"2021 LOCALITY-ADJUSTED PAYMENT AMOUNTS FOR ADMINISTRATION OF MONOCLONAL ANTIBODIES USED TO TREAT COVID-19
Last Updated: 5/6/2021
Effective for claims with dates of service 1/1/2021 - 5/5/2021"						"M0239*
National RVUs: 8.91
National PW: 0.59 / PE: 8.13 / MP: 0.19"					"M0243
National RVUs: 8.91
National PW: 0.59 / PE: 8.13 / MP: 0.19"					"M0245
National RVUs: 8.91
National PW: 0.59 / PE: 8.13 / MP: 0.19"				
Medicare Administrative Contractor (MAC)	Locality Number	Locality Name	2021 PW GPCI 	2021 PE GPCI	2021 MP GPCI	2021 PW	2021 PE	2021 MP	2021 RVU Total	Total Pay	2021 PW	2021 PE	2021 MP	2021 RVU Total	Total Pay	2021 PW	2021 PE	2021 MP	2021 RVU Total	Total Pay
10112	00	ALABAMA	1.000	0.888	0.921	0.59	7.22	0.17	7.98	 $278.60 	0.59	7.22	0.17	7.98	 $278.60 	0.59	7.22	0.17	7.98	 $278.60 
02102	01	ALASKA	1.500	1.118	0.614	0.89	9.09	0.12	10.09	 $352.11 	0.89	9.09	0.12	10.09	 $352.11 	0.89	9.09	0.12	10.09	 $352.11 
03102	00	ARIZONA	1.000	0.951	0.857	0.59	7.73	0.16	8.48	 $296.05 	0.59	7.73	0.16	8.48	 $296.05 	0.59	7.73	0.16	8.48	 $296.05 
07102	13	ARKANSAS	1.000	0.847	0.465	0.59	6.89	0.09	7.56	 $263.95 	0.59	6.89	0.09	7.56	 $263.95 	0.59	6.89	0.09	7.56	 $263.95 
01112	54	BAKERSFIELD	1.035	1.065	0.704	0.61	8.66	0.13	9.40	 $328.09 	0.61	8.66	0.13	9.40	 $328.09 	0.61	8.66	0.13	9.40	 $328.09 
01112	55	CHICO	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01182	71	EL CENTRO	1.027	1.065	0.616	0.61	8.66	0.12	9.38	 $327.35 	0.61	8.66	0.12	9.38	 $327.35 	0.61	8.66	0.12	9.38	 $327.35 
01112	56	FRESNO	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	57	HANFORD-CORCORAN	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01182	18	LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)	1.048	1.175	0.757	0.62	9.55	0.14	10.31	 $359.92 	0.62	9.55	0.14	10.31	 $359.92 	0.62	9.55	0.14	10.31	 $359.92 
01182	26	LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)	1.048	1.175	0.757	0.62	9.55	0.14	10.31	 $359.92 	0.62	9.55	0.14	10.31	 $359.92 	0.62	9.55	0.14	10.31	 $359.92 
01112	58	MADERA	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	59	MERCED	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	60	MODESTO	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	51	NAPA	1.044	1.220	0.504	0.62	9.92	0.10	10.63	 $370.92 	0.62	9.92	0.10	10.63	 $370.92 	0.62	9.92	0.10	10.63	 $370.92 
01112	07	SAN FRANCISCO-OAKLAND-BERKELEY (ALAMEDA/CONTRA COSTA CNTY)	1.077	1.329	0.458	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 
01182	17	OXNARD-THOUSAND OAKS-VENTURA	1.027	1.179	0.726	0.61	9.59	0.14	10.33	 $360.42 	0.61	9.59	0.14	10.33	 $360.42 	0.61	9.59	0.14	10.33	 $360.42 
