calcitonin salmon injection	K		"$2,839.223"	.	$567.85		
1440	Inj desmopressin acetate	K		$10.453	.	$2.10		
1442	Non-HEU TC-99M add-on/dose	K		$10.000	.	$2.00		
1443	Icatibant injection	K		$276.567	.	$55.32		
1446	Visualization adjunct	K		$7.552	.	$1.52		
1458	Phentolaine mesylate inj	K		$359.137	.	$71.83		
1466	"Inj, vincristine sul lip 1mg"	K		"$3,320.169"	.	$664.04		
1467	Factor ix recombinan rixubis	K		$1.456	.	$0.30		
1468	Inj Aripiprazole Ext Rel 1mg	K		$5.700	.	$1.14		
1469	Inj filgrastim excl biosimil	K		$0.925	.	$0.19		
1471	"Injection, Pertuzumab, 1 mg"	K		$12.945	.	$2.59		
1472	Inj beta interferon im 1 mcg	K		$54.322	.	$10.87		
1474	Certolizumab pegol inj 1mg	K		$8.161	.	$1.64		
1475	Golimumab for iv use 1mg	K		$18.997	.	$3.80		
1476	Obinutuzumab inj	K		$63.736	.	$12.75		
1478	Inj human fibrinogen con nos	K		$1.243	.	$0.25		
1480	"Elosulfase alfa, injection"	K		$246.196	.	$49.24		
1482	"	Darbepoetin alfa, esrd use"	K		$3.716	.	$0.75		
1485	"	Ferumoxytol, esrd use"	K		$0.983	.	$0.20		
1486	Factor ix fc fusion recomb	K		$3.252	.	$0.66		
1488	"Injection, ramucirumab"	K		$60.709	.	$12.15		
1489	"Injection, vedolizumab"	K		$20.297	.	$4.06		
1490	Inj pembrolizumab	K		$50.846	.	$10.17		
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		$36.366	.	$7.28		
1613	Inj trastuzumab excl biosimi	K		$99.675	.	$19.94		
1630	"Hep b ig, im"	K		$119.087	.	$23.82		
1643	"Y90 ibritumomab, rx"	K		"$56,746.934"	.	"$11,349.39"	*	
1656	Factor viii fc fusion recomb	K		$2.167	.	$0.44		
1658	"Injection, belinostat, 10mg"	K		$42.794	.	$8.56		
1660	"Injection, oritavancin"	K		$23.797	.	$4.76		
1662	Inj tedizolid phosphate	K		$1.590	.	$0.32		
1669	Erythro lactobionate /500 mg	K		$76.845	.	$15.37		
1670	Tetanus immune globulin inj	K		$476.569	.	$95.32		
1675	P32 Na phosphate	K		$449.310	.	$89.87		
1683	Basiliximab	K		"$4,005.187"	.	$801.04		
1684	Corticorelin ovine triflutal	K		$9.377	.	$1.88		
1685	"Darbepoetin alfa, non-esrd"	K		$3.716	.	$0.75		
1686	"Epoetin alfa, non-esrd"	K		$9.109	.	$1.83		
1687	Digoxin immune fab (ovine)	K		"$3,972.138"	.	$794.43		
1688	Ethanolamine oleate	K		$444.099	.	$88.82		
1689	Fomepizole	K		$5.326	.	$1.07		
1690	Hemin	K		$24.436	.	$4.89		
1694	Ziconotide injection	K		$8.171	.	$1.64		
1696	Palifermin injection	K		$22.812	.	$4.57		
1700	Inj secretin synthetic human	K		$34.781	.	$6.96		
1701	Treprostinil injection	K		$62.806	.	$12.57		
1704	"Humate-P, inj"	K		$1.207	.	$0.25		
1705	Factor viia recomb novoseven	K		$2.250	.	$0.45		
1709	Azacitidine injection	K		$0.801	.	$0.17		
1710	Clofarabine injection	K		$52.637	.	$10.53		
1711	Vantas implant	K		"$4,558.133"	.	$911.63		
1712	Paclitaxel protein bound	K		$13.298	.	$2.66		
