	Addendum A.-Final OPPS APCs for CY 2016																																																																																																																																																																																													
APC	Group Title	SI	Relative Weight 	Payment Rate 	National Unadjusted Copayment 	Minimum Unadjusted Copayment 																																																																																																																																																																																								
0701	Sr89 strontium	K		"$1,160.34"	.	$232.07																																																																																																																																																																																								
0726	Dexrazoxane HCl injection	K		$146.38	.	$29.28																																																																																																																																																																																								
0731	Sargramostim injection	K		$31.68	.	$6.34																																																																																																																																																																																								
0736	Amphotericin b liposome inj	K		$18.23	.	$3.65																																																																																																																																																																																								
0738	Rasburicase	K		$227.61	.	$45.53																																																																																																																																																																																								
0747	Chlorothiazide sodium inj	K		$119.93	.	$23.99																																																																																																																																																																																								
0751	Mechlorethamine hcl inj	K		$241.99	.	$48.40																																																																																																																																																																																								
0752	Dactinomycin injection	K		"$1,164.57"	.	$232.92																																																																																																																																																																																								
0759	"Naltrexone, depot form"	K		$3.18	.	$0.64																																																																																																																																																																																								
0800	Leuprolide acetate	K		$900.87	.	$180.18																																																																																																																																																																																								
0802	Etoposide oral	K		$68.74	.	$13.75																																																																																																																																																																																								
0807	Aldesleukin injection	K		"$2,667.51"	.	$533.51																																																																																																																																																																																								
0809	Bcg live intravesical vac	K		$122.88	.	$24.58																																																																																																																																																																																								
0810	Goserelin acetate implant	K		$281.05	.	$56.21																																																																																																																																																																																								
0812	Carmustine injection	K		"$2,973.34"	.	$594.67																																																																																																																																																																																								
0820	Daunorubicin injection	K		$26.45	.	$5.29																																																																																																																																																																																								
0821	Daunorubicin citrate inj	K		$238.86	.	$47.78																																																																																																																																																																																								
0823	Docetaxel injection	K		$3.49	.	$0.70																																																																																																																																																																																								
0825	Nelarabine injection	K		$148.57	.	$29.72																																																																																																																																																																																								
0827	Floxuridine injection	K		$67.69	.	$13.54																																																																																																																																																																																								
0831	Ifosfamide injection	K		$32.20	.	$6.44																																																																																																																																																																																								
0832	Idarubicin hcl injection	K		$34.88	.	$6.98																																																																																																																																																																																								
0835	Cosyntropin injection NOS	K		$101.68	.	$20.34																																																																																																																																																																																								
0836	Interferon alfa-2b inj	K		$24.05	.	$4.81																																																																																																																																																																																								
0838	Interferon gamma 1-b inj	K		"$5,265.95"	.	"$1,053.19"																																																																																																																																																																																								
0840	Inj melphalan hydrochl	K		"$1,285.40"	.	$257.08																																																																																																																																																																																								
0843	Pegaspargase injection	K		"$6,189.74"	.	"$1,237.95"																																																																																																																																																																																								
0844	Pentostatin injection	K		"$1,471.48"	.	$294.30																																																																																																																																																																																								
0849	Rituximab injection	K		$748.70	.	$149.74																																																																																																																																																																																								
0850	Streptozocin injection	K		$324.02	.	$64.81																																																																																																																																																																																								
0851	Thiotepa injection	K		$630.70	.	$126.14																																																																																																																																																																																								
0856	Porfimer sodium injection	K		"$20,438.61"	.	"$4,087.73"																																																																																																																																																																																								
0858	Inj cladribine	K		$20.91	.	$4.19																																																																																																																																																																																								
0864	Mitoxantrone hydrochl	K		$32.12	.	$6.43																																																																																																																																																																																								
0868	Oral aprepitant	K		$9.54	.	$1.91																																																																																																																																																																																								
0873	Hyalgan/supartz inj per dose	K		$88.61	.	$17.73																																																																																																																																																																																								
0874	Synvisc or synvisc-one	K		$12.87	.	$2.58																																																																																																																																																																																								
0875	Euflexxa inj per dose	K		$152.00	.	$30.40																																																																																																																																																																																								
0877	Orthovisc inj per dose	K		$172.63	.	$34.53																																																																																																																																																																																								
0887	Azathioprine parenteral	K		$217.30	.	$43.46																																																																																																																																																																																								
0890	Lymphocyte immune globulin	K		"$1,069.33"	.	$213.87																																																																																																																																																																																								
0901	Alpha 1 proteinase inhibitor	K		$4.45	.	$0.89																																																																																																																																																																																								
0902	"Injection,onabotulinumtoxinA"	K		$5.72	.	$1.15																																																																																																																																																																																								
0903	Cytomegalovirus imm IV /vial	K		"$1,064.77"	.	$212.96																																																																																																																																																																																								
0910	Interferon beta-1b / .25 MG	K		$357.22	.	$71.45																																																																																																																																																																																								
0913	Ganciclovir long act implant	K		"$16,960.00"	.	"$3,392.00"																																																																																																																																																																																								
0925	Factor viii	K		$0.96	.	$0.20																																																																																																																																																																																								
0927	Factor viii recombinant	K		$1.16	.	$0.24																																																																																																																																																																																								
0928	Factor ix complex	K		$1.19	.	$0.24																																																																																																																																																																																								
0929	Anti-inhibitor	K		$1.83	.	$0.37																																																																																																																																																																																								
0931	Factor IX non-recombinant	K		$1.07	.	$0.22																																																																																																																																																																																								
0932	Factor ix recombinant nos	K		$1.46	.	$0.30																																																																																																																																																																																								
0934	"Capecitabine, oral"	K		$19.50	.	$3.90																																																																																																																																																																																								
0943	Octagam injection	K		$42.80	.	$8.56																																																																																																																																																																																								
0944	Gammagard liquid injection	K		$38.56	.	$7.72																																																																																																																																																																																								
0946	Hepagam b im injection	K		$54.43	.	$10.89																																																																																																																																																																																								
0947	Flebogamma injection	K		$35.66	.	$7.14																																																																																																																																																																																								
0948	Gamunex-C/Gammaked	K		$40.30	.	$8.06																																																																																																																																																																																								
0961	"Albumin (human),5%, 50ml"	K		$10.91	.	$2.19																																																																																																																																																																																								
0963	"Albumin (human), 5%, 250 ml"	K		$54.54	.	$10.91																																																																																																																																																																																								
0964	"Albumin (human), 25%, 20 ml"	K		$22.49	.	$4.50																																																																																																																																																																																								
0965	"Albumin (human), 25%, 50ml"	K		$53.44	.	$10.69																																																																																																																																																																																								
1015	Injection glatiramer acetate	K		$194.25	.	$38.85																																																																																																																																																																																								
1052	"Injection, voriconazole"	K		$4.19	.	$0.84																																																																																																																																																																																								
1064	"I131 iodide cap, rx"	K		$40.70	.	$8.14																																																																																																																																																																																								
1083	Adalimumab injection	K		$742.96	.	$148.60																																																																																																																																																																																								
1086	Temozolomide	K		$2.66	.	$0.54																																																																																																																																																																																								
1138	"Hepagam b intravenous, inj"	K		$54.43	.	$10.89																																																																																																																																																																																								
1139	Protein c concentrate	K		$15.12	.	$3.03																																																																																																																																																																																								
1142	Supprelin LA implant	K		"$22,170.84"	.	"$4,434.17"																																																																																																																																																																																								
1150	"I131 iodide sol, rx"	K		$10.28	.	$2.06																																																																																																																																																																																								
1166	Cytarabine liposome inj	K		$576.48	.	$115.30																																																																																																																																																																																								
1168	"Inj, temsirolimus"	K		$62.50	.	$12.50																																																																																																																																																																																								
1178	Busulfan injection	K		$33.20	.	$6.64																																																																																																																																																																																								
1203	Verteporfin injection	K		$10.99	.	$2.20																																																																																																																																																																																								
1207	"Octreotide injection, depot"	K		$156.94	.	$31.39																																																																																																																																																																																								
1213	Antihemophilic viii/vwf comp	K		$0.96	.	$0.20																																																																																																																																																																																								
1214	Inj IVIG privigen 500 mg	K		$38.05	.	$7.61																																																																																																																																																																																								
1232	Mitomycin injection	K		$73.03	.	$14.61																																																																																																																																																																																								
1235	Valrubicin injection	K		"$1,117.31"	.	$223.47																																																																																																																																																																																								
1236	Levoleucovorin injection	K		$1.92	.	$0.39																																																																																																																																																																																								
1237	Inj iron dextran	K		$12.08	.	$2.42																																																																																																																																																																																								
1238	Topotecan oral	K		$101.36	.	$20.28																																																																																																																																																																																								
1253	Triamcinolone A inj PRS-free	K		$3.72	.	$0.75																																																																																																																																																																																								
1263	Antithrombin iii injection	K		$3.37	.	$0.68																																																																																																																																																																																								
1268	Xyntha inj	K		$1.42	.	$0.29																																																																																																																																																																																								
1272	Acetylcysteine injection	K		$2.00	.	$0.40																																																																																																																																																																																								
1274	Edetate calcium disodium inj	K		"$5,594.42"	.	"$1,118.89"																																																																																																																																																																																								
1280	Corticotropin injection	K		"$3,468.13"	.	$693.63																																																																																																																																																																																								