01112	61	REDDING	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.027	1.065	0.896	0.61	8.66	0.17	9.43	 $329.20 	0.61	8.66	0.17	9.43	 $329.20 	0.61	8.66	0.17	9.43	 $329.20 
01112	63	SACRAMENTO-ROSEVILLE-FOLSOM	1.036	1.079	0.597	0.61	8.77	0.11	9.50	 $331.38 	0.61	8.77	0.11	9.50	 $331.38 	0.61	8.77	0.11	9.50	 $331.38 
01112	64	SALINAS	1.058	1.122	0.597	0.62	9.12	0.11	9.86	 $344.03 	0.62	9.12	0.11	9.86	 $344.03 	0.62	9.12	0.11	9.86	 $344.03 
01182	72	SAN DIEGO-CHULA VISTA-CARLSBAD	1.035	1.145	0.616	0.61	9.31	0.12	10.04	 $350.21 	0.61	9.31	0.12	10.04	 $350.21 	0.61	9.31	0.12	10.04	 $350.21 
01112	05	SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO CNTY)	1.077	1.329	0.458	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 
01112	52	SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY)	1.071	1.311	0.504	0.63	10.66	0.10	11.39	 $397.30 	0.63	10.66	0.10	11.39	 $397.30 	0.63	10.66	0.10	11.39	 $397.30 
01112	65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.084	1.330	0.597	0.64	10.81	0.11	11.57	 $403.57 	0.64	10.81	0.11	11.57	 $403.57 	0.64	10.81	0.11	11.57	 $403.57 
01182	73	SAN LUIS OBISPO-PASO ROBLES	1.027	1.085	0.597	0.61	8.82	0.11	9.54	 $332.89 	0.61	8.82	0.11	9.54	 $332.89 	0.61	8.82	0.11	9.54	 $332.89 
01112	06	SAN FRANCISCO-OAKLAND-BERKELEY (SAN MATEO CNTY)	1.077	1.329	0.458	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 	0.64	10.80	0.09	11.53	 $402.22 
01112	09	SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)	1.096	1.383	0.414	0.65	11.24	0.08	11.97	 $417.64 	0.65	11.24	0.08	11.97	 $417.64 	0.65	11.24	0.08	11.97	 $417.64 
01112	66	SANTA CRUZ-WATSONVILLE	1.042	1.181	0.597	0.61	9.60	0.11	10.33	 $360.44 	0.61	9.60	0.11	10.33	 $360.44 	0.61	9.60	0.11	10.33	 $360.44 
01182	74	SANTA MARIA-SANTA BARBARA	1.038	1.157	0.597	0.61	9.41	0.11	10.13	 $353.55 	0.61	9.41	0.11	10.13	 $353.55 	0.61	9.41	0.11	10.13	 $353.55 
01112	67	SANTA ROSA-PETALUMA	1.042	1.159	0.597	0.61	9.42	0.11	10.15	 $354.20 	0.61	9.42	0.11	10.15	 $354.20 	0.61	9.42	0.11	10.15	 $354.20 
01112	68	STOCKTON	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	53	VALLEJO	1.044	1.220	0.504	0.62	9.92	0.10	10.63	 $370.92 	0.62	9.92	0.10	10.63	 $370.92 	0.62	9.92	0.10	10.63	 $370.92 
01112	69	VISALIA	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	70	YUBA CITY	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
01112	75	REST OF CALIFORNIA	1.027	1.065	0.597	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 	0.61	8.66	0.11	9.38	 $327.22 