1739	"Pegademase bovine, 25 iu"	K		"$1,471.845"	.	$294.37		
1745	Radium ra223 dichloride ther	K		$140.961	.	$28.20		
1746	Factor xiii recomb a-subunit	K		$15.526	.	$3.11		
1747	Monovisc inj per dose	K		$694.582	.	$138.92		
1748	Inj tbo filgrastim 1 microg	K		$0.470	.	$0.10		
1761	"Rolapitant, oral, 1mg"	K		$2.266	.	$0.46		
1809	"Injection, alemtuzumab"	K		"$1,984.320"	.	$396.87		
1822	"Injection, zarxio"	K		$0.468	.	$0.10		
1823	"Injection, dalbavancin"	K		$15.386	.	$3.08		
1824	"	Ceftaroline fosamil inj"	K		$3.322	.	$0.67		
1825	Ceftazidime and avibactam	K		$92.002	.	$18.41		
1826	Hyqvia 100mg immuneglobulin	K		$14.486	.	$2.90		
1827	Factor viii recomb obizur	K		$3.186	.	$0.64		
1829	"	Penicillin g benzathine inj"	K		$15.158	.	$3.04		
1832	Dimethyl sulfoxide 50% 50 ml	K		$635.667	.	$127.14		
1844	Factor viii pegylated recomb	K		$1.874	.	$0.38		
1846	Factor viii nuwiq recomb 1iu	K		$1.355	.	$0.28		
1847	"Injection, inflectra"	K		$43.724	.	$8.75		
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		$42.925	.	$8.59		
1851	Gamma globulin > 10 cc inj	K		$429.255	.	$85.86		
1852	Interferon beta-1a inj	K		"$2,276.610"	.	$455.33		
1853	Minocycline hydrochloride	K		$1.988	.	$0.40		
1854	Pentobarbital sodium inj	K		$33.926	.	$6.79		
1856	Factor viii recomb novoeight	K		$1.325	.	$0.27		
1857	"Inj, factor x, (human), 1iu"	K		$7.879	.	$1.58		
1859	Argatroban nonesrd use 1mg	K		$1.307	.	$0.27		
1861	"Inj., bendeka 1 mg"	K		$20.273	.	$4.06		
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		$68.303	.	$13.67		
2770	Quinupristin/dalfopristin	K		$458.041	.	$91.61		
2993	"Gen, neuro, trans sen/stim"	H			.	.		
4001	Echo guidance radiotherapy	S		$117.97	.	$23.59		
4002	Stereoscopic x-ray guidance 	S		$53.80	.	$10.76		
4003	"Radiation treatment delivery, MeV <= 5; simple "	S		$148.76	.	$29.75		
4004	"Radiation treatment delivery, 6-10 MeV; simple "	S		$137.74	.	$27.55		
4005	"Radiation treatment delivery, 11-19 MeV; simple "	S		$138.06	.	$27.61		
4006	"Radiation treatment delivery, MeV>=20; simple "	S		$137.41	.	$27.48		
4007	"Radiation treatment delivery, MeV<=5; intermediate"	S		$260.89	.	$52.18		
4008	"Radiation treatment delivery, 6-10 MeV; intermediate "	S		$190.89	.	$38.18		
4009	"Radiation treatment delivery, 11-19 MeV; intermediate"	S		$189.59	.	$37.92		
4010	"Radiation treatment delivery, MeV >=20; intermediate"	S		$188.94	.	$37.79		
4011	"Radiation treatment delivery, MeV<=5; complex"	S		$253.43	.	$50.69		
4012	"Radiation treatment delivery, 6-10 MeV; complex"	S		$252.14	.	$50.43		
4013	"Radiation treatment delivery, 11-19 MeV; complex"	S		$252.79	.	$50.56		
4014	"Radiation treatment delivery, MeV >=20; complex"	S		$251.81	.	$50.36		