1281	Bevacizumab injection	K		$1.74	.	$0.35																																																																																																																																																																																								
1289	AbobotulinumtoxinA	K		$8.06	.	$1.62																																																																																																																																																																																								
1291	Rilonacept injection	K		$24.09	.	$4.82																																																																																																																																																																																								
1295	Sm 153 lexidronam	K		"$10,962.42"	.	"$2,192.49"																																																																																																																																																																																								
1296	Degarelix injection	K		$3.59	.	$0.72																																																																																																																																																																																								
1297	"Ferumoxytol, non-esrd"	K		$0.81	.	$0.17																																																																																																																																																																																								
1311	Canakinumab injection	K		$91.78	.	$18.36																																																																																																																																																																																								
1312	Hizentra injection	K		$8.47	.	$1.70																																																																																																																																																																																								
1327	Imiglucerase injection	K		$42.00	.	$8.40																																																																																																																																																																																								
1331	Olanzapine long-acting inj	K		$2.92	.	$0.59																																																																																																																																																																																								
1332	Antithrombin recombinant	K		$103.35	.	$20.67																																																																																																																																																																																								
1338	"Methyl aminolevulinate, top"	K		$83.69	.	$16.74																																																																																																																																																																																								
1340	"Collagenase, clost hist inj"	K		$38.06	.	$7.62																																																																																																																																																																																								
1341	Amobarbital 125 MG inj	K		$194.26	.	$38.86																																																																																																																																																																																								
1352	Wilate injection	K		$1.02	.	$0.21																																																																																																																																																																																								
1353	Belimumab injection	K		$40.54	.	$8.11																																																																																																																																																																																								
1354	Hydroxyprogesterone caproate	K		$2.61	.	$0.53																																																																																																																																																																																								
1356	Zoledronic Acid 1mg	K		$34.97	.	$7.00																																																																																																																																																																																								
1361	Enfuvirtide injection	K		$18.63	.	$3.73																																																																																																																																																																																								
1408	Cyclophosphamide 100 MG inj	K		$48.95	.	$9.79																																																																																																																																																																																								
1413	Lumizyme injection	K		$153.60	.	$30.72																																																																																																																																																																																								
1415	Glassia injection	K		$4.11	.	$0.83																																																																																																																																																																																								
1416	Factor xiii anti-hem factor	K		$7.41	.	$1.49																																																																																																																																																																																								
1417	Gel-one	K		$578.11	.	$115.63																																																																																																																																																																																								
1420	Aflibercept injection	K		$980.50	.	$196.10																																																																																																																																																																																								
1421	Imported lipodox inj	K		$508.43	.	$101.69																																																																																																																																																																																								
1424	Nabilone oral	K		$34.10	.	$6.82																																																																																																																																																																																								
1426	Eribulin mesylate injection	K		$102.53	.	$20.51																																																																																																																																																																																								
1431	Centruroides immune f(ab)	K		"$3,635.80"	.	$727.16																																																																																																																																																																																								
1433	Calcitonin salmon injection	K		"$2,006.85"	.	$401.37																																																																																																																																																																																								
1440	Inj desmopressin acetate	K		$8.97	.	$1.80																																																																																																																																																																																								
1442	Non-HEU TC-99M add-on/dose	K		$10.00	.	$2.00																																																																																																																																																																																								
1443	Icatibant injection	K		$298.90	.	$59.78																																																																																																																																																																																								
1446	Visualization adjunct	K		$10.80	.	$2.16																																																																																																																																																																																								
1457	Totazoline hcl injection	K		"$1,600.40"	.	$320.08																																																																																																																																																																																								
1458	Phentolaine mesylate inj	K		$159.00	.	$31.80																																																																																																																																																																																								
1460	Interferon alfa-2a inj	K		$733.57	.	$146.72																																																																																																																																																																																								
1464	Factor VIII (porcine)	K		$0.20	.	$0.04																																																																																																																																																																																								
1465	Tacrol astagraf ex rel oral	G		$0.39	.	$0.08																																																																																																																																																																																								
1466	"Inj, vincristine sul lip 1mg"	G		"$2,321.82"	.	$464.37																																																																																																																																																																																								
1467	Factor ix recombinan rixubis	G		$1.23	.	$0.25																																																																																																																																																																																								
1468	Inj Aripiprazole Ext Rel 1mg	K		$4.10	.	$0.82																																																																																																																																																																																								
1469	Inj filgrastim excl biosimil	K		$1.00	.	$0.20																																																																																																																																																																																								
1471	"Injection, Pertuzumab, 1 mg"	K		$10.22	.	$2.05																																																																																																																																																																																								
1472	Inj beta interferon im 1 mcg	K		$40.52	.	$8.11																																																																																																																																																																																								
1474	Certolizumab pegol inj 1mg	K		$6.62	.	$1.33																																																																																																																																																																																								
1475	Golimumab for iv use 1mg	K		$24.33	.	$4.87																																																																																																																																																																																								
1476	Obinutuzumab inj	G		$54.21	.	$10.85																																																																																																																																																																																								
1478	"	Human fibrinogen conc inj"	K		$1.05	.	$0.21																																																																																																																																																																																								
1479	"	Theraskin"	G		$36.00	.	$0.00																																																																																																																																																																																								
1480	"Elosulfase alfa, injection"	G		$221.54	.	$44.31																																																																																																																																																																																								
1482	"	Darbepoetin alfa, esrd use"	K		$4.38	.	$0.88																																																																																																																																																																																								
1484	"	Pentazocine injection"	K		$121.83	.	$24.37																																																																																																																																																																																								
1485	"	Ferumoxytol, esrd use"	K		$0.81	.	$0.17																																																																																																																																																																																								
1486	Factor ix fc fusion recomb	G		$2.81	.	$0.57																																																																																																																																																																																								
1487	Testosterone undecanoate 1mg	G		$1.17	.	$0.24																																																																																																																																																																																								
1488	"Injection, ramucirumab"	G		$53.97	.	$10.80																																																																																																																																																																																								
1489	"Injection, vedolizumab"	G		$17.03	.	$3.41																																																																																																																																																																																								
1490	Inj pembrolizumab	G		$45.69	.	$9.14																																																																																																																																																																																								
1491	New Technology  - Level 1A ($0-$10)	S		$5.00	.	$1.00																																																																																																																																																																																								
1492	New Technology  - Level 1B ($10-$20)	S		$15.00	.	$3.00																																																																																																																																																																																								
1493	New Technology  - Level 1C ($20-$30)	S		$25.00	.	$5.00																																																																																																																																																																																								
1494	New Technology  - Level 1D ($30-$40)	S		$35.00	.	$7.00																																																																																																																																																																																								
1495	New Technology  - Level 1E ($40-$50)	S		$45.00	.	$9.00																																																																																																																																																																																								
1496	New Technology  - Level 1A ($0-$10)	T		$5.00	.	$1.00																																																																																																																																																																																								
1497	New Technology  - Level 1B ($10-$20)	T		$15.00	.	$3.00																																																																																																																																																																																								
1498	New Technology  - Level 1C ($20-$30)	T		$25.00	.	$5.00																																																																																																																																																																																								
1499	New Technology  - Level 1D ($30-$40)	T		$35.00	.	$7.00																																																																																																																																																																																								
1500	New Technology  - Level 1E ($40-$50)	T		$45.00	.	$9.00																																																																																																																																																																																								
1502	New Technology - Level 2 ($50 - $100)	S		$75.00	.	$15.00																																																																																																																																																																																								
1503	New Technology - Level 3 ($100 - $200)	S		$150.00	.	$30.00																																																																																																																																																																																								
1504	New Technology - Level 4 ($200 - $300)	S		$250.00	.	$50.00																																																																																																																																																																																								
1505	New Technology - Level 5 ($300 - $400)	S		$350.00	.	$70.00																																																																																																																																																																																								
1506	New Technology - Level 6 ($400 - $500)	S		$450.00	.	$90.00																																																																																																																																																																																								
1507	New Technology - Level 7 ($500 - $600)	S		$550.00	.	$110.00																																																																																																																																																																																								
1508	New Technology - Level 8 ($600 - $700)	S		$650.00	.	$130.00																																																																																																																																																																																								
1509	New Technology - Level 9 ($700 - $800)	S		$750.00	.	$150.00																																																																																																																																																																																								
1510	New Technology - Level 10 ($800 - $900)	S		$850.00	.	$170.00																																																																																																																																																																																								
1511	New Technology - Level 11 ($900 - $1000)	S		$950.00	.	$190.00																																																																																																																																																																																								
1512	New Technology - Level 12 ($1000 - $1100)	S		"$1,050.00"	.	$210.00																																																																																																																																																																																								
1513	New Technology - Level 13 ($1100 - $1200)	S		"$1,150.00"	.	$230.00																																																																																																																																																																																								
1514	New Technology - Level 14 ($1200- $1300)	S		"$1,250.00"	.	$250.00																																																																																																																																																																																								
1515	New Technology - Level 15 ($1300 - $1400)	S		"$1,350.00"	.	$270.00																																																																																																																																																																																								
1516	New Technology - Level 16  ($1400 - $1500)	S		"$1,450.00"	.	$290.00																																																																																																																																																																																								
1517	New Technology - Level 17 ($1500-$1600)	S		"$1,550.00"	.	$310.00																																																																																																																																																																																								
1518	New Technology - Level 18 ($1600-$1700)	S		"$1,650.00"	.	$330.00																																																																																																																																																																																								
1519	New Technology - Level 19 ($1700-$1800)	S		"$1,750.00"	.	$350.00																																																																																																																																																																																								
1520	New Technology - Level 20 ($1800-$1900)	S		"$1,850.00"	.	$370.00																																																																																																																																																																																								