04112	01	COLORADO	1.001	1.047	0.767	0.59	8.51	0.15	9.25	 $322.71 	0.59	8.51	0.15	9.25	 $322.71 	0.59	8.51	0.15	9.25	 $322.71 
13102	00	CONNECTICUT	1.037	1.114	0.934	0.61	9.06	0.18	9.85	 $343.56 	0.61	9.06	0.18	9.85	 $343.56 	0.61	9.06	0.18	9.85	 $343.56 
12202	01	DC + MD/VA SUBURBS	1.054	1.236	1.294	0.62	10.05	0.25	10.92	 $380.91 	0.62	10.05	0.25	10.92	 $380.91 	0.62	10.05	0.25	10.92	 $380.91 
12102	01	DELAWARE	1.005	1.022	0.927	0.59	8.31	0.18	9.08	 $316.76 	0.59	8.31	0.18	9.08	 $316.76 	0.59	8.31	0.18	9.08	 $316.76 
09102	03	FORT LAUDERDALE	1.000	1.001	1.860	0.59	8.14	0.35	9.08	 $316.88 	0.59	8.14	0.35	9.08	 $316.88 	0.59	8.14	0.35	9.08	 $316.88 
09102	04	MIAMI	1.000	1.023	2.629	0.59	8.32	0.50	9.41	 $328.22 	0.59	8.32	0.50	9.41	 $328.22 	0.59	8.32	0.50	9.41	 $328.22 
09102	99	REST OF FLORIDA	1.000	0.939	1.435	0.59	7.63	0.27	8.50	 $296.48 	0.59	7.63	0.27	8.50	 $296.48 	0.59	7.63	0.27	8.50	 $296.48 
10212	01	ATLANTA	1.000	0.998	0.904	0.59	8.11	0.17	8.88	 $309.69 	0.59	8.11	0.17	8.88	 $309.69 	0.59	8.11	0.17	8.88	 $309.69 
10212	99	REST OF GEORGIA	1.000	0.878	0.904	0.59	7.14	0.17	7.90	 $275.65 	0.59	7.14	0.17	7.90	 $275.65 	0.59	7.14	0.17	7.90	 $275.65 
01212	01	"HAWAII, GUAM"	1.010	1.143	0.675	0.60	9.29	0.13	10.02	 $349.52 	0.60	9.29	0.13	10.02	 $349.52 	0.60	9.29	0.13	10.02	 $349.52 
02202	00	IDAHO	1.000	0.877	0.416	0.59	7.13	0.08	7.80	 $272.13 	0.59	7.13	0.08	7.80	 $272.13 	0.59	7.13	0.08	7.80	 $272.13 
06102	16	CHICAGO	1.011	1.044	1.871	0.60	8.49	0.36	9.44	 $329.38 	0.60	8.49	0.36	9.44	 $329.38 	0.60	8.49	0.36	9.44	 $329.38 
06102	12	EAST ST. LOUIS	1.000	0.942	1.661	0.59	7.66	0.32	8.56	 $298.83 	0.59	7.66	0.32	8.56	 $298.83 	0.59	7.66	0.32	8.56	 $298.83 
06102	15	SUBURBAN CHICAGO	1.006	1.062	1.504	0.59	8.63	0.29	9.51	 $331.95 	0.59	8.63	0.29	9.51	 $331.95 	0.59	8.63	0.29	9.51	 $331.95 
06102	99	REST OF ILLINOIS	1.000	0.912	1.182	0.59	7.41	0.22	8.23	 $287.14 	0.59	7.41	0.22	8.23	 $287.14 	0.59	7.41	0.22	8.23	 $287.14 
08102	00	INDIANA	1.000	0.900	0.465	0.59	7.32	0.09	8.00	 $278.98 	0.59	7.32	0.09	8.00	 $278.98 	0.59	7.32	0.09	8.00	 $278.98 
05102	00	IOWA	1.000	0.907	0.425	0.59	7.37	0.08	8.04	 $280.70 	0.59	7.37	0.08	8.04	 $280.70 	0.59	7.37	0.08	8.04	 $280.70 
05202	00	KANSAS	1.000	0.908	0.458	0.59	7.38	0.09	8.06	 $281.21 	0.59	7.38	0.09	8.06	 $281.21 	0.59	7.38	0.09	8.06	 $281.21 
15102	00	KENTUCKY	1.000	0.869	0.827	0.59	7.06	0.16	7.81	 $272.59 	0.59	7.06	0.16	7.81	 $272.59 	0.59	7.06	0.16	7.81	 $272.59 
07202	01	NEW ORLEANS	1.000	0.927	1.528	0.59	7.54	0.29	8.42	 $293.69 	0.59	7.54	0.29	8.42	 $293.69 	0.59	7.54	0.29	8.42	 $293.69 