4015	Radiation tx delivery imrt	S		$366.86	.	$73.37		
4016	Delivery comp imrt	S		$365.89	.	$73.18		
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		$2.191	.	$0.44		
7043	Infliximab not biosimil 10mg	K		$47.620	.	$9.53		
7046	Doxorubicin inj 10mg	K		$315.731	.	$63.15		
7048	Alteplase recombinant	K		$87.154	.	$17.44		
7308	Aminolevulinic acid hcl top	K		$394.752	.	$78.96		
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		$129.255	.	$25.86		
9003	Palivizumab	K		"$1,838.680"	.	$367.74		
9005	Reteplase injection	K		"$2,386.298"	.	$477.26		
9006	Tacrolimus injection	K		$211.974	.	$42.40		
9012	Arsenic trioxide injection	K		$22.063	.	$4.42		
9015	"Inj., haegarda 10 units"	K		$9.918	.	$1.99		
9016	"Inj., triptorelin xr 3.75 mg"	K		"$3,044.011"	.	$608.81		
9018	"Inj, rimabotulinumtoxinB"	K		$11.929	.	$2.39		
9024	Amphotericin b lipid complex	K		$9.358	.	$1.88		
9028	Inj inotuzumab ozogam 0.1 mg	K		"$2,341.499"	.	$468.30		
9029	"Inj., guselkumab, 1 mg"	K		$93.123	.	$18.63		
9030	"Inj., copanlisib, 1 mg"	G		$78.989	.	$15.80		*
9032	Baclofen 10 MG injection	K		$171.593	.	$34.32		
9033	Cidofovir injection	K		$666.250	.	$133.25		
9034	"Inj cuvitru, 100 mg"	K		$14.022	.	$2.81		
9035	Axicabtagene ciloleucel car+	G		"$395,380.000"	.	"$79,076.00"	*	*
9036	"Injection, renflexis"	G		$44.547	.	$8.91		*
9038	Inj estrogen conjugate	K		$325.621	.	$65.13		
9042	Glucagon hydrochloride	K		$211.789	.	$42.36		
9043	"Inj, afstyla, 1 i.u."	K		$1.338	.	$0.27		
9044	Ibutilide fumarate injection	K		$316.198	.	$63.24		
9058	Buprenorphine implant 74.2mg	K		"$1,207.160"	.	$241.44		
9059	Vonvendi inj 1 iu vwf:rco	K		$1.783	.	$0.36		
9063	Rh ig minidose im	K		$151.410	.	$30.29		
9065	Argatroban esrd dialysis 1mg	K 		$1.307	.	$0.27		
9067	Lutetium lu 177 dotatat ther	G		$266.590	.	$53.32		*
9069	Phenobarbital sodium inj	K 		$47.334	.	$9.47		
9070	Inj luxturna 1 billion vec g	G		"$2,883.200"	.	$576.64		*
9071	Capsaicin 8% patch	K		$3.250	.	$0.65		
9073	Buprenorph xr 100 mg or less	G		"$1,743.482"	.	$348.70		*
9074	"Makena, 10 mg"	K		$15.881	.	$3.18		
9075	"Inj, kovaltry, 1 i.u."	K		$1.219	.	$0.25		
9077	Epoetin beta non esrd	K		$1.544	.	$0.31		
9078	Testosterone undecanoate 1mg	K		$1.543	.	$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		$11.998	.	$2.40		
9093	Plicamycin (mithramycin) inj	K		$115.400	.	$23.08		
9094	Radiesse injection	K		$222.090	.	$44.42		
9095	"Inj, sculptra, 0.5mg"	K		$3.190	.	$0.64		
9096	Inj retacrit esrd on dialysi	G		$0.861	.	$0.18		*
9097	Inj retacrit non-esrd use	G		$8.612	.	$1.73		*
9099	"Inj fosnetupitant, palonoset"	G		$695.767	.	$139.16		*
9104	Antithymocyte globuln rabbit	K		$817.122	.	$163.43		