1521	New Technology - Level 21 ($1900-$2000)	S		"$1,950.00"	.	$390.00																																																																																																																																																																																								
1522	New Technology - Level 22 ($2000-$2500)	S		"$2,250.00"	.	$450.00																																																																																																																																																																																								
1523	New Technology - Level 23 ($2500-$3000)	S		"$2,750.00"	.	$550.00																																																																																																																																																																																								
1524	New Technology - Level 24 ($3000-$3500)	S		"$3,250.00"	.	$650.00																																																																																																																																																																																								
1525	New Technology - Level 25 ($3500-$4000)	S		"$3,750.00"	.	$750.00																																																																																																																																																																																								
1526	New Technology - Level 26 ($4000-$4500)	S		"$4,250.00"	.	$850.00																																																																																																																																																																																								
1527	New Technology - Level 27 ($4500-$5000)	S		"$4,750.00"	.	$950.00																																																																																																																																																																																								
1528	New Technology - Level 28 ($5000-$5500)	S		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																								
1529	New Technology - Level 29 ($5500-$6000)	S		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																								
1530	New Technology - Level 30 ($6000-$6500)	S		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																								
1531	New Technology - Level 31 ($6500-$7000)	S		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																								
1532	New Technology - Level 32 ($7000-$7500)	S		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																								
1533	New Technology - Level 33 ($7500-$8000)	S		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																								
1534	New Technology - Level 34 ($8000-$8500)	S		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																								
1535	New Technology - Level 35 ($8500-$9000)	S		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																								
1536	New Technology - Level 36 ($9000-$9500)	S		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																								
1537	New Technology - Level 37 ($9500-$10000)	S		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																								
1539	New Technology - Level 2 ($50 - $100)	T		$75.00	.	$15.00																																																																																																																																																																																								
1540	New Technology - Level 3 ($100 - $200)	T		$150.00	.	$30.00																																																																																																																																																																																								
1541	New Technology - Level 4 ($200 - $300)	T		$250.00	.	$50.00																																																																																																																																																																																								
1542	New Technology - Level 5 ($300 - $400)	T		$350.00	.	$70.00																																																																																																																																																																																								
1543	New Technology - Level 6 ($400 - $500)	T		$450.00	.	$90.00																																																																																																																																																																																								
1544	New Technology - Level 7 ($500 - $600)	T		$550.00	.	$110.00																																																																																																																																																																																								
1545	New Technology - Level 8 ($600 - $700)	T		$650.00	.	$130.00																																																																																																																																																																																								
1546	New Technology - Level 9 ($700 - $800)	T		$750.00	.	$150.00																																																																																																																																																																																								
1547	New Technology - Level 10 ($800 - $900)	T		$850.00	.	$170.00																																																																																																																																																																																								
1548	New Technology - Level 11 ($900 - $1000)	T		$950.00	.	$190.00																																																																																																																																																																																								
1549	New Technology - Level 12 ($1000 - $1100)	T		"$1,050.00"	.	$210.00																																																																																																																																																																																								
1550	New Technology - Level 13 ($1100 - $1200)	T		"$1,150.00"	.	$230.00																																																																																																																																																																																								
1551	New Technology - Level 14 ($1200- $1300)	T		"$1,250.00"	.	$250.00																																																																																																																																																																																								
1552	New Technology - Level 15 ($1300 - $1400)	T		"$1,350.00"	.	$270.00																																																																																																																																																																																								
1553	New Technology - Level 16 ($1400 - $1500)	T		"$1,450.00"	.	$290.00																																																																																																																																																																																								
1554	New Technology - Level 17 ($1500-$1600)	T		"$1,550.00"	.	$310.00																																																																																																																																																																																								
1555	New Technology - Level 18 ($1600-$1700)	T		"$1,650.00"	.	$330.00																																																																																																																																																																																								
1556	New Technology - Level 19 ($1700-$1800)	T		"$1,750.00"	.	$350.00																																																																																																																																																																																								
1557	New Technology - Level 20 ($1800-$1900)	T		"$1,850.00"	.	$370.00																																																																																																																																																																																								
1558	New Technology - Level 21 ($1900-$2000)	T		"$1,950.00"	.	$390.00																																																																																																																																																																																								
1559	New Technology - Level 22 ($2000-$2500)	T		"$2,250.00"	.	$450.00																																																																																																																																																																																								
1560	New Technology - Level 23 ($2500-$3000)	T		"$2,750.00"	.	$550.00																																																																																																																																																																																								
1561	New Technology - Level 24 ($3000-$3500)	T		"$3,250.00"	.	$650.00																																																																																																																																																																																								
1562	New Technology - Level 25 ($3500-$4000)	T		"$3,750.00"	.	$750.00																																																																																																																																																																																								
1563	New Technology - Level 26 ($4000-$4500)	T		"$4,250.00"	.	$850.00																																																																																																																																																																																								
1564	New Technology - Level 27 ($4500-$5000)	T		"$4,750.00"	.	$950.00																																																																																																																																																																																								
1565	New Technology - Level 28 ($5000-$5500)	T		"$5,250.00"	.	"$1,050.00"																																																																																																																																																																																								
1566	New Technology - Level 29 ($5500-$6000)	T		"$5,750.00"	.	"$1,150.00"																																																																																																																																																																																								
1567	New Technology - Level 30 ($6000-$6500)	T		"$6,250.00"	.	"$1,250.00"																																																																																																																																																																																								
1568	New Technology - Level 31 ($6500-$7000)	T		"$6,750.00"	.	"$1,350.00"																																																																																																																																																																																								
1569	New Technology - Level 32 ($7000-$7500)	T		"$7,250.00"	.	"$1,450.00"																																																																																																																																																																																								
1570	New Technology - Level 33 ($7500-$8000)	T		"$7,750.00"	.	"$1,550.00"																																																																																																																																																																																								
1571	New Technology - Level 34 ($8000-$8500)	T		"$8,250.00"	.	"$1,650.00"																																																																																																																																																																																								
1572	New Technology - Level 35 ($8500-$9000)	T		"$8,750.00"	.	"$1,750.00"																																																																																																																																																																																								
1573	New Technology - Level 36 ($9000-$9500)	T		"$9,250.00"	.	"$1,850.00"																																																																																																																																																																																								
1574	New Technology - Level 37 ($9500-$10000)	T		"$9,750.00"	.	"$1,950.00"																																																																																																																																																																																								
1575	"New Technology - Level 38 ($10,000-$15,000)"	S		"$12,500.00"	.	"$2,500.00"																																																																																																																																																																																								
1576	"New Technology - Level 39 ($15,000-$20,000)"	S		"$17,500.00"	.	"$3,500.00"																																																																																																																																																																																								
1577	"New Technology - Level 40 ($20,000-$25,000)"	S		"$22,500.00"	.	"$4,500.00"																																																																																																																																																																																								
1578	"New Technology - Level 41 ($25,000-$30,000)"	S		"$27,500.00"	.	"$5,500.00"																																																																																																																																																																																								
1579	"New Technology - Level 42 ($30,000-$40,000)"	S		"$35,000.00"	.	"$7,000.00"																																																																																																																																																																																								
1580	"New Technology - Level 43 ($40,000-$50,000)"	S		"$45,000.00"	.	"$9,000.00"																																																																																																																																																																																								
1581	"New Technology - Level 44 ($50,000-$60,000)"	S		"$55,000.00"	.	"$11,000.00"																																																																																																																																																																																								
1582	"New Technology - Level 45 ($60,000-$70,000)"	S		"$65,000.00"	.	"$13,000.00"																																																																																																																																																																																								
1583	"New Technology - Level 46 ($70,000-$80,000)"	S		"$75,000.00"	.	"$15,000.00"																																																																																																																																																																																								
1584	"New Technology - Level 47 ($80,000-$90,000)"	S		"$85,000.00"	.	"$17,000.00"																																																																																																																																																																																								
1585	"New Technology - Level 48 ($90,000-$100,000)   "	S		"$95,000.00"	.	"$19,000.00"																																																																																																																																																																																								
1589	"New Technology - Level 38 ($10,000-$15,000)"	T		"$12,500.00"	.	"$2,500.00"																																																																																																																																																																																								
1590	"New Technology - Level 39 ($15,000-$20,000)"	T		"$17,500.00"	.	"$3,500.00"																																																																																																																																																																																								
1591	"New Technology - Level 40 ($20,000-$25,000)"	T		"$22,500.00"	.	"$4,500.00"																																																																																																																																																																																								
1592	"New Technology - Level 41 ($25,000-$30,000)"	T		"$27,500.00"	.	"$5,500.00"																																																																																																																																																																																								
1593	"New Technology - Level 42 ($30,000-$40,000)"	T		"$35,000.00"	.	"$7,000.00"																																																																																																																																																																																								
1594	"New Technology - Level 43 ($40,000-$50,000)"	T		"$45,000.00"	.	"$9,000.00"																																																																																																																																																																																								
1595	"New Technology - Level 44 ($50,000-$60,000)"	T		"$55,000.00"	.	"$11,000.00"																																																																																																																																																																																								
1596	"New Technology - Level 45 ($60,000-$70,000)"	T		"$65,000.00"	.	"$13,000.00"																																																																																																																																																																																								
1597	"New Technology - Level 46 ($70,000-$80,000)"	T		"$75,000.00"	.	"$15,000.00"																																																																																																																																																																																								
1598	"New Technology - Level 47 ($80,000-$90,000) "	T		"$85,000.00"	.	"$17,000.00"																																																																																																																																																																																								
1599	"New Technology - Level 48 ($90,000-$100,000) "	T		"$95,000.00"	.	"$19,000.00"																																																																																																																																																																																								
1605	Abciximab injection	K		$965.13	.	$193.03																																																																																																																																																																																								
1607	Eptifibatide injection	K		$32.39	.	$6.48																																																																																																																																																																																								
1608	Etanercept injection	K		$330.81	.	$66.17																																																																																																																																																																																								
1609	"Rho(D) immune globulin h, sd"	K		$19.40	.	$3.88																																																																																																																																																																																								
1612	"Daclizumab, parenteral"	K		$526.34	.	$105.27																																																																																																																																																																																								
1613	Trastuzumab injection	K		$87.36	.	$17.48																																																																																																																																																																																								
1630	"Hep b ig, im"	K		$110.39	.	$22.08																																																																																																																																																																																								
1631	Baclofen intrathecal trial	K		$76.07	.	$15.22																																																																																																																																																																																								
1633	Alefacept	K		$41.64	.	$8.33																																																																																																																																																																																								
1643	"Y90 ibritumomab, rx"	K		"$46,304.42"	.	"$9,260.89"																																																																																																																																																																																								
1656	Factor viii fc fusion recomb	G		$1.90	.	$0.38																																																																																																																																																																																								
1657	"Puraply, puraply antimic"	G		$109.18	.	$0.00																																																																																																																																																																																								
1658	"Injection, belinostat, 10mg"	G		$31.64	.	$6.33																																																																																																																																																																																								
1660	"Injection, oritavancin"	G		$25.07	.	$5.02																																																																																																																																																																																								