07202	99	REST OF LOUISIANA	1.000	0.872	1.307	0.59	7.09	0.25	7.93	 $276.62 	0.59	7.09	0.25	7.93	 $276.62 	0.59	7.09	0.25	7.93	 $276.62 
14112	03	SOUTHERN MAINE	1.000	0.997	0.652	0.59	8.11	0.12	8.82	 $307.74 	0.59	8.11	0.12	8.82	 $307.74 	0.59	8.11	0.12	8.82	 $307.74 
14112	99	REST OF MAINE	1.000	0.898	0.652	0.59	7.30	0.12	8.01	 $279.65 	0.59	7.30	0.12	8.01	 $279.65 	0.59	7.30	0.12	8.01	 $279.65 
12302	01	BALTIMORE/SURR. CNTYS	1.028	1.096	1.313	0.61	8.91	0.25	9.77	 $340.78 	0.61	8.91	0.25	9.77	 $340.78 	0.61	8.91	0.25	9.77	 $340.78 
12302	99	REST OF MARYLAND	1.011	1.037	1.070	0.60	8.43	0.20	9.23	 $322.08 	0.60	8.43	0.20	9.23	 $322.08 	0.60	8.43	0.20	9.23	 $322.08 
14212	01	METROPOLITAN BOSTON	1.049	1.203	0.842	0.62	9.78	0.16	10.56	 $368.45 	0.62	9.78	0.16	10.56	 $368.45 	0.62	9.78	0.16	10.56	 $368.45 
14212	99	REST OF MASSACHUSETTS	1.026	1.061	0.842	0.61	8.63	0.16	9.39	 $327.69 	0.61	8.63	0.16	9.39	 $327.69 	0.61	8.63	0.16	9.39	 $327.69 
08202	01	DETROIT	1.000	0.997	1.622	0.59	8.11	0.31	9.00	 $314.17 	0.59	8.11	0.31	9.00	 $314.17 	0.59	8.11	0.31	9.00	 $314.17 
08202	99	REST OF MICHIGAN	1.000	0.911	0.979	0.59	7.41	0.19	8.18	 $285.51 	0.59	7.41	0.19	8.18	 $285.51 	0.59	7.41	0.19	8.18	 $285.51 
06202	00	MINNESOTA	1.000	1.013	0.353	0.59	8.24	0.07	8.89	 $310.30 	0.59	8.24	0.07	8.89	 $310.30 	0.59	8.24	0.07	8.89	 $310.30 
07302	00	MISSISSIPPI	1.000	0.842	0.671	0.59	6.85	0.13	7.56	 $263.89 	0.59	6.85	0.13	7.56	 $263.89 	0.59	6.85	0.13	7.56	 $263.89 
05302	02	METROPOLITAN KANSAS CITY	1.000	0.955	0.890	0.59	7.76	0.17	8.52	 $297.40 	0.59	7.76	0.17	8.52	 $297.40 	0.59	7.76	0.17	8.52	 $297.40 
05302	01	METROPOLITAN ST. LOUIS	1.000	0.976	0.889	0.59	7.93	0.17	8.69	 $303.35 	0.59	7.93	0.17	8.69	 $303.35 	0.59	7.93	0.17	8.69	 $303.35 
05302	99	REST OF MISSOURI	1.000	0.852	0.828	0.59	6.93	0.16	7.67	 $267.77 	0.59	6.93	0.16	7.67	 $267.77 	0.59	6.93	0.16	7.67	 $267.77 
03202	01	MONTANA	1.000	1.000	0.977	0.59	8.13	0.19	8.91	 $310.75 	0.59	8.13	0.19	8.91	 $310.75 	0.59	8.13	0.19	8.91	 $310.75 
05402	00	NEBRASKA	1.000	0.908	0.235	0.59	7.38	0.04	8.02	 $279.73 	0.59	7.38	0.04	8.02	 $279.73 	0.59	7.38	0.04	8.02	 $279.73 
01312	00	NEVADA	1.005	1.000	1.351	0.59	8.13	0.26	8.98	 $313.33 	0.59	8.13	0.26	8.98	 $313.33 	0.59	8.13	0.26	8.98	 $313.33 
14312	40	NEW HAMPSHIRE	1.000	1.038	0.917	0.59	8.44	0.17	9.20	 $321.13 	0.59	8.44	0.17	9.20	 $321.13 	0.59	8.44	0.17	9.20	 $321.13 
12402	01	NORTHERN NJ	1.049	1.199	0.959	0.62	9.75	0.18	10.55	 $368.09 	0.62	9.75	0.18	10.55	 $368.09 	0.62	9.75	0.18	10.55	 $368.09 