9108	Thyrotropin injection	K		"$1,740.225"	.	$348.05		
9119	"Injection, pegfilgrastim 6mg"	K		"$3,571.681"	.	$714.34		
9120	"Injection, Fulvestrant"	K		$52.737	.	$10.55		
9122	Triptorelin pamoate	K		$385.610	.	$77.13		
9125	"Inj risperdal consta, 0.5 mg"	K		$10.532	.	$2.11		
9126	Natalizumab injection	K		$21.630	.	$4.33		
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$70.490	.	$14.10		
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$32.789	.	$6.56		
9132	"Kcentra, per i.u."	K		$2.091	.	$0.42		
9133	"Rabies ig, im/sc"	K		$273.035	.	$54.61		
9134	"Rabies ig, heat treated"	K		$331.803	.	$66.37		
9135	"Varicella-zoster ig, im"	K		"$1,703.971"	.	$340.80		
9139	"Rabies vaccine, im"	K		$303.241	.	$60.65		
9140	"Rabies vaccine, id"	K		$227.530	.	$45.51		
9171	Factor ix idelvion inj	K		$4.438	.	$0.89		
9172	"Injection, dexamethasone 9%"	G		$1.106	.	$0.23		
9173	"Injection, fulphila"	G		$269.041	.	$53.81		
9174	"Inj, durolane 1 mg"	G		$17.225	.	$3.45		*
9178	"Inj., meropenem, vaborbactam"	K		$1.780	.	$0.36		
9179	"Injection, Aristada Initio"	G		$2.858	.	$0.58		
9180	"Inj., patisiran, 0.1 mg"	G		$97.843	.	$19.57		
9181	"Inj., perseris, 0.5 mg"	G		$10.181	.	$2.04		
9182	"Inj mogamulizumab-kpkc, 1 mg"	G		$203.883	.	$40.78		
9183	"Inj., plazomicin, 5 mg"	G		$3.105	.	$0.63		
9186	"Inj., rituximab, 10 mg"	K		$92.556	.	$18.52		
9187	"Injection, burosumab-twza 1m"	K		$361.895	.	$72.38		
9188	Inj crotalidae im f(ab')2 eq	K		"$1,264.210"	.	$252.85		
9189	"Inj., ibalizumab-uiyk, 10 mg"	K		$63.624	.	$12.73		
9192	"Inj, bortezomib, nos, 0.1 mg"	K		$22.036	.	$4.41		
9193	Nivestym	G		$0.621	.	$0.13		
9194	Tisagenlecleucel car-pos t	G		"$429,813.310"	.	"$85,962.67"	*	*
9195	"Injection, udenyca 0.5 mg"	G		$286.674	.	$57.34		
9196	"Inj, trivisc 1 mg"	K		$7.195	.	$1.44		
9197	"Inj., fremanezumab-vfrm 1 mg"	G		$2.249	.	$0.45		
9198	"Inj andexxa, 10 mg"	G		$291.500	.	$58.30		
9199	"Injection, caplacizumab-yhdp"	G		$690.680	.	$138.14		
9207	"Inj., velcade 0.1 mg"	K		$44.973	.	$9.00		
9208	Agalsidase beta injection	K		$188.990	.	$37.80		
9209	Laronidase injection	K		$33.102	.	$6.63		
9213	Inj. pemetrexed nos 10mg	K		$71.811	.	$14.37		
9214	Bevacizumab injection	K		$76.361	.	$15.28		
9215	Cetuximab injection	K		$64.286	.	$12.86		
9217	Leuprolide acetate suspnsion	K		$224.452	.	$44.90		
9224	Galsulfase injection	K		$405.755	.	$81.16		
9225	"Inj., retisert, 0.01 mg"	K		$340.622	.	$68.13		
9227	Micafungin sodium injection	K		$1.180	.	$0.24		
9228	Tigecycline injection	K		$1.378	.	$0.28		
9229	Ibandronate sodium injection	K		$50.999	.	$10.20		
9230	Abatacept injection	K		$58.103	.	$11.63		
9231	Decitabine injection	K		$4.260	.	$0.86		