1661	"Gen, neuro, HF, rechg bat"	H			.	.																																																																																																																																																																																								
1662	Inj tedizolid phosphate	G		$0.12	.	$0.03																																																																																																																																																																																								
1663	"Inj, phenylephrine ketorolac"	G		$492.90	.	$0.00																																																																																																																																																																																								
1664	Florbetapir f18	G		"$2,756.00"	.	$0.00																																																																																																																																																																																								
1665	Capsaicin 8% patch	K		$2.81	.	$0.57																																																																																																																																																																																								
1666	"	Tetracyclin injection"	K		$97.97	.	$19.60																																																																																																																																																																																								
1668	"	Chorionic gonadotropin/1000u"	K		$22.59	.	$4.52																																																																																																																																																																																								
1669	Erythro lactobionate /500 mg	K		$50.75	.	$10.15																																																																																																																																																																																								
1670	Tetanus immune globulin inj	K		$255.21	.	$51.05																																																																																																																																																																																								
1675	P32 Na phosphate	K		$213.56	.	$42.72																																																																																																																																																																																								
1676	P32 chromic phosphate	K		$906.62	.	$181.33																																																																																																																																																																																								
1683	Basiliximab	K		"$2,851.52"	.	$570.31																																																																																																																																																																																								
1684	Corticorelin ovine triflutal	K		$7.74	.	$1.55																																																																																																																																																																																								
1685	"Darbepoetin alfa, non-esrd"	K		$4.38	.	$0.88																																																																																																																																																																																								
1686	"Epoetin alfa, non-esrd"	K		$12.62	.	$2.53																																																																																																																																																																																								
1687	Digoxin immune fab (ovine)	K		"$2,639.26"	.	$527.86																																																																																																																																																																																								
1688	Ethanolamine oleate	K		$404.09	.	$80.82																																																																																																																																																																																								
1689	Fomepizole	K		$7.01	.	$1.41																																																																																																																																																																																								
1690	Hemin	K		$21.77	.	$4.36																																																																																																																																																																																								
1693	Lepirudin	K		$235.52	.	$47.11																																																																																																																																																																																								
1694	Ziconotide injection	K		$7.08	.	$1.42																																																																																																																																																																																								
1695	Nesiritide injection	K		$72.98	.	$14.60																																																																																																																																																																																								
1696	Palifermin injection	K		$15.59	.	$3.12																																																																																																																																																																																								
1697	Pegaptanib sodium injection	K		"$1,031.85"	.	$206.37																																																																																																																																																																																								
1700	Inj secretin synthetic human	K		$34.78	.	$6.96																																																																																																																																																																																								
1701	Treprostinil injection	K		$61.24	.	$12.25																																																																																																																																																																																								
1704	"Humate-P, inj"	K		$0.99	.	$0.20																																																																																																																																																																																								
1705	Factor viia	K		$2.07	.	$0.42																																																																																																																																																																																								
1709	Azacitidine injection	K		$3.05	.	$0.61																																																																																																																																																																																								
1710	Clofarabine injection	K		$138.38	.	$27.68																																																																																																																																																																																								
1711	Vantas implant	K		"$3,012.29"	.	$602.46																																																																																																																																																																																								
1712	Paclitaxel protein bound	K		$9.77	.	$1.96																																																																																																																																																																																								
1738	Oxaliplatin	K		$0.48	.	$0.10																																																																																																																																																																																								
1739	"Pegademase bovine, 25 iu"	K		$281.12	.	$56.23																																																																																																																																																																																								
1741	"Urofollitropin, 75 iu"	K		$64.69	.	$12.94																																																																																																																																																																																								
1743	Nandrolone decanoate 50 mg	K		$122.78	.	$24.56																																																																																																																																																																																								
1745	Radium ra223 dichloride ther	K		$112.30	.	$22.46																																																																																																																																																																																								
1746	Factor xiii recomb a-subunit	G		$14.07	.	$2.82																																																																																																																																																																																								
1747	Monovisc inj per dose	K		$958.45	.	$191.69																																																																																																																																																																																								
1748	Inj tbo filgrastim 1 microg	G		$3.86	.	$0.78																																																																																																																																																																																								
1807	Menb pr w/omv vaccine im	K		$155.70	.	$31.14																																																																																																																																																																																								
1808	Menb rlp vaccine im	K		$122.70	.	$24.54																																																																																																																																																																																								
1809	"Injection, alemtuzumab"	K		"$1,743.19"	.	$348.64																																																																																																																																																																																								
1822	Inj filgrastim gcsf biosimil	G		$0.97	.	$0.20																																																																																																																																																																																								
1823	"Injection, dalbavancin"	G		$14.28	.	$2.86																																																																																																																																																																																								
1824	"	Ceftaroline fosamil inj"	K		$2.14	.	$0.43																																																																																																																																																																																								
1825	Ceftazidime and avibactam	K		$75.53	.	$15.11																																																																																																																																																																																								
1826	Hyqvia 100mg immuneglobulin	K		$10.96	.	$2.20																																																																																																																																																																																								
1827	Factor viii recomb obizur	K		$4.90	.	$0.98																																																																																																																																																																																								
1828	Carbidopa levodopa enteral	K		$2.14	.	$0.43																																																																																																																																																																																								
1829	"	Penicillin g benzathine inj"	K		$7.84	.	$1.57																																																																																																																																																																																								
1831	"	Chloramphenicol sodium injec"	K		$31.74	.	$6.35																																																																																																																																																																																								
1832	Dimethyl sulfoxide 50% 50 ml	K		$211.57	.	$42.32																																																																																																																																																																																								
1833	Epoetin beta esrd use	K		$11.29	.	$2.26																																																																																																																																																																																								
1834	"	Digoxin injection"	K		$114.94	.	$22.99																																																																																																																																																																																								
1835	"	Ergonovine maleate injection"	K		$91.15	.	$18.23																																																																																																																																																																																								
1836	"	Penicillin g procaine inj"	K		$21.59	.	$4.32																																																																																																																																																																																								
1837	"	Methocarbamol injection"	K		$46.19	.	$9.24																																																																																																																																																																																								
1838	"Urokinase 250,000 iu inj"	K		$262.79	.	$52.56																																																																																																																																																																																								
1839	"	Oral busulfan"	K		$12.62	.	$2.53																																																																																																																																																																																								
1842	"	Leuprolide acetate implant"	K		$168.48	.	$33.70																																																																																																																																																																																								
1843	Menacwy vaccine im	K		$101.36	.	$20.28																																																																																																																																																																																								
2613	Lung bx plug w/del sys	H			.	.																																																																																																																																																																																								
2616	"Brachytx, non-str,Yttrium-90"	U	217.3170	"$16,021.70"	.	"$3,204.34"																																																																																																																																																																																								
2623	"Cath, translumin, drug-coat"	H			.	.																																																																																																																																																																																								
2624	Wireless pressure sensor 	H			.	.																																																																																																																																																																																								
2632	Iodine I-125 sodium iodide	U	0.0968	$7.14	.	$1.43																																																																																																																																																																																								
2634	"Brachytx, non-str, HA, I-125"	U	1.1554	$85.18	.	$17.04																																																																																																																																																																																								
2635	"Brachytx, non-str, HA, P-103"	U	0.4780	$35.24	.	$7.05																																																																																																																																																																																								
2636	"Brachy linear, non-str,P-103"	U	0.1932	$14.24	.	$2.85																																																																																																																																																																																								
2638	"Brachytx, stranded, I-125"	U	0.5167	$38.09	.	$7.62																																																																																																																																																																																								
2639	"Brachytx, non-stranded,I-125"	U	0.4970	$36.64	.	$7.33																																																																																																																																																																																								
2640	"Brachytx, stranded, P-103"	U	0.9329	$68.78	.	$13.76																																																																																																																																																																																								
2641	"Brachytx, non-stranded,P-103"	U	0.8983	$66.23	.	$13.25																																																																																																																																																																																								
2642	"Brachytx, stranded, C-131"	U	1.1745	$86.59	.	$17.32																																																																																																																																																																																								
2643	"Brachytx, non-stranded,C-131"	U	0.7077	$52.18	.	$10.44																																																																																																																																																																																								
2644	Brachytx cesium-131 chloride	U	0.1683	$12.41	.	$2.49																																																																																																																																																																																								
2645	"Brachytx, non-str, Gold-198"	U	0.6177	$45.54	.	$9.11																																																																																																																																																																																								
2646	"Brachytx, non-str, HDR Ir-192"	U	3.9884	$294.04	.	$58.81																																																																																																																																																																																								
2647	"Brachytx, NS, Non-HDRIr-192"	U	1.2629	$93.11	.	$18.63																																																																																																																																																																																								
2698	"Brachytx, stranded, NOS"	U	0.5167	$38.09	.	$7.62																																																																																																																																																																																								
2699	"Brachytx, non-stranded, NOS"	U	0.1932	$14.24	.	$2.85																																																																																																																																																																																								
2731	"Immune globulin, powder"	K		$33.11	.	$6.63																																																																																																																																																																																								
2770	Quinupristin/dalfopristin	K		$311.04	.	$62.21																																																																																																																																																																																								
3041	Bivalirudin	K		$3.71	.	$0.75																																																																																																																																																																																								
5011	Level 1 Examinations and Related Services 	V	0.7380	$54.41	.	$10.89																																																																																																																																																																																								
5012	Level 2 Examinations and Related Services 	V	1.3852	$102.12	.	$20.43																																																																																																																																																																																								
5013	Level 3 Examinations and Related Services 	V	6.5201	$480.69	.	$96.14																																																																																																																																																																																								
5021	Level 1 Type A ED Visits	V	0.8044	$59.30	.	$11.86																																																																																																																																																																																								