12402	99	REST OF NEW JERSEY	1.037	1.141	0.959	0.61	9.28	0.18	10.07	 $351.39 	0.61	9.28	0.18	10.07	 $351.39 	0.61	9.28	0.18	10.07	 $351.39 
04212	05	NEW MEXICO	1.000	0.896	1.166	0.59	7.28	0.22	8.10	 $282.50 	0.59	7.28	0.22	8.10	 $282.50 	0.59	7.28	0.22	8.10	 $282.50 
13202	01	MANHATTAN	1.056	1.203	2.031	0.62	9.78	0.39	10.79	 $376.47 	0.62	9.78	0.39	10.79	 $376.47 	0.62	9.78	0.39	10.79	 $376.47 
13202	02	NYC SUBURBS/LONG ISLAND	1.046	1.223	2.702	0.62	9.94	0.51	11.07	 $386.39 	0.62	9.94	0.51	11.07	 $386.39 	0.62	9.94	0.51	11.07	 $386.39 
13202	03	POUGHKPSIE/N NYC SUBURBS	1.027	1.105	1.646	0.61	8.98	0.31	9.90	 $345.52 	0.61	8.98	0.31	9.90	 $345.52 	0.61	8.98	0.31	9.90	 $345.52 
13292	04	QUEENS	1.056	1.228	2.661	0.62	9.98	0.51	11.11	 $387.74 	0.62	9.98	0.51	11.11	 $387.74 	0.62	9.98	0.51	11.11	 $387.74 
13282	99	REST OF NEW YORK	1.000	0.955	0.752	0.59	7.76	0.14	8.50	 $296.49 	0.59	7.76	0.14	8.50	 $296.49 	0.59	7.76	0.14	8.50	 $296.49 
11502	00	NORTH CAROLINA	1.000	0.928	0.819	0.59	7.54	0.16	8.29	 $289.27 	0.59	7.54	0.16	8.29	 $289.27 	0.59	7.54	0.16	8.29	 $289.27 
03302	01	NORTH DAKOTA	1.000	1.000	0.431	0.59	8.13	0.08	8.80	 $307.13 	0.59	8.13	0.08	8.80	 $307.13 	0.59	8.13	0.08	8.80	 $307.13 
15202	00	OHIO	1.000	0.913	1.094	0.59	7.42	0.21	8.22	 $286.84 	0.59	7.42	0.21	8.22	 $286.84 	0.59	7.42	0.21	8.22	 $286.84 
04312	00	OKLAHOMA	1.000	0.881	0.782	0.59	7.16	0.15	7.90	 $275.69 	0.59	7.16	0.15	7.90	 $275.69 	0.59	7.16	0.15	7.90	 $275.69 
02302	01	PORTLAND	1.022	1.063	0.535	0.60	8.64	0.10	9.35	 $326.14 	0.60	8.64	0.10	9.35	 $326.14 	0.60	8.64	0.10	9.35	 $326.14 
02302	99	REST OF OREGON	1.000	0.947	0.535	0.59	7.70	0.10	8.39	 $292.78 	0.59	7.70	0.10	8.39	 $292.78 	0.59	7.70	0.10	8.39	 $292.78 
12502	01	METROPOLITAN PHILADELPHIA	1.022	1.083	1.199	0.60	8.80	0.23	9.64	 $336.22 	0.60	8.80	0.23	9.64	 $336.22 	0.60	8.80	0.23	9.64	 $336.22 
12502	99	REST OF PENNSYLVANIA	1.000	0.939	0.888	0.59	7.63	0.17	8.39	 $292.85 	0.59	7.63	0.17	8.39	 $292.85 	0.59	7.63	0.17	8.39	 $292.85 
09202	20	PUERTO RICO	1.000	1.008	0.986	0.59	8.20	0.19	8.97	 $313.07 	0.59	8.20	0.19	8.97	 $313.07 	0.59	8.20	0.19	8.97	 $313.07 
14412	01	RHODE ISLAND	1.021	1.048	0.981	0.60	8.52	0.19	9.31	 $324.82 	0.60	8.52	0.19	9.31	 $324.82 	0.60	8.52	0.19	9.31	 $324.82 
11202	01	SOUTH CAROLINA	1.000	0.903	0.695	0.59	7.34	0.13	8.06	 $281.36 	0.59	7.34	0.13	8.06	 $281.36 	0.59	7.34	0.13	8.06	 $281.36 
03402	02	SOUTH DAKOTA	1.000	1.000	0.347	0.59	8.13	0.07	8.79	 $306.57 	0.59	8.13	0.07	8.79	 $306.57 	0.59	8.13	0.07	8.79	 $306.57 