9233	Ranibizumab injection	K		$324.272	.	$64.86		
9234	Alglucosidase alfa injection	K		$73.810	.	$14.77		
9235	Panitumumab injection	K		$123.553	.	$24.72		
9236	Eculizumab injection	K		$230.479	.	$46.10		
9237	"Inj, lanreotide acetate"	K		$68.475	.	$13.70		
9239	Buprenorphine xr over 100 mg	G		"$1,743.482"	.	$348.70		*
9240	"Injection, ixabepilone"	K		$101.189	.	$20.24		
9242	"Injection, fosaprepitant"	K		$0.785	.	$0.16		
9243	"Inj., treanda 1 mg"	K		$24.693	.	$4.94		
9245	Romiplostim injection	K		$78.428	.	$15.69		
9251	C1 esterase inhibitor inj	K		$56.199	.	$11.24		
9252	Plerixafor injection	K		$365.294	.	$73.06		
9253	Temozolomide injection	K		$10.377	.	$2.08		
9255	Paliperidone palmitate inj	K		$12.102	.	$2.43		
9256	Dexamethasone intra implant	K		$199.756	.	$39.96		
9257	"Inj., emicizumab-kxwh 0.5 mg"	G		$47.467	.	$9.50		*
9258	Telavancin injection	K		$5.138	.	$1.03		
9259	Pralatrexate injection	K		$311.224	.	$62.25		
9260	Ofatumumab injection	K		$61.942	.	$12.39		
9261	"Ustekinumab sub cu inj, 1 mg"	K		$184.359	.	$36.88		
9263	Ecallantide injection	K		$494.686	.	$98.94		
9264	Tocilizumab injection	K		$5.401	.	$1.09		
9265	Romidepsin injection	K		$336.542	.	$67.31		
9269	"C-1 esterase, berinert"	K		$54.134	.	$10.83		
9270	Gammaplex IVIG	K		$53.662	.	$10.74		
9271	Velaglucerase alfa	K		$346.147	.	$69.23		
9272	"Inj, denosumab"	K		$20.123	.	$4.03		
9273	Sipuleucel-T auto CD54+	K		"$49,671.772"	.	"$9,934.36"	*	
9274	Crotalidae Poly Immune Fab	K		"$3,043.750"	.	$608.75		
9276	Cabazitaxel injection	K		$181.509	.	$36.31		
9278	Incobotulinumtoxin A	K		$5.019	.	$1.01		
9281	"Injection, pegloticase"	K		"$2,801.076"	.	$560.22		
9284	Ipilimumab injection	K		$157.382	.	$31.48		
9286	Belatacept injection	K		$3.775	.	$0.76		
9287	Brentuximab vedotin inj	K		$175.282	.	$35.06		
9289	Erwinaze injection	K		$427.269	.	$85.46		
9294	"Inj, taliglucerase alfa 10 u"	K		$40.857	.	$8.18		
9295	"Injection, Carfilzomib, 1 mg"	K		$39.198	.	$7.84		
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.073	.	$1.62		
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.976	.	$0.60		
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.927"	.	$209.39		
9299	Inj. jivi 1 iu	G		$2.020	.	$0.41		
9300	Omalizumab injection	K		$37.699	.	$7.54		
9301	"Aminolevulinic acid, 10% gel"	K		$1.525	.	$0.31		
9302	"Inj daunorubicin, cytarabine"	K		$197.794	.	$39.56		
9304	"Inj., cemiplimab-rwlc, 1 mg"	G		$27.401	.	$5.49		
9305	"Inj., lumoxiti, 0.01 mg"	G		$22.460	.	$4.50		
9306	"Inj., tildrakizumab, 1 mg"	G		$135.673	.	$27.14		
9307	Cocaine hcl nasal solution	G		$1.230	.	$0.25		
9308	Dexametha opth insert 0.1 mg	G		$139.547	.	$27.91		