5022	Level 2 Type A ED Visits	V	1.4852	$109.50	.	$21.90																																																																																																																																																																																								
5023	Level 3 Type A ED Visits	V	2.6582	$195.98	.	$39.20																																																																																																																																																																																								
5024	Level 4 Type A ED Visits	V	4.4353	$326.99	.	$65.40																																																																																																																																																																																								
5025	Level 5 Type A ED Visits	V	6.5926	$486.04	.	$97.21																																																																																																																																																																																								
5031	Level 1 Type B ED Visits	V	1.0745	$79.22	.	$15.85																																																																																																																																																																																								
5032	Level 2 Type B ED Visits	V	1.0331	$76.17	.	$15.24																																																																																																																																																																																								
5033	Level 3 Type B ED Visits	V	1.5626	$115.20	.	$23.04																																																																																																																																																																																								
5034	Level 4 Type B ED Visits	V	2.6619	$196.25	.	$39.25																																																																																																																																																																																								
5035	Level 5 Type B ED Visits	V	4.2846	$315.88	.	$63.18																																																																																																																																																																																								
5041	Critical Care	S	9.0373	$666.27	.	$133.26																																																																																																																																																																																								
5045	Trauma Response with Critical Care	S	11.5483	$851.40	.	$170.28																																																																																																																																																																																								
5051	Level 1 Skin Procedures	T	1.5982	$117.83	.	$23.57																																																																																																																																																																																								
5052	Level 2 Skin Procedures	T	3.0594	$225.55	.	$45.11																																																																																																																																																																																								
5053	Level 3 Skin Procedures	T	5.8144	$428.67	.	$85.74																																																																																																																																																																																								
5054	Level 4 Skin Procedures	T	19.1415	"$1,411.21"	.	$282.25																																																																																																																																																																																								
5055	Level 5 Skin Procedures	T	28.9928	"$2,137.49"	.	$427.50																																																																																																																																																																																								
5061	Hyperbaric Oxygen	S	1.4610	$107.71	.	$21.55																																																																																																																																																																																								
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	T	3.0962	$228.27	.	$45.66																																																																																																																																																																																								
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	T	6.5194	$480.64	.	$96.13																																																																																																																																																																																								
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	T	12.7769	$941.98	.	$188.40																																																																																																																																																																																								
5074	Level 4 Excision/ Biopsy/ Incision and Drainage	T	19.1832	"$1,414.28"	.	$282.86																																																																																																																																																																																								
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	T	29.6771	"$2,187.94"	.	$437.59																																																																																																																																																																																								
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	T	49.4684	"$3,647.06"	.	$729.42																																																																																																																																																																																								
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	J1	102.5127	"$7,557.75"	.	"$1,511.55"																																																																																																																																																																																								
5101	Level 1 Strapping and Cast Application	S	1.6174	$119.24	.	$23.85																																																																																																																																																																																								
5102	Level 2 Strapping and Cast Application	S	2.8197	$207.88	.	$41.58																																																																																																																																																																																								
5111	Level 1 Closed Treatment Fracture and Related Services	T	2.3375	$172.33	.	$34.47																																																																																																																																																																																								
5112	Level 2 Closed Treatment Fracture and Related Services	T	3.2214	$237.50	.	$47.50																																																																																																																																																																																								
5113	Level 3 Closed Treatment Fracture and Related Services	T	14.8722	"$1,096.45"	.	$219.29																																																																																																																																																																																								
5121	Level1 Musculoskeletal Procedures 	T	19.7390	"$1,455.26"	.	$291.06																																																																																																																																																																																								
5122	Level 2 Musculoskeletal Procedures 	T	32.4936	"$2,395.59"	.	$479.12																																																																																																																																																																																								
5123	Level 3 Musculoskeletal Procedures 	J1	67.4027	"$4,969.26"	.	$993.86																																																																																																																																																																																								
5124	Level 4 Musculoskeletal Procedures 	J1	95.8165	"$7,064.07"	.	"$1,412.82"																																																																																																																																																																																								
5125	Level 5 Musculoskeletal Procedures	J1	142.9352	"$10,537.90"	.	"$2,107.58"																																																																																																																																																																																								
5141	Thoracoscopy	T	42.7660	"$3,152.92"	.	$630.59																																																																																																																																																																																								
5151	Level 1 Airway Endoscopy	T	1.9167	$141.31	.	$28.27																																																																																																																																																																																								
5152	Level 2 Airway Endoscopy	T	5.0883	$375.13	.	$75.03																																																																																																																																																																																								
5153	Level 3 Airway Endoscopy	T	14.0725	"$1,037.50"	.	$207.50																																																																																																																																																																																								
5154	Level 4 Airway Endoscopy	T	27.0183	"$1,991.92"	.	$398.39																																																																																																																																																																																								
5155	Level 5 Airway Endoscopy	T	41.5935	"$3,066.48"	.	$613.30																																																																																																																																																																																								
5161	Level 1 ENT Procedures	T	1.7537	$129.29	.	$25.86																																																																																																																																																																																								
5162	Level 2 ENT Procedures	T	4.2445	$312.93	.	$62.59																																																																																																																																																																																								
5163	Level 3 ENT Procedures	T	9.3541	$689.63	.	$137.93																																																																																																																																																																																								
5164	Level 4 ENT Procedures	T	21.9315	"$1,616.90"	.	$323.38																																																																																																																																																																																								
5165	Level 5 ENT Procedures	J1	53.6586	"$3,955.98"	.	$791.20																																																																																																																																																																																								
5166	Level 6 ENT Procedures	J1	412.7172	"$30,427.58"	"$7,835.75"	"$6,085.52"																																																																																																																																																																																								
5181	Level 1 Vascular Procedures	T	11.6990	$862.51	.	$172.51																																																																																																																																																																																								
5182	Level 2 Vascular Procedures	T	30.4826	"$2,247.33"	.	$449.47																																																																																																																																																																																								
5183	Level 3 Vascular Procedures	T	51.4789	"$3,795.28"	.	$759.06																																																																																																																																																																																								
5188	Diagnostic Cardiac Catheterization	T	34.5760	"$2,549.12"	$784.25	$509.83																																																																																																																																																																																								
5191	Level 1 Endovascular Procedures	J1	62.2875	"$4,592.15"	.	$918.43																																																																																																																																																																																								
5192	Level 2 Endovascular Procedures	J1	129.4317	"$9,542.35"	.	"$1,908.47"																																																																																																																																																																																								
5193	Level 3 Endovascular Procedures	J1	198.1983	"$14,612.17"	.	"$2,922.44"																																																																																																																																																																																								
5211	Level 1 Electrophysiologic Procedures	J1	11.4621	$845.04	.	$169.01																																																																																																																																																																																								
5212	Level 2 Electrophysiologic Procedures	J1	63.7229	"$4,697.97"	.	$939.60																																																																																																																																																																																								
5213	Level 3 Electrophysiologic Procedures	J1	211.0697	"$15,561.11"	.	"$3,112.23"																																																																																																																																																																																								
5221	Level1 Pacemaker and Similar Procedures	T	33.7699	"$2,489.69"	.	$497.94																																																																																																																																																																																								
5222	Level 2 Pacemaker and Similar Procedures	J1	90.8356	"$6,696.85"	.	"$1,339.37"																																																																																																																																																																																								
5223	Level 3 Pacemaker and Similar Procedures	J1	125.7836	"$9,273.40"	.	"$1,854.68"																																																																																																																																																																																								
5224	Level 4 Pacemaker and Similar Procedures	J1	229.4256	"$16,914.40"	.	"$3,382.88"																																																																																																																																																																																								
5231	Level 1 ICD and Similar Procedures	J1	297.4572	"$21,930.03"	.	"$4,386.01"																																																																																																																																																																																								
5232	Level 2 ICD and Similar Procedures	J1	413.5610	"$30,489.78"	.	"$6,097.96"																																																																																																																																																																																								
5241	Transfusion	S	4.7357	$349.14	.	$69.83																																																																																																																																																																																								
5271	Blood Product Exchange and Related Services	S	14.2117	"$1,047.76"	.	$209.56																																																																																																																																																																																								
5281	Apheresis/Stem Cell and Related Services	S	40.8961	"$3,015.06"	.	$603.02																																																																																																																																																																																								
5291	Thrombolysis and Other Device Revisions 	T	2.7101	$199.80	.	$39.96																																																																																																																																																																																								
5301	Level 1 Upper GI Procedures	T	10.1100	$745.36	.	$149.08																																																																																																																																																																																								
5302	Level 2 Upper GI Procedures 	T	14.7575	"$1,088.00"	.	$217.60																																																																																																																																																																																								
5303	Level 3 Upper GI Procedures	T	26.8624	"$1,980.43"	.	$396.09																																																																																																																																																																																								
5311	Level 1 Lower GI Procedures 	T	6.6796	$492.45	.	$98.49																																																																																																																																																																																								
5312	Level 2 Lower GI Procedures 	T	10.2104	$752.76	.	$150.56																																																																																																																																																																																								
5313	Level 3 Lower GI Procedures 	T	22.5365	"$1,661.50"	.	$332.30																																																																																																																																																																																								
5314	Level 4 Lower GI Procedures 	T	31.5583	"$2,326.64"	.	$465.33																																																																																																																																																																																								
5331	Complex GI Procedures	J1	49.0142	"$3,613.57"	.	$722.72																																																																																																																																																																																								
5341	Peritoneal and Abdominal Procedures 	T	35.4367	"$2,612.57"	.	$522.52																																																																																																																																																																																								
5351	Level 1 Percutaneous Abdominal/Biliary Procedures and Related Procedures	T	29.5301	"$2,177.11"	.	$435.43																																																																																																																																																																																								
5352	Level 2 Percutaneous Abdominal/Biliary Procedures and Related Procedures	T	55.8594	"$4,118.23"	.	$823.65																																																																																																																																																																																								
5361	Level 1 Laparoscopy	J1	54.2713	"$4,001.15"	.	$800.23																																																																																																																																																																																								
5362	Level 2 Laparoscopy	J1	93.0608	"$6,860.91"	"$1,526.22"	"$1,372.19"																																																																																																																																																																																								
5371	Level 1 Urology and Related Services	T	2.8025	$206.61	.	$41.33																																																																																																																																																																																								
5372	Level 2 Urology and Related Services	T	7.1140	$524.48	.	$104.90																																																																																																																																																																																								
5373	Level 3 Urology and Related Services	T	20.4329	"$1,506.42"	.	$301.29																																																																																																																																																																																								
5374	Level 4 Urology and Related Services	T	30.4305	"$2,243.49"	.	$448.70																																																																																																																																																																																								
5375	Level 5 Urology and Related Services	J1	46.0323	"$3,393.73"	.	$678.75																																																																																																																																																																																								