10312	35	TENNESSEE	1.000	0.892	0.492	0.59	7.25	0.09	7.94	 $276.89 	0.59	7.25	0.09	7.94	 $276.89 	0.59	7.25	0.09	7.94	 $276.89 
04412	31	AUSTIN	1.000	1.059	0.539	0.59	8.61	0.10	9.30	 $324.58 	0.59	8.61	0.10	9.30	 $324.58 	0.59	8.61	0.10	9.30	 $324.58 
04412	20	BEAUMONT	1.000	0.944	0.550	0.59	7.67	0.10	8.37	 $292.03 	0.59	7.67	0.10	8.37	 $292.03 	0.59	7.67	0.10	8.37	 $292.03 
04412	09	BRAZORIA	1.032	1.023	0.550	0.61	8.32	0.10	9.03	 $315.10 	0.61	8.32	0.10	9.03	 $315.10 	0.61	8.32	0.10	9.03	 $315.10 
04412	11	DALLAS	1.023	1.026	0.546	0.60	8.34	0.10	9.05	 $315.74 	0.60	8.34	0.10	9.05	 $315.74 	0.60	8.34	0.10	9.05	 $315.74 
04412	28	FORT WORTH	1.016	0.995	0.539	0.60	8.09	0.10	8.79	 $306.75 	0.60	8.09	0.10	8.79	 $306.75 	0.60	8.09	0.10	8.79	 $306.75 
04412	15	GALVESTON	1.032	1.026	0.550	0.61	8.34	0.10	9.05	 $315.95 	0.61	8.34	0.10	9.05	 $315.95 	0.61	8.34	0.10	9.05	 $315.95 
04412	18	HOUSTON	1.032	1.029	0.900	0.61	8.37	0.17	9.15	 $319.12 	0.61	8.37	0.17	9.15	 $319.12 	0.61	8.37	0.17	9.15	 $319.12 
04412	99	REST OF TEXAS	1.000	0.955	0.584	0.59	7.76	0.11	8.47	 $295.37 	0.59	7.76	0.11	8.47	 $295.37 	0.59	7.76	0.11	8.47	 $295.37 
03502	09	UTAH	1.000	0.919	0.799	0.59	7.47	0.15	8.21	 $286.59 	0.59	7.47	0.15	8.21	 $286.59 	0.59	7.47	0.15	8.21	 $286.59 
14512	50	VERMONT	1.000	1.001	0.569	0.59	8.14	0.11	8.84	 $308.32 	0.59	8.14	0.11	8.84	 $308.32 	0.59	8.14	0.11	8.84	 $308.32 
11302	00	VIRGINIA	1.000	0.995	0.897	0.59	8.09	0.17	8.85	 $308.80 	0.59	8.09	0.17	8.85	 $308.80 	0.59	8.09	0.17	8.85	 $308.80 
09202	50	VIRGIN ISLANDS	1.000	1.008	0.986	0.59	8.20	0.19	8.97	 $313.07 	0.59	8.20	0.19	8.97	 $313.07 	0.59	8.20	0.19	8.97	 $313.07 
02402	02	SEATTLE (KING CNTY)	1.036	1.194	0.776	0.61	9.71	0.15	10.47	 $365.19 	0.61	9.71	0.15	10.47	 $365.19 	0.61	9.71	0.15	10.47	 $365.19 
02402	99	REST OF WASHINGTON	1.000	1.014	0.744	0.59	8.24	0.14	8.98	 $313.17 	0.59	8.24	0.14	8.98	 $313.17 	0.59	8.24	0.14	8.98	 $313.17 
11402	16	WEST VIRGINIA	1.000	0.858	1.198	0.59	6.98	0.23	7.79	 $271.93 	0.59	6.98	0.23	7.79	 $271.93 	0.59	6.98	0.23	7.79	 $271.93 
06302	00	WISCONSIN	1.000	0.942	0.296	0.59	7.66	0.06	8.30	 $289.78 	0.59	7.66	0.06	8.30	 $289.78 	0.59	7.66	0.06	8.30	 $289.78 
03602	21	WYOMING	1.000	1.000	0.841	0.59	8.13	0.16	8.88	 $309.84 	0.59	8.13	0.16	8.88	 $309.84 	0.59	8.13	0.16	8.88	 $309.84 
"*On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab when administered alone. Due to this revocation, Medicare will not pay for claims with HCPCS codes M0239 with dates of service after 4/16/2021.*"																				
																				
																				