9309	Inj. tagraxofusp-erzs 10 mcg	G		$270.585	.	$54.12		
9310	"Inj., emapalumab-lzsg, 1 mg"	G		$441.593	.	$88.32		
9311	"Inj., omadacycline, 1 mg"	G		$3.147	.	$0.63		
9312	"Inj., ravulizumab-cwvz 10 mg"	G		$226.275	.	$45.26		
9313	Inj. belrapzo/bendamustine	G		$21.612	.	$4.33		
9314	"Inj. herceptin hylecta, 10mg"	G		$75.084	.	$15.02		
9318	Inj hydroxyprogst capoat nos	K		$10.810	.	$2.17		
9319	Somatropin injection	K		$84.130	.	$16.83		
9320	Carbidopa levodopa ent 100ml	K		$213.095	.	$42.62		
9323	Gallium ga-68 dotatoc	G		$8.640	.	$0.00		
9327	Inj. romosozumab-aqqg 1 mg	G		$9.014	.	$1.81		
9328	"Inj., yutiq, 0.01 mg"	K		$491.133	.	$98.23		
9329	Inj mvasi 10 mg	G		$60.939	.	$12.19		
9330	"Inj., kanjinti, 10 mg"	G		$78.723	.	$15.75		
9331	"Inj, polatuzumab vedotin 1mg"	G		$110.717	.	$22.15		
9332	Inj lefamulin 1 mg	G		$0.724	.	$0.15		
9333	"Inj., brexanolone, 1 mg"	G		$76.909	.	$15.39		
9334	"Injection, khapzory, 0.5 mg"	G		$1.999	.	$0.40		
9336	Inj truxima 10 mg	G		$68.799	.	$13.76		
9337	"Synojoynt, inj., 1 mg"	G		$4.394	.	$0.88		
9339	Iodine i-131 iobenguane 1mci	G		$320.120	.	$64.03		
9340	"Inj, brolucizumab-dbll, 1 mg"	G		$311.994	.	$62.40		
9341	Inj ogivri 10 mg	G		$76.407	.	$15.29		
9343	Inj givosiran 0.5 mg	G		$106.875	.	$21.38		
9345	Inj pegfilgrastim-bmez 0.5mg	G		$305.552	.	$61.12		
9346	Mometasone furoate (sinuva)	G		$10.252	.	$2.06		
9347	Inj luspatercept-aamt 0.25mg	G		$36.320	.	$7.27		
9348	"Inj., zirabev, 10 mg"	G		$62.235	.	$12.45		
9349	Inj herzuma 10 mg	G		$91.523	.	$18.31		
9350	"Inj., trazimera, 10 mg"	G		$83.104	.	$16.63		
9351	Inj bimatoprost itc imp1mcg	G		$200.850	.	$40.17		
9352	Chloroquine injection	K		$165.220	.	$33.05		
9353	Inj fam-trastu deru-nxki 1mg	G		$24.142	.	$4.83		
9354	Inj recombin esperoct per iu	G		$2.286	.	$0.46		
9355	Inj. teprotumumab-trbw 10 mg	G		$315.880	.	$63.18		
9356	Inj golodirsen 10 mg	G		$166.326	.	$33.27		
9357	Inj. eptinezumab-jjmr 1 mg	G		$15.399	.	$3.08		
9359	Inj crizanlizumab-tmca 5mg	G		$122.413	.	$24.49		
9361	Inj. cetirizine hcl 0.5mg	G		$15.448	.	$3.09		
9362	Inj imip 4 cilas 4 releb 2mg	G		$2.255	.	$0.46		
9364	Inj enfort vedo-ejfv 0.25mg	G		$27.958	.	$5.60		
9367	"Inj ruxience, 10 mg"	G		$70.900	.	$14.18		
9370	Fluoroestradiol f 18	G		$0.752	.	$0.00		
9371	Inj. meloxicam 1 mg	G		$3.255	.	$0.00		
9372	"Inj. xembify, 100 mg"	K		$14.223	.	$2.85		
9373	Inj onase abepar-xioi treat	K		"$2,213,634.284"	.	"$442,726.86"	*	
9374	Mitomycin instillation	G		$275.216	.	$55.05		
9375	"Inj., evomela, 1 mg"	K		$26.959	.	$5.40		
9376	Sacituzumab govitecan-hziy	G		$28.790	.	$5.76		
9377	Inj. isatuximab-irfc 10 mg	G		$66.670	.	$13.34		
9378	"Daratumumab, hyaluronidase"	G		$43.340	.	$8.67		