5376	Level 6 Urology and Related Services	J1	100.7564	"$7,428.27"	.	"$1,485.66"																																																																																																																																																																																								
5377	Level 7 Urology and Related Services	J1	191.0888	"$14,088.02"	.	"$2,817.61"																																																																																																																																																																																								
5391	Level 1 Tube/Catheter Changes/Thoracentesis/Lavage	T	6.5491	$482.83	.	$96.57																																																																																																																																																																																								
5392	Level 2 Tube/Catheter Changes/Thoracentesis/Lavage	T	16.3818	"$1,207.75"	.	$241.55																																																																																																																																																																																								
5401	Dialysis	S	7.4150	$546.67	.	$109.34																																																																																																																																																																																								
5411	Level 1 Gynecologic Procedures	T	1.9069	$140.59	.	$28.12																																																																																																																																																																																								
5412	Level 2 Gynecologic Procedures	T	3.4032	$250.90	.	$50.18																																																																																																																																																																																								
5413	Level 3 Gynecologic Procedures	T	8.6381	$636.84	.	$127.37																																																																																																																																																																																								
5414	Level 4 Gynecologic Procedures	T	25.2449	"$1,861.18"	.	$372.24																																																																																																																																																																																								
5415	Level 5 Gynecologic Procedures	J1	49.6467	"$3,660.20"	$902.82	$732.04																																																																																																																																																																																								
5416	Level 6 Gynecologic Procedures	J1	77.3001	"$5,698.95"	"$1,405.70"	"$1,139.79"																																																																																																																																																																																								
5431	Level 1 Nerve Procedures	T	18.8886	"$1,392.56"	.	$278.52																																																																																																																																																																																								
5432	Level 2 Nerve Procedures	T	46.0736	"$3,396.78"	.	$679.36																																																																																																																																																																																								
5441	Level 1 Nerve Injections	T	3.0350	$223.76	.	$44.76																																																																																																																																																																																								
5442	Level 2 Nerve Injections	T	7.9372	$585.17	.	$117.04																																																																																																																																																																																								
5443	Level 3 Nerve Injections	T	11.1509	$822.10	.	$164.42																																																																																																																																																																																								
5461	Level 1 Neurostimulator and Related Procedures	T	29.6866	"$2,188.64"	$498.27	$437.73																																																																																																																																																																																								
5462	Level 2 Neurostimulator and Related Procedures	J1	71.1342	"$5,244.37"	.	"$1,048.88"																																																																																																																																																																																								
5463	Level 3 Neurostimulator and Related Procedures	J1	235.4611	"$17,359.37"	.	"$3,471.88"																																																																																																																																																																																								
5464	Level 4 Neurostimulator and Related Procedures	J1	362.5417	"$26,728.39"	.	"$5,345.68"																																																																																																																																																																																								
5471	Implantation of Drug Infusion Device	J1	208.2091	"$15,350.22"	.	"$3,070.05"																																																																																																																																																																																								
5481	Laser Eye Procedures	T	5.9733	$440.38	$101.51	$88.08																																																																																																																																																																																								
5491	Level 1 Intraocular Procedures	T	23.6785	"$1,745.70"	.	$349.14																																																																																																																																																																																								
5492	Level 2 Intraocular Procedures	J1	45.8565	"$3,380.77"	.	$676.16																																																																																																																																																																																								
5493	Level 3 Intraocular Procedures	J1	127.4794	"$9,398.42"	.	"$1,879.69"																																																																																																																																																																																								
5494	Level 4 Intraocular Procedures	J1	238.0581	"$17,550.83"	.	"$3,510.17"																																																																																																																																																																																								
5501	"Level 1 Extraocular, Repair, and Plastic Eye Procedures"	T	3.5406	$261.03	.	$52.21																																																																																																																																																																																								
5502	"Level 2 Extraocular, Repair, and Plastic Eye Procedures"	T	9.4501	$696.71	.	$139.35																																																																																																																																																																																								
5503	"Level 3 Extraocular, Repair, and Plastic Eye Procedures"	T	19.0052	"$1,401.16"	.	$280.24																																																																																																																																																																																								
5504	"Level 4 Extraocular, Repair, and Plastic Eye Procedures"	T	34.0502	"$2,510.35"	.	$502.07																																																																																																																																																																																								
5521	Level 1 X-Ray and Related Services	S	0.8247	$60.80	.	$12.16																																																																																																																																																																																								
5522	Level 2 X-Ray and Related Services	S	1.3658	$100.69	.	$20.14																																																																																																																																																																																								
5523	Level 3 X-Ray and Related Services 	S	2.6039	$191.97	.	$38.40																																																																																																																																																																																								
5524	Level 4 X-Ray and Related Services 	S	4.7706	$351.71	.	$70.35																																																																																																																																																																																								
5525	Level 5 X-Ray and Related Services	S	9.0598	$667.93	.	$133.59																																																																																																																																																																																								
5526	Level 6 X-Ray and Related Services	S	36.8780	"$2,718.83"	.	$543.77																																																																																																																																																																																								
5531	Level 1 Ultrasound and Related Services	S	1.2488	$92.07	$22.35	$18.42																																																																																																																																																																																								
5532	Level 2 Ultrasound and Related Services	S	2.0831	$153.58	.	$30.72																																																																																																																																																																																								
5533	Level 3 Ultrasound and Related Services	S	5.6534	$416.80	.	$83.36																																																																																																																																																																																								
5534	Level 4 Ultrasound and Related Services	S	9.4764	$698.65	.	$139.73																																																																																																																																																																																								
5561	Level 1 Echocardiogram with Contrast	S	6.1587	$454.05	$117.37	$90.81																																																																																																																																																																																								
5562	Level 2 Echocardiogram with Contrast	S	9.1008	$670.96	$168.06	$134.20																																																																																																																																																																																								
5570	Computed Tomography without Contrast	S	1.5258	$112.49	$43.50	$22.50																																																																																																																																																																																								
5571	Level 1 Computed Tomography with Contrast and Computed Tomography Angiography	S	3.2128	$236.86	.	$47.38																																																																																																																																																																																								
5572	Level 2 Computed Tomography with Contrast and Computed Tomography Angiography	S	4.7165	$347.72	$111.70	$69.55																																																																																																																																																																																								
5581	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	S	3.7103	$273.54	$107.79	$54.71																																																																																																																																																																																								
5582	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	S	6.1623	$454.32	$146.33	$90.87																																																																																																																																																																																								
5591	Level 1 Nuclear Medicine and Related Services 	S	4.5120	$332.65	.	$66.53																																																																																																																																																																																								
5592	Level 2 Nuclear Medicine and Related Services	S	5.9866	$441.36	.	$88.28																																																																																																																																																																																								
5593	Level 3 Nuclear Medicine and Related Services 	S	15.0350	"$1,108.46"	.	$221.70																																																																																																																																																																																								
5594	Level 4 Nuclear Medicine and Related Services	S	17.4320	"$1,285.17"	.	$257.04																																																																																																																																																																																								
5611	Level 1 Therapeutic Radiation Treatment Preparation	S	1.4567	$107.40	$32.44	$21.48																																																																																																																																																																																								
5612	Level 2 Therapeutic Radiation Treatment Preparation	S	2.2604	$166.65	$50.33	$33.33																																																																																																																																																																																								
5613	Level 3 Therapeutic Radiation Treatment Preparation	S	3.9575	$291.77	$82.35	$58.36																																																																																																																																																																																								
5614	Level 4 Therapeutic Radiation Treatment Preparation	S	13.9276	"$1,026.81"	$321.60	$205.37																																																																																																																																																																																								
5621	Level 1 Radiation Therapy	S	1.4966	$110.34	.	$22.07																																																																																																																																																																																								
5622	Level 2 Radiation Therapy	S	2.6362	$194.35	.	$38.87																																																																																																																																																																																								
5623	Level 3 Radiation Therapy	S	6.8567	$505.51	.	$101.11																																																																																																																																																																																								
5624	Level 4 Radiation Therapy	S	9.4433	$696.21	.	$139.25																																																																																																																																																																																								
5625	Level 5 Radiation Therapy	S	15.6079	"$1,150.69"	.	$230.14																																																																																																																																																																																								
5626	Level 6 Radiation Therapy	S	22.6777	"$1,671.91"	.	$334.39																																																																																																																																																																																								
5627	Level 7 Radiation Therapy	J1	99.0199	"$7,300.24"	.	"$1,460.05"																																																																																																																																																																																								
5661	Therapeutic Nuclear Medicine	S	3.3907	$249.98	.	$50.00																																																																																																																																																																																								
5671	Level 1 Pathology	S	0.6477	$47.75	.	$9.55																																																																																																																																																																																								
5672	Level 2 Pathology	S	1.3863	$102.20	.	$20.44																																																																																																																																																																																								
5673	Level 3 Pathology	S	2.8406	$209.42	.	$41.89																																																																																																																																																																																								
5674	Level 4 Pathology	S	5.9753	$440.53	.	$88.11																																																																																																																																																																																								
5681	Transfusion Laboratory Procedures	S	1.3974	$103.02	.	$20.61																																																																																																																																																																																								
5691	Level 1 Drug Administration	S	0.4187	$30.87	.	$6.18																																																																																																																																																																																								
5692	Level 2 Drug Administration	S	0.5739	$42.31	.	$8.47																																																																																																																																																																																								
5693	Level 3 Drug Administration	S	1.2533	$92.40	.	$18.48																																																																																																																																																																																								
5694	Level 4 Drug Administration	S	2.3490	$173.18	.	$34.64																																																																																																																																																																																								
5695	Level 5 Drug Administration	S	3.8015	$280.27	.	$56.06																																																																																																																																																																																								
5701	Dosimetric Drug Administration	S	26.7427	"$1,971.61"	.	$394.33																																																																																																																																																																																								
5721	Level1 Diagnostic Tests and Related Services	S	1.7599	$129.75	.	$25.95																																																																																																																																																																																								
5722	Level 2 Diagnostic Tests and Related Services	S	2.9888	$220.35	.	$44.07																																																																																																																																																																																								
5723	Level 3 Diagnostic Tests and Related Services	S	5.3783	$396.52	.	$79.31																																																																																																																																																																																								
5724	Level 4 Diagnostic Tests and Related Services	S	11.6167	$856.44	.	$171.29																																																																																																																																																																																								
5731	Level 1 Minor Procedures	S	0.1722	$12.70	.	$2.54																																																																																																																																																																																								
5732	Level 2 Minor Procedures	S	0.4139	$30.51	.	$6.11																																																																																																																																																																																								
5733	Level 3 Minor Procedures	S	0.7587	$55.94	.	$11.19																																																																																																																																																																																								
5734	Level 4 Minor Procedures	S	1.2367	$91.18	.	$18.24																																																																																																																																																																																								