9379	Romidepsin non-lyophilized	G		$329.456	.	$65.90		
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		$92.296	.	$18.46		
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		$6.180	.	$1.24		
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	.	$34.16		
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		
9399	"MFN drug add-on, per dose"	K		$148.730		$0.00		
9441	Inj ferric carboxymaltos 1mg	K		$1.106	.	$0.23		
9445	"Injection, ruconest"	K		$29.108	.	$5.83		
9448	"Oral netupitant, palonosetro"	K		$270.102	.	$54.03		
9449	"Injection, blinatumomab"	K		$118.586	.	$23.72		
9450	"Inj., iluvien, 0.01 mg"	K		$490.873	.	$98.18		
9451	"Injection, peramivir"	K		$1.596	.	$0.32		
9452	Inj ceftolozane tazobactam	K		$6.490	.	$1.30		
9453	"Injection, nivolumab"	K		$28.559	.	$5.72		
9454	"Inj, pasireotide long acting"	K		$332.591	.	$66.52		
9455	"Injection, siltuximab"	K		$111.935	.	$22.39		
9456	"Injection, isavuconazonium"	K		$0.783	.	$0.16		
9460	"Injection, cangrelor"	K		$15.320	.	$3.07		
9462	"Injection, delafloxacin"	G		$0.278	.	$0.06		*
9463	"Inj., aprepitant, 1 mg"	G		$1.732	.	$0.35		*
9466	"Inj., benralizumab, 1 mg"	G		$170.112	.	$34.03		*
9467	"Inj rituximab, hyaluronidase"	G		$41.140	.	$8.23		*
9468	Factor ix recomb gly rebinyn	G		$4.009	.	$0.81		*
9469	Inj triamcinolone ace xr 1mg	G		$18.204	.	$3.65		*
9470	Aripirazole lauroxil 1 mg	K		$2.847	.	$0.57		
9471	Hymovis injection 1 mg	K		$31.668	.	$6.34		
9472	Inj talimogene laherparepvec	K		$53.923	.	$10.79		
9473	"Injection, mepolizumab, 1mg"	K		$28.704	.	$5.75		
9474	Inj irinotecan liposome 1 mg	K		$54.331	.	$10.87		
9475	"Injection, necitumumab, 1 mg"	K		$5.731	.	$1.15		
9476	"Injection, daratumumab 10 mg"	K		$56.286	.	$11.26		
9477	"Injection, elotuzumab, 1mg"	K		$6.671	.	$1.34		
9478	Inj sebelipase alfa 1 mg	K		$541.130	.	$108.23		
9479	"Instill, ciprofloxacin otic"	K		$29.968	.	$6.00		
9480	Injection trabectedin 0.1mg	K		$318.927	.	$63.79		
9481	"Injection, reslizumab"	K		$9.758	.	$1.96		
9482	Sotalol hydrochloride IV	K		$15.999	.	$3.20		
9483	"Inj, atezolizumab,10 mg"	K		$78.279	.	$15.66		
9485	"Inj, olaratumab, 10 mg"	K 		$52.067	.	$10.42		
9487	"Ustekinumab, iv inject,1 mg"	K 		$12.033	.	$2.41		
9488	Conivaptan hcl	K 		$32.571	.	$6.52		
9489	"Inj, nusinersen, 0.1mg"	K 		"$1,122.512"	.	$224.51		
9490	"Inj, bezlotoxumab, 10 mg"	K 		$39.645	.	$7.93		
9491	"Injection, avelumab, 10 mg"	K 		$84.700	.	$16.94		
9492	"Inj., durvalumab, 10 mg"	K 		$76.023	.	$15.21		
9493	"Injection, edaravone, 1 mg"	K 		$19.892	.	$3.98		
9494	"Injection, ocrelizumab"	K 		$57.383	.	$11.48		
9495	Gemtuzumab ozogamicin inj	K 		$205.380	.	$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		