5741	Level 1 Electronic Analysis of Devices	S	0.4560	$33.62	.	$6.73																																																																																																																																																																																								
5742	Level 2 Electronic Analysis of Devices	S	1.4438	$106.44	.	$21.29																																																																																																																																																																																								
5743	Level 3 Electronic Analysis of Devices	S	3.2713	$241.18	.	$48.24																																																																																																																																																																																								
5771	Cardiac Rehabilitation	S	1.4096	$103.92	.	$20.79																																																																																																																																																																																								
5781	Resuscitation and Cardioversion	S	6.3356	$467.09	.	$93.42																																																																																																																																																																																								
5791	Pulmonary Treatment	S	2.0272	$149.46	.	$29.90																																																																																																																																																																																								
5801	Ventilation Initiation and Management	S	6.2002	$457.11	.	$91.43																																																																																																																																																																																								
5811	Manipulation Therapy	S	0.3113	$22.95	.	$4.59																																																																																																																																																																																								
5821	Level 1 Health and Behavior Services	S	0.3678	$27.12	.	$5.43																																																																																																																																																																																								
5822	Level 2 Health and Behavior Services	S	0.9447	$69.65	.	$13.93																																																																																																																																																																																								
5841	Psychotherapy	S	1.6960	$125.04	.	$25.01																																																																																																																																																																																								
5851	Level 1 Partial Hospitalization (3 services) for CMHCs	P	1.2817	$94.49	.	$18.90																																																																																																																																																																																								
5852	Level 2 Partial Hospitalization (4 or more services) for CMHCs	P	1.9397	$143.00	.	$28.60																																																																																																																																																																																								
5861	Level 1 Partial Hospitalization (3 services) for Hospital-based PHPs	P	2.4877	$183.41	.	$36.69																																																																																																																																																																																								
5862	Level 2 Partial Hospitalization (4 or more services) for Hospital-based PHPs	P	2.8847	$212.67	.	$42.54																																																																																																																																																																																								
5871	Dental Procedures	S	5.0351	$371.21	.	$74.25																																																																																																																																																																																								
5881	Ancillary Outpatient Services When Patient Dies	J1	83.3334	"$6,143.75"	.	"$1,228.75"																																																																																																																																																																																								
7000	Amifostine	K		$363.93	.	$72.79																																																																																																																																																																																								
7011	Oprelvekin injection	K		$417.79	.	$83.56																																																																																																																																																																																								
7034	"	Somatropin injection"	K		$81.59	.	$16.32																																																																																																																																																																																								
7035	Teniposide	K		"$3,494.46"	.	$698.90																																																																																																																																																																																								
7041	Tirofiban HCl	K		$8.94	.	$1.79																																																																																																																																																																																								
7042	"Capecitabine, oral"	K		$5.53	.	$1.11																																																																																																																																																																																								
7043	Infliximab injection	K		$78.76	.	$15.76																																																																																																																																																																																								
7046	Doxorubicin inj 10mg	K		$443.83	.	$88.77																																																																																																																																																																																								
7048	Alteplase recombinant	K		$73.74	.	$14.75																																																																																																																																																																																								
7308	Aminolevulinic acid hcl top	K		$292.79	.	$58.56																																																																																																																																																																																								
8001	LDR Prostate Brachytherapy Composite	T	45.9199	"$3,385.44"	.	$677.09																																																																																																																																																																																								
8004	Ultrasound Composite	S	3.8964	$287.26	.	$57.46																																																																																																																																																																																								
8005	CT and CTA without Contrast Composite	S	3.8538	$284.12	.	$56.83																																																																																																																																																																																								
8006	CT and CTA with Contrast Composite	S	6.6994	$493.91	.	$98.79																																																																																																																																																																																								
8007	MRI and MRA without Contrast Composite	S	7.6780	$566.06	.	$113.22																																																																																																																																																																																								
8008	MRI and MRA with Contrast Composite	S	11.6954	$862.24	.	$172.45																																																																																																																																																																																								
8010	Mental Health Services Composite	S	2.8847	$212.67	.	$42.54																																																																																																																																																																																								
8011	Comprehensive Observation Services	J2	29.4898	"$2,174.14"	.	$434.83																																																																																																																																																																																								
9001	Linezolid injection	K		$31.62	.	$6.33																																																																																																																																																																																								
9002	Tenecteplase injection	K		$93.96	.	$18.80																																																																																																																																																																																								
9003	Palivizumab	K		"$1,947.49"	.	$389.50																																																																																																																																																																																								
9005	Reteplase injection	K		"$2,301.91"	.	$460.39																																																																																																																																																																																								
9006	Tacrolimus injection	K		$163.25	.	$32.65																																																																																																																																																																																								
9012	Arsenic trioxide injection	K		$59.42	.	$11.89																																																																																																																																																																																								
9018	"Inj, rimabotulinumtoxinB"	K		$11.65	.	$2.33																																																																																																																																																																																								
9019	Caspofungin acetate	K		$12.75	.	$2.55																																																																																																																																																																																								
9024	Amphotericin b lipid complex	K		$12.38	.	$2.48																																																																																																																																																																																								
9032	Baclofen 10 MG injection	K		$170.03	.	$34.01																																																																																																																																																																																								
9033	Cidofovir injection	K		$650.18	.	$130.04																																																																																																																																																																																								
9038	Inj estrogen conjugate	K		$215.70	.	$43.14																																																																																																																																																																																								
9042	Glucagon hydrochloride	K		$190.60	.	$38.12																																																																																																																																																																																								
9044	Ibutilide fumarate injection	K		$63.10	.	$12.62																																																																																																																																																																																								
9104	Antithymocyte globuln rabbit	K		$638.49	.	$127.70																																																																																																																																																																																								
9108	Thyrotropin injection	K		"$1,432.17"	.	$286.44																																																																																																																																																																																								
9119	"Injection, pegfilgrastim 6mg"	K		"$3,772.79"	.	$754.56																																																																																																																																																																																								
9120	"Injection, Fulvestrant"	K		$93.44	.	$18.69																																																																																																																																																																																								
9121	"Injection, argatroban"	K		$15.14	.	$3.03																																																																																																																																																																																								
9122	Triptorelin pamoate	K		$144.59	.	$28.92																																																																																																																																																																																								
9124	Daptomycin injection	K		$0.76	.	$0.16																																																																																																																																																																																								
9125	"Risperidone, long acting"	K		$6.91	.	$1.39																																																																																																																																																																																								
9126	Natalizumab injection	K		$16.24	.	$3.25																																																																																																																																																																																								
9130	"Inj, Imm Glob Bivigam, 500mg"	K		$38.49	.	$7.70																																																																																																																																																																																								
9131	"Inj, Ado-trastuzumab Emt 1mg"	K		$29.21	.	$5.85																																																																																																																																																																																								
9132	"Kcentra, per i.u."	K		$1.62	.	$0.33																																																																																																																																																																																								
9133	"Rabies ig, im/sc"	K		$285.93	.	$57.19																																																																																																																																																																																								
9134	"Rabies ig, heat treated"	K		$252.95	.	$50.59																																																																																																																																																																																								
9135	"Varicella-zoster ig, im"	K		"$1,202.24"	.	$240.45																																																																																																																																																																																								
9137	"Bcg vaccine, percut"	K		$122.88	.	$24.58																																																																																																																																																																																								
9139	"Rabies vaccine, im"	K		$263.54	.	$52.71																																																																																																																																																																																								
9140	"Rabies vaccine, id"	K		$172.30	.	$34.46																																																																																																																																																																																								
9143	"Meningococcal vaccine, sc"	K		$106.49	.	$21.30																																																																																																																																																																																								
9207	Bortezomib injection	K		$46.75	.	$9.35																																																																																																																																																																																								
9208	Agalsidase beta injection	K		$158.04	.	$31.61																																																																																																																																																																																								
9209	Laronidase injection	K		$29.45	.	$5.89																																																																																																																																																																																								
9210	Palonosetron hcl	K		$20.53	.	$4.11																																																																																																																																																																																								
9213	Pemetrexed injection	K		$61.21	.	$12.25																																																																																																																																																																																								
9214	Bevacizumab injection	K		$69.60	.	$13.92																																																																																																																																																																																								
9215	Cetuximab injection	K		$53.48	.	$10.70																																																																																																																																																																																								
9217	Leuprolide acetate suspnsion	K		$242.80	.	$48.56																																																																																																																																																																																								
9224	Galsulfase injection	K		$364.78	.	$72.96																																																																																																																																																																																								
9225	Fluocinolone acetonide implt	K		"$20,138.08"	.	"$4,027.62"																																																																																																																																																																																								
9228	Tigecycline injection	K		$2.35	.	$0.47																																																																																																																																																																																								
9229	Ibandronate sodium injection	K		$116.67	.	$23.34																																																																																																																																																																																								
9230	Abatacept injection	K		$37.33	.	$7.47																																																																																																																																																																																								
9231	Decitabine injection	K		$22.13	.	$4.43																																																																																																																																																																																								
9232	Idursulfase injection	K		$497.48	.	$99.50																																																																																																																																																																																								
9233	Ranibizumab injection	K		$391.41	.	$78.29																																																																																																																																																																																								
9234	Alglucosidase alfa injection	K		$206.64	.	$41.33																																																																																																																																																																																								
9235	Panitumumab injection	K		$100.91	.	$20.19																																																																																																																																																																																								
9236	Eculizumab injection	K		$215.92	.	$43.19																																																																																																																																																																																								
9237	"Inj, lanreotide acetate"	K		$47.18	.	$9.44																																																																																																																																																																																								
9240	"Injection, ixabepilone"	K		$72.08	.	$14.42																																																																																																																																																																																								
9242	"Injection, fosaprepitant"	K		$1.73	.	$0.35																																																																																																																																																																																								
9243	Bendamustine injection	K		$24.66	.	$4.94																																																																																																																																																																																								
9245	Romiplostim injection	K		$57.47	.	$11.50																																																																																																																																																																																								
9248	"	Inj, clevidipine butyrate"	K		$4.32	.	$0.87																																																																																																																																																																																								
9251	C1 esterase inhibitor inj	K		$54.46	.	$10.90																																																																																																																																																																																								
9252	Plerixafor injection	K		$305.98	.	$61.20																																																																																																																																																																																								
9253	Temozolomide injection	K		$6.84	.	$1.37																																																																																																																																																																																								
9255	Paliperidone palmitate inj	K		$8.45	.	$1.69																																																																																																																																																																																								
9256	Dexamethasone intra implant	K		$201.03	.	$40.21																																																																																																																																																																																								
9258	Telavancin injection	K		$4.91	.	$0.99																																																																																																																																																																																								
9259	Pralatrexate injection	K		$212.80	.	$42.56																																																																																																																																																																																								
9260	Ofatumumab injection	K		$49.47	.	$9.90																																																																																																																																																																																								
9261	Ustekinumab injection	K		$166.99	.	$33.40																																																																																																																																																																																								
9263	Ecallantide injection	K		$402.44	.	$80.49																																																																																																																																																																																								
9264	Tocilizumab injection	K		$3.85	.	$0.77																																																																																																																																																																																								
9265	Romidepsin injection	K		$290.84	.	$58.17																																																																																																																																																																																								
9269	"C-1 esterase, berinert"	K		$40.52	.	$8.11																																																																																																																																																																																								
9270	Gammaplex IVIG	K		$37.28	.	$7.46																																																																																																																																																																																								
9271	Velaglucerase alfa	K		$346.08	.	$69.22																																																																																																																																																																																								
9272	"Inj, denosumab"	K		$15.24	.	$3.05																																																																																																																																																																																								
9273	Sipuleucel-T auto CD54+	K		"$36,704.05"	.	"$7,340.81"																																																																																																																																																																																								
9274	Crotalidae Poly Immune Fab	K		"$2,542.98"	.	$508.60																																																																																																																																																																																								
9276	Cabazitaxel injection	K		$148.66	.	$29.74																																																																																																																																																																																								
9278	Incobotulinumtoxin A	K		$4.67	.	$0.94																																																																																																																																																																																								
9281	"Injection, pegloticase"	K		"$1,239.16"	.	$247.84																																																																																																																																																																																								
9284	Ipilimumab injection	K		$138.83	.	$27.77																																																																																																																																																																																								
9286	Belatacept injection	K		$3.80	.	$0.76																																																																																																																																																																																								
9287	Brentuximab vedotin inj	K		$119.62	.	$23.93																																																																																																																																																																																								
9289	Erwinaze injection	K		$376.49	.	$75.30																																																																																																																																																																																								
9293	"Injection, glucarpidase "	K		$271.24	.	$54.25																																																																																																																																																																																								
9294	"Inj, Taliglucerace Alfa 10 u"	K		$36.48	.	$7.30																																																																																																																																																																																								
9295	"Injection, Carfilzomib, 1 mg"	K		$31.06	.	$6.22																																																																																																																																																																																								
9296	"Inj, ziv-aflibercept, 1mg"	K		$8.32	.	$1.67																																																																																																																																																																																								
9297	"Inj, Omacetaxine Mep, 0.01mg"	K		$2.48	.	$0.50																																																																																																																																																																																								
9298	"Inj, Ocriplasmin, 0.125 mg"	K		"$1,046.75"	.	$209.35																																																																																																																																																																																								
9300	Omalizumab injection	K		$29.91	.	$5.99																																																																																																																																																																																								
9441	Inj ferric carboxymaltos 1mg	G		$1.06	.	$0.22																																																																																																																																																																																								
9445	"Injection, ruconest"	G		$23.29	.	$4.66																																																																																																																																																																																								
9448	Netupitant palonosetron oral	G		$474.85	.	$94.97																																																																																																																																																																																								
9449	"Injection, blinatumomab"	G		$96.00	.	$19.20																																																																																																																																																																																								
9450	Fluocinol acet intravit imp	G		$490.95	.	$98.19																																																																																																																																																																																								
9451	"Injection, peramivir"	G		$1.68	.	$0.34																																																																																																																																																																																								
9452	Inj ceftolozane tazobactam	G		$0.42	.	$0.09																																																																																																																																																																																								
9453	"Injection, nivolumab"	G		$25.38	.	$5.08																																																																																																																																																																																								
9454	"Inj, pasireotide long acting"	G		$251.26	.	$50.26																																																																																																																																																																																								
9455	"Injection, siltuximab"	G		$8.90	.	$1.78																																																																																																																																																																																								
9456	"Injection, isavuconazonium"	G		$0.68	.	$0.14																																																																																																																																																																																								
9457	Inj sulf hexa lipid microsph	G		$33.06	.	$0.00																																																																																																																																																																																								
9458	Florbetaben f18	G		$989.33	.	$0.00																																																																																																																																																																																								
9459	Flutemetamol f18	G		"$3,300.00"	.	$0.00																																																																																																																																																																																								
9460	"Injection, cangrelor"	G		$15.88	.	$3.18																																																																																																																																																																																								
9497	"Loxapine, inhalation powder"	G		$147.34	.	$29.47																																																																																																																																																																																								
9500	"Platelets, irradiated"	R	2.1579	$159.09	.	$31.82																																																																																																																																																																																								
9501	Platelet pheres leukoreduced	R	6.6231	$488.29	.	$97.66																																																																																																																																																																																								
9502	Platelet pheresis irradiated	R	7.1633	$528.11	.	$105.63																																																																																																																																																																																								
9503	Fr frz plasma donor retested	R	0.6974	$51.42	.	$10.29																																																																																																																																																																																								
9504	RBC deglycerolized	R	5.1586	$380.32	.	$76.07																																																																																																																																																																																								
9505	RBC irradiated	R	2.7917	$205.82	.	$41.17																																																																																																																																																																																								
9506	"Granulocytes, pheresis unit"	R	20.5965	"$1,518.48"	.	$303.70																																																																																																																																																																																								
9507	"Platelets, pheresis"	R	5.7667	$425.15	.	$85.03																																																																																																																																																																																								
9508	Plasma 1 donor frz w/in 8 hr	R	0.9842	$72.56	.	$14.52																																																																																																																																																																																								
9509	"Frozen plasma, pooled, sd"	R	1.0295	$75.90	.	$15.18																																																																																																																																																																																								
9510	Whole blood for transfusion	R	3.0060	$221.62	.	$44.33																																																																																																																																																																																								
9511	Cryoprecipitate each unit	R	0.8090	$59.64	.	$11.93																																																																																																																																																																																								
9512	RBC leukocytes reduced	R	2.5004	$184.34	.	$36.87																																																																																																																																																																																								
9513	"Plasma, frz between 8-24hour"	R	0.9912	$73.08	.	$14.62																																																																																																																																																																																								
9514	"Plasma protein fract,5%,50ml"	R	0.3836	$28.28	.	$5.66																																																																																																																																																																																								
9515	"Platelets, each unit"	R	1.6010	$118.03	.	$23.61																																																																																																																																																																																								
9516	Plaelet rich plasma unit	R	1.6298	$120.16	.	$24.04																																																																																																																																																																																								
9517	Red blood cells unit	R	1.9775	$145.79	.	$29.16																																																																																																																																																																																								
9518	Washed red blood cells unit	R	4.1703	$307.46	.	$61.50																																																																																																																																																																																								
9519	"Plasmaprotein fract,5%,250ml"	R	0.5470	$40.33	.	$8.07																																																																																																																																																																																								
9520	Blood split unit	R	1.3903	$102.50	.	$20.50																																																																																																																																																																																								
9521	Platelets leukoreduced irrad	R	2.1985	$162.08	.	$32.42																																																																																																																																																																																								
9522	RBC leukoreduced irradiated	R	3.6301	$267.63	.	$53.53																																																																																																																																																																																								
9523	Cryoprecipitatereducedplasma	R	0.6934	$51.12	.	$10.23																																																																																																																																																																																								
9524	"Blood, l/r, cmv-neg"	R	2.7190	$200.46	.	$40.10																																																																																																																																																																																								
9525	"Platelets, hla-m, l/r, unit"	R	9.5623	$704.98	.	$141.00																																																																																																																																																																																								
9526	Platelets leukocytes reduced	R	1.5777	$116.32	.	$23.27																																																																																																																																																																																								
9527	"Blood, l/r, froz/degly/wash"	R	4.3578	$321.28	.	$64.26																																																																																																																																																																																								
9528	"Plt, aph/pher, l/r, cmv-neg"	R	6.2730	$462.48	.	$92.50																																																																																																																																																																																								
9529	"Blood, l/r, irradiated"	R	1.7282	$127.41	.	$25.49																																																																																																																																																																																								
9530	Plate pheres leukoredu irrad	R	8.7060	$641.85	.	$128.37																																																																																																																																																																																								
9531	"Plt, pher, l/r cmv-neg, irr"	R	8.0159	$590.97	.	$118.20																																																																																																																																																																																								
9532	"RBC, frz/deg/wsh, l/r, irrad"	R	2.7582	$203.35	.	$40.67																																																																																																																																																																																								
9533	"RBC, l/r, cmv-neg, irrad"	R	3.3806	$249.23	.	$49.85																																																																																																																																																																																								
9534	Pathogen reduced plasma pool	R	0.9912	$73.08	.	$14.62																																																																																																																																																																																								
9535	Pathogen reduced plasma sing	R	0.9842	$72.56	.	$14.52																																																																																																																																																																																								
9536	Pathogen reduced platelets	R	8.7060	$641.85	.	$128.37																																																																																																																																																																																								
